What Can Be Done For My Son’s Flat Back Of His Head?

Q: Dr. Eppley, I took my son to the Children’s Hospital to assess his deformational plagiocephaly and they told me that they would not address my son's skull deformity since it was not negatively impacting his facial features. They described the procedure as extremely painful and invasive. Where can I find more information describing the pros and cons of this procedure. I would also like to know more about the procedure itself in terms of surgery and recovery. Any information would be greatly appreciated. My son has a pretty severe flattening on the right posterior of his head. My pediatrician convinced me that helmeting was the wrong decision and his condition would improve over time. At this point, I regret listening to the pediatrician and am looking for solutions for my son.

A: What they were saying at the Children's Hospital is that major cranial remodeling surgery is not justified for a cosmetic skull deformity. That is certainly true, particularly if your son is older than 18 to 24 months old. An alternative treatment option is to build out the flattened occipital area with onlay hydroxyapatite cements. That may be able to be done in some cases with an injection technique or a small incision. This is a far simpler approach to major cranial bone reshaping and the risk:benefit ratio is much more favorable. Whether the magnitude of the occipital skull deformity justifies an onlay craniopasty procedure depends on many factors, most of which is the emotional concern of the parent about the shape of their child's skull.

Dr. Barry Eppley

Indianapolis, Indiana