At What Age Can Plagiocephaly in Children Be Treated Surgically?

Q: Dr. Eppley, My little boy is soon to be 6 years old. He has a wide head with flattening mainly to one side and his ear is slightly pushed forward on that side.

I would like to try and get this sorted for him before at this age. Is this something you can help him with?

I think you can use a skull cement that can be used at his age? Is this very costly? And is it effective? Does it leave much of a scar? How long does it take? 

We are based in the uk but I don’t think this can be done in the uk? 

I am really keen to sort and how do we progress with this?

A: When it comes to treating occipital plagiocephaly in children the only good option, in my opinion, is hydroxyapatite cement. While such HA cements don’t really turn into bone, the body does view them as more ‘natural’ and develops osseous integration with the surface of the skull. While such HA bone cements are the ideal material they are not perfect and have several notable downsides which include the following:

1) Placement of them requires direct visual access to properly place and shape the cement. This means that a longer scalp incision is needed to do so.

2) Any bone cements have to be placed exclusively on the bone or otherwise they will fracture. Since plagiocephaly skull deformities wraparound the side of the head into the posterior temporal muscle region, such corrections are imcomplete.

3) HA cements in the U.S. are very expensive compared PMMA acrylic bone cements. But PMMA is a material that should not be used in children due to the growing skull.

For the reasons so stated above I advice parents to wait until the teenage years when a more effective method in treating plagiocephaly exists (custom skull implant) and the use of these other more effective materials are placed in a skull that has undergone much of its development.

Dr. Barry Eppley

Indianapolis, Indiana