Table of Contents  
COMMENTARY
Year : 2016  |  Volume : 9  |  Issue : 3  |  Page : 407-408  

Fibro-osseous lesions of the jaw: Current management techniques (In response to Ramakrishnan R, Shrivastava S, Patel A, Agashe A. Fibrous dysplasia of bone causing unilateral proptosis. Med J DY Patil Univ 2015;8:237-40)"


Department of Oral and Maxillofacial Surgery, AME'S Dental College Hospital and Research Centre, Raichur, Karnataka, India

Date of Web Publication17-May-2016

Correspondence Address:
Yadavalli Guruprasad
Department of Oral and Maxillofacial Surgery, AME'S Dental College Hospital and Research Centre, Raichur - 584 103, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0975-2870.167997

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How to cite this article:
Guruprasad Y. Fibro-osseous lesions of the jaw: Current management techniques (In response to Ramakrishnan R, Shrivastava S, Patel A, Agashe A. Fibrous dysplasia of bone causing unilateral proptosis. Med J DY Patil Univ 2015;8:237-40)". Med J DY Patil Univ 2016;9:407-8

How to cite this URL:
Guruprasad Y. Fibro-osseous lesions of the jaw: Current management techniques (In response to Ramakrishnan R, Shrivastava S, Patel A, Agashe A. Fibrous dysplasia of bone causing unilateral proptosis. Med J DY Patil Univ 2015;8:237-40)". Med J DY Patil Univ [serial online] 2016 [cited 2019 Dec 7];9:407-8. Available from: http://www.mjdrdypu.org/text.asp?2016/9/3/407/167997

The publishing of the article "Fibrous dysplasia (FD) of bone causing unilateral proptosis" brings into focus of several factors like proper diagnosis and early management to prevent morbidity and associated late complications.

Fibro-osseous lesions of the craniofacial bones comprise a diverse group of pathologic conditions that include developmental lesions, reactive or dysplastic diseases, and neoplasms. The concept of fibro-osseous lesions has evolved over the last several decades and now includes two major entities: FD and ossifying fibroma. [1] The less common lesions include florid osseous dysplasia, periapical dysplasia, focal sclerosing osteomyelitis, proliferative periostitis of Garre, and osteitis deformans. Craniofacial involvement in FD is seen in both monostotic and polyostotic forms. Monostotic FD has a different skeletal distribution from polyostotic disease and occurs most commonly in the femur, followed by occurrences in the tibia, craniofacial bones, and the ribs. Craniofacial involvement occurs in about 30% of monostotic FD and typically affects the maxilla, mandible, and rarely, the calvarium. Polyostotic form of the disease has nearly 100% involvement of the craniofacial bones. [1],[2]

Computed tomography (CT) is gold standard, especially for assessing the extent of the tumor in cases of suspected optic canal involvement. While it is invaluable in preoperative planning, it is also a superior diagnostic tool, although CT alone is insufficient to make a diagnosis of FD. Other investigations like radionuclide scans and bone scintigraphy have some role in the diagnosis/evaluation of FD. Recent studies suggest that there is a role for biochemical markers in the management of FD. [2],[3] Serum alkaline phosphatase and urinary hydroxyproline are some of the useful markers, and are used to monitor response in the nonsurgical treatment rather than for diagnosis. [3]

Medical treatment has a role in the management of craniofacial FD with the use of steroids and bisphosphonates mainly in the treatment of visual symptoms from optic nerve compression. Surgical treatment of FD consists of either conservative shaving/contouring or radical excision with immediate reconstruction. [3],[4] The choice of surgical option depends on several factors: Site of involvement, rate of growth, aesthetic disturbance, functional disruption, patient preference, general health of the patient, surgeon's experience and the availability of a multi-disciplinary team (neurosurgeon, ophthalmologist, maxillofacial surgeon and orthodontist).

 
  References Top

1.
Mohammadi-Araghi H, Haery C. Fibro-osseous lesions of craniofacial bones. The role of imaging. Radiol Clin North Am 1993;31:121-34.  Back to cited text no. 1
    
2.
Guruprasad Y, Prabhakar C. Craniofacial polyostotic fibrous dysplasia. Contemp Clin Dent 2010;1:177-9.  Back to cited text no. 2
[PUBMED]  Medknow Journal  
3.
Grabias SL, Campbell CJ. Fibrous dysplasia. Orthop Clin North Am 1977;8:771-83.  Back to cited text no. 3
[PUBMED]    
4.
Guruprasad Y, Giraddi G. Juvenile ossifying fibroma of maxilla. J Maxillofac Oral Surg 2010;9:96-8.  Back to cited text no. 4
    




 

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