IgG4-related midline destructive lesion

Midline destructive lesion (MDL), also known as ‘lethal midline granuloma’, represents a fibroinflammatory condition characterised by relentless erosion of the nose, paranasal sinuses and palate.1 ,2 Disease attribution remains elusive for many cases, which continue to be labelled ‘idiopathic’.2 Four patients, two males and two females, were referred because of progressive erosion of midline facial structures that had occurred over 2–3 years....