Your Questions
Your Questions
Q: Dr. Eppley, Our four year old daughter has a flat back of the head due to positional brachycephaly. She has the additional bone growth over her ears that we would consider also having reduced. We want to know our options for building up the flat spot when she gets older. What is the right age? Have you built up flat spots for younger kids? We’d prefer to wait until she’s at least a teen but want to fully understand our options. Does the single step procedure provide enough material to build up the flat spot to the satisfaction of most clients or would you anticipate the two step method where the scalp is stretched to accommodate more material might make more sense?
A: The timing of elective skull augmentation for a flat back of head is matter of personal preference. In my opinion, it can be done very young or anytime later in life. Building up the bone requires the overlying scalp to stretch and age does make any difference in that regard. Since this is an onlay technique, the hydroxyapatite cement will grow with the surrounding bone so age is not a concern in that regard. I have done a child with unilateral occipital augmentation as young as age 4. The timing is merely a matter of parental and, if old enough, patient choice.
Because your child has bilateral occipital issues with biparietal width increase, the need to reduce the wider bone indicates a need to do it when she is older and the bone is thicker. So the teenage years would be a good consideration in your child’s case. While most cases are done in a single stage procedure, that would depend on how flat it is and how much occipital expansion is needed. If more than 15 to 20mms of occipital expansion is needed, then a first stage tissue expansion would be needed.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in skull reshaping surgery for the back of my head. I have attached some pictures. Although they are a little fuzzy I think you can see the problem. The left is much flatter than the right. Let me know if it is possible to do what I want which is to fix the head shape so that it is more round and therefore more normal in the back on both sides (more on the left than the right.) I also have a few more questions to ask. First of all, are there any long term side effects of the surgery? (not the rare ones but common ones I should know about as I know there are risks with any surgery). Secondly will I need to keep coming back for surgeries in the future (for such things as touch-ups)? Will it affect my hair growth? These are questions I was unable to find out for myself. I hope I have not been too much much of a bother. I am really excited for this as you can see and I really, really appreciate your prompt and helpful responses. Thank you for everything.
A: As skull reshaping surgery goes, your back of the head problem is the most common skull problem that I treat. Flat back of the heads are common and rarely are they perfectly symmetrical. They are corrected by an onlay cranioplasty procedure, most commonly using PMMA as the augmentation material. The surgery is done through a limited 9 to 10 cm incision (no hair is shaved) placed closer to the back of the head through the material is applied and shaped. The only short-term complication (< 6 months) that I have ever seen is aesthetic in nature, how smooth is the applied material and does it give enough of the desired augmentation. If either is observed and bothersome, a touch up procedure may be done to smooth it out or add more material if possible. I have not seen any long-term complications. If one has a satisfactory result by three months after surgery to their own assessment, then no further procedure will ever be needed. Lastly, he procedure does not affect hair growth.
Dr. Barry Eppley
Indianapolis, Indiana