A rare case report of craniofacial fibrous dysplasia
The term craniofacial FD (CFD) is used to describe FD where the lesions are confined to contiguous bones of the craniofacial skeleton. This report published in the Journal of Oral and Maxillofacial Pathology describes the case of CFD of a 20-year-old male who had unusual presentation involving right maxilla and frontal bone of the left side of the face.

A 20-year-old male patient presented with a painless swelling of the right maxilla and frontal bone of the left side of the face for the past 2 years. Clinically, the patient presented with facial asymmetry. There was no history of trauma, trismus, diminished vision, loosening of teeth or epistaxis. Extraoral examination revealed well-defined bony hard swelling in the right maxillary region. There was involvement of the left frontal bone which showed the prominence in that region.

Intraorally, there was enlargement of the right side of palate and expansion of alveolar buccal plate was present extending from 11 to 17. There was no swelling present elsewhere in the body, and café-au-lait spots were absent. Routine investigations such as hemogram, serum calcium and serum alkaline phosphatase (ALP) were performed. All parameters were within normal limits except ALP. ALP was raised to 300 U/L.

The CT revealed a radiodense mass with ground-glass appearance involving left frontal and right maxillary bone and its expansion causing facial asymmetry. CT scan demonstrated thickening of the frontal region with loss of anterior wall of frontal sinus and dense ossifications of the maxilla and its antrum.

An incisional biopsy was obtained from the lesion in the maxilla and histopathological analysis was done. Macroscopy showed two pieces of bony hard-tissue greyish white in color measuring 1 cm × 0.5 cm and 0.5 cm × 0.5 cm approximately. Microscopic examination showed irregular bony trabeculae in Chinese script pattern scattered within fibrous stroma. Bony trabeculae showed no osteoblastic rimming.

Poorly formed metaplastic bone was separated by cellular fibrous connective tissue stroma. The bone appeared woven rather than lamellar. Based on the clinical history, radiographic assessment and histological features of the lesion, a diagnosis of craniofacial FD was deduced. Surgical recontouring was restricted only to maxilla. Contour correction of the alveolar bone was performed using stainless steel drill and soft-tissue reduction was also performed. No treatment of frontal bone was done because there were no ocular symptoms and patient was unwilling too.

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