Q: Dr. Eppley, I have a dermoid cyst in my forehead bone that needs to be removed. Because of its size, it will leave a significant bone defect after its removal so it will need to be reconstructed. One plastic surgeon told me that he has to take out too many bad products from people’s head’s so he now only uses a titanium mesh covering for these repairs. My question is which is a better method for reconstruction, metal mesh or a bone filler? Also, two different incisions have been discussed. Since the lesion is not too far from the hairline, is it possible to do a smaller incision, one that goes from the sideburns to the midline of the forehead and just very slightly into the hair line? I know that a bicoronal incision can be used but it is a more difficult recovery and some scalp numbness will result. Which incision would be better to perform the surgery with the least risk of problems?
A: It appears that you have an epideroid cyst in the diploic space of the frontal bone. I assume the reason for its removal is that it is slowly growing.
I have no picture of you to see where exactly the lesion is located in reference to your frontal hairline so it is impossible for me to comment on what incisional approach could be used. Certainly some variation of the bicoronal incision can be used. The only question is whether some other form of more limited incisionall approach could be used. Without knowing where on the forehead it is (seeing a picture with a mark on your forehead), I can comment no further.
In terms of reconstruction, I would disagree strongly with the idea that there are a lot of bad products for skull reconstruction. I have used all available materials and have never had a problem with any of them in hundreds of cases. They all work well when used with proper technique. For covering a ‘crater’ in the forehead after the cyst removal, I absolutely would go with an hydroxypatite cement. It can fill in the defect and make the forehead perfectly smooth. While covering the defect with low profile plates and screws is also acceptable, there is always the chance that you will be availble to feel the outline of the metal hardware and even some risk that it may leave a negative image on the forehead skin should it thin out after the surgery.