Surgical Outcomes and Management Strategies for Ossifying Fibroma and Fibrous Osseous Dysplasia of the Craniofacial Skeleton

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Fibrous osseous dysplasia (FOD) and ossifying fibroma (OF) are craniofacial fibroosseous lesions with overlapping features but distinct biology and surgical needs, particularly when orbital involvement impairs function. This study described long-term outcomes after resection and reconstruction for ossifying fibroma compared with fibrous osseous dysplasia patients. Patients undergoing orbital fibrous osseous dysplasia or ossifying fibroma surgery between 2008 and 2019 were reviewed, excluding those lacking ≥3 years of follow-up. Demographic, symptom-to-surgery-related data and outcome data were compared. Patients were divided into 2 groups (fibrous osseous dysplasia and ossifying fibroma), and statistical comparisons were performed using the Mann-Whitney test. Twenty-seven patients were included (21 for fibrous osseous dysplasia and 6 for ossifying fibroma). Ossifying fibroma required radical excision with bony reconstruction (coronal/Weber-Ferguson approaches, pericranial flaps, parietal/rib grafts), while fibrous osseous dysplasia was treated with debulking or resection based on symptoms; orbital box osteotomy was performed in 4 patients. The mean age at the time of the first surgical intervention was 16.7±11.9 years for patients with ossifying fibroma and 14.8±6.9 years for those with fibrous osseous dysplasia. Average timing for new operation in months was 16.3±12.8 months for ossifying fibroma and 50.4±53.3 months for fibrous osseous dysplasia (P=0.08). Among 6 patients with amblyopia-related visual loss, 3 improved. Optic nerve decompression in 2 FOD patients did not halt visual deterioration, leading to blindness. Our data indicate that ossifying fibroma is more likely to necessitate a secondary surgical intervention at an earlier stage compared with fibrous dysplasia.