Your Questions
Your Questions
Q: Dr. Eppley, I have developed a small forehead osteoma and I want it removed. I am 38 years old but still wear my hair back, and show all of my face, wear light makeup, and do not want this on my forehead. I could get away with bangs but I really want to keep my face open and clear. I have no idea why I have developed this, I did hit my head as a child in this area, and may have hit it over the years, but it has just shown up in the last year front and center sad to say. I am looking for a ballpark price to have it removed, not an exact I understand, but a ball park quote.
A: I would need to see a picture of your forehead osteoma to determine its location and the best way to do its removal. The other issue to be addressed, particularly if it is sitting over the frontal sinus, is whether it involves the frontal sinus or just sitting on the outer table of the frontal sinus. Its location and frontal sinus involvement can make a very big difference in how it is treated. If you do not have a CT scan of it, then that needs to be done so the proper diagnosis can be done. Until alt his information is obtained the costs of surgery can not be precisely determined.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in a forehead osteoma removal. I have a bump inthe dead center of my forehead that I would like removed. It sticks out like aore thumb and is very visible and bothersome to me. I have attaches several pictures to show you where it is.
A: It is hard to say based on this picture whether your forehead bump is an osteoma or a natural frontal bone contour. That distinction is critically important as it affects the surgical technique to remove it. An osteoma is a bone growth that develops over time and looks very much like a flattened mushroom sitting on top of the bone. Because of its shape,it can be fairly easily removed by an osteotome (chisel) from a remote incision in the scalp. (endoscopic technique) In essence, it is just swiftly chiseled off of the bone. Conversely, a forehead bump that is just a natural part of the frontal bone has to be taken down by a handpiece and burr. This is much more technically challenging from an equipment standpoint when trying to that with an endoscopic scalp approach. (particularly given that it is way down in the center of his forehead.
The history of the bump goes a long way in defining what it may be. A natural frontal bone contour/bump will have been there since he was born or very young. An osteoma often appears later in life often after a traumatic event.
By feel, they also can have a different feel to them. Some osteomas almost feel like there is a ‘lip’ at the edge. While a natural born bump will feel smooth with no palpable edge or lip.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have developed an osteoma directly over the inside of my right brow bone. The osteoma developed approximately 15 years ago, and has steadily grown over time. Currently, it measures 0.9 cm x 2.5 cm transverse x 1.8 cm and extends into my right superior orbital rim. This is a benign osteoma. I was interested in Endoscoptic Osteoma removal. I was wondering if you thought it would be an option given the size and location of the Osteoma? If not what other procedure do you suggest. I hope you can help me. I truly appreciate your taking the time to look at the pictures. Thank you so much.
A: Thank you for your inquiry and sending your pictures. The first important question about your osteoma is its potential involvement with frontal sinus. Is it just located on the outer table of the frontal sinus or does it extend into and involve the frontal sinus air cavity?Since you provided such specific measurements you must have had a CT scan in which it was so measured. What does the CT scan show in this regard? Secondly, almost irregardless of whether it extends into the frontal sinus cavity or not, it removal will necessitate the anterior table of the frontal sinus to be removed and replaced (reconstructed) with normal bone. Simple burring it down will result in opening up the frontal sinus cavity, which would be impossible to fix through an endoscopic approach. If your osteoma was just about anywhere else it could be treated by a limited or endoscopic approach through burring or an osteotome…but not over the frontal sinus. This is going to necessitate an open scalp approach so it is removed under direct vision and the frontal sinus managed properly and a smooth brow bone contour is obtained. An open scalp approach means either a traditional scalp incision way behind the hairline or a pretrichial incision which is an irregular incision placed right at the frontal hairline. There are advantages and disadvantages to either incisional approach. I have done frontal sinus osteomas exactly identical to yours and they always involve the entire anterior table of the frontal sinus cavity wall and require some form of brow bone reconstruction.
Dr. Barry Eppley
Indianapolis, Indiana
Q : I have a bump at the front of my head. I would like for it to go down a bit. Please help me. Thanks.
A: Bumps on the forehead are not rare and are commonly seen by plastic surgeons. While the exact diagnosis can be varied, the usual suspects are either bone-based (osteoma) or of soft tissue origin. (lipoma) Feeling the bump can usually help one distinguish between the two. If in doubt, a CT scan can easily tell which one it is.
If the bump is hard and doesn’t move it most likely is a classic osteoma. These are benign bony growths that develop slowly. For many patients the exact origin is unknown. They can develop after being hit on the forehead, particularly if a bruise or hematoma resulted. It is thought that bleeding under the periosteum serves as a nidus to stimulate the laying down of bone.
Removal of forehead osteomas is traditionally done through an overlying horizontal skin incision. In an older patient, this can be skillfully placed in an adjacent wrinkle and the scarring can be quite minimal. In patients without a close wrinkle or few wrinkles, the scar is not as appealing. In most casesw of forehead osteoma removal, I prefer the use of an endoscope to recontour the bone of the forehead. By placing the incision in the hair, no visible scar is left on the face. Osteomas can usually be made to pop right off the bone by using a small chisel. Through two endoscopic incisions, the scope and the osteotome can be simultaneously used.
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Indianapolis, Indiana