Q: I have a major issue with my face that has effected me my entire life. I was born with a skeletal deformity which caused my entire right side of my face to be noticeably bigger then my left side. My bite pattern is off due to this problem which in turn has prevented me from getting any adult teeth on my left side because of the lack of bone to support the teeth. I was also born with glaucoma which has been said to be the result of a tiny unseen eye ball in my left socket which caused the orbit to grow different then my right side. I have attached some pictures. As you may notice, I need some serious help. I have dealt with it all my life but I dream of the day I can look in the mirror and see the same person on both sides. If you can help me in my time of need it would be greatly appreciated. God bless.
A: Thank you for sending your pictures and sharng your story, You were born with microphthalmia which has caused the left side of your face (orbit and maxilla in particular) to develop differently than the right. (the growing eyeball has a major influence on the surriounding maxillofacial bones). This means the the left side of your face is vertically shorter than that of your right, known as facial hypoplasia on the side with only an eyeball remnant. There is much that can be done but a good place to start would be with a 3-D craniofacial CT scan to clearly show the extent of the anatomic deformity. Treatment planning could then be done and could go in two different directions, major bone repositioning through osteotomies and/or bone grafts or a camouflage approach using facial implants. It would also be extremely helpful to have a good view of your existing teeth, even starting with a simple panorex x-ray and a view of your current bite relationship.
Dr. Barry Eppley
Q: Hello Dr. Eppley I am a 25 year old male who has been through several extensive surgeries due to craniosynostosis as a child. The last reconstruction surgery done was when I was 18. Unfortunately my Dr. wasn’t as concerned with the cosmetic outcome as I was. I feel that my head is to narrow both from ear to ear and back to the forehead. Additionally my forehead has irregularities and is not proportional. I feel that I need to widen my entire skull, giving it more girth. Augmenting the back of my skull, as well as the sides, starting in my temple regions, then along the front of the forehead so that my eyebrow line is defined rather than flat.
Also during surgery they left me with a 1.5″ wide scar from ear to ear. Towards the top of my head it actually creates a deep groove. Last but not least, I feel that my hairline is extremely close to my eyebrow line, and my left temple area of hair grows too far in towards the middle of my forehead. What would need to be done to improve all my skull imperfections and correct the proportions of it? Is there a way to make my scar smaller or vanish possibly by cutting along onside and folding my scalp over it? Finally, can I bring back my hairline and fix the side area as well? Since these are all things cause by a brith defect/disease what if any could possibly be covered under insurance?
A: Based on your concerns and objectives, I think it is possible to provide improvement for some but not all of them. Nor could whatever can be maximally done occur all in one surgery. Adding material to your skull (cranioplasty) is often best done for the forehead and front of the skull which is the most aesthetically visible. This should be your primary focus. While material can be added to the back of your skull, you can do not both front and back at the same time. Your coronal scalp scar may be able to be reduced depending upon how tight your scalp tissues are. It can certainly be narrowed, it is just a question of how much. Your concept of de-epithelization of the scar and advancing the other portions of the scalp over it for closure is the correct approach. Changing the position of your frontal and temporal hairlines, however, is not realistic as there is no procedure to really make that happen other than how the hairline may change slightly with the scalp scar excision and closure may cause.
Whether insurance will cover such a procedure must be determined by a process known as pre-determination.