Decortication of fibrous dysplasia of the maxillary sinus

We present 3 cases of fibrous dysplasia of the maxillary sinus that were treated by decortication through the anterior wall of the maxilla. The thickened anterior wall of the maxilla and the zygoma were contoured into normal shape with a bur, and a 2 × 2-cm window was made below the infraorbital foramen using a reciprocating saw. The removed piece of bone was 3 to 5 mm thick. All abnormal fibrous tissues in the maxillary sinus were extirpated by drilling through the window until the sinus cavity was clear. The preserved bone plate was restored in place to close the window of the maxillary anterior wall and fixed with miniplates. Three patients were treated by means of such internal decompression method. No overgrowth or disfigurement of the facial bone was appreciated 14 to 51 months postoperatively. We contend that internal decortication of fibrous dysplasia through a window in the anterior wall is effective to minimize external expansion of fibrous dysplasia.     

Orthognathic surgery in craniomaxillofacial fibrous dysplasia.

In craniomaxillofacial fibrous dysplasia, jaw involvement often causes facial asymmetry, an occlusal cant, and loss of teeth. Although conservative management of fibrous dysplasia affecting the jaws is widely practiced, orthognathic surgery is indicated in such cases to restore occlusion and correct dentofacial deformity brought on by the disease process. Since 1981, the Craniofacial Center at Chang Gung Memorial Hospital in Taiwan has treated a total of 84 patients with craniomaxillofacial fibrous dysplasia. Of these, 55 (65%) had fibrous dysplasia affecting the jaws (Zone 4). Between 1988 and 1997, orthognathic surgery was performed on 1 male and 4 female patients with fibrous dysplasia involving the teeth-bearing jaws. One patient had localized fibrous dysplasia that involved the mandible. The other 4 patients had polyostotic craniofacial involvement of Zones 1, 2, or 3 and 4A. The patient with isolated mandibular involvement and 2 patients with maxillary fibrous dysplasia had single-jaw surgery. The other 2 patients with maxillary involvement required simultaneous two-jaw surgery to correct the dentofacial deformities resulting from the disease process. Follow-up ranged from 12 months to 9 years. All the patients had stable occlusion, good facial aesthetics, and no further recurrence after surgery. The long-term stability of the achieved occlusion and facial appearance confirms that adequate healing in fibrodysplastic bone is to be expected using the standard fixation.     

Advanced osteosarcoma of the maxilla: a case report

Osteosarcomas are primary malignant bone tumours in which mesenchymal cells produce osteoid. It is generally the most common malignant bone neoplasm, although lesions of the jaw are uncommon. Osteosarcoma of the jaw (JOS) presents a lower incidence of metastasis and a better prognosis than osteosarcoma of the long bones. However, patients with JOS can exhibit advanced tumours, mainly when early diagnosis is not performed. This article reports on a case of an advanced osteosarcoma of the maxilla. A 38-year-old woman was referred for evaluation and treatment of recurrent fibrous dysplasia of the facial bones. The patient related that she had been diagnosed with fibrous dysplasia four years earlier and, since the first diagnosis, she was submitted to four surgical interventions, all followed by recurrences. The main clinical findings were redness and swelling of the facial skin, upper lip ulceration, and hard palate swelling. Computed tomography showed a large hyperdense mass in right maxilla extending to right orbit and left maxillary sinus. An incisional biopsy was performed and microscopic examination showed areas of osteoid and chondroid formation surrounded by a cellular stroma. The diagnosis of osteosarcoma was established and the patient was recommended for oncologic treatment. Unfortunately, she died six months after the diagnosis due to uncontrollable local spread.     

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.     

Cystic degeneration in fibrous dysplasia of the jaws: a case report.

A case of nonspecific cystic degeneration complicating fibrous dysplasia of the mandible is presented. This condition is extremely rare in the jaw bones. The patient had a painless swelling of the right face measuring 10 cm in diameter, and there was no history of trauma. Radiographs showed a poorly defined, "ground glass" radiopaque lesion; a central well-defined cyst was confirmed by means of computed tomography. During surgery, a large cystic cavity with surrounding, soft fibrous bone that merged with the cortex was observed. Histologic examination showed a large non-epithelial-lined cystic cavity with a surrounding fibro-osseous lesion, which was consistent with a diagnosis of fibrous dysplasia.     

