Summary
Radiographic evaluation including plain radiographies and computed tomographic (CT)
scans are considered as a necessary tool for diagnosis of craniosynostosis. As recently
concerns about harmful effects of ionising radiation in children have been raised,
some authors have suggested the use of magnetic resonance imaging (MRI) as a helpful
alternative in preoperative imaging of patients with isolated metopic synostosis.
Besides confirming the diagnosis of trigonocephaly, MRI is the superior technique
for the evaluation of underlying brain anomalies. However, if the benefit of preoperative
imaging justifies possible side effects is still discussed controversially. Hence,
this study investigated the value of preoperative imaging for the diagnosis of isolated
synostosis of the metopic suture compared to a sole clinical examination.
In a series of 63 cases with isolated metopic craniosynostosis operated at the Department
of Oral and Maxillofacial Surgery, 48 (76.2%) patients received additional radiography
or MRI investigation, while in 15 (23.8%) patients the diagnosis was based on clinical
examinations only. In all patients, diagnosis was confirmed intra-operatively by a
fused metopic suture. CT scans with three-dimensional reconstruction (12.5%) or plain
radiographs (39.6%) did not provide any additional benefit for the diagnosis or the
surgical treatment. In 23 patients (47.9%), MRI showed the typical soft-tissue alterations
like triangular brain deformation in the frontal area. Besides these findings, no
brain or other underlying anomalies were diagnosed which had required any additional
treatment. The incidence of underlying brain abnormalities in isolated metopic synostosis
seemed not to be different from that of the general population.
As the characteristic clinical manifestations were sufficient for an accurate diagnosis
of isolated metopic synostosis, and with respect to the biological effects of ionising
radiation and risks of sedation especially in infants, preoperative imaging should
be reduced to a minimum.
Keywords
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Article info
Publication history
Published online: April 25, 2012
Accepted:
March 26,
2012
Received:
November 7,
2011
Identification
Copyright
© 2012 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Inc. All rights reserved.
