Q: Dr. Eppley, Do you do temporal implants for people after craniectomy/craniotomy? Or only for those with wasting from other nonsurgical issues. I had a craniectomy after brain surgery after fractured my skull in a car wreck. Despite the severity of the injury I have made a full neurologic recovery.
However the neurosurgery itself caused a massive amount of temporal hollowing. My neurosurgeon for the last year has said I’d be eligible for 3D custom implants. However after waiting a year and consulting with another doctor who is supposed to specialize in 3D custom implants he told me he had only donetwo temporal implants which both had to be removed and would not do them on me. I’m not sure if there was a further scientific based reason for this as my appointment with him only lasted five minutes. He also said he would not recommend me to get the implants done by anyone else.
I understand these 3D custom implants have been around only shortly since 2013 but I know regular temporal implants have been around for decades. I feel trapped in being disfigured like this and don’t know where to really look for a solution. I’m not sure why my neurosurgeon would recommend me for 3D custom implants for a year and then I’d not be eligible for them or for any cosmetic solution to my temporal hollowing.
Do you take patients from Canada? I would really be relieved to find a solution to this as Canada does not have many plastic surgeons in total and then even fewer that have dealt with cranioplasty let alone anything with soft tissue replacement implants.
A: I have done temporal implants for years for both aesthetic purposes as well as for reconstruction after neurosurgery due to temporal muscle wasting/detachment. The key factor in success in neurosurgery patients is whether they have had radiation to the temporal region or not. With your trauma history, you clearly have not received temporal irradiation. I can not give you a good reason why two separate surgeons would not do a 3D temporal reconstruction on you. Unless there is something that is not clear to me, I can not envision the circumstances where it is not possible. Can you send me some pictures of your temporal deformity and any CT scans that have been done since your surgery. I know the CT scans may or may be available and are not important right now. If based on your pictures I feel you are a good candidate then we would need a new 3D CT scan anyway.
The success of any craniofacial implant reconstruction is the quality of the overlying soft tissue cover. Adequate thickness and good vascularity of the tissues are important for long term success.
I have patients that come from all over the world and Canadian patients, because of proximity to the U.S., are some of the most common international patients I treat.
Dr. Barry Eppley
Q: Dr. Eppley, I have read a recent blog post of yours about an implant for the treatment of temporal hollowing with great interest. I have a depression on my left temple as a result of a craniotomy performed to clip an unruptured brain aneurysm. I would like to know more about this implant including the manufacturer, case studies of its use, and any before and after photos if available. Many thanks for your help.
A: The new temporal implant to which you refer is manufactured by Osteosymbionics in Cleveland Ohio. While it is not the first temporal implant ever designed, it is unique due to its shape and flexible design. You would have to contact the company for their clinical experience to date. I have not yet used this implant although I have used about every conceivable material for temporal augmentation and reconstruction. The material of this implant is a soft and flexible elastomer, which is what composes the vast majority of facial implants used.
For temporal defects from craniotomies, the size and extent of the depression must be carefully assessed and the implant matched to it. Some defects are due to mild to moderate atrophy of the temporalis muscle. This will appear as a more central indentation most prominent above the zygomatic arch and to the side of the forehead. An implant like this new temporal one may work well for this type of depression. Other temporal defects are bigger and are due to atrophy and a retraction of the attachments of the posterior and superior skull attachments. This creates a larger temporal depression and a bigger implant or other form of temporal reconstruction must be used.