Inherited craniofacial fibrous dysplasia

Craniofacial fibrous dysplasia occurring in a mother and two of her three daughters is reported. In all three patients, the condition was characterized by extensive bilateral and bimaxillary involvement. All patients exhibited radiographic evidence of abnormal maxillary and mandibular bone and tooth displacement. Morphologic examination of deciduous teeth from the daughters showed replacement of normal pulp tissue by fibro-osseous lesion. Because of the familial occurrence of the cases, it is proposed that they comprise an example of inherited craniofacial fibrous dysplasia.     

Unusual radiographic presentation of an aneurysmal bone cyst of the mandible

An 11-year-old girl was referred because of a painless firm swelling in the right posterior mandible that had started 2 months previously. A panoramic radiograph showed a nonspecific finding of a tiny discreet shadow following the lower border of the mandible, without any radiographic signs of radiolucency in the affected area or discontinuity of the lower border. However, multislice computed tomography (MSCT) findings were suggestive of an aneurysmal bone cyst, and histopathological findings revealed a diagnosis of aneurysmal bone cyst. Complete surgical excision followed by extensive cortical bone curettage was done, and no recurrence has been observed in the past 5 years. A differential diagnosis list is included, and extended with fibrous dysplasia according to the radiographic findings. To the best of our knowledge, this is the first case of a jaw aneurysmal bone cyst with unusual initial radiographic findings. Furthermore, a ground-glass appearance on MSCT scans suggested fibrous dysplasia. The present case highlights the need for accurate differential diagnosis of the lesion described to obtain the correct diagnosis in a timely manner and plan the appropriate treatment.     

Orofacial mucormycosis

Two cases of orofacial mucormycosis are reported. The first patient represents the typical progression of rhinocerebral mucormycosis with infiltration of the sinuses, the orbit, and the brain. The second patient had a tumorous maxillary lesion resembling fibrous dysplasia clinically and radiographically. Microscopically, the fungal infection in case 2 was associated with new bone formation. The significance of this phenomenon is discussed, and the importance of early diagnosis and possible treatment regimens are highlighted.     

Diffuse sclerosing osteomyelitis in the maxilla: case report

A case of diffuse sclerosing osteomyelitis (DSO) in the maxilla of a 25-year-old male is presented. His chief complaint was recurrent painless swelling in the maxillary right molar region over a 3-year-period. The periapical and panoramic radiographs of the right maxilla showed diffuse sclerotic areas. Computed tomography (CT) indicated a high density area in the right maxilla. Although the tentative diagnosis was fibrous dysplasia on the basis of history, clinical symptoms and radiologic examination, the biopsy results supported chronic diffuse sclerosing osteomyelitis. The maxillary location and the painless course of the lesion in a male patient is a rare occurrence.     

上颌骨骨纤维异常增殖症38例

目的:探讨上颌骨骨纤维异常增殖症的治疗及预后效果。方法:对38例上颌骨骨纤维异常增殖症患者均采用手术治疗铲除增生的组织,修整形态或彻底切除病变组织。结果:上颌骨骨纤维异常增殖症手术后获得满意的面形和功能恢复,1年以上随访只有3例年龄偏小而畸形较重的患者复发。结论:上颌骨骨纤维异常增殖症手术彻底切除病变组织效果较好,但是需要考虑面形及功能恢复。20岁以后复发率小,应作为手术最佳时机。     

Radiographic appearance of fibrous dysplasia associated with the maxillary sinus

Fibrous dysplasia is a relatively rare tumorous lesion in the maxillofacial region. The radiographic appearance of this lesion varies widely in the jaw. Generally, the occurrence rate is higher in the maxilla than in the mandible. The purpose of this study was to report six cases of fibrous dysplasia associated with the maxillary sinus. In this study, we examined radiographic patterns which demonstrated the lesion's affect on the sinus radiographically. Mixed radiopacity and radiolucency (the so-called ground glass appearance) was also seen in each of these cases. In four cases in which CT images were obtained, the lesion showed buccal expansion and infiltration into the maxillary sinus.     

