Surgical management of two complex cases of large juvenile orbital ossifying fibroma

SummaryOssifying fibroma is a rare benign tumour of the craniofacial skeleton, which can have an aggressive biological behaviour in the paediatric population. Complete surgical excision, where possible, is the ideal. This case report discusses the multidisciplinary, surgical management of two complex cases of large juvenile ossifying fibroma (JOF), involving the orbit. Both patients underwent resection of the orbital ossifying fibroma with no macroscopic evidence of recurrence at 4 years follow-up. Full functional outcome was achieved with preservation of vision and facial nerve function as well as good facial symmetry and aesthetics.The successful surgical outcome of these cases was due to a combination of a multidisciplinary team approach, rigorous pre-operative planning, maximal tumour resection, and the use of a novel surgical technique involving a medial zygomatic-orbito-maxillary rotational osteotomy.

► Ossifying fibroma (OF) is a rare benign tumour of the craniofacial skeleton, which can be aggressive in the paediatric population.
► Two patients with orbital OF presented with significant displacement of their zygomatico-orbito-maxillary complex.
► Maximal safe macroscopic resection was achieved with image guided endoscopic transnasal and transfacial surgery.
► Accurate osteotomies were placed in the zygomatic-orbito-maxillary segment and the complex was rotated medially and secured.
► Optimum tumour resection and accurate positioning of bony osteotomies afforded improved aesthetic and functional outcome.