1
|
Vilos I, Nieminen MT, Mäkitie RE. Fibrous dysplasia of the head and neck in Southern Finland: a retrospective study on clinical characteristics, diagnostics, and treatment. Eur Arch Otorhinolaryngol 2024; 281:3189-3195. [PMID: 38564011 PMCID: PMC11065911 DOI: 10.1007/s00405-024-08595-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 03/04/2024] [Indexed: 04/04/2024]
Abstract
PURPOSE Fibrous dysplasia (FD) is a rare genetic disease with benign bone tumors. FD can affect one (monostotic FD) or multiple bones (polyostotic FD), with craniofacial lesions being common. Because of its rarity, there are only few clinical reports on FD in the head and neck region and its clinical characteristics remain incompletely defined. This study aimed to determine patient demographics, symptoms, diagnostics, and given treatment in patients with FD of the head and neck in a Finnish population. METHODS A retrospective review on all patients diagnosed with or treated for FD of the head and neck at the Helsinki University Hospital during 2005-2020. RESULTS In total 74 patients were identified; 54% were male and the mean age 45 years. Overall 95% had monostotic FD. Mandibula and maxilla were the most common anatomic sites. Majority of patients had symptoms, most commonly pain and lesion growth, and 49% had extra-skeletal symptoms. For all, diagnosis was primarily based on imaging findings, biopsies were obtained from 41%. Altogether 54 patients (73%) were managed by observation only, 20 patients (27%) received treatment; ten bisphosphonates, six surgery and four both. CONCLUSION Although highly variable in its clinical manifestations, head and neck FD lesions are often symptomatic and impose risk for extra-skeletal complications. Treatment is often conservative but should be individually tailored. Future studies are encouraged to better define the disease characteristics and hopefully offer new treatment possibilities.
Collapse
Affiliation(s)
- Isabella Vilos
- Department of Otorhinolaryngology, Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, HUS, Kasarmikatu 11-13, 00029, Helsinki, Finland
| | - Mikko T Nieminen
- Department of Otorhinolaryngology, Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, HUS, Kasarmikatu 11-13, 00029, Helsinki, Finland
| | - Riikka E Mäkitie
- Department of Otorhinolaryngology, Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, HUS, Kasarmikatu 11-13, 00029, Helsinki, Finland.
- Faculty of Medicine, University of Helsinki, Helsinki, Finland.
| |
Collapse
|
2
|
Chen L, Chen Y, Xiao K, Hu F, Wang H, Shao Q. Surgical Treatment of Craniofacial Fibrous Dysplasia With TP53 Gene Mutation. J Craniofac Surg 2023:00001665-990000000-01232. [PMID: 37983092 DOI: 10.1097/scs.0000000000009900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 10/20/2023] [Indexed: 11/21/2023] Open
Abstract
BACKGROUND To report the surgical treatment of craniofacial fibrous dysplasia (CFD) with TP53 gene mutation. METHODS The patient was diagnosed with CFD by surgery at the age of 14 years. At the age of 35 years, the tumor recurred, and the patient took active treatment. The tumor was resected 4 times by neuroendoscopy due to recurrence in a short period. Meanwhile, genetic tests were performed on the patient. The patient's postoperative pathology indicated leiomyosarcoma and genetic testing indicated TP53 gene mutation. RESULTS Despite the active surgical treatment, the patient finally died of a malignant tumor. The prognosis of patients with CFD malignancy accompanied by TP53 gene mutation is poor, and its treatment is difficult. CONCLUSIONS The prognostic benefit of surgical treatment for patients with CFD malignancy is limited. It is hoped that more genetic mutations will be identified and reported in patients with CFD malignancy, and long-term follow-up is necessary for patients with current fibrous dysplasia or CFD.