Craniomaxillofacial fibrous dysplasia

Fibrous dysplasia is a nonneoplastic developmental disease of osseous tissue. It is a lesion of unknown etiology, uncertain pathogenesis, and diverse histopathology. In this series of 16 patients with fibrous dysplasia of the craniomaxillofacial bones, the disease was generally monostotic and most commonly maxillary in location. Two patients demonstrated typical symptoms of the McCune Albright syndrome. Marked deformity or functional disturbances were the major indications for treatment. Total excision of the involved bone was the most successful form of treatment but produced the greatest functional and cosmetic deficits and long-term postoperative complications. A conservative therapeutic approach with a modest reduction in the bulk of these lesions may be sufficient to relieve signs and symptoms effectively. Periodic follow-up is indicated to detect recurrences or malignant changes in the early stages.     

Successive generations with inherited craniofacial fibrous dysplasia

Craniofacial fibrous dysplasia is a benign fibro-osseous lesion of bone that only affects the bones of the craniofacial complex. Here, we report a case of craniofacial fibrous dysplasia in a 16-year-old Thai male who presented with mild swelling and tenderness at the mandibular right first molar area and ipsilateral nasal congestion. Conventional and cone-beam CT radiographic examinations were performed. The radiographs revealed multiple mixed radiolucent and radiopaque lesions involving most of the craniofacial bones. The first biopsy from the right mandibular area was diagnosed as juvenile ossifying fibroma, whereas a biopsy from the right maxillary area was diagnosed as fibrous dysplasia. The defects appeared to have a genetic basis, because his mother and younger brother had the same clinical and radiological findings. Furthermore, the family history given by his mother revealed that several other members of her family had similar clinical signs and symptoms. We diagnosed this case as inherited craniofacial fibrous dysplasia on the basis of previously reported clinical, radiographic and histologic findings as well as family history.     

Clinical assessment of cemento‐osseous dysplasia based on three‐dimensional diagnostic imaging: A case report

Cemento‐osseous dysplasia (COD) is a lesion in which periapical bone is replaced by fibrous tissue, including osseous or cementum‐like tissue. In the initial stage of COD, radiolucencies are noted at the root apex on periapical radiography, which can be confused with apical periodontitis. Understanding of correct pathological condition and careful assessment of COD is critical to avoid unnecessary endodontic interventions in healthy teeth. This report describes the ability and usefulness of cone‐beam computed tomography (CBCT) and multi‐slice computed tomography (MSCT) to detect COD. The findings in this case suggest that MSCT is more appropriate than CBCT, especially for patients with early‐ to middle‐stage COD. However, the radiation dose is higher in MSCT than in CBCT; the application of MSCT should be limited to assessment of whether treatment or surgical management is necessary.     

颌骨纤维异常增殖症伴牙列重度磨耗的咬合重建

目的探讨颌骨纤维异常增殖症（FD）伴牙列重度磨耗的口腔修复方法。方法对1例颌骨FD伴牙列重度磨耗的患者进行口腔系统检查与修复设计。完成修复前准备之后,试戴下颌过渡性殆垫,观察4周：行上前牙及上颌第一前磨牙牙冠延长术,4周后行上下颌牙体预备和精细临时冠桥修复,根据临时冠桥参考模型．对上下牙均行两段式钴铬生物合金烤瓷长桥修复。结果修复后患者面容对称,口唇自然美观,义齿逼真,感觉舒适,咀嚼有力,患者对修复体的临床效果满意。结论对于颌骨FD伴牙列重度磨耗患者的口腔修复．根据适应症选择合适的修复方案,进行上下颌牙列的固定桥修复可以取得良好的修复效果。     

Craniofacial Fibrous Dysplasia in an Elderly Patient: A Case Report with a Review of Literature

Fibrous dysplasia is a benign fibro-osseous disorder, characterized by fibrous connective tissue containing abnormal bone which replaces normal bone. It represents 2 to 5% of all bone tumors and 7% of all benign tumors. Most commonly it affects younger age groups, with a higher prevalence in the maxilla than the mandible. It is a lesion of unknown etiology, uncertain pathogenesis, and diverse histopathology. Fibrous dysplasia can involve multiple bones (polyostotic) or a single bone (monostotic). The lesions of fibrous dysplasia can be surgically recontoured for esthetic or functional purposes once the growth ceases. Here we report a case of craniofacial fibrous dysplasia in an 83-year-old elderly male patient with emphasis on radiographic features.     

