During the past decade several authors1,6 have reviewed the scientific literature pertaining to midline lethal granuloma, and their efforts have culminated in a detailed description of the characteristic clinical picture and in an extensive evaluation of the available therapeutic modalities.
While the etiology of midline lethal granuloma continues to remain a mystery, there is an increased tendency to regard this dread malady as a collagen disease related to periarteritis nodosa.16,21 The location of the major clinical manifestation strongly supports such a hypothesis, for the structures near the median line of the face are supplied by a rich network of smaller blood vessels. A breakdown in the normal defense mechanism of these tissues results in the formation of a granuloma whereas involvement of larger blood vessels leads to extensive destruction and necrosis.
Recent experiments by Hans Selye17 focus additional light on the development of allergic phenomena. Without
LEDEN HV, SCHIFF M. Antimetabolite Therapy in Midline Lethal Granuloma. Arch Otolaryngol. 1964;80(4):460–468. doi:10.1001/archotol.1964.00750040472016