Idiopathic Midface Lesions

The term lethal midline granuloma has been used to describe a number of lesions which may present in the midface. A list of possible causes is presented and three entities, midline malignant reticulosis, Wegener's granulomatosis, and malignant lymphoma, are discussed in detail. The pathological descriptions, the clinical features, and the recommended forms of therapy are outlined. It is important to vigorously pursue the patient with a midline facial lesion until a definite tissue diagnosis is obtained. Multiple biopsies may be necessary because necrosis and nonspecific inflammatory changes may be present in various of these disease entities. The correct diagnosis is essential because the treatment of these diseases is different: Wegener's granulomatosis responds best to chemotherapy, whereas midline malignant reticulosis and lymphoma should be treated with radiation therapy if they are localized. Despite conceptual variations, most recent authors believe that these three diseases exist as separate entities, and furthermore, recommend that the term lethal midline granuloma be either dropped from the lexicon or relegated to a descriptive clinical term to be used only until a more definitive diagnosis can be made.