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Physiologic closure time of the metopic suture in South Australian infants from 3D CT scans

  • Sophie Jane Teager
  • Sarah Constantine
  • Nicolene Lottering
  • Peter John Anderson
Original Paper

Abstract

Metopic synostosis is a craniofacial condition characterised by the premature fusion of the metopic suture. This early fusion restricts frontal bone growth [17] and has significant impacts on the developing infant during a critical phase of rapid growth and development [4]. Diagnosis of the condition is usually achieved by clinical assessment, followed by a three-dimensional computed tomography (3D CT) scan, verifying premature metopic suture fusion.

Purpose

This retrospective study aims to investigate the timing of metopic suture fusion in the developing infant in an Australian subpopulation.

Methods

The study evaluates metopic suture fusion in 258 cranial 3D CT scans of children aged 0–24 months over a 5-year period (2011–2016), scanned at Women’s and Children’s Hospital.

Results

The findings suggest that the age range over which physiologic metopic suture fusion occurs is larger than previously reported.

Conclusions

The approximate range for physiologic fusion was found to be 3–19 months and patients with fusion within this range can be considered normal. Complete suture fusion is expected by 19 months. Additionally, results indicate suture fusion prior to 3 months is abnormal and diagnostically indicative of metopic synostosis.

Keywords

Craniosynostosis Metopic synostosis Trigonocephaly Suture biology 

Notes

Acknowledgements

The authors would like to thank the Australian Craniofacial Unit and Women’s and Children’s Medical Imaging Unit for their assistance in providing patient records and their ongoing support throughout this study. In addition, the authors are grateful for the support of the Women’s and Children’s Health Network Human Research Ethics Committee for providing ethical approval for the study (Audit 838A, 2016). Written informed consent was obtained from the form parent/LAR of the patient for publication of any accompanying images (Fig. 1b).

Author contributions

S.J. Teager: project development, data collection, data analysis and manuscript writing

