How Can I Augment The Temporal Area That A Previous PMMA Skull Augmentation Missed?

Q: Dr. Eppley,Do you use MMA skull reshaping method for plagiocephaly (one side back head flat correcting method ) ? if yes most of my skull is corrected but I have a dent small area on back left which is the edge part connects with the left side part the previous Dr left to fill that area coz he ( thinks ) said its very risky to touch the temporalis muscle . Since my case is plagiocephaly I want to know if it’s ok to do it ? Is that going to affect my chewing process or the temporalis muscle movement ? Since there is only a small portion left i want to know the price and how long it will take me to heal ? Thank you !!

A: What you are experiencing with PMMA skull augmentation is the exact limitation of the material. When it comes to treating plagiocephaly implant augmentation is two thirds on the bone but one third onto the temporal muscle on the side of the head. P MMA material must stay on the bone and cannot be placed on top of the muscle. Your surgeon may have told you it was too risky to touch the temporal muscle this is not a remotely accurate statement. I have done hundreds of skull augmentations where is the material used is directly on top of the muscle on the side of the head and it has never caused any temporal muscle movement or functional problems nor would I expect it to do so. The key is not whether you can put an implant material on top of the fascia covering the muscle but what should that material be. Therein lies the limitations of P.MMA bone cement. As the name implies it is a bone cement not a soft tissue cement. It requires a bone surface to which it must be applied. As soon as you need to cross over the bony temporal line anywhere on the skull onto the temporal muscle area this requires a solid silicone material. This is why for almost any significant skull augmentation need the use of custom solid silicone skull implants are far superior as they do not have surface area limitations not to mention preoperative control of the augmentation areas actually needed.

Dr. Barry Eppley

Plastic Surgeon