There are times when a child is born with a convex groove in the middle of the forehead. Sometimes such an education appears in the first year of life. In this case, the baby's skull has a triangular shape. Such defects may be associated with early overgrowth of the metopic seam. Can this anomaly affect the health and development of children? Is such a pathology curable? We will answer these questions in the article.
What it is
The frontal bone of the skull consists of two parts. They are connected by a metopic seam. Normally, it remains completely open in infants up to 1 year. In the future, the seam begins to overgrow, this process continues until the age of 8 years.
However, sometimes the connection of the frontal bones overgrows in the prenatal period or in the first year of life. In this case, a metopic suture on the forehead is noticeable in the baby. Such a formation looks like a convex ridge that runs from the superciliary arches to the large fontanel. In this case, the child has an irregular shape of the skull. Doctors call this anomaly synostosis of a metopic suture or trigonocephaly.
Causes
Why is the suture between the frontal bones closed prematurely? The following reasons can provoke its early overgrowth:
- Heredity. In approximately 2-8% of cases, this disease is transmitted from parents. The cause of metopic synostosis is damage to the gene responsible for the growth of connective tissue.
- Chromosomal abnormalities. Premature overgrowth of the metopic suture may be only one of the manifestations of serious genetic pathologies. This deviation is observed in children with Jacobsen syndrome and Opitia trigonocephaly syndrome. In this case, not only synostosis and deformation of the skull are observed, but also abnormalities of the internal organs, as well as a delay in mental development.
- Hypoxia of the fetus. A lack of oxygen in the prenatal period can provoke premature overgrowth of the suture.
- Prematurity. Babies born prematurely have an increased risk of trigonocephaly.
Symptomatology
The metopic seam in a child is a convex groove in the middle of the forehead. It starts on the bridge of the nose or between the eyebrows and ends in the crown area. In this case, the volume of the frontal lobes of the skull in children decreases and the proliferation of the parietal bones is noted. Because of this, the baby's head has a triangular shape.
A photo of the metopic seam can be seen below.
Often, parents confuse the manifestations of synostosis with the usual bump on the forehead. With trigonocephaly, the groove has a solid structure. A bruising hematoma is a mild formation.
Close-set eyes are one of the signs of trigonocephaly. Doctors call this defect hypothelorism. The distance between the eyeballs decreases due to deformation of the skull.
A convex metopic seam in an adult patient can also be a manifestation of synostosis. If trigonocephaly was not treated in childhood, then the groove on the forehead, the triangular shape of the skull and hypothelorism remain throughout life. This disease lends itself well to correction in a child. Correcting such a defect in an adult is much more difficult.
However, it is important to remember that the bulge in the middle of the forehead does not always indicate a disease. In some people, this is an anatomical feature. If a person has a seam on his forehead, but there is no deformation of the skull, then there is no reason for concern.
Effects
Metopic seam is not only an aesthetic problem. In advanced cases, deformation of the skull leads to pinching of the optic nerve and eye muscles. This leads to the appearance of ophthalmic pathologies:
- strabismus;
- exophthalmos (bulging eyeballs);
- decrease in visual acuity.
In addition, early closure of the suture between the frontal bones leads to an increase in intracranial pressure. This is expressed in frequent headaches, dizziness, nausea. Many babies with metopic synostosis suffer from hydrocephalus, a pathological increase in head volume.
If trigonocephaly is not treated in early childhood, then in 15-20% of cases this disease leads to a delay in mental development. Intellectual disorders occur only at the age of 7-8 years. The child has problems with memorization, it becomes difficult for him to learn new material, which creates serious problems in learning. Mental retardation is more often observed in children suffering from high intracranial pressure.
Diagnostics
The treatment of trigonocephaly is carried out by a neurologist. If the pathology in a child or adult is accompanied by damage to the organ of vision, then an ophthalmologist consultation may be required.
External manifestations of metopic synostosis can be noted already during the examination of the patient. As already mentioned, trigonocephaly can be either a separate disease or one of the signs of chromosomal abnormalities. Therefore, the patient must undergo a comprehensive diagnosis. The doctor may prescribe the following examinations:
- Spiral CT scan of the skull in 3D. This is the most accurate method for detecting metopic synostosis. The procedure is carried out when the baby is sleeping.
- Neurosonography (ultrasound of the skull). This study is usually prescribed for children under the age of 1 year. The procedure is absolutely painless and harmless. It shows anomalies in the structure of the cranial bones and the condition of the sutures.
- MRI of the head. This study is more often prescribed for children of primary school age to identify the causes of cognitive impairment.
In addition, they measure the distance between different parts of the face. This helps to identify hypothelorism and deformations of the facial part of the skull.
Additionally prescribed ECG, MRI of the spine and ultrasound of the digestive tract. This allows you to identify signs of chromosomal diseases, which are often associated with trigonocephaly.
Surgical intervention
Completely eliminate the protruding seam on the forehead is possible only with the help of surgery. Surgical intervention is carried out in a hospital.
Surgery is only necessary if trigonocephaly is confirmed by spiral CT in 3D. If a premature overgrowth of the suture is noticeable in a three-dimensional image, then this is considered an indication for surgical treatment.
Experts recommend doing this operation to a child aged 4-6 months. Surgery is performed under general anesthesia. The doctor cuts the fused seam and inserts special plates that support the bones of the skull in the correct position. The operation lasts about 4 hours.
After correction of metopic synostosis in children, the normal structure of the skull is restored and deformations disappear. In the photo below you can see the results of surgery. The left picture shows the child before the operation, and the right picture 2 years after the defect has been removed.
After operation
The recovery period after surgery lasts quite a long time. In the first 2-7 days after correction of synostosis, the child is in the hospital. After surgery, hematomas and swelling in the eye area may appear. This is a natural phenomenon that passes quickly.
There are times when synostosis recurs after correction. Therefore, doctors recommend that the child wear a special orthopedic helmet in the postoperative period. This device helps prevent cranial deformity.
In the first year after surgery, children should be under medical supervision. During this time, you must regularly visit a doctor and periodically do a spiral computed tomography of the head in 3D. This will help to track the recurrence of the disease in time.
Is it possible to do without surgery
Often, parents of children are interested in: "Is it possible to cure synostosis without surgery?" This is possible only with mild forms of trigonocephaly, if the child has only a cosmetic defect, but there are no functional impairments.
In such cases, an orthopedic helmet is used. It must be worn for at least 20 hours a day. The duration of treatment may be different, depending on the severity of synostosis. The helmet-orthosis allows you to adjust the existing defects in the formation of the skull. This device compresses only deformed areas and does not interfere with the natural growth of healthy bones.
Conclusion
It can be concluded that metopic synostosis not only spoils the appearance of the child, but also poses a threat to the health and development of the baby. Therefore, such a pathology must be cured on time. If the doctor suggests performing a surgical correction of trigonocephaly, then you should not refuse surgery. This will help to avoid future neurological disorders and vision problems.