15 - Tumors of the facial skeleton: Fibrous dysplasia

Abstract

Since the skeletal framework basically determines the facial appearance, many factors come into play when treating a patient with a craniofacial tumor. Understanding the features of these tumors, the interaction of surface deformities, and their underlying anatomic counterpart is paramount to design an individualized solution for each patient. Due to the complexity of the craniofacial region and the consequences of inappropriate treatment, planning these reconstructions usually requires a multidisciplinary team. The facial skeleton includes the frontal bone, the midface bones, and the mandible. Tumors of these bones may arise from multiple cellular lineages; however, primary malignant tumors are rare. In contrast, tumor-like lesions are more common than true bone tumors. The most common craniofacial tumor-like lesion encountered by plastic surgeons is fibrous dysplasia; therefore, by using it as a model, many of the principles applied in the management of this pathology can be extended to other tumor types. As will be seen, this chapter reviews the clinical considerations including a detailed differential diagnosis with other bone tumors and surgical approaches in patients with fibrous dysplasia. Moreover, the surgical techniques presented here give the surgeon full access to the facial skeleton as well as various strategies for the resection and reconstruction of other craniofacial tumors.