Correction of Proptosis and Zygomaticomaxillary Asymmetry Using Orbital Wall Decompression and Zygoma Reduction in Craniofacial Fibrous Dysplasia

Abstract

Craniofacial fibrous dysplasia is associated with facial asymmetry, orbital dystopia, and orbital proptosis. Although radical excision of the affected bone with immediate craniofacial reconstruction is usually the best treatment option, complete excision may be impossible in some patients because of involvement of the skull base, including the sphenoid and ethmoidal bones. In adult patients without functional loss or rapid disease progression, a shaving procedure is the optimal alternative for fibrous dysplasia affecting the maxilla and zygoma areas. Lesions in the skull base causing exophthalmos, however, cannot be corrected by shaving, whereas shaving only the zygoma and maxilla can worsen the exophthalmos or cause incomplete contouring of the zygomatic arch area. Thus, we had undertaken malar reduction with osteotomies and orbital wall decompression to avoid these adverse effects and complement the shaving procedure in these patients. Five patients with craniofacial fibrous dysplasia and unacceptable aesthetic appearance were treated from December 2005 to July 2006. Operative extent was decided using computed tomography (CT) scans and three-dimensional skull models. Orbital wall decompression was performed through a subciliary incision by burring and osteotomies, and zygoma reduction was performed by an intraoral approach with minimal dissection. Some patients underwent shaving in the maxillary area at the same time. Outcomes were assessed using CT scans and photographs. All outcomes were successful, as determined using CT scans and clinical photographs, and all 5 patients were satisfied with the results of their surgery. No complications were observed, including facial nerve and optic nerve injury. This procedure may be an acceptable alternative for contouring in adult patients with nonprogressing fibrous dysplasia, who suffer from exophthalmos and asymmetry of the midcheek.