An Analysis of Clinical and Histopathologic Features of Fibrous Dysplasia of the Jaws: A Series of 40 Cases and Review of Literature

Monostotic Fibrous Dysplasia with Rare Histopathologic Features: A Case Report

Fibrous dysplasia is a slow-progressing benign condition characterized by abnormal bone formation that leads to some skeletal disorders. Although some of the fibrous dysplasia have unusual clinical and radiographic features that can lead to a challenging diagnosis, most lesions reveal an expansile bone defect due to cortex thinning. This report presented a case of monostotic fibrous dysplasia of a 43-year-old woman with involvement of the right maxillary jaw and sinuses, which indicated unusual histopathological features. The patient was referred to the Department of Oral and Maxillofacial Surgery of Tehran University of Medical Sciences (Tehran, Iran) in 2022. Radiological and histological findings were discussed. The unusual histomorphic pattern of the lesion caused uncertainty and resulted in a missed definitive diagnosis in the primary biopsy. It was highlighted that awareness of rare histologic variants in fibro-osseous lesions especially fibrous dysplasia was required to improve diagnostic confidence.

Predicting craniofacial fibrous dysplasia growth status: an exploratory study of a hybrid radiomics and deep learning model based on computed tomography images

OBJECTIVE

This study aimed to develop 3 models based on computed tomography (CT) images of patients with craniofacial fibrous dysplasia (CFD): a radiomics model (Model Rad), a deep learning (DL) model (Model DL), and a hybrid radiomics and DL model (Model Rad+DL), and evaluate the ability of these models to distinguish between adolescents with active lesion progression and adults with stable lesion progression.

METHODS

We retrospectively analyzed preoperative CT scans from 148 CFD patients treated at Shanghai Ninth People's Hospital. The images were processed using 3D-Slicer software to segment and extract regions of interest for radiomics and DL analysis. Feature selection was performed using t-tests, mutual information, correlation tests, and the least absolute shrinkage and selection operator algorithm to develop the 3 models. Model accuracy was evaluated using measurements including the area under the curve (AUC) derived from receiver operating characteristic analysis, sensitivity, specificity, and F1 score. Decision curve analysis (DCA) was conducted to evaluate clinical benefits.

RESULTS

In total, 1,130 radiomics features and 512 DL features were successfully extracted. Model Rad+DL demonstrated superior AUC values compared to Model Rad and Model DL in the training and validation sets. DCA revealed that Model Rad+DL offered excellent clinical benefits when the threshold probability exceeded 20%.

CONCLUSIONS

Model Rad+DL exhibits superior potential in evaluating CFD progression, determining the optimal surgical timing for adult CFD patients.

Robot-Guided Microballoon Compression of the Trigeminal Nerve for the Treatment of Trigeminal Neuralgia Caused by Fibrous Dysplasia of the Skull: A Case Report and Literature Review

Cranial fibrous dysplasia (FD) syndrome is a benign, rare, and idiopathic skeletal disorder characterized by the replacement and expansion of medullary bone by disorganized fibro-osseous tissue. Trigeminal neuralgia (TN) is most commonly caused by vascular compression at the trigeminal nerve root entry zone. Secondary TN caused by cranial FD syndrome is extremely rare. This article reports a case of cranial FD syndrome in which the lesion resulted in posterior cranial fossa narrowing, leading to the occurrence of TN. We located the patient's foramen ovale with robotic navigation, and we effectively treated the patient's TN with balloon compression.

A review of oral pathology in orthodontics. Part 2: Pathology of the jaw bones

For many patients, their first full jaw imagining will be requested and reported by an orthodontist. This may lead to the discovery of unexpected pathology in the jaws. In this review article, we discuss the clinical and radiological appearance as well as the pathologic features and treatment of the more common entities of the jaws. In addition, we will discuss the less common lesions which carry important consequences for the patient. Through the identification of these lesions, appropriate referral and management can be pursued.

Alveolar Bone Box Ostectomy Grafted with Particulate Bone Substitute with Subsequent Dental Implant Placement in a Case of Craniofacial Fibrous Dysplasia Involving the Posterior Maxilla: Case Report and Literature Review

BACKGROUND

Patients with dysplastic bone diseases, including fibrous dysplasia (FD), represent a particular challenge for placement of dental implants. This is due to structural bony changes that may compromise the bone blood supply and plasticity, thus potentially affecting the process of osseointegration. This case report describes a novel approach for dental-implant-based rehabilitation of the posterior maxilla affected by craniofacial fibrous dysplasia (CFD), with 7 years of treatment follow-up.

CASE PRESENTATION

A 35-year-old female patient was referred due to a suspected unidentified bone lesion affecting the left side of the maxilla. A clinical and radiographic diagnosis of fibrous dysplasia was confirmed through a wedge bone biopsy. Particulate bone substitute was packed into a box-shaped ostectomy area of the lesion in the affected maxillary alveolar ridge. This was followed by the placement of four implants 6 months post operation. The implants were successfully integrated, as confirmed by clinical examination over 7 years of follow up.

