Functional Outcomes and Recurrence Determinants in Craniofacial Fibrous Dysplasia: Insights from 3D Computed Tomography and Comprehensive Clinical Evaluation

Background This study aimed to identify risk factors for postoperative lesion regrowth and to assess functional outcomes in craniofacial fibrous dysplasia, using three-dimensional computed tomographic volumetric analysis. Methods A retrospective analysis was conducted on 47 patients with craniofacial fibrous dysplasia who were treated from July 2005 to December 2020. Patients were treated with either conservative shaving or radical excision followed by reconstruction. Demographic data, surgical details, lesion recurrence, and functional outcomes were assessed. Lesion volume changes and recurrence were evaluated clinically and through computed tomographic volumetric analysis. Results Among the patients, 16 underwent conservative treatment, while 31 received radical treatment. The radical group showed more significant improvements in functional outcomes, particularly in orbital dystopia and facial asymmetry. Postoperative lesion volume was notably lower in the radical group (41.94±38.13cm³) compared to the conservative group (78.3±47.3cm³, p=0.008). This reduction was maintained over an average follow-up of 3 years. Lesion growth rates were similar between the groups (8.17±5.85% in radical vs. 5.84±6.43% in conservative, p=0.268). Multivariate analysis indicated that patients aged ≤20 years and those with multifocal involvement had significantly higher risks of recurrence, with adjusted odds ratios of 11.269 (p=0.039) and 6.914 (p=0.046), respectively. Conclusions Our findings suggest that both conservative and radical treatments for craniofacial fibrous dysplasia provide benefits, with the radical approach notably enhancing functional outcomes. However, neither method definitively reduces lesion recurrence, highlighting the necessity for an individualized treatment strategy. This approach should balance functional enhancement with recurrence risks, tailored to each patient's specific clinical scenario.