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Background: The forehead is the largest facial surface area that is relatively smooth. Besides the brow bone prominences in a male, no bumps or protrusions should be present in the rest of the forehead of either male or female. When one develops a forehead prominence later in life, even if it is small, it becomes readily apparent.

Most forehead bumps that appear later in life are most commonly bone-based (osteoma) or soft-tissue based. (lipoma) They appear as circular projections that theoretically can be differentiated by whether they are fixed or mobile. An osteoma would obviously be a fixed bumping which the skin slides back and forth over it. Conversely a lipoma, which in in the overlying soft tissues, should be mobile as the skin is moved back and forth. Because of these clinical differences a preoperative x-ray is not commonly done.

While removal of either an osteotomy or lipoma of the forehead can be done by direct excision, the resultant visible scar may not be acceptable to many patients. This is only a good aesthetic approach if prominent horizontal wrinkle lines already exist. If the mass is high on the forehead and nose to the frontal hairline, a hairline incision above it may be used. Otherwise an endoscopic approach can be done as a scarless forehead excision technique.

Case Study: This female developed a right mid-forehead bump with no obvious reason. (e.g., prior trauma) It was small (1 x 1 cm) but fixed at its location. It was assumed that it was an osteoma.

Under anesthesia a small hairline incision was made directly above the bump for one incision endoscopic technique. In looking down over the bone no osteoma was seen. But an overlying yellow bulge was seen above the raised periosteum.

The now apparent lipoma was dissected out  and removed.

Closure of the small hairline incisions will result in an eventual undetectable scar.

Case Highlights:

1)  A fixed forehead mass typically has the pathology of an osteoma.

2) Lipomas, however, can also present as a seemingly fixed forehead mass also.

3) An endoscopic approach to a forehead osteoma or lipomas avoids a mid-forehead scar line.

Dr. Barry Eppley

Indianapolis, Indiana

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