Temporal reduction is a very effective procedure for reducing an undesired width excess on the side of the head. Patients so affected can have a head referred to a ‘light bulb’ shape, an excessive convexity above the ears seen in the front and back views. While there may be a bony component to it the most treatable component is the muscle. As a result temporal reduction involves partial removal of the temporalis muscle. Specifically the portion of the muscle that sits over the convex portion of the temporal bone. (referred to as the posterior temporal muscle)
The posterior temporal muscle has its origin along the bony temporal line at 6the occipital and parietal bones. At its most posterior-superior point lies the parental eminence. Also known as the parietal tuberosity this is a rounded convex area of the parietal bone and helps give the skull its rounded appearance. This is the location of where the parietal bone begins development in the embryo. With posterior temporal muscle removal this parietal eminence can become more prominent with loss of muscle cover. As a result it may be necessary to reduce this small bony prominence.
While a small incision can be made directly over the parietal eminence for reduction it would be preferable to do so from the same incision used for the muscle removal. This can be done using large-toothed rasps on long handles. They can be placed through the post auricular incision and can reach back to the parietal eminence. With back and forth motion pressing down on the end of the rasp one can remove a good 2 to 3mms of bone off of the eminence. While this is not as productive as high speed burring it can be a good complement to the posterior muscle removals without adding an exposed scalp incision/scalp scar.
In the effort to maximize the reduction of one’s head width most patients think/aski about temporal bone reduction along with the muscle removal. Because the convex part of the temporal bone is so thin there is little width reduction to be gained…not too mention that an exposed incision would be needed along the side of the head to do so. But the parietal eminence is different as it creates a small peak of bone that adds to the projection of the side of the head seen in the oblique view. Softening its projection by scarless rasping can be a good adjunct to the temporal reduction procedure.
Dr. Barry Eppley
World-Renowned Plastic Surgeon