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Background: The occipital knob is for many one of the most smallest of the aesthetic skull deformities. While its surface area is relatively small the degree of protrusion it creates can be significant. Besides its aesthetic prominence it can also cause some discomfort for some when laying on it and be an impediment in the wearing of some headgear such as helmets.

By far patients that present for occipital knob reduction are overwhelming men who have very short hair or shave their heads. Far less common are women or men that have longer hair. But when a male presents with significant hair coverage it is because they keep their hair longer to hide it. They are well aware of its existence and their goal is to get it reduced so they can wear their hair shorter.      

Case Study: This male had a prominent occipital knob that was completely camouflaged by his hair. But he preferred to wear his hair much shorter but couldn’t because it stuck out prominently.

Under general anesthesia and in the prone position a small horizontal incisions was made right over the knob paralleling the exist of the hair shafts from the scalp. The knob was not only raised as a central prominence but it also has a sharp rim of bone around the bottom of it.

In reducing the knob the bone must be taken around he bottom of the back of the skull which requites release of some of the fibers of the splenius capitus and trapezius muscle fibers. This allows the bottom half of the knob to be adequately removed by high speed bone burring.

Good reduction of the prominent occipital knob can be dine through a small scalp incision that does not need to be shaved or have the hair removed. Getting a good occipital knob reduction requires getting to the understate of the knob though some muscle fiber release.

Case Highlights:

1) Short hair can make an occipital knob skull deformity more prominent.

2) Reduction of an occipital knob can be done without having to shave or remove hair.

3) Adequate reduction of an occipital knob requires turning the corner and getting on the underside of the bone’s surface.

Dr. Barry Eppley

Indianapolis, Indiana

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