CONCLUSION

this treatment approach may be considered as a predictable and efficient treatment modality for dental implant rehabilitation in patients with a variety of fibro-osseous lesions, including fibrous dysplasia, which affect the alveolar bone.

Multimodal imaging diagnosis for bone fibrous dysplasia malignant transformation: A case report

Fibrous dysplasia of bone (FDB) is a rare benign condition in which fibrous tissue replaces normal bone architecture. FDB rarely undergoes malignant transformation, but there are reports of locally aggressive fibrous dysplasia with cortical destruction and soft tissue extension. Diagnosis of FDB malignant transformation is not easy, especially in monostotic form, because of the overlap in imaging features of locally aggressive fibrous dysplasia and fibrous dysplasia with malignant transformation. The present case study reports a rare case of FDB in a 23-year-old man with polyostotic fibrous dysplasia arising in the left side of the pelvis and lower limb bones with partial transformation to fibrosarcoma. This study explored the multimodal imaging features of FDB malignant transformation, to achieve early detection and improve diagnostic accuracy of local FDB aggressiveness and its malignant transformation.

Fibrous Dysplasia of the Jaw: Advances in Imaging and Treatment

A total of 7% of all benign bone lesions are diagnosed as fibrous dysplasia (FD). The symptoms of FD of the jaw range from asymptomatic to dental anomalies, pain and facial asymmetry. Due to its resemblance to other fibro-osseous bone lesions, misdiagnosis often occurs and can lead to inadequate treatment. Particularly in the jaw, this lesion does not become quiescent during puberty, making fundamental knowledge about the diagnosis and treatment of FD crucial. Mutational analysis and nonsurgical approaches offer new diagnostic and therapeutic options. In this review, we examine the advances and the difficulties of the diagnosis and the various treatment modalities of FD of the jaw in order to capture the current scientific knowledge on this bone disease.

The dilemma of juvenile fibrous dysplasia versus chronic osteomyelitis of the posterior mandible: A case report

The clinical and radiographic dilemma of fibrous dysplasia versus osteomyelitis is highlighted in this case of a 4-year-old girl with a bony hard swelling in mandibular body and ramus. Rather than relying on histopathological appearance alone, dental professionals should be familiar with the radiographic differences between the two conditions.

Nonspecific Cystic Degeneration in Craniofacial Fibrous Dysplasia: A Rare Finding

Fibrous dysplasia (FD) is a developmental pathology of the bones in which normal bone is replaced by fibrous tissue and immature bone. It can affect single bone (monostotic) or multiple bones (polyostotic), sporadically or in association with McCune-Albright syndrome, Jaffe-Lichtenstein syndrome, or Mazabraud syndrome. When multiple bones in the craniofacial region are affected, the term "craniofacial FD" is used. Nonspecific cystic degeneration occurring in FD of the jaws has rarely been reported in the literature. Here, we present a 52-year-old male patient who reported with a longstanding gradual expansion of the mandible unilaterally. Investigations revealed the presence of mixed radiolucent radioopaque appearance in the mandible and dense sclerotic multiple craniofacial bones. In addition, a lytic lesion in the mandible was appreciated. Histopathological examination of the mandible confirmed the diagnosis of FD with nonspecific cystic degeneration.

Monostotic Fibrous Dysplasia of the Mandible in a 9-Year-Old Male Patient Treated with a Conservative Surgical Treatment: A Case Report and 15-Year Follow-Up

Fibrous dysplasia is a developmental disorder of the bone that originates from a genetic defect disturbing the osteogenesis leading to the replacement of normal bone with the excess proliferation of fibrous tissue. It can be associated with hyperpigmentation of the skin and endocrine disorders. Fibrous dysplasia can manifest in a monostotic form affecting one bone or in a polyostotic form involving several bones. Approximately 30% of monostotic forms are observed in the maxilla and the mandible. It frequently appears in the posterior region and is usually unilateral. It is found in teenagers and could become static after adulthood. Patients can present with swelling, facial asymmetry, pain, or numbness on the affected side. Treatment modalities vary between conservative surgical treatment, radical surgical approach, and medical treatment based on bisphosphonates. Here, we present a case of a monostotic form of fibrous dysplasia affecting the posterior left region of the mandible in a 9-year-old male complaining of gradually increased swelling on the left mandibular side of one-year duration. The diagnosis of fibrous dysplasia is established based on clinical, radiographical, and histopathological features. Conservative surgery is implemented with surgical shaving and reencountering of the bone excess to reduce the facial asymmetry. Recurrence is reported 10 years later and is also treated with a localized osteoplasty and remodeling of the bone contours. Five years later, the lesion remains stable. In conclusion, a conservative approach should be adopted as the first line of treatment for young patients suffering from monostotic fibrous dysplasia.