Long-Term Clinical Course of Benign Fibro-Osseous Lesions in the Paranasal Sinuses

Objectives Fibro-osseous lesions of the paranasal sinuses can present various clinical manifestations. This study aimed to report the long-term clinical course of benign fibro-osseous lesions (BFOLs) in the paranasal sinuses, including clinical and radiologic features. Methods Radiologically confirmed BFOLs between 1994 and 2016, with the exclusion of osteoma cases, were retrospectively reviewed. We compared demographic characteristics between the surgery and observation groups. The reasons for the imaging study, radiographic features, histopathology, and clinical course based on serial image scans were analyzed. Results In total, 183 subjects were selected from a thorough review of head and neck radiologic tests (n=606,068) at a tertiary referral hospital over 22 years. Patients’ mean age was 28.6±18.1 years, and 56.3% were males. A diagnostic imaging workup was performed in 55.7% of patients due to facial asymmetry, headache, skull mass, or other symptoms related to BFOLs. In other patients (37.7%), BFOLs were found incidentally on computed tomography or magnetic resonance imaging. The most common diagnosis was fibrous dysplasia, followed by ossifying fibroma, based on both radiologic exams and histopathologic results. In total, 42.6% of the patients underwent surgery because of subjective symptoms or esthetic concerns. The patients who underwent surgery were younger (P<0.001) and had a longer follow-up duration (P<0.001) than those who underwent observation. Patients who experienced lesion growth (11.5%) were younger (P<0.001) and had more lesion sites (P=0.018) than those who did not, regardless of surgical treatment. Five patients underwent optic nerve decompression, and one patient experienced malignant transformation. Conclusion BFOL in the paranasal sinuses is a rare disease, and most cases were observed without specific treatment. Surgical treatment should be considered in symptomatic patients with aggressive clinical features. Regular observation and management are needed, particularly in younger patients in their teens.

[1]  S. de Sousa,et al.  Can non-collagenous proteins be employed for the differential diagnosis among fibrous dysplasia, cemento-osseous dysplasia and cemento-ossifying fibroma? , 2019, Pathology, research and practice.

[2]  Jiang Du,et al.  Skull Base Juvenile Psammomatoid Ossifying Fibroma: Clinical Characteristics, Treatment, and Prognosis. , 2019, World neurosurgery.

[3]  Brenda L. Nelson,et al.  Benign Fibro-Osseous Lesions of the Head and Neck , 2019, Head and Neck Pathology.

[4]  Sergey Y Turin,et al.  Fibrous Dysplasia and Juvenile Psammomatoid Ossifying Fibroma: A Case of Mistaken Identity , 2019, The Cleft palate-craniofacial journal : official publication of the American Cleft Palate-Craniofacial Association.

[5]  Hongmeng Yu,et al.  Characteristics of sinonasal fibrous dysplasia: experience from a single department , 2018, Acta oto-laryngologica.

[6]  A. Hassanein,et al.  Orbitocranial Fibrous Dysplasia: Outcome of Radical Resection and Immediate Reconstruction With Titanium Mesh and Pericranial Flap , 2016, The Journal of craniofacial surgery.

[7]  P. Herman,et al.  Ossifying fibromas of the paranasal sinuses: diagnosis and management , 2015, Acta otorhinolaryngologica Italica : organo ufficiale della Societa italiana di otorinolaringologia e chirurgia cervico-facciale.

[8]  S. El-Mofty.  Fibro-Osseous Lesions of the Craniofacial Skeleton: An Update , 2014, Head and Neck Pathology.

[9]  E. Hocaoğlu,et al.  Computed Tomography Imaging Findings of Craniofacial Fibrous Dysplasia , 2014, The Journal of craniofacial surgery.

[10]  Fang Xie,et al.  Surgical Treatment of Craniomaxillofacial Fibrous Dysplasia: Functionally or Aesthetically? , 2013, The Journal of craniofacial surgery.

[11]  L. Tong,et al.  Paranasal Sinus and Skull Base Fibro-Osseous Lesions: When Is Biopsy Indicated for Diagnosis? , 2012 .

[12]  Y. Liu,et al.  Ossifying fibromas of the jaw bone: 20 cases. , 2010, Dento maxillo facial radiology.

[13]  A. Godt,et al.  Dislocation of an upper third molar by an ossifying fibroma--case report. , 2008, Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery.

[14]  L. Su,et al.  Benign Fibro-Osseous Lesions of the Craniofacial Complex A Review , 2008, Head and neck pathology.

[15]  Janice S. Lee,et al.  LONG‐TERM OUTCOME OF OPTIC NERVE ENCASEMENT AND OPTIC NERVE DECOMPRESSION IN PATIENTS WITH FIBROUS DYSPLASIA: RISK FACTORS FOR BLINDNESS AND SAFETY OF OBSERVATION , 2006, Neurosurgery.

[16]  F. Glorieux,et al.  Effect of pamidronate treatment in children with polyostotic fibrous dysplasia of bone. , 2003, The Journal of clinical endocrinology and metabolism.

[17]  Edmond FitzGibbon,et al.  Normal vision despite narrowing of the optic canal in fibrous dysplasia. , 2002, The New England journal of medicine.

[18]  M. Zenn,et al.  Treatment of Fibrous Dysplasia of the Mandible with Radical Excision and Immediate Reconstruction: Case Report , 2001, The Journal of craniofacial surgery.

[19]  P. Delmas,et al.  Long-term effects of intravenous pamidronate in fibrous dysplasia of bone , 1994, The Lancet.

[20]  C. Waldron,et al.  Benign fibro-osseous lesions of the jaws: a clinical-radiologic-histologic review of sixty-five cases. II. Benign fibro-osseous lesions of periodontal ligament origin. , 1973, Oral surgery, oral medicine, and oral pathology.

[21]  E. Strong,et al.  Fibrous dysplasia of the craniofacial bones. , 1968, American journal of surgery.