Your Questions
Your Questions
Q: Dr. Eppley, My son needs skull reshaping surgery. He is currently six yearrs old and will turn seven later this year. I have many concerns for my son. My son has never had a hair cut in his entire life. I braid his hair down in efforts to try to disguise the deformity located on the right side of his head. We are African-American and one day, after my son graduates from college, he will need to be appropriate to interview for jobs. No one will want to hire my son with braids in his hair. He needs to be able to cut his hair and wear suits proudly. Also, both his grandfather and father are bald. What happens to my son if his hair pattern follows in that same direction? When my son was born, his head shape was absolutely perfect. I want my son to be able to fit in with society and not be ashamed or judged on his deformity. My son is an innocent child and if there were anyway I could take his place I would. Please help us.
A: Skull reshaping surgery by an onlay cranioplasty is most commonly performed for flat areas on the back of the head. I am assuming that his flatness is on one side of his head in the back of his head. Such a skull deformity is very amenable to being built up by an onlay cranioplasty procedure by putting material on top of the bone. This does require a scalp incision to do it, located more to the back of his head. He does not have to shave his head or unbraid his hair to do it. In fact, having braids in his hair is the best hair management for the procedure.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I incurred a closed depressed skull fracture from a head-butt when I was 22. I am now 28. The depression in my skull has bothered me emotionally since it happened and I have some physical pain too (I feel like there is constant pressure on the area). When I participate in rigorous physical activity (such as running) I get severe head aches. I hope to get surgery to elevate the depression and was interested to know more about possible procedures.
A: If you are having symptoms of headaches and pain from your depressed skull fracture, the first thing you need to do is to consult a neurosurgeon to be certain that there is no undue pressure on the brain. While I would doubt that is the case after this many years, it would be an important first step to do. That is the only reason that the skull fracture would be elevated and that will require an open craniotomy to accomplish. If your neurosurgical work-up is negative then the depressed skull area can be treated for its cosmetic appearance by an onlay cranioplasty to build up the outside of the bone. A skull fracture is not elevated by craniotomy for a cosmetic change only.
Dr. Barry Eppley
Indianapolis,Indiana
Q: Dr. Eppley, my son is 2 yrs old with mild to moderate plagiocephaly. One side of his head is noticeably flat on the back. I’ve read on here about the procedures available to fix this, in particular the cement injections. My question is if we decide to do this now at his age will the material expand with his head growth or will the procedure have to be done every so often throughout his life until his head reaches its final size? Thank you
A: The application of a calcium phosphate cement to the outside of the bone, known as an onlay cranioplasty, builds out the contour of the bone. It does not influence the growth of the skull in anyway. It allows it to grow as it normally would, albeit in its misshapen form. Knowing that non-synostotic occipital plagiocephalies do not display progression of the deformity, it is safe to assume that an altered/improved occipital shape achieved at a young age would be relatively stable as they grow. I would not envision that a periodic addition of material would be needed until the child reaches skeletal maturity. The skull grows by resorbing bone on its inside and adding it to the outside. When done at age two, I would imagine that much of the added material would be incorporated into the bone as the child grows.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in an onlay cranioplasty for back of my head. It is true that hydroxyapatite would be very light and much more like my bone than PMMA materials. Is PMMA heavier than hydroxyapatite? Would I feel the heaviness in my back of my head if I choose PMMA for the surgery? I know that PMMA would work to make my head round, What are the pros and cons of using PMMA? Are there any side effects of PMMA to my body? Thanks.
A: There is no real weight differences between PMMA and hydroxyapatite (HA), so that is not a concern. The differences between them is three fold. First, PMMA is a plastic material and it just as hard as bone if not actually harder. Secondly, it is a well tolerated and commonly used cranioplasty material. But it is not bone so, like a breast implant, it is well tolerated and accepted by the body but it never truly becomes part of the breast. It is simply walled off (encapsulated or surrounded by scar) HA is a lot more like bone biologically since it is the inorganic mineral content of bone. Because it it more like bone, the body actually grows into it and integrates into it. It is not as strong as PMMA or bone and is more ‘brittle’ much like a ceramic. The risk of fracture is greater on hard impact although I have yet to see fracture of the material as ever having occurred or being a problem that I have heard of. Lastly, there are cost differences betwene the two in terms of volume used. PMMA has a flat rate cost that is substantially less than that of HA as it comes in 40 gram packets. HA is charged by volume in grams per 10 grams used. So the equivalent material cost for, let’s say 40 grams of material, is about 4X the cost over PMMA. That is a several thousand dollar cost difference between the use of the two materials.
As you can see, the choice between PMMA and HA offers certain advantages and disadvantages for each material.
Indianapolis, Indiana
