Differential diagnosis of midline facial granulomas

The list of differential diagnoses in the case of midline facial granulomatous lesions is long. Intensive investigation into the true origin of disease must be done before definitive treatment can be begun. Extensive and repeated biopsies are necessary. The diagnosis may narrow down to the nonspecific midline lethal granuloma. Evidence in the literature coupled with our experience strongly indicates that this disease does not exist as a pathologic entity but merely as a clinical syndrome which upon further evaluation will reveal either Wegener's granulomatosis or a reticulum cell neoplasm. Treatment of the syndrome consists of corticosteroid drugs, irradiation, and chemotherapy until a definitive diagnosis is made. Midline granulomas have been and will continue to be a challenging diagnostic and therapeutic problem for the otolaryngologist.