Fibrous Dysplasia of the Face: Utility of Three-Dimensional Modeling and Ex Situ Malar Recontouring

Abstract

A 20-year-old male with fibrous dysplasia involving the right fronto-orbital and malar regions showed no significant progression of disease by serial computed tomography (CT) scans over 6 years. Two prior attempts to recontour the right maxilla and zygoma in situ and to increase the right orbital volume had been unsatisfactory. To solve the problem of persistent right-sided proptosis and facial asymmetry, a three-dimensional model of the midface and orbits was made on the basis of a pre-operative CT scan. Removable components transformed the model of the affected right side of the midface into a mirror image of the unaffected side, giving a precise indication of where and how much bone needed to be removed. Surgical correction was performed using a right malar osteotomy in which the zygoma was mobilized in continuity with the lateral and inferior orbital rims. This approach gave direct access to the orbit, through which the lateral and medial orbital walls were re-contoured to increase intraorbital volume. The freely mobilized zygoma was then shaped to match the prefabricated model. The zygoma was repositioned, and the affected maxilla was recontoured to blend with the remodeled zygoma. Follow-up CT scan and physical examinations postoperatively demonstrate excellent facial symmetry and correction of right-sided proptosis. When there is no documented progression of fibrous dysplasia in the face over several years, three-dimensional modeling as a guide to ex situ malar recontouring can improve the accuracy of facial reconstruction. This approach also provides direct access to the orbit for the correction of bony orbital volume.