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Surgical correction of fibrous dysplasia involving the maxilla

3/3/2019

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A 14-year old boy

A 14-year-old boy form Meghalaya came to our hospital with a complaint of difficulty in breathing and facial swelling. The patient complained that he felt a heaviness in his face. The parent’s described that the swelling was growing in size. They requested for immediate correction of the swelling.

Fibrous dysplasia

Fibrous dysplasia is a disorder where normal bone and marrow is replaced with fibrous tissue. This results in the formation of weak bone. Thereby leading to expansion. It may result in fracture and can cause bone deformity. Certain people may feel pain associated with fibrous dysplasia. Functional impairment can also occur. Fibrous dysplasia is not cancerous but may pre-dispose to cancer in about 1% of the population.

Treatment of choice

As such, there is no cure for fibrous dysplasia other than symptomatic treatment. A fracture is treated if evident. Bony expansion is treated surgically. Fibrous dysplasia may require cosmetic correction depending on the position and the size of the lesion.  In this case, fibrous dysplasia was involving the maxilla, zygoma, floor of the orbit and nasal cavity. Thereby, causing functional impairment.

Investigations

Thorough clinical, radiological and histopathological examination done. A biopsy was done. The biopsy results revealed fibrous dysplasia. CT scan revealed fibrous dysplasia involving the maxilla, zygoma, nasal cavity and extending up to the orbital floor. Maxillofacial surgeon Dr.S.M.Balaji planned to resect the entire fibrous tissue.

Procedure

Incision placed Intraorally. Mucoperiosteal flap elevated. The entire fibrous bone was resected and burred down completely. It was also made flush with the surrounding bone. The surgery was a great success.

Results

The patient was able to breathe well after the surgery. He no longer felt a heaviness in his face. He expressed his joy after the surgery. He stated that his face felt lighter than before. The entire procedure was done intra orally and hence there was no scar on the face.
Pre-operative frontal view showing a huge swelling in relation to the nose
Pre-operative frontal view showing a huge swelling in relation to the nose
Maxillofacial Surgery India
Pre-operative submental view showing huge nasal swelling
Maxillofacial Surgeon India
CT scan showing expansive lesion involving the maxillary sinus and extending upto the orbit
CT scan showing expansile lesion involving the maxilla, zygoma and ethmoidal cells
CT scan showing expansile lesion involving the maxilla, zygoma and ethmoidal cells
Maxillofacial Surgery Pictures
Immediate post-operative view following fibrous bone removal
Facial Surgery India
Immediate post operative submental view following fibrous bone removal
Dr SM Balaji Maxillofacial Surgeon india
30 days post-operative view showing normal facial appearance
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