Evaluation and Excision of Firm, Immobile Forehead Masses

Abstract

Introduction: The differential diagnosis of a firm, immobile lesion of the forehead includes more than just osteoma. Preoperative computed tomography (CT) imaging may alter surgical precautions and reduce the complications to allow for a minimally invasive approach. Materials and Methods: This is a retrospective case series of a single, private facial plastic surgeon in New York, New York, of patients evaluated for a firm, immobile forehead mass. The impact of CT scan on diagnosis and treatment was analyzed. Intraoperative and postoperative complications, recurrences, and patient satisfaction were recorded. Results: Nineteen patients (age range = 19–66 years; mean age = 36 years) presented with one or more firm, immobile forehead masses measuring <4 cm. Before 2011, preoperative CT evaluation was not routinely performed; during this period, 5 patients underwent excision of presumed osteomas with no complications. In 2011, patient 6 was found to have an intradiploic hemangioma on outside CT scan. From 2011 to 2014, preoperative CT was recommended (n = 13) to confirm osteoma. Ultimately, our series (n = 19) revealed 17 osteomas (16 patients), 1 intradiploic hemangioma, 1 pneumosinus dilitans, and 1 compact lipoma. Follow-up (mean = 3 months) did not reveal any complications. All patients reported high satisfaction with the aesthetic outcome, and there was no recurrence or need for revision surgery. Conclusions: The differential diagnosis of a firm, immobile forehead mass includes various pathologies of the scalp and calvarium. Though these masses are most commonly osteomas, other pathologies may present similarly. Preoperative CT scans without contrast can distinguish these unexpected etiologies. With proper evaluation and diagnosis, minimally invasive excision may be performed with excellent results.