Craniofacial fibrous dysplasia
Long standing craniofacial deformity and right proptosis.
MRI of the brain
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All the involved bones show different degrees of expansion, heterogeneous sclerosis and cortical interruptions. The following bones are involved:
- left hemi-mandible, from just beyond the symphysis to the condylar process
- right maxilla, involving the alveolar process, obliterating and expanding the whole maxillary antrum, and elevating the right orbital floor
- left middle and inferior turbinates
- Both sphenoid bones, more on the right, involving the pterygoid processes, greater and lesser wings
- squamous and petrous parts of the right temporal bones
- both frontal bones
Previous surgical resections with a deficient sphenoid roof, as well as plate reconstruction at the junction of roof and lateral walls of the right orbit. Wide right frontal craniotomy. Left frontal encephalomalacia. A meningoencephalocele is noted at the junction of roof and left lateral wall of the sphenoid sinus, harbouring gliotic gyri representing the site of an osteo-dural defect with underlying the CSF leak.
Craniofacial fibrous dysplasia is a benign developmental tumor-like bone lesion. It is one of four types of fibrous dysplasia and is characterised by involvement of the skull and facial bones.
It is a chronic, slowly progressive process that produces craniofacial deformities and complications that usually arise from compression upon skull foramina and their neurovascular contents, and other intracranial structures. Most common mainfestations are neurological symptoms such as hearing loss, visual loss, headache and proptosis.
The suggestive features are the facial deformity, bony expansion with heterogeneous appearance of hypo-intensity at T2WI that is due to the fibro-osseous ground glass matrix. It typically shows heterogeneous contrast enhancement.