Osteomas are well known benign bony growths that are most commonly seen in the forehead. (at least by plastic surgeons) These forehead osteomas are peripheral in origin and arise from the periostea lining of the bone. They are said to result from trauma although many forehead osteomas that I have seen have no such history. They typically appear as a single solid round immobile mass. They almost always pose an aesthetic issue with no other symptoms. If large enough or near the supraorbital nerve of the brow bone it can cause some pain.
In the February 2023 issue of the Archives of Craniofacial Surgery an article on this topic was published entitled ‘Frontal Peripheral Osteomas: A Retrospective Study’. Over an eight year period the authors reviewed thirty-nine (39) patients with forty-one (41) osteomas of the forehead, most of which were women. (82%) Most were sessile osteomas (70%) while the rest were pedunculated. (30%) Osteomas sizes ranged from 4mm to 30mms with an average size of 10mms. Most of the patients (74%) underwent a burring ostectomy by a direct approach. None of the treated patients experienced recurrence.
While all the forehead osteomas treated in this study were done by burring through a direct approach, that is not always aesthetically possible the lower on the forehead they appear. If they can be accessed from a frontal hairline incision then a burring reduction is possible. With a pedunculated osteoma the osteotome (chisel) technique works well and permits removal anywhere on the forehead with a remote incision endoscopic approach. But sessile osteomas are more difficult to remove with the osteotome technique as they have no edge to get under. In these cases when they are close to the hairline I use a reciprocating saw technique.
Of equal interest is that in this study they had no recurrences. I have never yet seen an osteoma regrowth either, regardless of the technique used for its removal.
Dr. Barry Eppley
World-Renowned Plastic Surgeon