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Background: Elective skull augmentations are done for a variety of indications most of which are due to aesthetic head shape concerns. Such concerns are simply the way the head developed without any specific reason why. But one event after birth that can change the shape of the head is invasive skull surgery, specifically craniotomies. They usually result in indentations and skull contour defects due to loss of bone or soft tissue thickness. Smoothing them over with bone cements or custom skull implants are effective methods of contour restoration.

Rarely a craniotomy can be the source of changing the way the rest of head shape is perceived. Such can be the case of orbital box osteotomies. Using a coronal incision and a frontal craniotomy, orbital box osteotomies can be used to widen or decrease the distance between the eyes in adults. When used to widen the eyes this may make the side of the forehead and temporal regions appear more narrow. Increasing these head shape dimensions require a custom skull implant.   

Case Study: This male had a prior orbital box osteotomy to increase the distance between the eyes. While interorbitally effective he felt his temporal and forehead was now too narrow. He also wanted to provide some additional skull height as well. Using his 3D CT scan a custom skull implant was designed to address all off his head shape concerns. Because of its surface area coverage and volume (210ccs) it was designed in two pieces even though a full coronal scalp scar would be used for the surgery. 

Under general anesthesia and using the full extent of the existing scalp scar, the skull was exposed from the brow bones to the back of the head including the sides of the head on top of the temporal muscles. The previous craniotomy burr hole covers were seen but left in place since it is doubtful the burr holes had filled with bone. The two piece skull implant was placed and put together with large sutures and secured at edge locations with screws.

His three month result showed a healed scalp incision and an improvement in his forehead and temporal widths.

Custom skull implants for aesthetic head reshaping can be designed to achieve a wide variety of dimensional increases. The amount of surface area coverage they can cover are only limited by the length of the incision needed to place it and whether its volume is within what the scalp can stretch to accommodate it. Smoothing over irregular skull areas or making the skull bigger on multiple surfaces in a smooth fashion is one of the great benefits of contemporary custom skull implant technology.

Case Highlights:

1) Custom skull implants can be used to smooth over prior craniotomy sites as well as having an expansive effect.

2) In orbital box osteotomies for increasing interorbital width this may make the bitemporal width appear too narrow.

3) Large custom skull implants usually have to be designed to be placed in two pieces, even if one has a wide open coronal scalp incisional exposure. 

Dr. Barry Eppley

Indianapolis, Indiana


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