Optimizing Surgical Management of Craniofacial and Orbital Fibrous Dysplasia: A Multi‐Center Retrospective Study

BACKGROUND: Fibrous dysplasia (FD) is a rare osseous disorder with limited understanding. This study aimed to evaluate the clinical characteristics of craniofacial FD (CFD) and orbital FD (OFD), explore vision impairment mechanisms, and identify recurrence risk factors. METHODS: A retrospective analysis was conducted on 54 CFD patients across three centers, including 30 patients with orbit involved. RESULTS: OFD patients exhibited higher prevalences of polyostotic FD and McCune-Albright syndrome, and more often underwent debulking rather than radical surgery. Vision impairment was primarily attributed to compressive and stretched optic neuropathy. Polyostotic involvement (p = 0.034) was a risk factor of subjective recurrence. Surgery age < 16 years (p = 0.046) and abnormal body mass index (p = 0.002) were associated with greater postoperative lesion regrowth volume. CONCLUSIONS: OFD patients exhibit distinct clinical features. Optic canal decompression is not required for all OFD-related vision loss patients. Recurrence risk should be thoroughly assessed before surgery.