Decade-Long Stable Monostotic Fibrous Dysplasia of The Midface: A Case Report on Conservative Surgical Recontouring

Abstract

Introduction: Fibrous dysplasia is a benign fibro-osseous disorder that typically presents in childhood or adolescence with gradual, painless bony expansion. While craniofacial involvement is well documented, cases presenting with isolated, long-standing unilateral midface enlargement without progressive growth or systemic association are less commonly reported. This case highlights the diagnostic and surgical considerations in managing a decade-long stable monostotic lesion confined to the midface, and adds to the limited literature on conservative recontouring as a definitive esthetic solution in such stable presentations, with particular emphasis on the role of piezoelectric osteotomy in reducing postoperative morbidity relative to conventional rotary techniques.

Case Presentation: An 18-year-old female presented with left-sided facial asymmetry of 10 years’ duration, involving the midface region extending anteroposteriorly from the left alar base to the left lateral canthus, and superoinferiorly from the infraorbital rim to the left oral commissure. The swelling was asymptomatic and had shown no notable increase in size. A prior biopsy was reported as consistent with fibrous dysplasia.

Intervention, and Outcome: Comprehensive clinical, radiographic, and hematological evaluation confirmed monostotic fibrous dysplasia limited to the left midface, with no evidence of systemic or polyostotic involvement. The patient underwent surgical recontouring of the affected region under general anesthesia, performed primarily with a piezoelectric device rather than conventional rotary instrumentation, to achieve precise, selective bone reduction while preserving adjacent soft tissue and neurovascular structures. Postoperative recovery was uneventful, with satisfactory esthetic correction of facial symmetry, minimal intraoperative bleeding, and notably reduced postoperative morbidity compared with outcomes typically reported for conventional burr-based recontouring.

Conclusion: Stable, long-standing monostotic fibrous dysplasia of the midface can be effectively managed with conservative surgical recontouring alone, achieving favourable esthetic outcomes without need for more extensive resection, provided systemic involvement is thoroughly ruled out. The use of piezoelectric instrumentation for this recontouring offered a precision-driven alternative to conventional rotary osteotomy, associated with lower postoperative morbidity, supporting its preferential use in similar conservative craniofacial recontouring procedures.