The outdated phrase ‘‘lethal midline granuloma’’ has been a source of confusion ever since it was first introduced in the literature. Most clinicians use it in a generic sense to describe any patient who presents with progressive ulceration and destruction primarily of the midfacial tissues (Fig. 1). It must be emphasized, however, that it is a clinical term, much like leukoplakia, and that it cannot be equated, either clinically or pathologically, with any specific entity. The phrase is further misleading in that the diseases that cause lethal midline granuloma are not always lethal, they are not always midline, and they are not always granulomatous (Table 1). The more descriptive phrase ‘‘midfacial destructive disease’’ is, therefore, preferred.