Q: Dr. Eppley, I am wondering if sagittal ridge skull reduction plus/minus skull augmentation is an option for me. I went to my doctor with this and had an x-ray, head CT, and bone scan done. A surgeon then biopsed this ridge about two months ago. The biopsy showed benign fibroadipose tissue which he tried to take as much of that tissue off as he could. The surgeon also told me the rest of the ridge is bone. I would like to have this extra bone removed so I can achieve a more natural head shape. The ridge measures approximately 7 cm long x 2.5 cm wide x 0.5 cm high. Of note, I have a healing scar from the biopsy that is about 5 cm long that is midline and runs anterior to posterior over the ridge.
A: Your pictures show what appears to be a classic sagittal ridge skull deformity. I have not seen the x-rays but that entire ridge would be expected to be solid bone. I do not know why a ‘biopsy’ was done nor why there would be a sagittal incision of that length for it….but that is past history now. Using that same incision sagittal ridge skull reduction could be down by a bone burring technique. It would be help to see the thickness of the sagittal ridge on the CT scan.
Dr. Barry Eppley
Q: Dr. Eppley, I have a prominent sagittal ridge on my skull that has bothered me greatly since I began losing my hair several years ago. I’ve viewed your before-and-after sagittal ridge reduction photos, and have a couple questions for you:
As you can see from my attached profile photo, the midline ridge on my skull is prominent not just on top but also extends about half way down the backside of my skull. Is it possible to obliterate the full length of the ridge through just one incision? If so, approximately how long would such an incision need to be?
On a related note, in one of your “after” photos, I noticed that the gentleman has a raised area below the horizontal incision (on the back of his head). Is this raised area simply post operative swelling or is it excess bone that you couldn’t reach with your rotary burr?
Are there any curved burrs or blades that would allow you to more easily work around the curvature of the skull?
Thank you for taking the time to answer my questions.
A: The extent that any sagittal ridge can be reduced is a function of the thickness of the bone (before the inner cortex is encountered) and the length of the incision ‘permitted’ to do the procedure. It is not a function of the rotary burrs or large rasps that are used to do the surgery. They all can more than adequately take down bone at any location. To work around the curvature of the skull, incision location is the key element in sagittal ridge skull reduction. The more it it is located to the back of the head, the further around the skull curvature one can go. Generally incisional lengths will range from 5 to 7 cms.
Dr. Barry Eppley
Q: Dr. Eppley, I am interested in skull reshaping, specifically a reduction of a sagittal ridge. Not sure what to expect, I got a high top ridge at the back of my head (covered by hair, so a photo does not really show it) – rising maybe 2.5 cm above the rest of the skull top, which looks strange. Would you have reduction experience for that kind of surgery? Can one expect a great change in appearance. (assuming only 5-7mm can be reduced)? Thanks for your advise. 🙂
A: With very high sagittal ridges in which bony reduction alone can not make it confluent with the parasagittal skullbone, one can consider a combined sagittal reduction with augmentation of the areas right next to it. However, the first question to answer is really how much bone can be reduced. In very high ridges the bone may be quite thick and more than the typical 5 to 7mms could be reduced. This would require a CT scan to determine the sagittal ridge thickness and what type of reduction change to expect. It is also possible that in many sagittal ridge reductions I have seen that the bone is much thicker than normal and more may be possible to be reduced. This will be seen in a CT scan.
Dr. Barry Eppley