Clinical Experience of Malignant Transformation of Multiostotic Fronto-Orbital Fibrous Dysplasia

The malignant transformation of fibrous dysplasia is a rare condition and the incidence is estimated at 0.4% for fibrous dysplasia and 4% for Albright's syndrome. And fronto-orbital fibrous dysplasia can have a devastating outcome with high rates of recurrence and blindness, especially following incomplete resection. So a radical and extensive approach to treatment is recommended. We report the case of a multiostotic fronto-orbital fibrous dysplasia in a 54-year-old male patient which had a malignant transformation to osteosarcoma. There had been a recurrence after partial removal and no effect by chemotherapy. Although we had have a favorable outcome in functional and aesthetic aspects without any evidences of recurrence by total removal and reconstruction with titanium mesh, the patient died with lung metastasis 4 and half years later after the first operation.

Clinical Usefulness of Titanium Mesh in Reconstruction of the Craniofacial Bone Defects

PURPOSE: Reconstruction of the craniofacial defects can be carried out with autogenous tissues, allogenic implants, or alloplastic materials. Titanium mesh systems have been used for bony reconstruction in non load- bearing areas. They offer several advantages: immediate availibility without any donor site morbidity, easy handling, stable 3-D reconstruction, and low susceptibility to infection. The aim of this study is to evaluate the usefulness and complications of titanium mesh system in the reconstruction of the craniofacial defects. METHODS: From Jan. 2000, to Dec. 2004, we performed reconstruction of craniofacial bone defects in 21 patients who had benign or malignant tumor and fracture events in the cranium, orbit, nasal bone, maxilla, zygoma and the mandible. The size of the defects ranged from 1.0 X 1.5 cm to 12 X 10 cm. Two different mesh systems, micro-titanium augmentation mesh and dynamic mesh was used for bony reconstruction in non load-bearing areas. The patients were evaluated from 1 to 4 yrs clinically and radiographically with a mean follow up period of 1.5 yrs. RESULTS: There were no serious complications, including wound infection, foreign body reaction, exposures or loos of the mesh, central infection and pathologic findings of bone around mesh exception of one patient, who had expired of skull base tumor recurrence. Long-term stability of the reconstructions and the overall functional and aesthetic outcome was excellent. CONCLUSION: Our experiences demonstrate that the Titanium mesh system is a relatively safe and efficient method in the craniofacial reconstruction and have broadens our choices of therapeutic procedures in the craniomaxillofacial surgery.

Clinical Usefulness of Titanium Mesh in Reconstruction of the Craniofacial Bone Defects

PURPOSE: Reconstruction of the craniofacial defects can be carried out with autogenous tissues, allogenic implants, or alloplastic materials. Titanium mesh systems have been used for bony reconstruction in non load- bearing areas. They offer several advantages: immediate availibility without any donor site morbidity, easy handling, stable 3-D reconstruction, and low susceptibility to infection. The aim of this study is to evaluate the usefulness and complications of titanium mesh system in the reconstruction of the craniofacial defects. METHODS: From Jan. 2000, to Dec. 2004, we performed reconstruction of craniofacial bone defects in 21 patients who had benign or malignant tumor and fracture events in the cranium, orbit, nasal bone, maxilla, zygoma and the mandible. The size of the defects ranged from 1.0 X 1.5 cm to 12 X 10 cm. Two different mesh systems, micro-titanium augmentation mesh and dynamic mesh was used for bony reconstruction in non load-bearing areas. The patients were evaluated from 1 to 4 yrs clinically and radiographically with a mean follow up period of 1.5 yrs. RESULTS: There were no serious complications, including wound infection, foreign body reaction, exposures or loos of the mesh, central infection and pathologic findings of bone around mesh exception of one patient, who had expired of skull base tumor recurrence. Long-term stability of the reconstructions and the overall functional and aesthetic outcome was excellent. CONCLUSION: Our experiences demonstrate that the Titanium mesh system is a relatively safe and efficient method in the craniofacial reconstruction and have broadens our choices of therapeutic procedures in the craniomaxillofacial surgery.

Clinical Application of Cranialization of the Frontal Sinus

Both frontal sinus ablation and osteoplastic frontal surgery with obliteration have limitations in treatment of injury to the frontal sinus that extends into the posterior wall and frontal lobes of the brain. In these problematic cases, cranialization of the frontal sinus is the method of choice. The purpose of the cranialization of the frontal sinus was as follows: (1) ablation of the sinus, precluding later infection or mucocele, mucopyocele formation (2) restoration of a normal aesthetic frontal bony contour (3) protection of frontal lobe by allowing space for the expansion of the edematous brain. From May 1999 to December 2003, we performed cranialization of involved frontal sinus in 23 patients who had malignant tumor, fibrous dysplasia, osteoma, mucoele, and fracture event in the frontal sinus on each other. After the frontal sinus was exposed through a bicoronal incision, the excision of posterior wall and removal of mucosa remaining on the floor of the sinus and residual anterior wall were done. The nasofrontal ducts were occluded with pericranial flap or/and bone source(R), or bone graft. Reconstruction of anterior wall was done with autogenous bone or/and bone source(R), or mesh plate, bone graft, and mesh plate with bone source(R).The average follow-up period was one and half years (from 1 year to 4 years).There were no serious complications including CNS infections, mucocele formation and CSF leakage, with an exception of one person who was expired of recurrence of skull base tumor. Also, the overall functional and aesthetic outcome was excellent except one case in which there was irregularity in the frontal area. The cranialization of the frontal sinus is a safe surgical procedure without complications if prevented.

Surgical Correction of the False Oxycephaly in Adult Patient: A Case Report

Oxycephaly, which is a frontal deformity in which the forehead is recessed and tilted backwards, is usually caused by the premature fusion of mainly the coronal and sagittal suture. In 1926, David M. Greig proposed to classify oxycephaly into three different forms; true oxycephaly, delayed oxycephaly and false oxycephaly. False oxycephaly is a simple morphotype of the skull without any clinical symptoms which does not affect the brain in any way. Surgical repair of oxycephaly for adults can include cosmetic considerations and the prevention or possible improvement of functional symptoms such as headaches, vomiting and visual disturbance. Furthermore, in adults who does not have any functional problems, cosmetic surgery can be done. But oxycephaly of adult patients need more complex and extensive surgical interventions than that of infant patients. A-21-year-old male who had a retroverted forehead, pointed head and a flat fronto-nasal angle, without any functional problems, was treated by a fronto- orbital advancement and a transposition between the frontal and fronto-parietal bone. This method provided us with a good frontonasal angle and a gently backward sloping forehead above the supraorbital bar. An acceptable aesthetic appearance was achieved 6 months after the operation. This remodeling technique is adequate for resolving the aesthetic problems of adult false oxycephalic patients who does not have any functional problems.