Hard knots on the forehead can often be attributed to benign bony growths called osteomas. Osteomas are uncommon, but these benign tumors in the bone of the skull can have a unpleasing appearance, and ;ead tp pain, sight issues. Typically, they are rather slow growing in nature. Other bone tumors are possible and include osteoid osteomas, which can sometimes be distinguished radiologicaly.
The classic approach to the removal of forehead osteomas in an incision along the face. Dr. Shah preference is to recontour the bone of the forehead with the use an endoscope. By making the incision in the scalp, no scar is visible on the face. The instruments Dr. Shah uses to reshape the forehead create an improved appearance and actually feel smoother.
Endoscopic forehead osteoma removal is done on an outpatient basis. Due to Dr. Shah's technique of selectively blocking nerves with local anesthesia, most patients only need minimal anesthetic, allowing for a relatively pain free experience. Many patients are able to return to work either the next day or in a few days.
Osteoma before removal by Dr. Shah(left)and after removal (right)
Forehead lumps can be caused by a variety of issues including osteomas, lipomas, and unevenness of the skull caused by facial fracture. Dr. Shah has pioneered a technique to remove the lesions by concealing a scar in the scalp and using endoscopic visualization and specialized instruments to remove the lesions.
Traditionally speaking, the removal of osteomas utilizes a coronal scar. There are two main issues with a coronal scar. First of all, the scar can be seen rather easily in some patients and with some hairstyles, particularly shorter hair. In addition, there is a nerve from the patient called the supraorbital nerve which will be cut when performing a coronal incision. This nerve provides sensation to the scalp which can be disconcerting to the patient as they cannot feel their hair when brushing it or combing it.
The other approach to removing osteomas has involved direct incision of the lesion over the skin. This can create a visible scar in the forehead and can result in a tradeoff of removal of the osteoma with a visible scar.
By hiding the incision within the scalp (see diagram), the patient can have an incision which is difficult to see. While it is technically more difficult to remove the osteoma from this approach, it does allow for a more pleasing aesthetic outcome.
Forehead bump (Osteoma) FAQ's
Do I need general anesthesia for removal of a forehead bump?
Most patients do extraordinarily well in an office setting with small amounts of local. The benefit of this technique is that patients have decreased downtime and less risk from an anesthetic standpoint. Dr. Shah is able to do this due to the large amount of forehead bumps he has removed making his approach both efficient and effective.
Is it painful to have an osteoma removed?
Most patients can return to work in 1 day. Rarely do patient require pain medications.
How intense is my post procedure care and recovery process?
Swelling is typically limited but can include the lower eye area and bruising can occur. Ice is recommended for the first 72 hours. Many patients fly in and out the same day as the procedure and many return to work within 24 hours.
How can Dr. Shah's approach be so much quicker and have a fast recuperation period?
Dr. Shah limits the amount of dissection around the bump which can help reduce swelling. In addition, patients with local anesthesia often have less vasodilation and subsequent swellin
Can the forehead osteoma return?
It is unlikely for the osteoma to return with the approach utilized.
Do I need a CT scan prior to the procedure?
For bony lesions of the skull, Dr. Shah requires imaging prior to the procedure. Our office can help to arrange.
Does Dr. Shah treat forehead lipomas?
Yes, he utilizes a similar approach for forehead lipomas. With this approach he will go from underneath the galea and muscle and remove the lipoma directly. This avoids a scar.
Can I have general anesthesia or a deeper type of anesthesia?
The office has several options available. Most patients prefer local anesthesia however, other options are available if desired for patients.