Collapse
Affiliation(s)
- Lang Chen
- Department of Neurosurgery, Yangtze River Shipping General Hospital, Wuhan Brain Hospital, Wuhan City, Hubei Province
| | - YuJing Chen
- The Eighth Clinical Medical School of Guangzhou University of Chinese Medicine, Foshan, Guangdong Province, China
| | - Kai Xiao
- Department of Neurosurgery, Yangtze River Shipping General Hospital, Wuhan Brain Hospital, Wuhan City, Hubei Province
| | - Fei Hu
- Department of Neurosurgery, Yangtze River Shipping General Hospital, Wuhan Brain Hospital, Wuhan City, Hubei Province
| | - HuanMing Wang
- Department of Neurosurgery, Yangtze River Shipping General Hospital, Wuhan Brain Hospital, Wuhan City, Hubei Province
| | - Qiang Shao
- Department of Neurosurgery, Yangtze River Shipping General Hospital, Wuhan Brain Hospital, Wuhan City, Hubei Province
| |
Collapse
|
3
|
Wadewale SN, Bhola ND, Agarwal A. Polyostotic Fibrous Dysplasia: A Case Report of Rarity. Cureus 2023; 15:e36403. [PMID: 37090354 PMCID: PMC10115768 DOI: 10.7759/cureus.36403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 03/20/2023] [Indexed: 04/25/2023] Open
Abstract
A skeletal condition known as fibrous dysplasia (FD) is characterized by the replacement of healthy bone with fibrous bone tissue. One bone (monostotic) or several bones could be involved (polyostotic). Any bone in the body might become affected by FD. The skull and face bones are the most typical locations. It is connected to a GNAS1 gene mutation (20q13.2). It begins during childhood and could continue far into adolescence and adulthood. In this case study, a 22-year-old woman was identified as having polyostotic FD based on her clinical, radiological, and histological characteristics.
Collapse
Affiliation(s)
- Sanjana N Wadewale
- Oral and Maxillofacial Surgery, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Medical Sciences, Wardha, IND
| | - Nitin D Bhola
- Oral and Maxillofacial Surgery, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Medical Sciences, Wardha, IND
| | - Anchal Agarwal
- Oral and Maxillofacial Surgery, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Medical Sciences, Wardha, IND
| |
Collapse
|
4
|
Wang J, Du Z, Li D, Yang R, XiaodongTang, Yan T, Guo W. Increasing serum alkaline phosphatase is associated with bone deformity progression for patients with polyostotic fibrous dysplasia. J Orthop Surg Res 2020; 15:583. [PMID: 33272306 PMCID: PMC7713166 DOI: 10.1186/s13018-020-02073-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 11/05/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Fibrous dysplasia (FD) is a rare bone disorder in which normal intramedullary bone is replaced by fibro-osseous tissue, which is complicated by the progression of Shepherd's crook deformity. How to predict the progression of Shepherd's crook deformity is still a challenging for the orthopedic surgeon. METHODS A total of 159 cases were reviewed in the retrospective study between January 2000 and September 2016. Clinical and monitoring data were collected. We analyzed the correlationship between the bone turnover markers and other parameters (age, gender, FD type, deformity, BMI, and lesion location). RESULTS Age, gender, lesion location, lesion type, and shepherd's crook deformity had a close relationship with preoperative ALP level in the univariate analysis, and the multivariate analysis showed age, gender, lesion type, and shepherd's crook deformity had the significant relationship with the preoperative serum ALP level. The surgery could remove the bone lesion and suppressed the abnormal bone metabolism. Furthermore, the preoperative ALP level of FD patients with the shepherd's crook deformity was obviously higher than that without deformity, and the preoperative calcium and phosphorus levels of FD patients with deformity were significantly lower than that without deformity. Notably, for some patients with progression of the shepherd's crook deformity during the follow-up, ALP increased to the high level and at that time X-ray showed the shepherd's crook deformity severely progressing. CONCLUSIONS PFD with higher serum ALP level has obvious tendency to progress severely, and risk factors of progression to the deformity are the condition of bony metabolism and FD type. The deformity of PFD may be related to high speed of bone turnover, which is exactly reflected by the levels of serum ALP and calcium. Evaluation of patients with FD should include a thorough evaluation of calcium/phosphate metabolism and bone turnover.
Collapse
Affiliation(s)
- Jun Wang
- Musculoskeletal Tumor Center, Peking University People's Hospital, No. 11 Xizhimen South Street, Beijing, 100044, China
| | - Zhiye Du
- Musculoskeletal Tumor Center, Peking University People's Hospital, No. 11 Xizhimen South Street, Beijing, 100044, China
| | - Dasen Li
- Musculoskeletal Tumor Center, Peking University People's Hospital, No. 11 Xizhimen South Street, Beijing, 100044, China
| | - Rongli Yang
- Musculoskeletal Tumor Center, Peking University People's Hospital, No. 11 Xizhimen South Street, Beijing, 100044, China
| | - XiaodongTang
- Musculoskeletal Tumor Center, Peking University People's Hospital, No. 11 Xizhimen South Street, Beijing, 100044, China
| | - Taiqiang Yan
- Musculoskeletal Tumor Center, Peking University People's Hospital, No. 11 Xizhimen South Street, Beijing, 100044, China
| | - Wei Guo
- Musculoskeletal Tumor Center, Peking University People's Hospital, No. 11 Xizhimen South Street, Beijing, 100044, China.
