Management of craniofacial fibrous dysplasia: conservative or radical approach?

Abstract

Purpose: The timing and approach to the management of craniofacial fibrous dysplasia (CFD) remains controversial in literature. Thus, the aim of this study was to analyse the management of CFD and correlate treatment methods with post-operative outcomes. Methods: A retrospective cohort analysis was performed on all histologically confirmed CFD over an 18-year period. Patient demographics along with symptoms and site of each lesion were recorded. Treatment modalities were correlated with recurrences or aggressive exacerbation. Chi-squared and Fishers’ exact tests were used to determine associations between different variables. Statistical significance was set at p < 0.05. Results: Forty-five patients were included with a mean age of 25.2 years and a male to female ratio of 1:1.8. Majority of patients (n:38) were symptomatic while the maxilla was the most affected site. Two patients had polyostotic involvement. Most patients were treated surgically (n:27) while asymptomatic cases were monitored (n:15). Bone recontouring was performed in 22 patients while five patients underwent resection. Three patients experienced progression/reactivation following recontouring and needed further intervention. No recurrences occurred in the resection group. Active disease process was the only statically significant factor that led to delay in surgical treatment (p = 0.001). Conclusion: Recontouring should be considered for extensive CFD with functional impairment and facial asymmetry. Radical surgery should be reserved for lesions confined to a solitary region that display significant symptoms and rapid growth. The decision to surgically intervene and which surgical methods to utilize should be based on the patient’s age, symptoms, disease activity, facial regions involved and patient preference.