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Background: The shape of the skull is prone to a wide variety of defects consisting of either lack of adequate projection, too much projection or a combination of both. Usually these occur in very specific and recognizable patterns and are seen relatively commonly in my practice. Almost always there is a biologic explanation for their existence either related to external deformation or some association with one of the skull sutures.

Most  skull deformities associated with a suture present as a raised area due to bone growth being restricted perpendicular to its linear direction. A bone thickening occurs as it builds up along the sutural indentations with growth. (e.g., sagittal crest deformity) Conversely, sutural indentations or areas of depression along or around them are caused by external forces which have compressed  a wide area of bone in which the suture resides. (e.g., occipital plagiocephaly)

But occasionally skull deformities are seen that defy an exact explanation as the following case study illustrates.

Case Study: This young man had been bothered by a depression cross the top of his head which he had recognized since he was a child. While he had a lot of hair and wore it long (perhaps to hide it?), there was a very palpable depression that crossed the skull across the top in a horizontal direction. A 3D CT scan Showa broad-based depression across the anterior top of the skull along the location of the coronal sutures. Given its location and association with the suture I would call this an aesthetic ‘coronal skull indentation’.

Using the 3D CT scan a custom skull implant was designed to fill in the transverse depression of the skull along the coronal suture lines. It crossed the anterior temporal lines on each side to blend into the sides of the head.

Custom Skull Implant for Sagittal Suture Depression Dr Barry Eppley IndianapolisUnder general anesthesia a 3 cm long sagitally-orieted scalp incision was made in the midline over the depression. This permitted subperiosteal dissection to be done along the side to side skull depression. The implant was then inserted, positioned and then secured in the midline with two small microscrews.

This unique discrete skull depression was effectively treated with virtually next to no scarring using the custom skull implant approach. While an explanation could not be given as to why such a skull depression occurred, that did not deter a satisfactory skull reshaping result.

Case Highlights:

1) An unusual type of aesthetic skull deformity is one that goes horixotally across the top of the head along the coronal suture lines.

2) A custom skull implant can be made to augment the coronal suture defect to bring it up to the level of the rest of the skull’s surrounding surface.

3) Such a linear custom skull implant can be placed through an incredibly small scalp incision.

Dr. Barry Eppley

Indianapolis, Indiana

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