Advanced technology in the management of fibrous dysplasia

The aim of this paper is to describe the applications of advanced imaging technology in optimising the surgical management of complex craniofacial fibrous dysplasia (FD).

Preoperative planning involved a number of advanced technologies. Haptic modelling was used to simulate tumour excision and the design of the osteotomies, on a virtual 3D computerised tomographic (CT) scan. Rapid prototyping was employed in fabricating a physical prototype of the skull, featuring the ideal, symmetrical reconstruction. Tumour extirpation was carried out with the aid of stereotactic navigation. Intraoperatively, resorbable mesh is moulded precisely to the shape of the skull prototype, thereby transferring the surgical simulation to the patient in the operating room. The resorbable mesh serves as a template which guides the shape and spatial orientation of an autologous bone graft reconstruction. Pre- and postoperative volumetric differences were assessed to determine the accuracy of the final results.

Short and long term follow-up examinations show excellent cosmetic outcome, with significant restoration of volumetric symmetry.

The added complexity of using the new technologies increases preoperative planning time, but we believe that this is offset by the improved safety during the resection of the tumours as well as the excellent aesthetic outcomes.