Rare location of facial osteoma

Osteomas are slow growing benign bone tumors that frequently occur in the craniofacial area. So far eight cases have been reported in English literature to be located along the zygomatic arch. A case of a rapid growth hard swelling bone mass of a Caucasian 69-year-old male is reported. The developing facial asymmetry was the main concern of the patient that had no other symptoms. Computed tomography imaging showed a bone density growing mass located on the lateral side of the right zygomatic arch, about at the temporozygomatic suture, in close relation with the facial nerve temporo-zygomatic branch. Under general anesthesia, via a hemi-coronal approach, the bone mass was removed and the resulting defect was closed with a homologous parietal bone graft. Immediately after the intervention no facial asymmetry was evident, with a House-Brackmann facial nerve grading system scale value of 1. Three months after the intervention no recurrence was evident. Facial osteomas of the zygomatic arch are rare but due to their location, like the case reported here, they can be a challenge for the surgeon for both aesthetic and functional outcomes, and a major concern for the patient. Despite their simple diagnosis, no recurrence is evident, major efforts have to be made while planning a safe surgical excision.