Skull Reshaping

Q: Dr. Eppley, My questions are concerning what skull reshaping procedures could be combined under a single operation. My skull deformity isn’t localized, the result of untreated craniosynostosis. I have the typical trigonocephalic skull, which is narrow in the front, and wide and tall in the back.

I believe that for an augmentation covering such a large area of the forehead, a preformed silastic implant is preferable.

1. Can a silastic implant be combined with burring of the forehead? How does that affect the printing of the implant, since you’re modifying the bony contours the implant is based on?

2. Can the posterior temporalis muscle be resected in the same operation?

3. Can the saggital ridge be burred down a couple millimeters in the same operation?

4. Would it make more sense to make a number of smaller incisions versus a large coronal incision when combining procedures?

The contours of my skull cause great psychological distress, so I have no particular concern for scarring.

Thank you.

A: Thank you for your inquiry. In answer to your questions:

1) Skull implants combined with skull bone reductions are common. The bone reductions are factored into the implant design process.

2) The posterior temporals muscle can be removed in the same operation as #1.

3) The sagittal ridge can be burred at the sam time as #1 and #2.

4) If the hair density and hairline permit, it is always ideal to use a coronal incision. But I regularly seek how to limit the scalp incision as much as possible in skull reshaping surgery. I can certainly envision for #1 to #3 above that a complete coronal incision would not be needed.

Dr. Barry Eppley

Indianapolis, Indiana