A Multimodal Approach to Huge Fibrous Dysplasia With Ocular Symptoms Using a Navigation System and Endoscope

Fibrous dysplasia (FD) is a rare sporadic benign disease, which involves from single to several bones with unilateral distribution. Recently, image-based surgical navigation systems have played a significant role in surgical process on neurological and orthopedic operations. However, because an intraoral approach can visualize the field for maxillary surgery, there are few cases using endoscopes for excision of FD. Even though, a huge mass involving posterior side of maxillary sinus can be assisted with an endoscope to protect essential structures. To the best of our knowledge, this is the first report of plastic and reconstructive surgeons to perform the operation of a huge FD with both an endoscope and a navigation system.

Preoperative computed tomography scan and magnetic resonance imaging was performed for precise diagnosis and setting the navigation system (Medtronic Navigation, Louisville, CO). The main problem of the patient was exophthalmos and decreased visual acuity, the authors decided to remove the mass involving the intraorbital portion and sphenoidal portion. Moreover, the mass was extending to intracranium, cooperation with the department of neurosurgery and otolaryngology was planned. The tumor reached by the endoscope was resected as much as possible. During the excision of the sphenoidal portion by the head and neck surgeon of the department of otolaryngology, cerebrospinal fluid leakage was observed and repaired by the neurosurgeon.

The exophthalmos measured by Hertel exophthalmometry was reduced only 1 mm, however, gross morphology of the patient was totally changed after the operation. Visual acuity of the right eye was improved from 0.3 to 0.9. The patient was followed up about 6 months and had a seizure event at 2 weeks after the surgery. Afterwards, the symptom has been well controlled by the medication.

This multimodal approach offers a safe, rapid surgical aid in treating huge lesions involving orbital and intracranial area.