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Skull reshaping surgery uses a variety of augmentative and reductive techniques to treat a large number of aesthetic deformities. One such skull shape problem that is commonly treated is the sagittal crest or ridge deformity. This is a thickened midline of bone that runs between the original anterior and posterior fontanelles. It can extend completely between or only cover a part of the sagittal suture’s midline distance. Most commonly the ridge is located at the posterior half of the sagittal suture line and extends anteriorly from the crown area.

The sagittal ridge skull deformity is treated by a burring reduction technique. Because it is usually thickened bone it can be safely reduced enough to lessen or eliminate its prominence. One of the keys to the procedure is that the incision needed for access to do the procedure must be limited in size for aesthetic reasons. Since most of the patients who undergo the procedure are men and may have limited hair coverage, there is an important need for a discrete incision and eventually imperceptible scar.

The sagittal ridge skull reduction procedure can be done through a 3.5 cm incision. This is large enough to permit retractors to be placed through which a high speed handpiece and burr can be placed. But the length of the sagittal ridge that can be adequately reached through this incision is limited and where it is placed along the length of the ridge is of critical importance.

Because the skull is a curved surface and the instruments used to reduce the sagittal ridge are straight, the incision is often best not placed at its most posterior extent. If the posterior sagittal crest extends around the curve of the crown area, the  incision needs to be placed closer to the middle of the crest. By so doing the effect of the curved shape of the skull is negated.

While it is ideal to place the incision for sagittal ridge skull reduction at its most posterior extent, this is not always possible. Fortunately such scalp incisions heal extremely well often to the point of imperceptibility.

Dr. Barry Eppley

Indianapolis, Indiana

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