What Type Of X-Rays Do I Need To Evaluate My Skull and Facial Deformities?
Q: Dr. Eppley, The right side of my skull is caved in and bulging therefore causing an asymmetrical appearance on my facial profile. From my right temple area, the skull leans towards the right, almost appearing to sag to the right side of my head. I wish to straighten that side so that both sides of my skull are structured straight up and are symmetrical. The pictures limit how much you can actually see, I believe an x-ray would do justice to my explanation. The problem is it bulges outwards. Whether it is muscle atrophy or bone, the cause was due to the way I would lay down on my side at 12 years old. The palm of my right hand would be pressed into my skull pushing the temple muscles upwards or inwards causing the deformed bulge. I basically used to use my right hand as a pillow, so my whole right face was subjected to being pressed into causing the disfigurement. It wasn’t the best way for me to lay but it was the most comfortable at the time. I put a lot of strain on my neck area, as my head and palm pressed into each other. Months afterwards, I noticed pain in my neck. Whenever I moved my right arm in a punching motion, I would feel a shock of pain surge through my neck causing me to yell out in pain. Migraines followed for sometime then stopped. My jaw was affected as well since my palm would push into it while my head rested on it. I can see a noticeable difference when I look at the right side of my maxilla and the left, the right is pushed in, so the top right row of teeth slant inwards. In response, it changed the alignment of my whole top row teeth in that it slants to the right. This is something I can see when I open my mouth, and using my tongue can feel the change including when I bite down on things. Then there’s the problem with my right nostril. It feels like it’s always stocked up in that whenever I sleep it tightens up so that I barely breath out of that side of my nostril. Also, whenever I’m in a warm environment, it closes and I’m forced to breath out of one nostril. I believe I damaged that area as well by applying pressure and somehow pressing inwards into the right side of my maxilla/nostril. It’s not congestion. So, here I hope is a general outlay of my problem and the problems along side it. I honestly believe an x-ray is much needed because a visual will better explain what words fail to. I can feel it and I’ve lived with the changes and a thorough scan of my head and neck will show you what I’m talking about.
A: You are correct in that the pictures don’t do justice to the skull/facial problems as you have described it. It would be highly unusual to reshape bone by any form of external pressure beyond the first few years of life but it is possible. That issue aside, I would agree that the best way to determine of your skull and facial issues are from bone or soft tissue deformity is to get an x-ray study. I can make those orders to any facility in your geographic location. The question is what type of x-rays would be best. The best type of x-ray to get is a 3-D CT scan of your craniofacial skeleton. That would provide an absolutely clear view of your skull and facial shape. In an ideal world, we would even get a model made from these x-rays which could even be used in treatment planning/designing the surgery. But from a cost standpoint, the bare minimum x-ray study you should get is a plain skull and facial series.
Dr. Barry Eppley