Background: Flat or deficient areas of the skull are reasons for aesthetic head shape concerns. The most common areas of head shape deficiences is on the back of the head as well as the crown of the head. Men and women are equally concerned when the back of their head is very flat. Deficiencies in the top of the head or crown area tend to be of more concern to women than men.
The crown of the head usually refers to the top of the head. In anatomical terms, the roof of the skull or cranial cavity is the whole top of the head. The top of the head can also be referred to as a the skull cap. The portion of the skull known as the crown refers to the upper back of the head. The crown begins at the point where the top of the head begins to curve downward to the back of the head. It is a semi-circular area whose outline looks like a cap sitting halfway between the top and the back of the head.
What usually bothers women about a flat or deficient crown of the head is how it affects their hair and the appearance/shape of their head. A flat crown creates a lack of volume over the crown. While it can be camouflaged by styling the hair, this is time consuming and is not always an option for some women.
Case Study: This 25 year female had a prior history of skull augmentation using bone cement material. It turned out to be inadequate in both size and the amount of skull augmentation that it created. Using a 3D CT scan, a custom skull cap implant was designed that would augment the crown of the head by 12mm in thickness.
Under general anesthesia, her previous coronal skull incision was used to access the entire skull behind it. After scalp flap elevation back to the bottom of the occiput, the custom skull cap implant was placed, oriented by use of a marker on the implant and secured with two small microcrews. Prior to placement the skull implant was prepared by making multiple perfusion holes through it with a 3mm dermal punch. The scalp incision was closed over a small drain which was removed the following day.
A custom skull cap implant can be designed to cover any amount of skull surface area in any thickness and contour. In consideration of its design, the stretch of the scalp must be considered to ensure that a competent scalp closure is obtained. There is no preoperative way to know how much any patient’s scalp will stretch. My experience in custom skull implants is that the range of 10 to 12mms its thickness is usually a safe amount. More skull augmentation can be obtained but this may require a 1st stage scalp expansion.
Highlights:
- A skull cap implant can create a higher crown area at the back of the top of the head.
- A 3D CT scan is needed to design and fabricate a custom skull cap implant.
3) While in this patient an old coronal incision was used for placement, most custom skull implants can be place through much smaller scalp incisions.
Dr. Barry Eppley
Indianapolis, Indiana