Certain head shapes are known to have a wide skull width. This is particularly evident in those skulls that have a brachycephalic tendency. (flat back of the head) With a flat and wide back of the head the sides are pushed outward creating a noticeable wide skull from the front and back views. This increased head width occurs at the parietal-temporal bone area also known as the parietal eminence. The parietal eminence is a prominent skull area that creates a rounded area on the external surface of the parietal bone. It is the most convex part of the parietal skull bone and becomes excessively wide and rounded when he flat back of the head.
While the definitive treatment for a brachycephalic skull shape is augmentation of the back of the head a complementary procedure is reducing the width of the head in the parietal skull area. While the bone is not overly thick in this area some reduction is possible. But besides the bone reduction this bony area is covered by the posterior aspect of the temporal muscle which also adds to the width. When feeling the parietal eminence bulge it always feels like completely solid bone and patients swear that it is solid bone….but they are not anatomically accurate. Muscle must be removed with bone for optimal width reduction.
Parietal eminence reduction can be done to help with head width reduction with or without back of head augmentation. But either way the technique for parietal-temporal reduction involves a 5 to 6cm vertical incision right over the widest part of the parietal bone. This provides direct access and initial exposure to the deep temporal fascia. The fascia is vertically split to expose the muscle. Going under the fascia the temporal muscle is dissected out as far forward as can be seen and removed by electrocautery. This then exposes the bulging bone.
Before doing the bone reduction with a high speed drill and burr the hair is protected by stapling gauze sponges to the incision edges. The shaft of the high speed is also covered by a plastic sleeve as another maneuver to protect the hair. The bone is then reduced as much as safely possible over a wide area of the parietal eminence. The incision is then closed over a drain with resorbable sutures.
The procedure is performed bilaterally and, together, will result in a bi-parietal skull width of 10mm or more. But more importantly than numbers one can see a visible difference.
When the parietal-temporal skull reduction is performed as an isolated procedure the custom back of head implant can be placed through the existing vertical scar lines. When done with an implant the incisional access to place it is the same.
Dr. Barry Eppley
World-Renowned Plastic Surgeon