[Subaponeurotic lipoma of the forehead]

On the forehead, the epicranial fascia or aponeurosis (galea) splits to enclose the musculus frontalis. The superficial fascia, thin and transparent, separates the muscle from the fatty layer (panniculus) of the overlying skin. The deep fascia, thick and fibrous, is separated from the periosteum by a loose areolar tissue which allows the whole skin to move over the skeleton. The two bellies of the m. frontalis are anchored jointly on the midline, where their superficial and deep fasciae are tightly joined together. The loose areolar tissue beneath the galea is a cleavage plane facilitating plastic surgery of the scalp. On the scalp and forehead of adult male patients, benign, well differentiated and encapsulated lipomas may develop in this deep plane. This localization seems to be particularly frequent but has seldom been described. According to the available literature, 1.9 to 14.5 per cent of cutaneous lipomas are situated on the head and neck. In a retrospective review of 246 skin lipomas from our own files, we found 20 lipomas of the forehead (8 per cent), and among these 12 were located beneath the galea, between the frontal muscle and the periosteum. While the M/F sex ratio is approximately 2:1 for the cervico-cephalic lipomas, subfascial lipomas of the forehead prevail in adults and old men (90 per cent). Clinically, the "subfacial forehead lipoma" presents as a round or oval, smooth, flat or dome-shaped tumour. The skin is raised above the lesion, glides over its surface, and the parallel pattern of its wrinkles remains unaltered. The lesions are usually symptom-free and are ascribed by some patients to a minor, woundless trauma.(ABSTRACT TRUNCATED AT 250 WORDS)