Single-Port Endoscopic Approach for Benign Tumors in the Lower Half of Forehead: A Comprehensive Surgical Algorithm

Purpose: For forehead masses, the endoscopic approach offers superior aesthetic outcomes compared with direct excision. However, existing studies are limited, particularly for lesions located in the lower half of the forehead. This study describes a single-port endoscopic technique for such lesions and presents a comprehensive surgical algorithm. Patients and methods: The authors conducted a retrospective study of patients who underwent single-port endoscopic excision for benign forehead masses located in the lower half between September 2019 and November 2023. Lesions suspected of malignancy, those with high bleeding risk, or intraosseous involvement were excluded. Preoperative evaluation included visual inspection, ultrasound, and CT imaging. A Daniel endoscopic forehead nerve dissector or a Ramirez-type frontotemporal dissector was used as appropriate. Postoperative follow-up included wound care, recurrence monitoring, and patient satisfaction assessment. Results: Of 303 patients, 150 underwent endoscopic excision and 153 received direct excision. All endoscopic procedures were performed through a single port. One case of sarcoidosis recurred, and one seroma required aspiration. Aesthetic outcomes, particularly in terms of scar visibility, were superior in the endoscopic group. Conclusions: This study established a comprehensive algorithm for endoscopic forehead mass excision. Preoperative evaluation is essential for determining the suitability of endoscopic surgery, and the findings demonstrate that even lesions located in the lower half of the forehead can be effectively excised endoscopically using a single port.