Pediatric Metopic Synostosis

What is Pediatric Metopic Synostosis?

Metopic craniosynostosis (also referred to as trigonocephaly or metopic suture craniosynostosis) is more common than previously recognized. Approximately 20-25 percent of craniosynostosis cases involve the metopic suture. The head shape that results from the closure of this suture is called trigonocephaly, because of the triangular shape of the skull with an abnormally pointed, narrow forehead and wide, flat back of the skull.


The severity of head shape and appearance changes in metopic craniosynostosis ranges from thickening of the suture, causing a ridge in an otherwise normal skull, to the most severe, with a severely pointed forehead. The most severe have:

  • A narrow forehead with a noticeable ridge in the midline
  • Eyes that are too close to each other, with eyelid folds that cover the inside corners of the eyes (epicanthal folds)

See Before and After Photos

How is Pediatric Metopic Synostosis treated?

There has been increased interest in using extended strip craniectomy with post-operative helmeting in patients with metopic synostosis. We feel that this approach may undercorrect the abnormal contour of the eye sockets and forehead when compared to the degree of improvement seen in open cranial vault procedures. In general, we use a fronto-orbital advancement tailored to a patient’s deformity.

This approach allows widening and reshaping of the forehead and moving the upper part of the eye sockets and temple areas to correct the “pinched” appearance to the forehead. Bone from the back of the skull is fixed into position to widen the forehead using absorbable plates to allow for this reshaping. Surgery overcorrects the width of the forehead so the patient will “grow into” his or her forehead. Again, the goal is to achieve a normal dimension to the forehead when the patient is fully grown.