Posts Tagged ‘skull reshaping’
Tuesday, May 7th, 2013
Q: Dr. Eppley, My daughter had craniosynostosis. After which she was left with plagiocephaly(right side). Was wondering what are the best options for her, she has 5mm deformity after wearing the helmet for 1 year. Now she is 9 years old. Need to know if the surgery can be done anytime or there is a certain period that is beneficial for the kids.
A: Once the skull has undergone much of its growth spurt and it is clear that ongoing growth is not improving the asymmetry, it is reasonable to consider an onlay skull augmentation. The decision to do so is based on an aesthetic judgment since there are no neurologic benefits to doing it. So the question is not whether it can be done but whether it should it be done. At 9 years of age, that is a decision for the parents to consider or to allow the child to decide for herself when she is old enough to do so.
Dr. Barry Eppley
Indianapolis,Indiana
Tags: dr barry eplpey, indianapolis, occipital plagiocephaly, skull reshaping
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Sunday, May 5th, 2013
Q: Dr. Eppley, Hi, I have a weird shaped head where the back of my head really sticks out so it looks long from a side view. Are there any implants that can be inserted to give it a more rounded normal shape or can the skull be reduced slightly at the back. Thanks.
A: Some reduction of an occipital skull prominence can be done which is usually about 7mms. The bone above the prominence can also be augmented to make the top part more round as it goes into the top of the skull and beyond. If done together this will create a better skull reshaping of the back of the head than either procedure done alone.
Dr. Barry Eppley
Indianapolis,Indiana
Tags: dr barry eppley, indianapolis, skull reshaping
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Friday, May 3rd, 2013
Q: Dr. Eppley, Thank you for your follow up on my questions about reshaping the top of my skull.. I realize that you are a surgeon in high demand and you taking the time to follow up is very impressive and kind. The cost is fair given the amount of work that needs to be done. The 10″ incision is my only concern. How large would the incision need to be if we simply build up the uneven side and leave the bump untouched. What would the cost be if we went this alternative route?
A: Understandably a long incision in your scalp is a concern, even to me given your young age and for the correction of only an aesthetic skull shape concern. But the same length of the incision is needed whether one merely reduces the high midline sagittal ridge or does a concomitant build along the side of it. The reason it needs to be of that length is that the hardest part of the skull reshaping procedure is getting the implanted material to have feather edges and blend into the surrounding skull smoothly and without a visible or palpable edge to it.
Dr. Barry Eppley
Indianapolis,Indiana
Tags: dr barry eppley, indianapolis, skull reshaping
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Wednesday, May 1st, 2013
Q: Dr. Eppley, Wow. Information about dents on a persons head is next to impossible to find on the internet. I have about dent on the very top of my head that is about 2 inches in diameter, so it is a fairly large dent. After an accident, some skin was literally ripped from the top of my skull. Eventually, the skin did grow back, but I have no hair there now as the hair follicles went with the skin when it was ripped from my skull. The main problem is though I have a dent in my head there too. At first I thought that all the tissue ( the matter under the skin ) didn’t grow back even though the skin did. Recently, a CT scan showed that part of my skull was thin, so now I don’t know if I have the dent because I need tissue or if it’s because of my skull. Is there any way to determine what the actual cause of this dent is, and if it’s the skull, would anything procedure done to the skull raise the tissue so that it is flush with the rest of my head?
A: While I don’t know the details of your original injury, it strikes me as unlikely that you would have pushed in your skull or removed the outer layer of cranial bone with an avulsion type injury. My suspicion is that this is more of soft tissue defect than bone. the scalp is incredibly thick in many patients particularly of your ethnicity. If you lost enough scalp to remove the hair what is healed is now a partial thickness of scalp which can certainly create an ‘indentation’. The definitive answer, however, would be the CT scan which should clearly show what the bone looks like underneath of the scalp…if the scan was done using coronal images and not just axial slices. I would need to see the the scan and pictures of your scalp defect to definitively determine the anatomic basis of your head indentation.
