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Mild metopic craniosynostosis differs from other forms of single suture craniosynostosis in its severity levels: mild, moderate, and severe. These categories are not always straightforward, but they often relate to the forehead's shape. Moderate and severe cases of premature frontal suture closure typically result in a noticeable triangular head shape, along with crossed eyes and pseudoproptosis. Surgery is generally advised for these cases due to the abnormal appearance and high risk of increased intracranial pressure, which can impact the baby's development.
In contrast, mild premature frontal suture closure often lacks obvious visual signs. It requires an experienced craniofacial surgeon or pediatric neurosurgeon to assess it visually. The forehead does not appear triangular, and its curve remains quite normal. The only potential issue is a slight depression above the outer eyebrows on both sides. Typically, mild cases are identified when developmental delays emerge after the first year of age, prompting referral to a specialist.
The metopic suture is the first to close, usually by around eight months. After this age, diagnosing mild premature frontal suture closure via skull X-rays or CT scans becomes difficult unless the physician is highly experienced. If a diagnosis is made earlier through imaging—showing closure without visible signs—what should be done?
Globally, there's no universal agreement on treating mild premature frontal suture closure. A 2015 study in the Journal of Craniofacial Surgery surveyed craniofacial surgeons and pediatricians in the United States. Seventy-two specialists responded, focusing on cases diagnosed at 3-4 months. For mild cases, 53% opted for continued observation without intervention. Among those choosing surgery, 25% selected fronto-orbital advancement after six months, 15% preferred endoscopic cranioplasty, and only 1.6% chose simple cranioplasty.
During training at a children's hospital, the approach emphasized that mild cases diagnosed after six months should be monitored without immediate action.
Research from Japan on patients with mild premature frontal suture closure, referred after one year due to developmental issues, found no problems before that age, but intracranial pressure can rise afterward. Surgery in these cases yields improvement rates of 80-90%, with better outcomes the earlier it's performed. Specific improvements include:
The Japanese study defined mild cases as having a relatively normal forehead with shallow central protrusions, versus moderate cases with a narrower forehead and more pronounced protrusions, confirmed by CT scans showing narrowed frontal space.
Based on current evidence, for mild metopic craniosynostosis, close monitoring is recommended. If developmental or behavioral issues arise, early surgical intervention can be considered.