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Black bone disease of the skull incidentally discovered during endoscopic brow lifting

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Black bone disease presents as abnormal osseous hyperpigmentation following tetracycline antibiotic use. Several case studies have reported this incidental finding in the setting of orthopedic, cranial, and oromaxillofacial surgery. Herein, we describe a case of black bone disease discovered intraoperatively in a 63-year-old female with a 3-year history of tetracycline use during adolescence for acne treatment. During routine endoscopic brow-lifting surgery, patchy dark frontal bone discoloration was observed through all four incision sites. The integrity of the bone appeared normal, and the operative procedure, including bone tunnel fixation, was completed without complication. Postoperative course was uneventful. We review previous reports of this finding, the proposed mechanisms by which tetracycline antibiotics induce bone discoloration, and discuss its surgical implications. This case is the first to our knowledge to describe the finding of black bone disease in the setting of facial plastic surgery.

Level of evidence: Level V, risk / prognostic study.

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All authors contributed to the following case report. All authors read and approved the final manuscript.

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Correspondence to Natalie A. Homer.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. For this case report, formal consent from a local ethics committee is not required.

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Informed consent was obtained from the patient included in the study.

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Patient signed informed consent regarding publishing her data and photographs. The participant has consented to the submission of the case report to the journal.

Conflict of interest

Nakra Tanuj is a shareholder of Global Beauty Science, Inc. Vaswani, Zameer G; Homer, Natalie A; and Epstein Aliza declare no competing interests.

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Vaswani, Z.G., Homer, N.A., Epstein, A. et al. Black bone disease of the skull incidentally discovered during endoscopic brow lifting. Eur J Plast Surg 45, 183–186 (2022).

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