| |
Collapse
|
5
|
Zhang K, Qu P, Wang B, Zhang E, Chen B. Management of the Temporal Bone Fibrous Dysplasia With External Auditory Canal Stenosis and Secondary Cholesteatoma in an Asian Population: A 11-Case Series. EAR, NOSE & THROAT JOURNAL 2020; 100:NP469-NP474. [PMID: 32438822 DOI: 10.1177/0145561320927922] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE This article summarizes the experience of diagnosis and treatment of temporal bone fibrous dysplasia (FD) with external auditory canal (EAC) stenosis and secondary cholesteatoma in the Chinese population, in order to improve the quality of life of patients in the future. METHODS Eleven patients with FD of the temporal bone who underwent surgery were retrospectively reviewed. RESULTS All lesions originated from the temporal bone, and all involved of the EAC. There were 11 cases of cholesteatoma in the EAC, 4 cases of cholesteatoma in the middle ear. The most common symptoms were hearing loss (100%), tinnitus (36.4%), and otorrhea (36.4%). Two patients were severe-profound sensorineural hearing loss, and one patient was complicated with subperiosteal abscesses. All 11 patients underwent surgery. There were no perioperative complications in this series and median follow-up time was 4.2 years. CONCLUSION Temporal bone FD remains a rare diagnosis, especially in the Asian population. The lesions mainly lead to stenosis of the EAC, especially at the osteochondral junction. Cholesteatoma is the main complication of this disease, which is secondary to occlusion of the EAC with the growth of the lesion. Canaloplasty of EAC combined with wide meatoplasty can provide excellent prognosis in most cases.
Collapse
Affiliation(s)
- Kun Zhang
- ENT Institute and Otorhinolaryngology Department, Affiliated Eye and ENT Hospital, Shanghai Medical College, Fudan University, Shanghai, China.,Key Laboratory of Hearing Medicine of National Health and Family Planning Commission (NHFPC), Shanghai, China
| | - Peng Qu
- Graduate School, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Bing Wang
- ENT Institute and Otorhinolaryngology Department, Affiliated Eye and ENT Hospital, Shanghai Medical College, Fudan University, Shanghai, China.,Key Laboratory of Hearing Medicine of National Health and Family Planning Commission (NHFPC), Shanghai, China
| | - Endong Zhang
- Department of Otorhinolaryngology, Affiliated WeiHai Hospital, Qingdao University, Shandong, China
| | - Bing Chen
- ENT Institute and Otorhinolaryngology Department, Affiliated Eye and ENT Hospital, Shanghai Medical College, Fudan University, Shanghai, China.,Key Laboratory of Hearing Medicine of National Health and Family Planning Commission (NHFPC), Shanghai, China
| |
Collapse
|
6
|
Dong D, Wang Y, Li C, Zhang H, Zhao Y, Lai J. Fibro-osseous Lesions of Paranasal Sinus and Craniofacial Region: A Retrospective Study of 282 Cases. Laryngoscope 2020; 131:E1-E7. [PMID: 32057109 DOI: 10.1002/lary.28529] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Revised: 01/03/2020] [Accepted: 01/06/2020] [Indexed: 02/05/2023]
Abstract
OBJECTIVES To compare the clinical characteristics of osteoma, ossifying fibroma (OF) and fibrous dysplasia (FD) in the paranasal sinus and craniofacial regions. METHODS Totally 282 patients (112 males, 170 females) with osteoma (161), OF (44), and FD (77) involving the paranasal sinus, skull base and orbit treated surgically from January 2012 to August 2018 were analyzed retrospectively. RESULTS For osteoma, OF and FD, the onset ages were 40.3 (6-75), 24.5 (5-62), and 15 (1-63) years, and the most common locations were ethmoid sinus (49.7%), maxilla (36.4%) and maxilla (49.4%), respectively. There were significant differences of the preoperative serum alkaline phosphatase (ALP) levels between patients with osteoma (65 [25,184] U/L), OF (85.5 [41,474] U/L), and FD (104 [39,362] U/L) (Z = 44.9, P < .05). The ALP levels of OF and FD patients were comparable between monostotic and polyostotic lesions (P > .05). The recurrent rates of osteoma, OF, and FD were 0%, 13.6%, and 15.6%, respectively. The recurrent OF cases had significantly higher ALP level than the primary ones (283.5 [108,474] U/L vs. 76 [41,348] U/L, U = 14, P < .05). CONCLUSION There are differences in the onset age, location, and recurrence rate among osteoma, OF and FD involving the paranasal sinus and craniofacial region. Osteoma most commonly occurs in the ethmoid sinus, while OF and FD involve the maxilla most and are more likely to involve the orbit and the skull base, respectively. Endoscopic surgery is currently the main method for treatment, but individualized treatment regimen should be developed for patients. LEVEL OF EVIDENCE IV Laryngoscope, 131:E1-E7, 2021.
