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What can a morphometric study of unoperated children teach us about the natural history of metopic synostosis?

Elawadly, Ahmed M; Smith, Luke P J; Borghi, Alessandro; Abdelaziz, Khaled I; Silva, Adikarige Haritha Dulanka; Dunaway, David J; Jeelani, Noor Ul Owase; Ong, Juling; Hayward, Richard D; James, Greg

What can a morphometric study of unoperated children teach us about the natural history of metopic synostosis? Thumbnail


Ahmed M Elawadly

Luke P J Smith

Khaled I Abdelaziz

Adikarige Haritha Dulanka Silva

David J Dunaway

Noor Ul Owase Jeelani

Juling Ong

Richard D Hayward

Greg James


Outcomes of surgical repair of trigonocephaly are well reported in the literature, but there is a paucity of information on the natural history of unoperated children. The authors evaluated a group of unoperated children with metopic synostosis to describe the natural change in head shape over time. A database was screened for scans of children with unoperated trigonocephaly (2010-2021). Multisuture cases and those with a metopic ridge were excluded. Three-dimensional surface scans (3D stereophotogrammetry/CT) were used for morphological analysis. Nine previously published parameters were used: frontal angle (FA30°), anteroposterior (AP) volume ratio (APVR), AP area ratio (APAR), AP width ratios 1 and 2 (APWR1 and APWR2), and 4 AP diagonal ratios (30° right APDR [rAPDR30], 30° left APDR [lAPDR30], 60° right APDR [rAPDR60], and 60° left APDR [lAPDR60]). Ninety-seven scans were identified from a cohort of 316 patients with a single metopic suture, in which the male-to-female ratio was 2.7:1. Ages at the time of the scan ranged from 9 days to 11 years and were stratified into 4 groups: group 1, < 6 months; group 2, 6-12 months; group 3, 1-3 years; and group 4, > 3 years. Significant improvements were detected in 5 parameters (APVR, APAR, APWR1, rAPDR30, and lAPDR30) over time, whereas no significant differences were found in FA30, APWR2, rAPDR60, and lAPDR60 between age groups. Forehead shape (surface area and volume), as well as narrowing and anterolateral contour at the frontal points, differed significantly over time without surgery. However, forehead angulation, narrowing, and anterolateral contour at temporal points did not show significant differences. This knowledge will aid in surgical and parental decision-making.

Journal Article Type Article
Acceptance Date Nov 21, 2023
Online Publication Date Jan 19, 2024
Publication Date 2024-04
Deposit Date Feb 7, 2024
Publicly Available Date Feb 7, 2024
Journal Journal of neurosurgery. Pediatrics
Print ISSN 0022-3085
Electronic ISSN 1933-0693
Publisher American Association of Neurological Surgeons
Peer Reviewed Peer Reviewed
Volume 33
Issue 4
Pages 374-381
Keywords craniofacial, 3D scans, synostosis, metopic, stereophotogrammetry, unoperated, natural history
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