If it is just soft tissue you can have the defect excised and the hair-bearing scalp defect loosened and used to repair the defect. If there is a loss of bone component to it this can be simply filled in with hydroxyapatite cement (cranioplasty) and the hair-bearing scalp tissue closed over it.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: cranioplasty, dr barry eppley, head dent repair, indianapolis, skull reshaping
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Sunday, March 24th, 2013
Q: Dr. Eppley, I have read most of the material on your website relative to skull reduction. I have a disproportionately large head and face compared to my body. If you burr my head, how many months it will take before I can see a result? Because I assume in this kind of operations you get lots of swelling and you don’t see a result right away. So, the head will look bigger before starting to look smaller. Most importantly, I am an active person and work out every single day (aerobic, elliptical, walks). For this kind of surgery, how many weeks should I take off from the work out? And what is the worst that can happen if I work out 10 days post op, for instance? Thanks
A: While the scalp will swell after any skull reshaping procedure (the bone doesn’t), it usually takes about three weeks before the initial results start to become apparent. It will take up to three months to see the final result. There is harm in returning to working out whenever you feel comfortable, even if it just 10 days after surgery. You can not hurt
the surgical result.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, indianapolis, skull reshaping
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Friday, March 22nd, 2013
Q: Dr. Eppley, about a year ago I received a blow to the head from the rear causing a depressed skull fracture. The fractured skull segments were removed and replaced with a titanium material. But there is the emergence of the head of the screws now seen through the scalp. Are there other ways to patche skull defects without these materials?
A: It is very common when scalp swelling goes down over time that the metal mesh and screwheads become apparent through the skin on skull reconstructive surgery. This is particularly evident in the forehead although it can be seen all over the scalp. In some cases, just the screws can be removed and leave the titanium mesh behind. But if one wants to remove all metal material, the titanium can be removed and replaced with a skull reshaping bone cement that will leave a smooth surface and no risk of visibility through the scalp.
Dr. Barry Eppley
Indianapolis, Indiana
Tags: dr barry eppley, indianapolis, skull reshaping
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Tuesday, March 19th, 2013
Q: Dr. Eppley, The right side of my head (just above my ear when looking at me face on) buldges out about 5mm more than the left side. The left side looks perfect compared to the right. Would it be possible to reduce this ‘buldge’ and would the scar be noticeable? Thank you.
A: The simple answer to your questions is yes…and no. A 5 to 7mm reduction is what usually can be achieved in side of the head (temporo-parietal reduction). While most people think the reduction in this area of the skull is bony in nature, it is actually largely a muscular reduction. By releasing and shortening the posterior extension of the very large temporalis muscle, this will reduce the bulge on the side of head. (head reshaping) It is done through a fine line vertical incision over the thickest part of the bulge that is not longer than 4 to 4.5 cms in length. Usually this scar heals very well because the scalp incision is not under any tension. The noticeability of the scar would also depend on how one cuts their hair. If you shave your head I can not guarantee that the very fine line will not be seen.
Dr. Barry Eppley
Indianapolis,Indiana
Tags: dr barry eppley, indianapolis, skull reshaping
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Tuesday, March 5th, 2013
Q: Dr.
Eppley, I am interested in skull augmentation. I have heard of Osteobond being used overseas. Is an expander needed? I have a normal shape, just want to make it larger. What is the estimated cost? Thank you, I appreciate your time.
A: Whether an expander is needed for skull augmentation depends on how much skull expansion is desired and where that expansion on the skull is needed. Please send me some pictures so I can do imaging to get a feel if yours is a one-stage or two-stage skull augmentation. Knowing that and the material used plays a major role in the cost of the procedure.
Osteobond is not an FDA-approved cranioplasty material in theU.S. The approved options here are polymethylmethacrylate (PMMA, Cranioplast) and hydroxyapatite (HA, Mimix and others).
Dr. Barry Eppley
Indianapolis,Indiana
Tags: cranioplasty, dr barry eppley, indianapolis, skull augmentation, skull reshaping
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Monday, March 4th, 2013
Q: Dr. Eppley, Firstly, I would like to take the opportunity to thank you endlessly for the abundance of information you have on your website regarding cranioplasty. You seem to be the only person that has posted information about it, which has in turn reassured
me throughout my own medical process.
The reason for my email is to find out the best proposed solution you can present to me for my current cosmetic concern.
