Temporal Craniotomy Defect Reconstruction

Q: Dr. Eppley, I had two subdural hematomas removed five years ago and one hole to remove a bone flap was done on my temple and has left a indentation to my face shape. Is there a possibility of an implant being set there because of the injury. I am going to talk to my neurologist about this and see how they feel about it. Very interested if it is a possiblity.

A: Thank you for sending your pictures. I have seen such temporal indentation deformities many times after temporal craniotomies. While they may be an underlying craniotomy flap indentation that accounts for some of the concavity, most of it is caused by the loss and retraction of temporalis muscle. The muscle has retracted from its superior attachments and is now sitting like a ball down above the zygomatic arch all shrunken up so to speak. This accounts for the severe temporal indentation  (loss of muscle and sinking of the bone flap) as well as the excessive width by the eye. (contracted temporal muscle) 

There are two approaches to treating your temporal craniotomy defect reconstruction:

1) Building up the temporal hollow with bone cement and thinning out the overly thick muscle mass by the eye through an open scalp approach, or

2) Doing fat injections into the temporal indentation. (closed approach, only requires small external puncture sites, may require multiple fat injection surgeries)

Either temporal craniotomy defect reconstruction approach has their advantages and disadvantages. I have attached a result from the open application of bone cement for your review.

Dr. Barry Eppley
Indianapolis, Indiana