Collapse
Affiliation(s)
- Dong Dong
- Department of Rhinology, the ENT Hospital, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yue Wang
- Department of Rhinology, the ENT Hospital, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Chang Li
- Department of Rhinology, the ENT Hospital, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Hongyan Zhang
- Department of Pathology, Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yulin Zhao
- Department of Rhinology, the ENT Hospital, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jinping Lai
- Department of Pathology, Immunology, and Laboratory Medicine, University of Florida College of Medicine, Gainesville, Florida, U.S.A.,Department of Pathology and Laboratory Medicine, Kaiser Permanente, Permanente Medicine, KP Sacramento Medical Center, Sacramento, California, U.S.A
| |
Collapse
|
7
|
Udayakumar SIV, Paeng JY, Choi SY, Shin HI, Lee ST, Kwon TG. Orthognathic surgery for patients with fibrous dysplasia involved with dentition. Maxillofac Plast Reconstr Surg 2018; 40:37. [PMID: 30581810 PMCID: PMC6275155 DOI: 10.1186/s40902-018-0176-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 10/19/2018] [Indexed: 12/14/2022] Open
Abstract
Background Fibrous dysplasia (FD) is characterized by the replacement of normal bone by abnormal fibro-osseous connective tissue and typically treated with surgical contouring of the dysplastic bone. When dysplastic lesions involve occlusion, not only is surgical debulking needed, orthognathic surgery for correction of dentofacial deformity is mandatory. However, the long-term stability of osteotomized, dysplastic bone segments is a major concern because of insufficient screw-to-bone engagement during surgery and the risk of FD lesion re-growth. Case presentation This case report reviewed two patients with non-syndromic FD that presented with maxillary occlusal canting and facial asymmetry. Le Fort I osteotomy with recontouring of the dysplastic zygomaticomaxillary region had been performed. The stability of osseous segments were favorable. However, dysplastic, newly formed bone covered the previous plate fixation site and mild bony expansion was observed, which did not influence the facial profile. Including the current cases, 15 cases of orthognathic surgery for FD with dentition have been reported in the literature. Conclusion The results showed that osteotomy did not appear to significantly reduce the long-term stability of the initial fixation insufficiency of the screw to the dysplastic bone. However, based on our results and those of the others, long-term follow-up and monitoring are needed, even in cases where the osteotomized segment shows stable results.
Collapse
Affiliation(s)
- Santhiya Iswarya Vinothini Udayakumar
- 1Department of Oral and Maxillofacial Surgery, School of Dentistry, Kyungpook National University, 2177 Dalgubeol-daero, Jung-gu, Daegu, 41940 Republic of Korea
| | - Jun-Young Paeng
- 2Department of Oral and Maxillofacial Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - So-Young Choi
- 1Department of Oral and Maxillofacial Surgery, School of Dentistry, Kyungpook National University, 2177 Dalgubeol-daero, Jung-gu, Daegu, 41940 Republic of Korea
| | - Hong-In Shin
- 3Department of Oral Pathology, School of Dentistry, Institute for Hard Tissue and Bio-tooth Regeneration, Kyungpook National University, 2177 Dalgubeol-daero, Jung-gu, Daegu, 41940 Republic of Korea
| | - Sung-Tak Lee
- 1Department of Oral and Maxillofacial Surgery, School of Dentistry, Kyungpook National University, 2177 Dalgubeol-daero, Jung-gu, Daegu, 41940 Republic of Korea
| | - Tae-Geon Kwon
- 1Department of Oral and Maxillofacial Surgery, School of Dentistry, Kyungpook National University, 2177 Dalgubeol-daero, Jung-gu, Daegu, 41940 Republic of Korea
| |
Collapse
|