Craniofacial Fibrous Dysplasia of the Skull Assisted by Virtual Surgical Planning.

Bar Y Ainuz, Imran Rizvi, Alex A Kane
Author Information
  1. Bar Y Ainuz: Department of Plastic and Reconstructive Surgery, University of Texas Southwestern School of Medicine.
  2. Imran Rizvi: Department of Plastic and Reconstructive Surgery, University of Texas Southwestern School of Medicine.
  3. Alex A Kane: Department of Plastic and Reconstructive Surgery, University of Texas Southwestern School of Medicine.

Abstract

Craniofacial fibrous dysplasia (FD) involves thickening of the skull and facial bones, causing asymmetry and distortion of overlying soft tissues. Surgical contouring is often performed with rotary bur or osteotome, with the goal of matching contralateral unaffected anatomy. This is made technically challenging by having no direct visualization of contralateral structures, and the desire to control depth of resection to match the contour of the unaffected side. In our report, a 13-year-old male presented for surgical evaluation of craniofacial FD affecting the right parietal/temporal bones. A novel virtual surgical planning approach of premade drilling template with numerous pilot guide holes was used to assist bone debulking. The pilot holes allowed precise burring of the dysplastic bone. The patient achieved excellent calvarial contour symmetry without unintended intracranial extension. We believe that virtual surgical planning and drilling depth guides are effective tools in the reconstruction of craniofacial FD.

References

  1. Lichtenstein L. Polyostotic fibrous dysplasia. Arch Surg. 1938;36:874–898.
  2. Riddle ND, Bui MM. Fibrous dysplasia. Arch Pathol Lab Med. 2013;137:134–138.
  3. Valentini V, Cassoni A, Marianetti TM, et al. Craniomaxillofacial fibrous dysplasia: conservative treatment or radical surgery? A retrospective study on 68 patients. Plast Reconstr Surg. 2009;123:653–660.
  4. Murray DJ, Edwards G, Mainprize JG, et al. Advanced technology in the management of fibrous dysplasia. J Plast Reconstr Aesthet Surg. 2008;61:906–916.
  5. Nuss DW, Janecka IP, Sekhar LN, et al. Craniofacial disassembly in the management of skull-base tumors. Otolaryngol Clin North Am. 1991;24:1465–1497.
  6. Fattah A, Khechoyan D, Phillips JH, et al. Paediatric craniofacial fibrous dysplasia: the Hospital for Sick Children experience and treatment philosophy. J Plast Reconstr Aesthet Surg. 2013;66:1346–1355.
  7. Liu S, Zhang WB, Yu Y, et al. Three-dimensional accuracy of bone contouring surgery for zygomaticomaxillary fibrous dysplasia using virtual planning and surgical navigation. J Oral Maxillofac Surg. 2020;78:2328–2338.
  8. Efanov JI, Roy AA, Huang KN, et al. Virtual surgical planning: phe pearls and pitfalls. Plast Reconstr Surg Glob Open. 2018;6:e1443.
  9. Barretto MDA, Sabóia ACL, Lemos JBD, et al. Fibrous dysplasia treated with virtual planning - report of two cases. Autops Case Rep. 2019;9:e2018086.
  10. Osada Y, Iwasawa M, Tanaka Y. Use of image-guiding template for contouring surgery of midfacial fibrous dysplasia. Ann Plast Surg. 2007;59:459–463.

MeSH Term

Adolescent
Craniofacial Fibrous Dysplasia
Facial Bones
Fibrous Dysplasia, Polyostotic
Humans
Male
Skull
Tomography, X-Ray Computed

Word Cloud

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