Surgical treatment of nasal obstruction secondary to craniofacial fibrous dysplasia

Craniofacial fibrous dysplasia, a skeletal disorder most often affecting the mandible or maxilla, can cause a variety of complications. Nasal obstruction secondary to this unusual disorder presents a diagnostic and therapeutic challenge. The nasal obstruction in this case is due to expansion of fibrous lesions in adjacent bones as well as direct involvement of the turbinates with fibrous dysplasia. We describe the surgical correction of nasal obstruction in this unique setting and present a brief update of this intriguing disorder.

Polyostotic fibrous dysplasia associated with extensive linear epidermal naevi

Albright's syndrome is characterized by the combination of polyostotic fibrous dysplasia, precocious puberty and café-au-lait spots. We describe a patient with polyostotic fibrous dysplasia who also had extensive linear epidermal naevi, an association that has not been previously described in the English literature.

Osteosarcoma in fibrous dysplasia

Two cases are reported with osteosarcomatous transformation in fibrous dysplasia, one in the skull and one in the iliac bone. In both cases the patient was known to have longstanding polyostotic fibrous dysplasia; no radiation therapy was ever given. The incidence of sarcomatous transformation in fibrous dysplasia in the files of the Netherlands Committee on Bone Tumours is 0.5%. When strict criteria for spontaneous malignant transformation are used, the actual incidence is probably lower than is suggested.

Fibro-osseous lesions of the head and neck

Review and classification of fibro-osseous lesions of the head and neck is presented. The common denominator to all these pathologic entities is replacement of normal bone with fibrous tissue.

Multiple myxomata of soft tissue associated with polyostotic fibrous dysplasia. A case report

Polyostotic fibrous dysplasia with associated myxomata of soft tissue has been reported rarely. In most cases, the patient appears first with fibrous dysplasia and many years later presents with soft-tissue tumors. This is a report of a 57-year-old woman--an unusual case of soft-tissue myxomas with fibrous dysplasia. This case suggests that a patient developing myxomatous tumors of the soft tissues might be evaluated for the possibility of associated fibrous dysplasia.

Fibrous dysplasia of bone and the Weil-Albright syndrome. A study of thirteen cases with special reference to the orthopaedic treatment

Four patients with monostotic and nine with polyostotic fibrous dysplasia of bone, including one with the classical Weil-Albright syndrome and a male child who may have had this syndrome, are presented. While monostotic forms affect adults and are amenable to curative surgery, polyostotic involvement may become evident in childhood and early infancy, and represent a difficult therapeutic problem. Screening of the skeleton is essential for proper diagnosis and treatment, and should be achieved by total body scan in preference to a complete radiological survey. Biopsy is of particular importance in monostotic cases. The course of polyostotic fibrous dysplasia of bone is not predictable and depends partly upon the unassessable osteogenic potential of the bone, and also on surgery. The Weil-Albright syndrome and its variants are no worse than polyostotic fibrous dysplasia. Orthopaedic treatment deals with pathological fractures and with the prevention and correction of deformities, particularly of coxa vara. Sufficient stability of diaphyseal and metaphyseal lesions of the femur and tibia can usually be provided by intramedullary fixation, which needs to be left, or exchanged, at least until the end of adolescence. Extensive lesions of the proximal femur make aggressive surgery necessary. Pelvic involvement and destruction of the hip joint preclude surgery and require the use of calipers.

Osteosarcoma of the mandible arising in fibrous dysplasia. A case report

A Grade 3 chondroblastic osteosarcoma is reported in the mandible of a 37-year-old man with longstanding polyostotic fibrous dysplasia. There was also a history of multiple endocrine disturbances including hyperthyroidism, pituitary adenoma, and acromegaly. Malignant transformation of fibrous dysplasia is very rare and occurs most often when the lesion is polyostotic in distribution. The patient received preoperative radiation therapy followed immediately by marginal excision, i.e., left hemimandibulectomy. Forty-two months after initial presentation of the osteosarcoma of the mandible, he is alive with no evidence of disease.

Craniofacial polyostotic fibrous dysplasia

Three cases of gross craniofacial polyostotic fibrous dysplasia are presented, together with a brief review of the condition, and pertinent points regarding the cases are discussed. As complete excision of the lesion and immediate reconstruction is rarely feasible or possible, and partial excision may result in accelerated growth of the lesion during the patient's active growth phase, resection only to protect, maintain or restore certain important functions (e.g. vision) during this period are advocated, after which close follow-up is mandatory until the lesion becomes quiescent, when further surgical procedures may be undertaken.

