The new technique entails cutting a round hole out of the skull. A trough is then cut, extending from the original hole, making the entire hole shaped like a lollipop. A screw is then placed into the round end of the hole, head first. The threads of the screw remain sticking out, leading to the dubbing of the procedure as the inside-outside technique, Dr. Pait said. The screw is then slid along to the foot of the trough.
Bone graft is used to fill the hole, and a metal plate is then fitted over the screw.
The screw and the plate are locked into place with a bolt. Dr. Pait believes having the point of the screw sticking out is safer than the traditional approach. So far, the new approach has been used on 21 patients ranging in age from four to 80. The head and neck is a unique arrangement which moves hundreds of times an hour. That movement is provided by a very intricate connection between bones, ligaments and muscles.