Background
Juvenile psammomatoid ossifying fibroma (JPOF) is a benign yet locally aggressive fibro‑osseous lesion of the craniofacial skeleton. Complete excision with thoughtful reconstruction is essential to minimise recurrence and preserve aesthetics in the growing skull.
Case
A 14‑year‑old boy presented with persistent conductive hearing loss, tinnitus, and recurrent otitis media after rugby trauma. MRI obtained during the otological work‑up incidentally demonstrated a 21 × 25 × 29 mm expansile mass in the left frontal sinus extending into the ethmoid sinus. Endoscopic biopsy confirmed JPOF.
Multidisciplinary Planning
The case was reviewed at the National Sarcoma Multidisciplinary Meeting, which recommended radical excision via open craniofacial approach followed by immediate autologous reconstruction to achieve clear margins and restore frontal contour.
Surgical Technique
In conjunction with the neurosurgery service a immediate resection and reconstruction was planned. Through a bicoronal incision, a frontal craniotomy was performed. The tumour was excised en bloc, and the frontal and ethmoid sinuses were cranialised. Immediate reconstruction employed an autologous bone flap harvested from the contralateral medial orbital wall, achieving single‑stage restoration of the anterior cranial fossa and forehead contour.
Outcome
Post‑operative recovery was uneventful. The patient was discharged post op day 5. Three‑month MRI demonstrated no residual or recurrent disease, and the patient achieved an excellent aesthetic result without functional deficits. Annual imaging surveillance has been instituted.
Conclusion
This case underscores the importance of multidisciplinary planning in JPOF, enabling a one‑stage strategy that combines oncologic clearance with autologous craniofacial reconstruction. Early collaboration among ORL, neurosurgical, and plastic‑surgical teams optimises both disease control and aesthetic outcomes in adolescent patients.