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Fibrous dysplasia (FD) is a non-neoplastic developmental disease of bone characterized by replacement of normal bone by immature bone and osteoid in a cellular fibrous matrix. FD affecting the cranial base is often challenging to treat because of the proximity to neurovascular and ocular structures.This is a retrospective study comprising 32 patients diagnosed with FD involving the anterior cranial base during a 9-year period. From these cases, 26 patients were surgically treated at the Department of Otorhinolaryngology, Alexandria University. The remaining 6 patients refused surgical treatment and were followed up. The follow-up period ranged from 1.5 to 9 years (mean, 4.6±2.1 y).The most common symptoms were headache (75%), nasal obstruction (65.6%), and proptosis (59.4%). The most frequently involved bone was the ethmoid (93.8%), followed by the sphenoid (68.8%). Out of the 32 patients, 6 patients refused surgical treatment and were followed up. Among the 26 patients who underwent surgery, 15 underwent radical excision, and in the remaining 11 cases the resection was considered subtotal. None of the patients who had radical resection developed any regrowth of their lesions. Three of the 11 patients who had subtotal resection demonstrated radiologic evidence of regrowth.In most cases of FD involving the anterior cranial base, accurate preoperative radiologic planning and modern surgical techniques with immediate reconstruction allow an aggressive but definitive treatment with good functional and aesthetic results.