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The Endocranial Bifrontal Angle

A Longitudinal Evaluation in Two Patients With Metopic Synostosis

Cabrejo, Raysa BA*; Lu, Xiaona MD; Persing, John MD*

doi: 10.1097/SCS.0000000000005358
Original Article: PDF Only

Background: Metopic craniosynostosis is the early fusion of the skull bones in the frontal region of the metopic suture, which leads to trigonocephaly and neurological sequelae. Severe metopic craniosynostosis is defined by an endocranial bifrontal angle less than 124°, and this serves as a threshold for neurological deficit and significant skull deformity, typically warranting surgical treatment.

Methods: Two patients presented for evaluation for metopic craniosynostosis. Low-dose computed tomography imaging was performed in both patients due to concern for underlying metopic craniosynostosis.

Results: In both patients, imaging demonstrated an initial endocranial bifrontal angle greater than 124°. However, in subsequent evaluation, the children developed severe trigonocephaly, and an angle less than 124°.

Conclusion: The authors present 2 patients with metopic craniosynostosis, which became severe over time. The authors hypothesize that this may be due to an initial smaller head circumference, which later experienced rapid growth, leading to narrower endocranial bifrontal angle. Therefore, younger children with suspected metopic craniosynostosis, with initially smaller head circumference (but not meeting the threshold of 124°) should be followed longitudinally, as the head circumference may demonstrate greater narrowing subsequently into a more severe form of trigonocephaly and possibly surgery.

*Section of Plastic Surgery, Department of Surgery, Yale Medical School, New Haven, CT

Chinese Academy of Medical Sciences, Peking Union Medical College, Plastic Surgery Hospital, Beijing, China.

Address correspondence and reprint requests to John Persing, MD, Section of Plastic Surgery, Department of Surgery, Yale School of Medicine, P.O. Box 208041, New Haven, CT 06520-8041; E-mail:

Received 12 September, 2018

Accepted 22 December, 2018

The authors report no conflicts of interest.

© 2019 by Mutaz B. Habal, MD.