Surgical palliation of respiratory insufficiency secondary to massive exuberant polyostotic fibrous dysplasia of the ribs

A middle-aged man with long-standing polyostotic fibrous dysplasia had severe progressive restrictive lung disease with hypoxemia and pulmonary hypertension with heart failure because of exuberant intrathoracic, extraosseous proliferation of dysplastic tissue. Subtotal resection of this benign tissue mass ameliorated the respiratory insufficiency and led to sustained improvement in exercise tolerance, increase in pulmonary reserve, and decrease in signs of heart failure and pulmonary hypertension.

Absence of pubertal gonadotropin secretion in girls with McCune-Albright syndrome

Precocious puberty in girls with McCune-Albright syndrome has been attributed in some cases to early activation of the hypothalamic-pituitary-gonadal axis and in other cases to sex steroid secretion by apparently autonomous ovarian cysts. We evaluated serum gonadotropins and sex steroids in six girls (aged 1-9 yr) with McCune-Albright syndrome. The children had Tanner stage II-IV pubertal development. In five patients, nocturnal gonadotropin concentrations and the gonadotropin response to LHRH were within the normal range for prepubertal children. Thus, the precocious puberty in these patients could not be explained by activation of the hypothalamic-pituitary-ovarian axis. One child had high amplitude nocturnal pulses of serum LH and a LH-predominant response to LHRH. She was the oldest of the six girls and had a bone age of 13.5 yr which is within the range in which hypothalamic-pituitary-ovarian activation normally occurs. The children all had ovarian enlargement and ovarian cysts determined by ultrasound. It appears that precocious puberty in McCune-Albright syndrome may result from ovarian estrogen secretion in the absence of normal pubertal activation of the hypothalamic-pituitary-ovarian axis.

Albright syndrome

The Albright Syndrome consists of the triad of polyostotic fibrous dysplasia, skin lesions and endocrinopathies. We are presenting the case of a young girl with the Syndrome, who was treated for a mandibular lesion with a bone graft taken from her mother.

Mammosomatotroph hyperplasia associated with acromegaly and hyperprolactinemia in a patient with the McCune-Albright syndrome. A histologic, immunocytologic and ultrastructural study of the surgically-removed adenohypophysis

An 11-year-old girl, with the McCune-Albright syndrome, exhibited fibrous dysplasia of several bones, skin pigmentation, precocious puberty, growth hormone hypersecretion, acromegaly and hyper-prolactinemia. Histologic, immunocytologic and ultrastructural investigation of the surgically-removed pituitary showed massive mammosomatotroph hyperplasia. Since no adenoma was found, the abundance of these bihormonal cells, capable of producing both growth hormone and prolactin, was implicated in the causation of growth hormone and prolactin excess. Somatoliberin overproduction and/or somatostatin and dopamine deficiency could not account for the hypophysial abnormality, since changes in secretory rates of these hypothalamic hormones would lead to proliferation of mature somatotrophs and lactotrophs, rather than mammosomatotrophs. In our patient, a congenital hypothalamic malfunction might have been accompanied by hypersecretion of an unidentified releasing factor, resulting in pathologic differentiation of the pituitary and mammosomatotroph hyperplasia. Alternatively, mammosomatotroph hyperplasia may have been due to an inherent genetic or embryonic defect affecting primarily the pituitary. According to this interpretation, the pituitary lesion represented yet another developmental error in the setting of the McCune-Albright syndrome.

A probable monogenic form of polyostotic fibrous dysplasia

A 37 year-old female patient with polyostotic fibrous dysplasia (PFD) is described. She presented the typical "café au lait" spots and severe bone involvement including a maxillary osteosarcoma. The father, four sibs, two nephews, two paternal aunts and two paternal first cousins were clinically examined, and seven of them also radiologically evaluated. "Café au lait" spots were found in the father, three sibs, one nephew, one aunt and one first cousin. Although no definite PFD bone lesions, mild radiological abnormalities were found in the father, three sibs and one nephew. These findings were interpreted as the variable expression of a pleiotropic gene. The present observation and three previous familial cases of this entity strongly suggest the existence of a form of PFD determined by an autosomal dominant gene.

