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The shape of the skull can be affected by a variety of irregularities that cause various elevations and depressions. Some of these are natural, some have occurred from minor amounts of trauma and other have been directly caused by some form of surgery. Most of these are modest in size and can always be felt and sometimes seen based on hairstyle. I find that patients are bothered as much by minor elevations just as much as they are by depressions.

Small depressed skull areas can be augmented by a variety of techniques and materials. Injectable techniques using fat or small amounts of injectable cement may be effective but are highly prone to resorption (fat) or irregularities. (bone cements) Making a small incision and placing a non-resorbable implant offers the most reliable method of achieving a smooth fill of small skull defects…providing the implant material has the right characteristics.

Having used every available implant material over decades of clinical practice, the most user friendly and effective is ePTFE sheets for augmenting small skull depressions. It comes in 1 and 2mm sheets which are easily cut to any desired shape and the edges can be crimped to a feather edge.

It is easiest to place cut ePTFE implants though a scalp incision that is the same diameter as the needed implant. But in the spirit of making the smallest scalp incision possible, ePTFE can be folded for insertion. Once in the dissected pocket it needs to be unfolded and positioned. If needed multiple layers can be placed for additional augmentation thickness.

ePTFE has a material advantage of tissue adherence. It has a long track history of successful use in subcutaneous sites on the nose and for facial bone augmentation. Its rapid tissue adherence to its microporous surface ensures its positional stability.

ePTFE implants work well for small skull defects but the key word is …small. With larger defects or depressions a different material approach is needed which may be better served with a 3D computer designed skull implant.

Dr. Barry Eppley

Indianapolis, Indiana

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