Fibrous dysplasia in paranasal cavities

Sinonasal disease in polyostotic fibrous dysplasia and McCune-Albright Syndrome

OBJECTIVES/HYPOTHESIS

To characterize the spectrum, symptoms, progression, and effects of endocrine dysfunction on sinonasal disease in polyostotic fibrous dysplasia (PFD) and McCune-Albright Syndrome (MAS).

STUDY DESIGN

Retrospective review.

METHODS

A prospectively followed cohort of subjects with PFD/MAS underwent a comprehensive evaluation that included otolaryngologic and endocrine evaluation, and imaging studies. Head and facial computed tomography scans were analyzed, and the degree of fibrous dysplasia (FD) was graded using a modified Lund-MacKay scale. Those followed for >4 years were analyzed for progression.

RESULTS

A total of 106 patients meeting inclusion criteria were identified with craniofacial FD. A majority (92%) demonstrated sinonasal involvement. There were significant positive correlations between the sinonasal FD scale score and chronic congestion, hyposmia, growth hormone excess, and hyperthyroidism (P < .05 for all). Significant correlations were not found for headache/facial pain or recurrent/chronic sinusitis. Thirty-one subjects met the criteria for longitudinal analysis (follow-up mean, 6.3 years; range, 4.4-9 years). Those who demonstrated disease progression were significantly younger than those who did not (mean age, 11 vs. 25 years). Progression after age of 13 years was uncommon (n = 3) and minimal. Concomitant endocrinopathy or bisphosphonate use did not have any significant effect on progression of disease.

CONCLUSIONS

Sinonasal involvement of fibrous dysplasia in PFD/MAS is common. Symptoms are usually few and mild, and disease progression occurs primarily in young subjects. Concomitant endocrinopathy is associated with disease severity, but not progression.

Fibrous dysplasia-like appearance of the frontal process of the maxilla on CT: prevalence in North China

The frontal process of the maxilla occasionally shows a localized FD-like appearance. The purpose of this study was to determine its prevalence and findings on CT. A retrospective study of 1000 consecutive paranasal sinus CT scans was preformed on outpatients without a history of trauma or previous surgery in our hospital during 6 months. CT images were interpreted independently by 2 experienced head and neck radiologists on a PACS system in a bone window setting. Of the 1000 patients (546 males; 454 females), 51 (5.1%,41 males and 10 females) had an FD-like appearance in the frontal process of the maxilla. There was a statistically significant difference between sexes (P < .001). Twenty-nine (56.9%) entities arose from the right frontal process and 22 (43.1%) from the left frontal process. These entities, with well-defined margins, were located at the base of the frontal process of the maxilla, appearing as an ovoid or triangular configuration on axial-plane CT and as a spindle or elliptic shape on the coronal plane. The mean maximal diameter was 9.8 mm (range, 3.6-16.1 mm). These entities exhibited a pagetoid appearance (type I) in 37 (72.5%), a ground-glass appearance (type II) in 8 (15.7%), and a cyst-like appearance (type III) in 6 (11.8%) patients on CT. The FD-like appearance of the frontal process of the maxilla is not rare and can be readily detected by CT.

Reconstruction of a Total Maxillectomy Defect With a Zygomatic Implant-Retained Obturator

Treatment options of maxillary fibrous dysplasia are surgical recontouring or total or partial maxillectomy depending on the site and behavior of the lesion. Among the reconstruction procedures, which include many surgical options, reconstruction using a maxillary obturator is the least invasive one. This report describes a case of aggressive maxillary fibrous dysplasia that was treated with a total maxillectomy and reconstructed with a malar implant-retained maxillary obturator.

Endoscopic surgery for fibrous dysplasia of the sinonasal tract in pediatric patients

Fibrous dysplasia (FD) is a non-neoplastic, expansile lesion of unknown origin. In about one-fourth of cases this disorder affects the head and neck area, where the mandible and maxilla are the most frequently involved sites. Its localization to the ethmoid is a rare event. Since the disease slowly progresses, its management is delayed until significant clinical symptoms or non-well-tolerated aesthetic deformities are present. When required, surgery is the treatment of choice. Several external procedures have been used to manage the lesion, but recently, more conservative transnasal approaches have been proposed. We report the history of a 6-year-old boy with fibrous dysplasia of the ethmoid labyrinth that underwent successful transnasal endoscopic removal. Furthermore, an analysis of the literature is presented with particular emphasis on clinical picture, diagnosis, and treatment of this rare illness.

Fibrous dysplasia of the frontal sinus: an uncommon cause of frontal lobe abscess

Fibrous dysplasia of the cranial air sinuses is rarely reported in the literature. This is the first report of frontal lobe abscess (FLA) associated with fibrous dysplasia of the frontal sinus (FDFS). A 29-year-old female presented with seizures and acute confusion. Cranial computed tomography (CT) revealed fibrous dysplasia of the left frontal sinus and associated FLA. She was referred to the neurosurgical service and the abscess and dysplastic tissue were removed. Histological examination confirmed fibrous dysplasia. We review the radiological appearance of FDFS with FLA. Clinicians should be aware of the association between these two conditions.

[An exceptional form of cranio-facial fibrous dysplasia: fibrous dysplasia of middle turbinate]

Fibrous dysplasia is a rare bone disease that can be misdiagnosed because of the slowness of its symptoms. Although it is a benign disease its clinical behaviour can be severe, with possibility of local growth and malignant degeneration into osteosarcoma. An uncommon case of fibrous dysplasia is reported, affecting only the middle turbinate. Diagnostic and therapeutic problems are discussed.

[Monostotic fibrous dysplasia of the frontal sinus with orbital extension]

We present the case of a localized monostotic fibrous dysplasia in the frontal sinus with orbital extension and persistency after the first surgery; it had to be operated again with a fronto-orbitary reconstruction. The fibrous dysplasia is a rare bony alteration with transformation of the healthy bony tissue for a disestructuredone. Its etiology is unknown and can be associated to different syndromes, such as Albright's Disease. Its treatment is surgical, but presents a high percentage of recurrence, this is the xenson why it needs a close follow up.

Fibrous dysplasia with cystic appearance in maxillary sinus

Fibrous dysplasia (FD) in the paranasal sinuses is uncommon, and its management may be difficult. We report the case of a 25-year-old female with FD exhibiting a cystic appearance in the maxillary sinus. The patient had been complaining of facial swelling for few years. Imagery study showed a cystic lesion and dense bone changes in the maxillary bone. Inferior meatal antrostomy with a nasal endoscope failed to confirm a histological diagnosis. After a 3-year follow-up, the degree of facial swelling was unchanged, and the patient underwent middle meatal antrostomy and was diagnosed with FD.