Q: Dr. Eppley, I am a 24 year-old male seeking help and guidance about my head shape. I have caphocephaly which was untreated from childhood and now as an adult I find the appearance of my head very troubling. I am concerned in particular about the temporal hollowing and frontal bossing of my head shape. Is there something that can be done about this?
A: As you have well described, you have a classic case of mild to moderate scaphocephaly with bicranial narrowing from front to back with a midline ridge. While the bone can not be changed at this point, there is room for substantial cosmetic improvement through cranioplasty techniques. I envision a cranial reshaping procedure in which some of the midline ridge from the forehead is reduced but, more effective, would be augmentation in the parasagittal areas from the forehead to the top of the head. This would produce some greater width or roundness to your forehead and frontal skull. Due to the volume of material needed, I would use PMMA for cost purposes. This would need to be done through a bicoronal incision in the hairline. The temporal narrowing could be partially improved by either extending the cranioplasty into the upper temporal area or placing temporal implants in the subfascial plane.
While you can not completely correct the skull and forehead narrowness, substantial improvement can be done which would be enough to no longer be seen as having scaphocephaly.
Dr. Barry Eppley
Q: I am a 24 year-old male. I believe that I might have sagittal synostosis (scaphocephaly) and it has been quite a burden throughout my life. Furthermore, I have an extremely long face. I know that options are very limited for adults but I wanted to explore possible solutions (if any) to perhaps lessen the deformity. I am not sure whether the risks or thr trouble of surgery is worth and this is what I want to dicuss with you.
A: Thank you for your inquiry and photos. Scaphocephy refers to a horizontally long but narrow in width skull shape that is seen most prominently in the forehead. Ofthe this type of skull shape has a bulge in the upper forehead as well. In looking at your pictures, I can shortcut to the final conclusion fairly quickly. The risks and trade-offs of surgery are not worth it for you. You do not have enough of a ‘problem’ to justify any surgery so your assumption is correct. Your skull is not that deformed to merit a scalp or coronal scar to do some bone burring. It is best to put these concerns behind you and move on with life…and feel fortunate that whatever bothers you is not significant enough to justify surgery. Many patients are not quite so fortunate with their skull and forehead concerns.