Forehead Osteomas and Their Treatment
Forehead osteomas are a relatively common and benign condition where a knob of normal bone forms under the skin. They can occur at birth, develop over many years or develop quickly. There is not distinct cause although I have seen it be hereditary.
The bony knob can be single or multiple and can occur just about anywhere on the skull or face. Forehead osteomas frequently occur between the hairline and the eyebrows.
These non-mobile lumps of bone are generally benign and cause not specific problems other than cosmetic concern. It is interesting that some patients live with this condition for years because they don’t realize that the treatment is generally a simple office procedure.
Most benign osteomas involve only the outer portion of the skull and are not at risk for perforation deeper into the skull or brain. I always perform a CT scan to make sure that there is no unusual plunging or deep extension of the lesion.
Figure 1 shows a typical forehead osteoma and the lower image shows a CT scan of the osteoma.
The treatment can frequently be performed with endoscopic technique through a button hole incision. It can be performed with local anesthesia, but due to the instrumentation required to remove the lump and smooth the bone, IV sedation is preferable. Forehead osteomas can also be treated with an open technique where the incision is hidden in the hairline.
Depending upon the size and location, the bony lump is reduced by using surgical instruments to trim it flat or grind it flat and smooth. The procedure generally takes about 30 minutes and the recovery is minor.
Figure 2 shows a case of open treatment through a hairline incision. The top picture shows the osteoma exposed, the middle image shows the osteoma being separated at its base and the bottom picture shows the lesion removed with a smooth base on the forehead bone.
Figure 3 shows the removed osteoma which is about the size of a small peach seed.
Figure 4 shows the same patient before and after osteoma removal from the forehead.
Figure 5 shows another case of before (top) and after (bottom) of a small osteoma removal performed with an endoscope.
To find out more about cosmetic facial surgery by Dr. Joe Niamtu, III in Richmond, Virginia, visit www.lovethatface.com
Joe Niamtu, III DMD
Cosmetic Facial Surgery