Q: Dr. Eppley, I am interested in a forehead cranioplasty but I have an unusual request for it. I also want to add width to the sides to make my forehead wider. What would be the safest method and how would you do the augmentation (implants or cement)?
A: Your question is a very good one. Normally I would use an acrylic or hydroxyapatite bone cement for a frontal cranioplasty but yours is not the standard frontal cranioplasty. Adding width to a forehead requires going past the anterior temporal line of the forehead into the temporal muscle area. Thus one has to decide whether the augmentation should be done on top of or under the temporalis muscles to add the width. There are arguments to be made for either approach. If the material is placed on top of the muscle, it has to have a very feathered edge and edge demarcation or visibility of the implant-muscle transition will occur. This would be much more possible with a preformed silicone implant than an intraoperatively formed bone cement augmentation. Conversely, raising the temporalis mucle and putting the width augmentation under it requires reattachment of the muscle over it and that is frequently associated with some muscle atrophy and resultant overlying indentation/contour. With bone to bone contact throughout, a bone cement would be preferable.
Dr. Barry Eppley