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

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.