Bicoronal Incision and Frontal-Basal Approach for Removal of Sinonasal Fibrous Dysplasia Complicated by Orbital Subperiosteal Abscess

• Published in: World neurosurgery 2020-11, Vol.143, p.389-391
• Main Authors: Hu, Chih-Yu, Wu, Chieh-Tsai, Chen, Chien-Cheng, Fu, Chia-Hsiang
• Format: Article
• Language: English
• Subjects: Abscess; Adolescent; Bicoronal incision; Brain Abscess - complications; Brain Abscess - surgery; Drainage - methods; Endoscopy; Eye Diseases - etiology; Fibrous dysplasia; Fibrous Dysplasia of Bone - complications; Fibrous Dysplasia of Bone - surgery; Humans; Male; Nasal Cavity - surgery; Neurosurgical Procedures - methods; Orbit - surgery; Orbital Diseases - complications; Orbital Diseases - surgery; Reconstructive Surgical Procedures; Sinusitis; Treatment Outcome
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2020.07.167

Fibrous dysplasia (FD) is a benign, slowly progressive disease resulting from the replacement of normal bone by fibro-osseous tissue. The incidence of craniofacial involvement of FD is as high as 23%. Sinonasal involvement of FD may lead to obstruction of the natural sinus ostium, resulting in acute sinusitis. We present a rare case of sinonasal FD complicated by subperiosteal abscess that was removed by bicoronal incision and frontal-basal approach in the second surgery. A 16-year-old male patient presented with painful swelling on his left eye that had persisted for 2 days. Transnasal endoscopic drainage of the left orbital subperiosteal abscess was performed and progressive improvement of the swelling of the left eye was noted. After the acute phase, transcranial removal of the sinonasal bony lesion and mesh reconstruction of the left orbital wall were performed. There has been no progression of FD to date, with 24 months of follow-up. After the acute phase, radical excision with reconstruction or debulking surgery after skeletal maturation may prevent recurrence. Although malignant transformation is rare, long-term follow-up is necessary for FD.