Craniofacial Measurement Protocol Helps Evaluate Skull Deformities

The cephalic width-intercoronal distance ratio could aid in the clinical evaluation of children with metopic craniosynostosis, claims a new study.

Researchers at the University of Missouri (MU; Columbia, USA) conducted a retrospective study in 104 infants diagnosed with isolated metopic craniosynostosis (also known as trigoncephaly), a condition in which a vertical ridge develops in the forehead due to premature fusing of the cranium’s frontal bones along the metopic suture. The fusing which can create increased pressure on the brain that can lead to neurodevelopmental disorders, learning problems, and reduced IQ. All children received a computed tomography (CT) scan as part of their workup.


The infants were divided into those recommended for surgery and those recommended for close observation, based on a multidisciplinary, multimodality evaluation. Comparisons were made with a control group of unaffected patients from the MU trauma registry. Skull development was evaluated using five existing standard cranial measurements; in addition, the researchers evaluated the cephalic width–intercoronal distance ratio, which indicates how narrow the front of the skull is compared to the back; when the ratio is above a certain value, the measurement shows a potential need for surgery.

The results showed that the average intercoronal distances were significantly different among all three groups, with the average cephalic width-intercoronal distance ratio in the children who received a recommendation for surgery differing significantly from that of both the observation cohort and the control group. On the other hand, the cephalic width-intercoronal distance ratio did not differ between the observation cohort and the control group. The study was published in the July 2016 issue of The Cleft Palate–Craniofacial Journal.

“While it may not be a suitable measurement for all craniosynostosis patients, in certain cases in which the premature fusion of the frontal bones is not as pronounced, surgeons can benefit by adding the cephalic width–intercoronal distance ratio to their evaluation,” said senior author Professor Arshad Muzaffar, MD, of the division of plastic surgery at the MU School of Medicine. “We feel this is another tool to help treatment centers around the country make surgical decisions in cases that do not present a clear course of action.”

Craniosynostosis is a condition in which one or more of the fibrous sutures in an infant skull prematurely fuse, thereby changing the growth pattern of the skull. Children born with craniosynostosis have a distinct appearance, the features of which are determined by which particular suture is closed. Because the skull cannot expand perpendicular to the fused suture, it compensates by growing more in the direction parallel to the closed sutures to make room for the growing brain. There are 17 sutures, most named for the bones they articulate, but some have special names of their own.

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