Q: Dr. Eppley, Six months ago I had a small dent on the top of my head repaired using an injectible cranioplasty technique. Since then, I have noticed a small piece has broken off and the implant is a bit more raised then I expected. The doctor that performed the procedure said that it may feel raised for up to a year and we should readdress it at that point. I’ve read a lot of your articles and in hindsight I should have come to you for the procedure. However, I must deal with the issues as they are. My questions to you are: is it normal for a piece to chip off? Should the area be slightly swollen up to 6 months? What are my repair options?
A: Thank you for your inquiry. Can you tell me more about this injectable cranioplasty technique. What material was used and how was it injected? While this is a complication that I have not seen, I could envision it occurring depending upon the material. It could only really occur with a hydroxyapatite cement material not with PMMA bone cement. But more likely than not it is not a broken off piece of material. It likely is an edge or surface irregularity that has become apparent as the swelling subsided and the scalp tissues adhered back down. Since this takes months to occur, the visible edge may not have been seen for awhile. What you see now is not going to go away. If it is just only one area, a small incision directly over it to remove it would seem the logical approach. Also a small incision can be used to introduce a rasp to smooth the material down if it is an hydroxyapatite
Dr. Barry Eppley