S Constantine: data analysis and interpretation

N Lottering: data analysis and manuscript editing

P J Anderson: project development, manuscript editing

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Bajwa M, Srinivasan D, Nishikawa H, Rodrigues D, Solanki G, White N (2013) Normal fusion of the metopic suture. J Craniofac Surg 24:1201–1205.  https://doi.org/10.1097/SCS.0b013e31829975c6 CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Boyadjiev SA, International Craniosynostosis C (2007) Genetic analysis of non-syndromic craniosynostosis. Orthod Craniofac Res 10:129–137.  https://doi.org/10.1111/j.1601-6343.2007.00393.x CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Cohen SR, Maher H, Wagner JD, Dauser RC, Newman MH, Muraszko KM (1994) Metopic synostosis: evaluation of aesthetic results. Plast Reconstr Surg 94:759–767CrossRefPubMedCentralGoogle Scholar
  4. 4.
    Da Costa AC, Anderson VA, Savarirayan R, Wrennall JA, Chong DK, Holmes AD, Greensmith AL, Meara JG (2012) Neurodevelopmental functioning of infants with untreated single-suture craniosynostosis during early infancy. Childs Nerv Syst 28:869–877.  https://doi.org/10.1007/s00381-011-1660-1 CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Di Rocco C, Velardi F, Ferrario A, Marchese E (1996) Metopic synostosis: in favour of a “simplified” surgical treatment. Childs Nerv Syst 12:654–663CrossRefPubMedCentralGoogle Scholar
  6. 6.
    Flaherty K, Singh N, Richtsmeier JT (2016) Understanding craniosynostosis as a growth disorder. Wiley Interdiscip Rev Dev Biol 5:429–459.  https://doi.org/10.1002/wdev.227 CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Kapp-Simon KA, Figueroa A, Jocher CA, Schafer M (1993) Longitudinal assessment of mental development in infants with nonsyndromic craniosynostosis with and without cranial release and reconstruction. Plast Reconstr Surg 92:831–839 discussion 840-831CrossRefPubMedCentralGoogle Scholar
  8. 8.
    Kim HJ, Rice DP, Kettunen PJ, Thesleff I (1998) FGF-, BMP- and Shh-mediated signalling pathways in the regulation of cranial suture morphogenesis and calvarial bone development. Development 125:1241–1251PubMedPubMedCentralGoogle Scholar
  9. 9.
    Kosty J, Vogel TW (2015) Insights into the development of molecular therapies for craniosynostosis. Neurosurg Focus 38:E2.  https://doi.org/10.3171/2015.2.FOCUS155 CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Lattanzi W, Barba M, Di Pietro L, Boyadjiev SA (2017) Genetic advances in craniosynostosis. Am J Med Genet A 173:1406–1429.  https://doi.org/10.1002/ajmg.a.38159 CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Lattanzi W, Bukvic N, Barba M, Tamburrini G, Bernardini C, Michetti F, Di Rocco C (2012) Genetic basis of single-suture synostoses: genes, chromosomes and clinical implications. Childs Nerv Syst 28:1301–1310.  https://doi.org/10.1007/s00381-012-1781-1 CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Lee HQ, Hutson JM, Wray AC, Lo PA, Chong DK, Holmes AD, Greensmith AL (2012) Changing epidemiology of nonsyndromic craniosynostosis and revisiting the risk factors. J Craniofac Surg 23:1245–1251.  https://doi.org/10.1097/SCS.0b013e318252d893 CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Lloyd MS, Buchanan EP, Khechoyan DY (2016) Review of quantitative outcome analysis of cranial morphology in craniosynostosis. J Plast Reconstr Aesthet Surg 69:1464–1468.  https://doi.org/10.1016/j.bjps.2016.08.006 CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Lottering N, MacGregor DM, Alston CL, Watson D, Gregory LS (2016) Introducing computed tomography standards for age estimation of modern Australian subadults using postnatal ossification timings of select cranial and cervical sites. J Forensic Sci 61(Suppl 1):S39–S52.  https://doi.org/10.1111/1556-4029.12956 CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Manzanares MC, Goret-Nicaise M, Dhem A (1988) Metopic sutural closure in the human skull. J Anat 161:203–215PubMedPubMedCentralGoogle Scholar
  16. 16.
    Sidoti EJ Jr, Marsh JL, Marty-Grames L, Noetzel MJ (1996) Long-term studies of metopic synostosis: frequency of cognitive impairment and behavioral disturbances. Plast Reconstr Surg 97:276–281CrossRefPubMedCentralGoogle Scholar
  17. 17.
    van der Meulen J (2012) Metopic synostosis. Childs Nerv Syst 28:1359–1367.  https://doi.org/10.1007/s00381-012-1803-z CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Vu HL, Panchal J, Parker EE, Levine NS, Francel P (2001) The timing of physiologic closure of the metopic suture: a review of 159 patients using reconstructed 3D CT scans of the craniofacial region. J Craniofac Surg 12:527–532CrossRefPubMedCentralGoogle Scholar
  19. 19.
    Wall SA, Thomas GP, Johnson D, Byren JC, Jayamohan J, Magdum SA, McAuley DJ, Richards PG (2014) The preoperative incidence of raised intracranial pressure in nonsyndromic sagittal craniosynostosis is underestimated in the literature. J Neurosurg Pediatr 14:674–681.  https://doi.org/10.3171/2014.8.PEDS1425 CrossRefGoogle Scholar
  20. 20.
    Weinzweig J, Kirschner RE, Farley A, Reiss P, Hunter J, Whitaker LA, Bartlett SP (2003) Metopic synostosis: defining the temporal sequence of normal suture fusion and differentiating it from synostosis on the basis of computed tomography images. Plast Reconstr Surg 112:1211–1218.  https://doi.org/10.1097/01.PRS.0000080729.28749.A3 CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.School of Dentistry`The University of AdelaideAdelaideAustralia
  2. 2.Department of Medical ImagingWomen’s and Children’s HospitalNorth AdelaideAustralia
  3. 3.School of MedicineUniversity of AdelaideAdelaideAustralia
  4. 4.Australian Craniofacial UnitAdelaideAustralia

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