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Background: Plagiocephaly is the most recognizable type of skull deformity. It is usually associated with infants and children because this is when non-surgical and surgical treatments would be most effective to partially or totally reverse the abnormal skull shape. But many more patients affected by plagiocephaly never receive treatment or fail to get substantial improvement when they are young (particularly with helmet therapies)…often told they would grow out of it.

While plagiocephaly affects the entire skull, and even the face, it presents most significantly on the back of the head. One side will be flatter, more frequently the right side, which extends forward into the posterior temporal region just above and behind the ear. For those affected they frequently describe it as if part of the back of their head was cut off.

As an adult with plagiocephaly it is often bothersome particularly in men because of shorter hairstyles. They frequently wear longer hair to help hide it or cover it with hats or caps. I have heard many a male plagiocephaly patient tell me that they never go out or leave their home without a head covering. The goal of surgical correction is to make that lifestyle change…to go out without the concern or need to cover their head .     

Case Study: This male has an aesthetically bothersome flat back of his right head. He fell into the category of patients who always wore a hat with the goal of having the luxury to not do so without worry.

Using his 3D CT scan a custom right back of the head implant was designed to match that of his left side. It is necessary touring its further around to the side that one might initially think. There is also the consideration of the thickness of the scalp which will be thinner one the flatter side. That may factor into the thickness of the implant at the maximum projection area by an additional 1mm over that of what the bone symmetry would be.

The other important issue to consider is what the volume of the skull implant is. The scalp is naturally tighter particularly in the flatter side. Implant volumes under 150ccs will be able to be placed in most patients. His implant volume was 96ccs.

Under general anesthesia and in the prone position a 9cm long horizontal scalp incision was made just above the nuchal ridge. Long dissecting instruments were used to make the subperiosteal pocket up across the top of his head and on the deep temporal fascia on the right side of his head. The implant was inserted, positioned and screwed into place. The scalp was extremely tight and getting the implant through the incision and into position was anything but easy.

His immediate result showed the improvement in the roundness of his flat right back of his head.

The most common reason men see skull augmentation is for asymmetries or flatness on the back of their heads.

Case Highlights:

1) The most common aesthetic presentation of plagiocephaly is a flat back of the head which occurs more frequently on the right side.

2) A custom skull implant can correct the flat back of the head within the limits of the stretch of the scalp.

3) The plagiocephalic skull implant is placed through a low horizontal scalp incision.

Dr. Barry Eppley

Indianapolis, Indiana

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