Metopic Synostosis Trigonocephaly

Did you know that your baby’s skull isn’t a single, solid entity — it’s actually made up of several bony plates? Between those plates are fibrous joints called sutures.

Normally, the sutures in a developing infant’s skull fuse in a gradual process over time. However, sometimes the fusing occurs too early. This is a medical problem known as craniosynostosis.

Mark Proctor, MD - Chief, Department of Neurosurgery

One type of craniosynostosis is called metopic synostosis (also referred to as trigonocephaly or metopic suture craniosynostosis). A prominent ridge along the forehead by itself is often a normal finding, but children with metopic synostosis from premature fusing of the metopic suture have a triangular shape to the forehead. To summarize with metopic synostosis:

  • They have a noticeable ridge along their foreheads.
  • They will also have a pointed, almost triangular shape to the front and top of their skulls and eyes that appear too close together.

As with any type of craniosynostosis, metopic synostosis can carry a risk of other complications, but it’s important to remember that every child is different, and the condition can vary widely in its severity.

Here are a few more important facts about metopic synostosis:

  • Metopic synostosis can be quite mild in some children and fairly serious in others.
  • There is no single proven cause for metopic synostosis.
  • Metopic synostosis is often noticeable at birth, but can also become apparent over time in older infants.
  • Metopic synostosis and other types of craniosynostosis should not be confused with plagiocephaly — a different condition that is associated with the baby’s position during sleep. 
  • Children with more serious instances of metopic synostosis can experience problems with vision, learning, and behavior.
  • Some children with just a ridge or mild metopic synostosis don’t need any medical treatment. For those who do, surgery has proven to be a successful approach.

How Boston Children’s Hospital approaches metopic synostosis

Boston Children’s treats hundreds of patients with metopic synostosis and other types of craniosynostosis every year in our Craniofacial Program.

Drawing on our extensive experience treating these disorders in young patients, we will use a multidisciplinary approach to ensure the right treatment for your child's specific symptoms and circumstances.

If, after evaluation, your child is determined to need treatment for his metopic synostosis, members of his Craniofacial Program care team may include:

  • neurosurgeons, who perform surgical procedures on a child’s brain, spinal cord or nerves
  • plastic surgeons, who diagnose and surgically correct skeletal abnormalities of the skull, facial bones, and soft tissue
  • neurologists, who diagnose, treat, and manage conditions affecting the nervous system
  • oral and maxillofacial surgeons, whose surgical procedures to correct injuries or deformities of the mouth, jaws, face, and skull
  • audiologists, who diagnose, evaluate, and implement treatment approaches for a child’s hearing problems
  • neuroscience nursing professionals, who combine expertise in all aspects of pediatric nursing with a focus on the neurosciences, and act as liaisons between a child’s family and clinical treatment team
  • speech therapists, who evaluate a child’s communicative abilities and formulate treatment plans to enhance and improve speech and language
  • physical therapists, who help children recover, return to their previous level of function, or learn to work within their functional limitations
  • dentists, who maintain a child’s oral health 
  • orthodontists, who evaluate the position and alignment of a child’s teeth and help design corrective treatment plans as needed
  • otolaryngologists, who are “ear-nose-throat specialists” who help manage a child’s ear infections, hearing loss, and other related issues that may be tied to a craniofacial abnormality
  • ophthalmologists, who evaluate vision problems and formulate medical or surgical treatment plans to improve or restore vision
  • psychiatrists, who assess a child’s psychosocial functions and behavioral development and can prescribe psychiatric medications if necessary
  • psychologists and social workers, who help children and families express and cope with feelings like worry, fear, frustration, anger and sadness

Working together, our team will develop a customized treatment plan that meets your child's physical, emotional, and social needs — and one that involves you and your family at every step of the way.

Metopic synostosis: Reviewed by Mark R. Proctor, MD

© Boston Children’s Hospital; posted in 2012