Craniosynostosis & Craniofacial Surgery

Metopic Synostosis
Metopic synostosis occurs when the suture in the
middle of the forehead closes too early. This gives
an infant a forehead that often looks pointed or
triangular from above. The sides of the forehead
appear pinched causing the eyes to look like they
are too close together (hypotelorism). Sometimes
you may be able to feel a ridge in the middle of the
forehead. Your doctor or surgeon may call this type
of head shape “trigonocephaly” (Figure 9).
Surgery is required. The goal of the surgery is to
open the suture that is closed and to restore the
natural shape of the forehead (Figure 10). A wavy
incision is made over the top of your child’s head
from ear to ear. The neurosurgeon removes the
skull and dissects the bone from the brain. The
plastic surgeon removes the bones of the forehead,
reshapes them and puts them back in place often
with absorbable plates.
After surgery to repair metopic synostosis it may
seem that your child’s forehead protrudes or sticks
out too much, especially at the outer edges. Just
as in coronal synostosis mentioned previously,
this is done on purpose by the surgeon and called
overcorrection. Overcorrection is necessary to
make the forehead bone look more natural over
time. After surgery, forehead bones will recede
or move back toward their original position from
the tension of the overlying skin and scalp. The
surgeon intentionally overcorrects so that the
movement back returns the forehead to a natural
shape. This often takes 6 to 18 months. Try not to
be alarmed when you see overcorrection in your
child’s forehead.
Fused
metopic
suture
Front
Absorbable
plate
Back
Supraorbital
bar
Figure 9. Trigonocephalic head viewed from above.
Figure 10. Frontal orbital advancement: the surgeon removes the
bone of the forehead as well as supraorbital bar and advances the
forehead to allow for growth of the brain, and to allow the skull to
resume a more normal shape.
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