Background: One of the most common of all aesthetic skull deformities is flattening of the back of the head. Commonly called plagiocephaly it causes a flatness on one side of the back of the head that is frequently associated with an overall craniofacial scoliosis. It can occur in mild to more severe manifestations whose aesthetic significance often depends on the shortness of the patient’s hair. It is no surprise, therefore, that the aesthetic sequelae of unilateral occipital flatness affects men more than women.
The best method without question in adults for correcting occipital plagiocephaly is a custom made occipital skull implant. Designed and manufactured from the patient’s 3D CT scan, it can match the dimension’s of the opposite more normal side of the occipital skull. While it can be argued that in plagiocephaly the side of the occipital skull opposite to the flattened side may be overexpanded (although not always so), it is best to use it as a reference when trying to achieve symmetry on the back of the head.
Case Study: This 42 year-old male had long been bothered by the flatness on the right side of his head. Even he did not have a close cropped hairstyle, he was very conscious of it. Using a 3D CT scan, a custom right occipital skull implant was designed to match his opposite normal occipital skull projection.
Under general anesthesia and in the prone position, a 7 cm low horizontal scalp incision was made without shaving any hair. Making an extended implant pocket with long curved instruments, the implant was inserted in a rolled fashion. It was then unrolled and properly positioned using a ‘compass’ marker embedded into the implant and the 3D image designs. The incision was closed with resorbable sutures placing them either in tissue planes below or above the hair follicles. No drain was used.
His immediate intraoperative results showed the back of the head shape improvement that the implant design predicted. His head dressing was removed the next day and he could wash his hair the following day. He returned to work the following week.
A custom occipital skill implant offers a straightforward and predictable method of obtained improved back of the head shape and projection for unilateral asymmetry. Placement in the subperiosteal plane on top of the bone can be done through very small scalp incisions through unique insertion techniques and positioning markers embedded into the implant’s outer surface.
Highlights:
1) Asymmetry of the back of the head is the most common form of occipital skull deformity.
2) A custom made occipital skull implants is the best treatment method in an adult.
3) A custom occipital skull implant can be inserted through the smallest scalp incision.
Dr. Barry Eppley
Indianapolis, Indiana