metopic ridge

A benign metopic ridge presents itself as a slight or noticeable ridge in the metopic suture (also called frontal suture), that is running down the middle of a child's forehead. The child otherwise has a mostly normally shaped forehead and head. A metopic ridge is usually a benign and isolated finding. In most cases, a metopic ridge does not affect brain development or cause any functional issues. Usually the child does not show any abnormal mood or general condition like crying a lot or showing prolonged discomfort, and is perceived as present and normal.

Metopic ridges are usually caused by a birth defect called craniosynostosis, more specifically metopic synostosis, but can also be associated with other congenital skeletal defects.{{cite web|access-date=2025-02-24 |language=en-US |title=Metopic ridge Information {{!}} Mount Sinai - New York |url=https://www.mountsinai.org/health-library/symptoms/metopic-ridge |work=Mount Sinai Health System}} Both metopic ridge and trigonocephaly involve premature fusion of the metopic suture. Like with trigonocephaly, there is no single proven cause for metopic ridge, and there is often no identifiable reason.{{cite web|access-date=2025-02-24 |title=Metopic Synostosis (Trigonocephaly) {{!}} Boston Children's Hospital |url=https://www.childrenshospital.org/conditions/metopic-synostosis-trigonocephaly |work=www.childrenshospital.org}}

In metopic ridge the fusion is not severe enough to cause significant changes in the shape of the skull except a slight bulge along the metopic ridge.{{citation needed|date=February 2025}} It is often differentiated from trigonocephaly, which is more serious, affects the shape of the forehead and head more, and requires medical intervention to avoid danger of significant impact on the child's brain development.

Medical experts on craniosynostosis (for example a pediatric craniofacial specialist) should be consulted to distinguish between the two. Both by visual inspection and with CT scans it is easier to distinguish between metopic ridge and trigonocephaly as the child gets older, but early classification is important in case the diagnosis is trigonocephaly, which requires surgery.{{cite journal|date=February 2017 |doi=10.1097/01.GOX.0000513444.64547.d9 |first1=Min-Jeong |first2=Rami R. |first3=Maleeh |first4=James R. |first5=Alex A. |language=en-US |last1=Cho |last2=Hallac |last3=Effendi |last4=Seaward |last5=Kane |pages=36–37 |periodical=Plastic and Reconstructive Surgery – Global Open |series=2S |title=Abstract 29. To Operate or Not?: Surgical Decision-making Concerning the Spectrum of Orbitofrontal Deformity Associated with Metopic Suture Closure |volume=5|issue=2S |pmc=5361355 }} Early diagnosis is beneficial, since surgery for trigonocephaly can be done endoscopic between 4 and 6 months, or as open surgery between 6 and 12 months.{{cite web|title=Metopic Craniosynostosis: What It Is, Symptoms & Treatment |url=https://my.clevelandclinic.org/health/diseases/metopic-craniosynostosis-trigonocephaly}} After about 12 months of age the skull (like the skeleton in the rest of the body) hardens, and becomes less malleable, and decreases its tendency to close any open sutures after surgery (even though it still has a much higher likelihood of closing compared to an adult).

Benign metopic ridges should show normal intracranial pressure, and may be inspected non-invasively by a pediatrician by slight palpation of the fontanelle. A basic eye exam looking for papilledema can also be performed.[https://www.imdb.com/title/tt33278740/ "Everyday Oral Surgery" Non-syndromic Craniosynostosis review and pearls (with Dr. Michael Markiewicz) (Podcast Episode 2023) - IMDb] 17:40: "Always the patients go for a baseline eye exam. What we are looking for is papilledema. Is there any pressure building up [on the optic nerve]

Benign metopic ridge usually does not require treatment. It is often considered a normal variant, and may not require treatment if there are no other symptoms or concerns. In cases that are purely cosmetic with a small ridge on the forehead, observation is the recommended approach.{{cite web|access-date=2025-02-24 |first=The Children's Hospital of |language=en |surname=Philadelphia |title=Non-syndromic Craniosynostosis {{!}} Children's Hospital of Philadelphia |url=https://www.chop.edu/conditions-diseases/non-syndromic-craniosynostosis |work=www.chop.edu}}

Surgical intervention is not needed for benign metopic ridge, however it is needed if the diagnose is trigonocephaly.

Non-surgical options are generally limited. Methods such as molding via helmet therapy for shaping a baby's head over time is not commonly used for benign metopic ridge, but is used for plagiocephaly, brachycephaly or scaphocephaly.

The metopic ridges may become less cosmetically prominent during the first few years of life{{when|date=February 2025}} as the head grows and facial features develop.{{cite web|access-date=2025-02-24 |language=en |title=Metopic Ridge |url=https://www.chp.edu/our-services/plastic-surgery/resources/metopic-ridge |work=UPMC Children's Hospital of Pittsburgh}} How much a metopic ridge flattens out and when can vary from child to child.{{citation needed|date=February 2025}} It can be monitored over time with regular check-ups with a pediatrician. By the time a child reaches the age of about 6 years the ridge might be significantly less noticeable or even barely detectable.{{citation needed|date=February 2025}} In some cases the ridge can remain prominent into adulthood, which can cause concern in patients about appearance{{cite web|access-date=2025-02-24 |date=2023-09-25 |first=Dr Barry |language=en |surname=Eppley |title=Plastic Surgery Case Study - Aesthetic Reduction of the Metopic Midline Forehead Ridge |url=https://exploreplasticsurgery.com/plastic-surgery-case-study-aesthetic-reduction-of-the-metopic-midline-forehead-ridge/ |work=Explore Plastic Surgery}} (not to be confused with persistent metopic suture).

"Benign metopic ridge from a normal physiological of closure can be present in 10–25% of infants (Cohen and MacLean, 2000)".

• Plagiocephaly, asymmetric distortion of the skull, with flattening of one side

• [https://ojrd.biomedcentral.com/articles/10.1186/s13023-024-03197-8 New diagnostic criteria for metopic ridges and trigonocephaly: a 3D geometric approach], a study using principal component analysis on images to automatically classify benign metopic ridge versus trigonocephaly, with graphs illustrating the typical shapes that differentiate the two variants

Category:Congenital disorders of musculoskeletal system