Introduction: Fibrous dysplasia (FD) is a non-neoplastic developmental fibro-osseous disease. It represents 2.5% of all bone tumors and 5–7% of the benign bone tumors. Orbitocranial region is involved in about 20% of the cases. The main presentations are craniofacial deformity and headache. Loss of vision is the most devastating result of this disease. There is no medical treatment to cure or prevent fibrous dysplasia. Radiation therapy is contraindicated. Surgery for the orbitocranial FD is often challenging because of the proximity of neurovascular and ocular structures. Conservative surgical shaving and re-contouring is always associated with suboptimal results. Radical excision is potentially curative with no extra morbidity. Orbital hypertelorism, dystopia, or proptosis can only be corrected by radical excision and reconstruction.

Aim of the study: to evaluate the outcome of radical excision of the orbitocranial FD and immediate reconstruction using titanium mesh and pericranial flap.

Patients and Methods: this prospective study had been conducted on 22 cases with orbitocranial fibrous dysplasia with age range from 17 to 52 years (mean 29.5). Radical excision of the lesions was done for all cases through transcranial approach. Immediate reconstruction was achieved using titanium mesh and pericranial flap.

Results: intraoperative dural tears and cerebrospinal fluid (CSF) leak were reported in two cases and repaired with galeal graft. Supraorbital anesthesia occurred in six cases. Of these; two cases were transient, while the remaining four cases were permanent. Wound infection was noticed in one patient that improved by medical treatment. Temporary postoperative diplopia occurred in one patient and temporary postoperative impaired vision in another one. In all patients, acceptable or good aesthetic results were observed. No recurrence was detected in our series during the follow up period that ranged from 24 to 58 months (mean 37.5 months).

Conclusion: Radical excision of orbitocranial FD is potentially curative with no extra morbidity. It can achieve good esthetic and functional results with no recurrence.

Key Words: Fibrous dysplasia, orbitocranial, pericranial flap, radical excision, reconstruction, titanium mesh