So Your Child has a Metopic Ridge

Note: This article was originally published on medium.com.

Discovering a metopic ridge in your child yourself or being told by your doctor that she or he has a concern can be an alarming time for you as a parent. Is there something wrong with my child? How did I not notice this before? What does this mean? This can be even harder when you are told you need to see a craniofacial surgeon.

What is a cranial suture?

Babies are born with five major bones of the skull: two frontal bones, two parietal bones, and one occipital bone. Where these bones meet are called sutures. Cranial sutures are special joints of the skull bones that play several important roles in the growing child. First, sutures allow the skull bones to move during birth to allow the head to fit through the birth canal. Second, sutures allow the skull to grow quickly during the first few years of life in response to the rapidly growing brain.

When does the Metopic Suture fuse?

Child with a benign metopic ridge

Metopic suture is the name for the suture that separates the two frontal bones in the middle of your child's forehead. It is different from all the other major sutures of the skull. The other sutures fuse in the second or third decade of life. In contrast, the metopic suture normally fuses in the first year of life – between 3 and 9 months of age usually. When the metopic suture fuses, the bone next to the suture will often thicken, creating a metopic ridge. The ridge may be subtle or obvious, but it is normal and usually goes away after a few years.

What is Craniosynostosis?

Craniosynostosis is an abnormal condition when a cranial suture fuses too early. Most babies with craniosynostosis are born with a fused suture, but occasionally, children may develop craniosynostosis after birth. Craniosynostosis leads to two major problems. First, skull growth is limited at the site of a fused suture. The remaining open sutures will attempt to compensate by growing faster. This can lead to an abnormal head shape that takes on a specific pattern depending on the suture that is fused. Second, because sutures are important sites of skull growth in the first few years of life, premature fusion of a cranial suture can increase a child's risk of developing increased pressure inside the skull (intracranial hypertension). This can lead to headaches, developmental delay, and even blindness.

What is Metopic Craniosynostosis?

Metopic craniosynostosis occurs when the metopic suture fuses prematurely. Babies usually with this condition have an abnormally shaped head referred to as trigonocephaly. There is a ridge at the metopic suture, the forehead is angled instead of flat, like the front of a boat, and the eyebrow bones (supra-orbital rims) are pulled back. The eyes can also appear close together. The best way to see this abnormal shape is by looking at your child from the top where the head will appear triangular, or tear drop shaped.

How do we treat Metopic Craniosynostosis?

There are several different interventions that may be recommended to treat a child with metopic craniosynostosis. These will vary depending on the child's age, the severity of the deformity, and the philosophy of the treating surgeon. Most surgeons treat metopic craniosynostosis with an open surgery, sometimes called a cranial vault remodeling (CVR) or fronto-orbital advancement (FOA). These are two names for the same operation which involves reshaping the front of the skull including the forehead and upper portion of the eye socket to create space for the brain to grow and improve the shape of the head. These operations are typically done between 9-18 months of age and involve an ear-to-ear incision and a multi-hour operation.

What do you do if you want more information?

If you have questions or comments, or would like to learn more about craniosynostosis, please contact our office at 412-692-8650.