I have noted in some of the answers you have provided prospective patients with, you recommend using Kryptonite Bone Cement. My enquiries all relate to the use of Kryptonite Bone Cement to amend some defects I have from a past cranioplasty. I would really like to avoid having to shave off my hair where possible as it is almost as devastating as the defects themselves.
Last year in June 2012 I had a titanium plate inserted to cover the bifrontal (top front part of my head) due to replacing bone from a decompressive craniotomy after sustaining Traumatic Brain Injury. After the swelling had subsided from the insertion of the plate, I have been left with a visible line (indentation) where my plate goes across my forehead. I have also been left with a decent sized dent in the side of my face in the temple area, there also seems to be a smaller dent on the other side too. I have attached photographs so you can see the extent of my concerns.
What I would like to know is:
1. Will Kryptonite Bone Cement be suitable to use with my titanium plate? It seems to be an ideal solution to conceal the indentation along my forehead (where the plate meets my forehead) and fill in the gaps around my temple area and being injectable reduced the shaving and scarring as I would imagine.
2. If Kryptonite is not suitable, please tell me what the other options are that you would suggest.
3. Are there any side effects that I would need to be aware of?
4. Are there any long term studies on Kryptonite or proposed solutions that are available?
Many thanks in advance for your assistance, I eagerly anticipate your response.
A: In looking at your pictures and the accompanying commentary, let me answer your questions in the order that you presented them.
1) Kryptonite bone cement is no longer commercially available for reasons that are unknown to us as surgeons. But even if it were, it would not be appropriate for your case. Any injectable cranioplasty technique requires an unscarred scalp/skull area, no indwelling hardware and a defect surface area that is not unduly large. With your craniotomy history, presumably large titanium plate and the extent of the cosmetic deformity (bitemporal crossing the forehead), it is going to require an open cranioplasty approach to adequately correct. It should be approached no other way. While this is not the approach you would like to hear, the good news is that the procedure can be done without shaving any hair. I never shave any hair for an extracranial crcanioplasty procedure.
2) The only issue with an open cranioplasty is what material to use. It could be either hydroxyapatite (HA) or standard acrylic cranioplasty. (PMMA) There are some minor advantages and disadvantages with either material. I would have to see some x-rays of the extent of the plate location to answer that questions better.
3) The only real risks of this procedure are aesthetic in nature. Can a seamless transition be done in building up all the areas from the temples across the forehead. The front of head looks very much like a ‘vice’ across it so more volume is needed to build out these areas in your cranioplasty than one would think.
4) There are no long-term studies of Kryptonite that have ever been published. But this is irrevelant now since it is no longer available for clinical use.
Dr. Barry Eppley
Indianapolis,Indiana
Tags: cranioplasty after craniotomy, dr barry eppley, indianapolis, skull reshaping
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Monday, February 11th, 2013
Q: Dr. Eppley, I am looking at building up the back of my head. In reading your blogs you say that you usually add about 60 grams of material. But I don’t know how that would look and whether that is enough. I went on with my experiments, but rather than water I used plasticine which conveniently has a density close to PMMA, to check the volume. I adapted it to the back of my head like an implant would be, and as you said the change is bigger than one would expect (I tried 60g and 80g). So if the trade-off for a bigger volume is ‘longer or more full coronal incision’, could you tell me what would be its size and location for 60g and 80g? (I’m not sure I’ve read around 10 centimeters for 60g on your blog) As a side question, how would you attach the implant to my skull?
A: That is a clever way to see how much volume 60 grams of cranioplasty material is. Remember that it will also look bigger than you think when placed under the scalp skin. To get this amount of material on the back of the skull, an incision of 14 to 16cms long is usually needed. Onlay cranioplasty materials are fixed to the skull by first applying small screws to the skull bone allowing them to set up about 3 or 4mms above the bone. When the material is then applied this gives it something to hang onto to like rebar used in concrete. While screw fixation may not be absolutely necessary for augmentative skull reshaping, I prefer it since it is simple to do and adds a bit of security for prevention of implant mobility.
Dr. Barry Eppley
Indianapolis,Indiana
Tags: cranioplasty, dr barry eppley, indianapolis, skull reshaping
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