Combining cryopreserved autografts and vascularized bone flap for craniofacial defect reconstruction in fibrous dysplasia: a case report

Introduction and Importance: Polyostotic fibrous dysplasia (PFD) is a rare, benign skeletal disorder characterized by the replacement of normal bone with fibro-osseous tissue. Craniofacial involvement often results in progressive deformities, functional impairments, and aesthetic concerns. Surgical intervention aims to remove diseased bone and restore structure and function, employing techniques like vascularized bone flaps, autografts, and cryopreserved bone. This report presents a case utilizing cryopreservation combined with vascularized fibula flap for craniofacial reconstruction. Case Presentation: A 28-year-old male presented with a 10-year history of painless swelling in the right hemifacial region. Imaging revealed a ground-glass opacity encompassing the maxillary sinus, zygomaticomaxillary complex, and orbital floor. Histopathological analysis confirmed polyostotic fibrous dysplasia. Surgical resection of the affected bone was followed by reconstruction using cryopreserved autografts processed with liquid nitrogen and a vascularized fibula flap. This approach ensured elimination of tumorous cells while preserving structural integrity and restoring vascular supply. Postoperative recovery was uneventful, and follow-up over 1 year demonstrated excellent bone viability, functional restoration, and cosmetic improvement. Clinical Discussion: Cryopreservation and vascularized bone flaps offer promising reconstructive modalities for extensive craniofacial defects. Combining these techniques ensures structural preservation, reduced donor-site morbidity, and restoration of functionality. Innovative multidisciplinary approaches continue to enhance surgical outcomes in PFD management. Conclusion: Combining cryopreserved autografts with vascularized fibula flap reconstruction offers a promising strategy for craniofacial defects in fibrous dysplasia, ensuring structural integrity, functional restoration, and favorable cosmetic outcomes.