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One aspect of skull reshaping surgery are reductive procedures. This could be the removal of bone or muscle depending upon where the skull shape excess exists. Most skull reduction surgeries involve the removal of bone and they consist of either larger surface areas to reduce an overall prominence or are more of a ‘spot reduction’ of specific high spots or ridges.

Parietal EminenceOne such area of spot skull reduction is that now as the ‘parietal eminence’. The parietal bones of the skull are large sides bones that make up much of the side and back part of the top of the head. Crossing in the middle of the bone is a small curved ridge known as the superior temporal line to which is attached the temporalis fascia. At the back end of the bone is a more vertical and smaller ridge known as the inferior temporal line which indicates the upper limit of the muscular origin of the temporals muscle. Near the junction of the superior and inferior temporal lines is the parietal eminence. Also known as the parietal tuber, it is where ossification started for bone formation.

The parietal eminence can be a spot area of the skull that is aesthetically bothersome due to its protrusion. Having reduced it many times I have made some observations about its successful surgical resolution. Reduction of the parietal eminence bone is a fundamental element of its treatment and this is done by a burring technique. The bone is thick enough that a significant reduction can be obtained. As an isolated skull issue that can be done a small vertical incision over it. In other larger skull procedures a more wide open incision provides unimpeded access to it.

Posterior Temporal Muscle and Parietal Skull Reduction intraop Dr Barry Eppley Indianapolis_edited-2Posterior Temporal Muscle Resection and Parietal Skull reduction intraop bnefore and after Dr Barry Eppley IndianapolisBut a part of the parietal eminence is covered by the very superior origin of the temporalis muscle. Not only does the muscle cover a part of the parietal eminence but it is also responsible for contributing to some fullness in the general region. For this reason it can be helpful to remove the posterior portion of the temporalis muscle as well as the parietal eminence skull reduction. This can be illustrated in an actual patient who was having many other skull procedures done through a larger coronal incision. In this example the thing effect of the muscle removal can be seen as a complement to the bone reduction.

As an isolated procedure parietal eminence skull reduction through a limited vertical incision can still accomplish both the bone and muscle removal.

Dr. Barry Eppley
Indianapolis, Indiana

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