Q: Dr. Eppley, I am a 23 year old male with an indentation on the back left area of my skull. It has been there as long as I can remember. It is made worse by the the fact there is a slight bone protrudence to the right of the indent. I have no idea if it is congenital or not. This is clearly visible when my hair is cut short and I am looking to get it fixed. I have attached pictures so you can take a look. I have done a little research and discovered kryptonie, the bone cement and was wondering if that would be an option, or would you recommend something else? I have seen a plastic surgeon in where I am from but he’s not too sure if he could even help. I stumbled across your website and from your previous work, I am very interested in your opinion and setting up a consultation/procedure. I would much rather prefer to make only one trip if possible. I would like to know what are your thoughts on my skull and have you ever dealt with a case like mine before? Would a large incision with scarring be the only way to go about fixing this? Also, what is a rough estimation to what it would cost? Thanks so much for taking the time to read my email.
A: Your pictures show a skull indentation directly over the original site of the posterior fontanelle. This is where the back soft spot was as a baby that did not develop enough skull bone thickness as that of the surrounding skull when it fused. That indentation has probably been there since you were one or two years of age. That is why you have it and I have seen it and treated it before. Basically it is a simple indented skull area that can be built up and smoothed out. The key question is what is the best way to do it. It can be made absolutely smooth and level through a longer open incision but that is understandably not desirous due to your close-cropped hair. That leaves the other options of a minimal incisional approach (maybe 1 to 2 cms) which would allow the indented scalp soft tissues to be adequately elevated from the bone and through which some material could be used inserted. Understand that an injectable technique does not mean incision free, it means that the material as the ability to flow through tubes (not needles) and thus only a small incision is used to place it. This is best thought of as a ‘minimal incision cranioplasty’. Kryptonite as an ‘injectable’ material is no longer commercially available to do this so that leaves us with two other options, PMMA or OsteoVation. There are minor advantages and disadvantage to each material which can be discussed later. Both are liquid and powders that are mixed into an initially runny material which allows it to be pushed into a pocket by syringe created over the bone indentation after the release of the attached soft tissues.
Dr. Barry Eppley