What Is The Best Method For Forehead Reconstruction?

Q: Dr. Eppley, My 15 year-old son needs his forehead reconstructed after an injury last year. He lost a portion of his forehead from the fracture and now has a large indentation from his brow up to just under his hairline. Which is better for his reconstruction, a cranial bone graft or a bone cement?

A: From a growth standpoint, his skull/forehead is essentially fully formed so the method of reconstruction is not really important from that standpoint. What counts is how smooth it can be after it heals and will have the least chance of irregularities down the road when all swelling truly subsides. Either a bone cement or bone graft has their own advantages and disadvantages in this regard. A bone cement will give the smoothest contour result by far because it can be molded completely into the defect and smoothly contoured to the surrounding bone edges. While it is a synthetic material, it is made of hydroxyapatite which is the inorganic composition of natural bone so ti is very biocompatible.  While bone grafts are an autogenous material, they are prone to some resorption and hence irregularities down the road. Even though the forehead has thick soft tissue, plate and srew profiles inevitably become evident unless very low profile (< 1mm) devices are used. It is likely that I would do a combination frontal cranioplasty, using bone grafts to obliterate any frontal sinus exposure and bone cement to fill the defect and contour into the surrounding forehead.

Dr. Barry Eppley

Indianapolis, Indiana