Clinical evaluation of association of bovine organic osseous matrix and bovine bone morphogenetic protein versus autogenous bone graft in sinus floor augmentation.

PURPOSE: The purpose of the present study is to evaluate clinically and radiographically the behavior of the association between bovine organic osseous matrix (BOM) and bovine bone morphogenetic protein (bBMP) versus autogenous bone graft in promoting bone healing in maxillary sinus lifting procedures. MATERIALS AND METHODS: Ten nonsmoking and systemically healthy patients who needed bilateral maxillary sinus grafting for the placement of osseointegrated implants were treated. In all patients, 1 side was selected as test (bBMP + BOM) and the other as control using autogenous particulated bone graft from mandibular ramus. After a period varying from 6 to 11 months, the implants were placed. The radiographic analysis was realized by panoramic-rx. The clinical analysis consisted of transoperative evaluation by visual observation of bone formation of grafted area and initial stability of implants. RESULTS: Radiographically, the images were evaluated observing radio-opaque aspect. Clinically, a better bone formation pattern of the grafted area in the side grafted with autogenous bone could be observed. The initial stability of the implants in the side grafted with autogenous bone was better than in the test side. The placement torque of the implants in the test side was more than 30 N-cm. CONCLUSIONS: In the present study, the association of bovine organic osseous matrix and bBMP as a growth factor showed different results when compared with autogenous graft. It was observed in the absence of an radio-opaque image, making it difficult to select the implants. Clinically, the bone formation was partial and showed the presence of the fibrous tissue in the grafted area when using the association of bovine organic osseous matrix and bBMP, and the placement torque of implants was less than the control side.     

Investigation of the GSalpha gene in the diagnosis of fibrous dysplasia

Fibrous dysplasia is a benign fibro-osseous disease of bone and its etiology has been previously established. Activating mutations in the gene that encodes the alpha subunit of stimulatory G protein (G(S)alpha) has been described in monostotic and polyostotic fibrous dysplasia and in the McCune-Albright syndrome. The present report describes a patient with monostotic fibrous dysplasia which diagnosis was confirmed by sequencing of the G(S)alpha gene, demonstrating a heterozygous missense mutation on codon 201 (201C --> T). Due to the high prevalence of G(S)alpha gene mutations in fibrous dysplasia in contrast to other benign and malignant fibrous-osseous lesions, mutational analysis are an additional and helpful parameter for the diagnosis of fibrous dysplasia in selected cases.     

Cemento-ossifying fibroma--a rare case

The concept of 'fibro-osseous lesions' of bone has evolved over the last several decades and now includes two major entities: fibrous dysplasia and ossifying fibroma, as well as the other less common lesions such as florid osseous dysplasia, periapical dysplasia, focal sclerosing osteomyelitis, proliferative periostitis of garrie, and ostitis deformans. The cemento-ossifying fibroma is a central neoplasm of bone as well as periodontium which has caused considerable controversy because of confusion regarding terminology and the criteria for its diagnosis. The cemento-ossifying fibroma is odontogenic in origin, whereas ossifying fibroma is of bony origin. This article reports a rare case of an 11-year-old male who came to us with the history of swelling in the maxillary anterior region causing difficulty in closing of mouth as well as in mastication.     

A Case Report of Cemento-Ossifying Fibroma

The concept of ‘fibro-osseous lesions’ of bone evolved over the last several decades to include two major entities: fibrous dysplasia and ossifying fibroma as well as the other less common lesions such as florid osseous dysplasia, periapical dysplasia, focal sclerosing osteomyelitis, proliferative periostitis of garrie and ostitis deformans. The cemento-ossifying fibroma is a central neoplasm of bone as well as periodontium which has caused considerable controversy because of confusion of terminology and criteria of diagnosis. The cemento-ossifying fibroma is odontogenic in origin where as ossifying fibroma of bony origin. This article reports a case of an 11-year-old male who came to us with the history of swelling at the maxillary anterior region causing difficulty in closing of mouth as well as mastication.