Background: The frontal bone which makes up the forehead develops from bony outgrowths of the frontal eminence region. As a result it occurs in some people that the frontal eminences may remain somewhat prominent when the forehead is fully developed. Because there is a frontal eminence on each side of the forehead any residual prominence is frequently paired (bilateral appearance) and is given the name ‘forehead horns’.
While prominent frontal eminences are benign and cause no functional issues, they can be an aesthetic issue. Because the forehead is so exposed and is usually a smooth surface, bumps that exist in the upper forehead can be a source of aesthetic dissatisfaction. In some forehead horn patients they are very evident while in other patients they are only seen in certain lighting and angles.
Whether they are big or small forehead horns can be successfully reduced. They are raised low level rounded areas of bone that can be burred down. The thickness of the forehead bone will usually allow successful reduction. (down close to or into the thin diploic space) The key issues in doing so is the location and length of the incision and the necessary hair management around it.
Case Study: This male had prominent forehead horns with the right side larger than the left Like all such horns they are best appreciated in angular views of the forehead rather than a straight on appearance. He had a low frontal hairline that came down to the upper edge of the horns so an incision behind the hairline was chosen for access.
Under general anesthesia his long hair was parted along the paired small scalp incisions (3 cms) and protected with wet lap pads stapled into place. It is very important with a high speed rotary handpick that all hair is protected from getting caught into its rotating burr and shaft.
The forehead prominences were burred down and smoothed using a variety of carbide burrs. On the right side the diploic space was encountered but not on the left side. Complete reduction was obtained.
Case Highlights:
1) Forehead horns are benign paired overgrowths of the frontal eminences of the forehead.
2) Forehead horn reduction can be done through a hairline or retro hairline approach using a burring technique.
3) The small incision tunnel technique allows just working room to perform an adequate bone reduction.
Dr. Barry Eppley
Indianapolis, Indiana