23 Fibrous dysplasia is a developmental condition in which fibroosseous tissue replaces normal marrow within a portion of one (monostotic – 70 to 80%) or more bones (polyostotic). Polyostotic fibrous dysplasia (20 to 30%) involves multiple bones, and may have extensive skeletal involvement. Any bone may be involved, but the hip, proximal femur, tibia, cranial, and facial bones are most common. Although reported incidences vary, craniofacial and jaw involvement occurs in up to 50% of patients with polyostotic disease and in up to 25% of patients with monostotic disease. Given the varied appearances of fibrous dysplasia, the differential diagnosis is extensive and includes ossifying fibroma, Paget’s disease of bone, aneurysmal bone cyst, giant cell tumor, brown tumor of hyperparathyroidism, Langerhans cell histiocytosis, osteomyelitis, metastases, primary bone neoplasms, and unicameral bone cyst (Table 23.1). Metastatic neoplasms are discussed in Chapter 24 and in Chapters 141
Focal Calvarial Lesions
Fibrous Dysplasia
Metastases
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