A Novel Approach to Preventing Temporal Hollowing Using Virtual Surgical Planning and Suture Suspension of the Temporalis Muscle

Cranioplasty is a well-described technique used to restore the contour and function of calvarial defects using various alloplastic implants and autologous bone grafts. However, unsatisfactory esthetic outcomes after cranioplasty are frequently reported, specifically postoperative temporal hollowing. Temporal hollowing arises when the temporalis is inadequately resuspended after cranioplasty. Several methods to prevent this complication have been described with variable degrees of esthetic improvement, but no single method has proven superior. Herein the authors present a case report demonstrating a novel approach to resuspending the temporalis that incorporates holes in the custom cranial implant to allow for resuspension of the temporalis through suture fixation to the implant.