Fibrous dysplasia: a review of the disease and its manifestations in the temporal bone

Fibrous dysplasia is a fairly common, localized misdifferentiation of the bone-forming mesenchyme affecting a single or many bones, in which skeletal aberrations represent the cardinal feature, but in which certain endocrinopathies, abnormal pigmentation of skin and mucous membrane, and occasionally other abnormalities form part of the entire disease process. The craniofacial skeleton is one of its predilective sites and therefore the temporal bone may become involved. In such instances the disease manifests itself with 1) progressive loss of hearing, 2) increasing obliteration of the external ear canal, and 3) enlargement and distortion of the temporal bone. The first part of this communication is concerned with a review of the clinical and pathological aspects of the disease in general. The second part is concerned with a discussion of the clinical manifestations in the temporal bone, based upon analysis of the entire literature and the authors' personal experience. The indications for surgical intervention include 1) maintenance of a normal outer ear canal, 2) preservation of cochlear and vestibular function, and 3) prevention of secondary complications.

Electron microscopic studies of fibrous dysplasia

Very few ultrastructural studies of fibrous dysplasia have been reported up to date. Eight cases of fibrous dysplasia (six cases of monostotic and two cases of polyostotic disease) were studied in detail by an electron microscope, and were compared with desmoplastic fibroma and fibrous cortical defect in order to clarify the fine structure of this disease. The fine structure of osteoblast or osteocyte-like cells, large cells including collagen fibers in the cytoplasm and so on was newly observed in this study. It was impossible to distinguish between monostotic and polyostotic forms even through an electron microscope.

Albright's syndrome involving the facial bone

A case of ALbright's syndrome involving the facial bone is presented. A satisfactory result was obtained by surgically recontouring the patient's facial asymmetry.

A bizarre manifestation of polyostotic fibrous dysplasia of the facial bones

A 35-year-old white female is presented for case review. According to H. M. Worth, the classification polyostotic fibrous dysplasia, leontiasis ossea type, would be appropriate. Bone lesions are present in the skull, all facial bones, ribs, pelvic girdle and extremities. The patient's oral/maxillofacial appearance is characterized by massive bony protuberances, hypertelorism and malocclusion, resulting in a grossly distorted leonine mask-like facies. Serum alkaline phosphatase levels are high and, in spite of five facial operations, the patient's disease process continues.

Computed tomography and bone scintigraphy is polyostotic fibrous dysplasia. Report of a case

A case of polyostotic fibrous dysplasia is presented in which the extent of bony lesions was defined on the results of the CT scan and bone scan with 99m Tc polyphosphate in addition to conventional radiography. These diagnostic procedures appear to be of considerable value in defining the extent of a variety of oral-maxillofacial bony lesions. This report describes the comparative findings from 99m Tc polyphosphate bone imaging and computed tomography (CT) in one patient with polyostotic fibrous dysplasia.

Osteosarcoma, fibrous dysplasia, and a chromosomal abnormality in a 3-year-old child

Osteosarcoma is a type of malignant bone tumor that is rare among children less than five years old. This report describes a 3-year-old boy with osteosarcoma of the right proximal femur and polyostotic fibrous dysplasia of the right femur and tibia. After hemipelvectomy, histologic examination of the amputated limb disclosed that the osteosarcoma had developed in a focus of fibrous dysplasia. Cytogenetic analysis of the patient's blood lymphocytes revealed a 4q-/7p + translocation in all cells. The patient's mother had an identical translocation but did not have a history of osteosarcoma or evidence of fibrous dysplasia. The chromosomal abnormality and the developmental osseous disorder may have predisposed this patient to developing osteosarcoma at an exceptionally young age.

Malignant transformation of polyostotic fibrous dysplasia

We have described an unusual case of polyostotic fibrous dysplasia in a 25-year-old white woman who had malignant transformation into a mesenchymal tumor with widespread metastases and features of rhabdomyosarcoma. Masculinization also occurred with high plasma testosterone levels. A mechanism for the development of masculinizing features is discussed.

Polyostotic fibrous dysplasia involving the maxilla and mandible: report of case

The case presented here represents an aggressive form of polyostotic fibrous dysplasia. Because of lack of evidence to substantiate precocious puberty and abnormal pigmentation, Albright syndrome cannot be established. Because of the nature of this disease, its clinical course and prognosis are unpredictable. However, it is believed that continued growth of the lesion may necessitate additional surgery.

Familial polyostotic fibrous dysplasia

A case of polyostotic fibrous dysplasia of the craniofacial type is presented, together with substantial evidence that this condition had a genetic basis in this patient. A review of the literature indicates that there is absolutely no previous evidence of a genetic basis to this condition. The possibility that the propositus suffered from polyostotic fibrous dysplasia of the Jaffe or the Albright type was excluded.