title: Endoscopic forehead approach for minimally invasive benign tumor excisions.
abstract: OBJECTIVE
  Direct transcutaneous resection has been a widely accepted standard for the removal of benign forehead lesions. In recent years, the endoscopic approach has become more prevalent because of its noninvasiveness. To date, only a few studies with limited case numbers have reported on this technique. We report our findings from one of the largest cohorts of patients undergoing tumor resection of the forehead via the endoscopic approach.
  
  
  OBJECTIVE
  To evaluate results of the endoscopic forehead approach for benign tumor excisions, to give a more nuanced insight into this procedure, and to discuss technical pearls and potential pitfalls from our experience.
  
  
  METHODS
  Multicenter, retrospective case study at 2 university centers and 1 private practice among 36 patients aged 18 to 72 years (mean age, 44 years) who underwent the endoscopic forehead approach for benign tumor resections.
  
  
  METHODS
  Symptoms at presentation, surgical procedure and duration, type of lesions, intraoperative and postoperative complications, recurrences, and patient satisfaction.
  
  
  RESULTS
  In total, 34 patients had an asymptomatic forehead mass, while 2 patients reported discomfort and headache. Among all patients, complete tumor excision was achieved endoscopically. The mean operative time was 36 minutes. Histopathological examination revealed 18 lipomas, 13 osteomas, 2 dermoid cysts, and 1 bone fragment after previous rhinoplasty. In 2 patients, no specimen was submitted. No hematomas, infections, scalp numbness, contour irregularities, temporal branch paralysis, or tumor recurrences occurred. One patient had a prolonged area of alopecia, which resolved on its own. All patients attested to a high satisfaction rate.
  
  
  CONCLUSIONS
  The endoscopic approach offers excellent aesthetic results and allows for safe tumor removal. It has proven to be an effective and minimally invasive alternative to the conventional open approach.
  
  
  METHODS
  4.
authors.affiliation: Division of Facial Plastic and Reconstructive Surgery, Department of Otorhinolaryngology, University Hospital of Mannheim, Mannheim, Germany.
authors.forename: Haneen
authors.initials: H
authors.lastname: Sadick
authors.affiliation: Division of Facial Plastic and Reconstructive Surgery, Department of Otorhinolaryngology, University Hospital of Regensburg, Regensburg, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Huber
authors.affiliation: Meridian Plastic Surgery Center, Indianapolis, Indiana.
authors.forename: Stephen W
authors.initials: SW
authors.lastname: Perkins
authors.affiliation: Meridian Plastic Surgery Center, Indianapolis, Indiana.
authors.forename: Heather H
authors.initials: HH
authors.lastname: Waters
authors.affiliation: Division of Facial Plastic and Reconstructive Surgery, Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Grant S
authors.initials: GS
authors.lastname: Hamilton
authors.affiliation: Division of Facial Plastic and Reconstructive Surgery, Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Ashley G
authors.initials: AG
authors.lastname: O'Reilly
authors.affiliation: Division of Facial Plastic and Reconstructive Surgery, Department of Otorhinolaryngology, University Hospital of Regensburg, Regensburg, Germany.
authors.forename: Holger G
authors.initials: HG
authors.lastname: Gassner
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003884:Dermoid Cyst / Q000601:surgery*; D004724:Endoscopy / Q000379:methods*; D005153:Facial Neoplasms / Q000601:surgery*; D005260:Female; D005546:Forehead; D005624:Frontal Bone / Q000601:surgery*; D006801:Humans; D008067:Lipoma / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D010016:Osteoma / Q000601:surgery*; D017060:Patient Satisfaction; D011183:Postoperative Complications; D012189:Retrospective Studies; D012888:Skull Neoplasms / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult