Your Questions
Your Questions
Q: Dr. Eppley, I came across an article of yours discussing osteoma on the skull. I could not understand what was advised in the event the osteoma was located on the forehead (male)? Is it that there is no treatment because of the fact that a scar would be left? Thank you.
A: When osteomas are on the visible forehead, which quite frankly is the most common osteoma location that I see, their removal must consider a variety of approaches because of potential scar considerations. The most direct way to remove a forehead osteoma is through an overlying incision. In the male with pre-existing horizontal forehead wrinkles this may not be a significant scar issue. But when it is, more distant access off of the forehead must be done or considered. This would mean using an endoscopic technique to do it. The success or adviseability of endoscopic forehead osteoma removal is based on the size and location of this benign bony tumor. If it is small and has a well-defined bony base, then an endoscopic approach using an osteotome can work quite well. If it is larger and has a broad and ill-defined edge at its base, this can be more problematic for an effective removal with a smooth contour to the surrounding frontal bone. Burring with an instrument can not be done through endoscopic access as of yet which is what is ideally needed in this broader-based lesions.
Dr. Barry Eppley
Indianapolis, Indiana
Q: I have a bump in the middle of my forehead the size of a nickel and seems to be slightly growing. . . saw a plastic surgeon yesterday and we are going to watch it. He mentioned a hematoma. . . I haven’t had any head injuries. Is hematoma common with this type of immovable hard lump?
A: I do not have the advantage of actually looking at your forehead lump. So anything I would say is speculative and without the advantage of the plastic surgeon who has seen it.
However, without a specific history of any head trauma, the most likely diagnosis is an osteoma, a benign bony growth down at the bone surface. Sometimes they appear as a result of forehead trauma but many times they do not. They can develop from any bleeding that occurs underneath the periosteum which is a great stimulus for bone growth. They almost always are associated with a perforating blood vessel where it exits the bone. They are hard and very slow growing. They are like a small circular disk or small mountain sitting right on top of the forehead bone. They can be removed through an endoscopic technique if they get big enough to cause a noticeable forehead bump. This is done through small scalp incisions where they are chiseled off of the bone under direct vision of the endoscopic camera. If there is a prominent foreheasd wrinkle nearby, they can also be removed through an incision in the wrinkle.
Indianapolis Indiana
