Chen Y R, Noordhoff M S
Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Tapiei, Taiwan.
Plast Reconstr Surg. 1990 Nov;86(5):835-42; discussion 843-4.
Twenty-eight craniomaxillofacial fibrous dysplasia patients were treated as early as the symptoms occurred. The principles of surgical treatment were based on the zones of involvement: total excision of dysplastic bone of fronto-orbital, zygoma, and upper maxillary origin (zone 1) and bone reconstruction primarily; conservative excision on hair-bearing skull (zone 2), central cranial base (zone 3), and tooth-bearing bones (zone 4); and optic canal decompression on patients with orbital dysplasia and decreasing visual acuity. Patients were followed for 1 to 11 years (average 5.3 years). No recurrence or invasion of the fibrous dysplasia into the grafted bone was seen. One patient had orthognathic maxillary osteotomy on the reconstructed maxilla 6 years after initial reconstruction. Five of 19 patients with alveolar dysplasia had a recurrence and were reshaped. One patient had mandibular sagittal osteotomies to set back the prognathic, fibrous dysplasic mandible after three attempts at conservative shaving. Another patient with mandibular fibrous dysplasia had recurrence with pain and a hemimandibulectomy with successful immediate free vascularized iliac bone graft reconstruction.
28例颅颌面骨纤维异常增殖症患者在症状出现后即接受治疗。手术治疗原则基于受累区域：对额眶、颧骨和上颌骨起源的发育异常骨进行全切除（1区）并首先进行骨重建；对有毛发的颅骨（2区）、颅底中部（3区）和含牙骨（4区）进行保守切除；对眼眶发育异常且视力下降的患者进行视神经管减压。对患者进行了1至11年的随访（平均5.3年）。未见纤维异常增殖症复发或侵入移植骨。1例患者在初次重建6年后对重建的上颌骨进行了正颌上颌截骨术。19例牙槽骨发育异常患者中有5例复发并进行了整形。1例患者在尝试三次保守刮除术后，进行了下颌矢状截骨术以矫正前突的纤维异常增殖性下颌骨。另1例下颌骨纤维异常增殖症患者复发并伴有疼痛，接受了半侧下颌骨切除术，并成功进行了即刻游离血管化髂骨移植重建。
