Background: Flatness on one side of the back of the head is known as occipital plagiocephaly and can occur for a variety or reasons. In utero positioning and infant sleep positions are two of the most common etiologies. Regardless of its cause its presence is of aesthetic significance only when seen in an adult.
While people affected with this skull flatness are well aware that they have it, the camouflage of hair usually makes it a relatively non-issue. This is why it is the male patient who most commonly presents for its treatment as a result of short or thinning hair or the desire to shave their head. Such topical maneuvers will reveal to the public eye what the patient has always known. With a more exposed skull shape an improved symmetric appearance is desired. The hair issue does not exclude the female patient from seeking treatment for occipital plagiocephaly, they are understandably much less common.
Occipital plagiocephaly in adults is best treated with a custom skull implant. It has the best chance for optimal improvement of the skull asymmetry because the computer can match the flatter side to the fuller side by overlying the good side over the bad side and making the design. The elastic deformation property of the solid silicone implant also allows it to be inserted through the smallest possible scalp incision.
Case Study: This older male has been bothered since he was young by a flat area on the back of his head. He fortunately had a good head of hair but did spend considerable time and worry about making sure it was adequately covered. A 3D CT scan revealed the significance of the right occipital flattening from which a custom skull implant was designed to treat it. The design demonstrates that the surface area coverage to corrected flatness is much greater than one would think to create a confluent and smooth skull shape.
Under general anesthesia and in the prone position an 8 cm horizontal skin incision was made over the nuchal ridge in the low occipital region. A subperiosteal pocket was made and the implant prepared for insertion by placing perfusion holes in it with a 4mm dermal punch. The implant was inserted and oriented using the compass marker on the implant. It was secured with two small titanium microscrews.
The expansion of the flattened right occiput could be immediately appreciated once the incision was fully closed.
The correction of occipital plagiocephaly with a custom skull implant is a reliable and effective operation that can be performed in a relatively short operation. It does not involve any substantial recovery and most patients will return to work within ten days after the surgery.
Case Highlights:
1) While plagiocephaly often affects the entire skull, its most noticeable effect is often on the back of the head. (occiput)
2) Flatness occurs on one side of the back of the head and rarely causes excessive protrusion of the opposite side.
3) Insertion of a custom skull implant can be done through a small incision over the nuchal ridge on the back of the head.
Dr. Barry Eppley
Indianapolis, Indiana