Background: Plagiocephaly, also known as cranioscoliosis, is one of the most recognized skull shape abnormalities deformities. It has a relatively common occurrence amongst all the possible congenital skull deformities. While it affects the entire skull shape its greatest effect and patient concern is often on the back of the head. Asymmetry and variable amounts of flattening affect the back of the head as part of the overall twisted skull shape.
Not surprisingly occipital plagiocephaly concerns are more prevalent in men than women due to their often shorter hairstyles. A close cropped haircut or a shaved head is an unforgiving surface where the shape of the head takes on great aesthetic significance. Similarly, however, any efforts at skull reshaping will be exposed to the same critical eye of the patient. Thus the effectiveness of the skull reshaping and the incision needed to do it must be done with as small as a scalp incision as possible.
Case Study: This male had long been bothered by the asymmetric and flat shape of the back of his head. The left occipital area was very asymmetric to the opposite right side and the overall occipital region lacked good projection even on the better right side. Using the patient’s 3D CT scan a custom occipital implant was designed to correct both skull shape issues. The maximum point of implant projection was 13.5mm thick.
Under general anesthesia and in the prone incision, a 9 cm horizontal skin incision was made over the nuchal ridge. Wide subperiosteal undermining was done to create the implant pocket. To place the skull implant, with a horizontal side to side diameter of 24 cms, it was rolled into a burrito shape that allowed it to pass through a much smaller incision. Once inside the pocket the implant was unrolled so that all edges that were well out of view from the incision laid flat.
To help position the implant inside the pocket to give it the correct orientation, the perfusion holes commonly placed in skull implants, also provides a method to help move and rotate the implant inside the pocket.
The improvement in the skull shape was apparent on the operating room table at the end of the surgery as seen in the prone position. While perfect external head shape symmetry is never completely achieved, correction of the skull shape gets one as close as is surgically possible.
Highlights:
1) Plagiocephaly is one of the most common aesthetic skull deformities in adults.
2) Occipital plagiocephaly is often combined with some upper flattening of the bone as well.
3) A 3D custom skull implant design is the best method to correct the entire occipital skull shape.
Dr. Barry Eppley
Indianapolis, Indiana