Background: Plagiocephaly or craniofacial scoliosis is a well known craniofacial deformity that truly affects the whole craniofacial skeleton. The most well known component of it is the flattening of the back of the head which for many patients may be the most severely affected area. At the least treating the asymmetric back of the head is the number one priority in its treatment in adults.
The shape of the back of the head becomes very apparent for short hairstyles or when one shaves their head. The exposure of the back of the head is more common in men for these reasons either by an elective hairstyle or when one is losing or has lost their hair. But it also can affect women who, despite having more hair, may be equally self-conscious about it. They may avoid being seen coming of the shower with their hair wet or when swimming due to their being a flat side of the back of the head.
Unlike in infants, correction of adult occipital plagiocephaly is done by onlay bone augmentation. There are numerous methods of building up the bone of the skull by various synthetic materials. Having used all of them, the best method for occipital augmentation is the creation of a custom skull implant made from a 3D CT scan. No hand created intraoperative method can match the symmetry and smoothness of the implant contours created by computer designing.
Case Study: This 30 year-old Asian male has long been bothered by the shape of his head, particularly that of the back. The right side was noticeably flatter than that of the left with the right ear more anteriorly located than the left. There were some forehead asymmetry but this was not a priority. Using a 3D CT scan, a computer-generated right occipital implant custom skull implant that matched the left side perfectly. The maximum thickness of the implant over the most deficient occipital ares was 8mms.
Under general anesthesia in the prone position, a 5 cm horizontal skin incision was made in the low occipital scalp location. Wide subperiosteal undermining was done 2 cms beyond the border of the implant location as marked on the scalp. The implant was prepared for insertion by the placement of multiple perfusion holes through it using a 3mm dermal skin punch. The implant was inserted and positioned based on its shape and location on the 3D design images. The scalp was closed in multiple layers using resorbable sutures.
The effect of a custom skull implant is both immediate and profound. Besides getting the right shape and thickness of the implant, it must be inserted through an incision that is as small as possible. This makes the final definitive argument for a custom silicone implant which allows itself to be rolled and inserted through an incision that is usually about 1/3 in 1/3 in length as the most narrow width of the implant.
1) Plagiocephaly is most commonly associated with a flattening of one side of the back of the skull.
2) An important component of correction of plagiocephaly in adults is augmentation of the flat side of the back of the head.
3) The best method for correction of the unilateral occipital plagiocephaly in adults is a custom skull implant.
Dr. Barry Eppley