Orthognathic surgery for patients with fibrous dysplasia involved with dentition

Abstract

BackgroundFibrous dysplasia (FD) is characterized by the replacement of normal bone by abnormal fibro-osseous connective tissue and typically treated with surgical contouring of the dysplastic bone. When dysplastic lesions involve occlusion, not only is surgical debulking needed, orthognathic surgery for correction of dentofacial deformity is mandatory. However, the long-term stability of osteotomized, dysplastic bone segments is a major concern because of insufficient screw-to-bone engagement during surgery and the risk of FD lesion re-growth.Case presentationThis case report reviewed two patients with non-syndromic FD that presented with maxillary occlusal canting and facial asymmetry. Le Fort I osteotomy with recontouring of the dysplastic zygomaticomaxillary region had been performed. The stability of osseous segments were favorable. However, dysplastic, newly formed bone covered the previous plate fixation site and mild bony expansion was observed, which did not influence the facial profile. Including the current cases, 15 cases of orthognathic surgery for FD with dentition have been reported in the literature.ConclusionThe results showed that osteotomy did not appear to significantly reduce the long-term stability of the initial fixation insufficiency of the screw to the dysplastic bone. However, based on our results and those of the others, long-term follow-up and monitoring are needed, even in cases where the osteotomized segment shows stable results.

Modification of LeFort I Osteotomy for Correction of Severe Maxillary Cant Associated With Fibrous Dysplasia

“…Navigation was used by Matsuao et al 9 and Heiland et al 10 with a contradictory conclusion for safety and limitation of its application. A review done by Udaykumar et al 11 in 2018 only 15 cases are reported of FD with dentoskeletal asymmetry correction. Gross facial deformity with social problems may be an indication for an early intervention but it is suggested to intervene for debulking after the skeletal maturity and secondary correction only after orthodontic decompensation to rule out interferences during maxillary cant correction.…”

Extensive titanium mesh invasive cranial fibrous dysplasia

“…e surgical management varies according to patient. [1][2][3][4]6] In prepubertal age, wait is advised till puberty; unless there is functional loss. After puberty, FD growth slows down and excision gives better results.…”

“…[1] In McCune Albright syndrome and pediatric population, growth hormone excess is found to be cause of extensive FD. [1,4] CONCLUSION Despite its benign nature, craniofacial FD has a tendency to recur after surgery. Frontal FD recurrence occurs due to missed lesion at deeper or difficult locations, for example, in sinus area.…”

“…ere is single case report of recurrent FD, which engulfs titanium mesh and few case reports about titanium plate invasion. [4,6] We are reporting second such case of extensive titanium mesh cage invasion and its management.…”

An unusual presentation of non-specific cystic degeneration of craniofacial fibrous dysplasia: a case report and review of literature

“…Surgical treatment for FD is limited to cases involving esthetic or functional problems. It is recommended when FD poses a threat to important anatomical structures, such as the eyes or the optic nerves, causes significant esthetic deformities, or if severe pain is clearly associated with the FD process [ 24 ]. In some cases, cosmetic trimming of excess bone may be required [ 11 , 25 ].…”