Is There a Relationship Between the Severity of Metopic Synostosis and Speech and Language Impairments?

Abstract

The occurrence of cognitive impairment and behavioral problems in patients with metopic synostosis has been described. The relationship between the severity of metopic synostosis and the incidence of speech and language delays has not been established. Twenty patients with nonsyndromic isolated metopic synostosis were evaluated. Five different preoperative measurements (metopic angle at the roof of the orbit, angle of lateral orbital wall at the sella, cranial indices, and distances between medial orbital walls and lateral orbital walls) were taken from computed tomography and compared with results from postoperative speech and language assessments. Frontal orbital advancement and remodeling were carried out by the same surgical team at a mean age of 1 year 4 months. Speech and language were assessed at 3 and 5 years. Six of the 20 patients had delayed speech and language developments. No consistent trend was observed linking the severity of frontal stenosis using the measured parameters with speech and language delays. Speech and language impairments in these patients cannot be explained by a physical concept, causing mechanical compression of the frontal lobes.

Language, learning, and memory in children with and without single-suture craniosynostosis

“…Given the mixed findings from previous studies, 4,6,9,12,13,15,23,34,41,48 the primary aim of this investigation was to determine whether school-age children with SSC, all of whom underwent cranioplasty, have deficits in language and memory skills in relation to demographically similar children without a craniofacial disorder. Use of a control group for such comparisons is critical but has been rarely undertaken in previous research on this topic.…”

“…As such, the study's design is limited in its ability to elucidate the mechanisms by which SSC or factors associated with SSC (e.g., surgery and anesthesia exposure 35 ) have led to the group differences observed here and elsewhere. 4,6,9,13,15,23,34,41,48 The etiology of the neurodevelopmental consequences and correlates of SSC remains unclear, with some hypotheses focusing on the effects of the fused suture on brain development [1][2][3]47,49 and others emphasizing preexisting neuropathology that may affect both brain and cranium. 5,19 These studies provide some evidence that changes in brain morphology present prior to surgery persist after surgery.…”

Una revisión de la literatura acerca de las características neuropsicológicas de niños con craneosinostosis simple en diferentes edades

“…Shipster et al 32 observaron funcionamiento cognoscitivo normal, mientras que otros reportan alteraciones en el lenguaje [32][33][34][35][36] , en la cognición 33,36 , en la motricidad 36 y en la conducta 33 . El hallazgo más frecuente es el déficit en el lenguaje, los distintos estudios mencionan porcentajes variables de pacientes con estas alteraciones, desde el 30% 33,35 hasta el 50% 32,34 . También se menciona que los pacientes con craneosinostosis simple tienen de 1,5 a 2 veces mayor probabilidad de presentar alteraciones cognitivas, de lenguaje y motoras que en la población normal 36 .…”

“…La mayoría de los estudios que mencionan el funcionamiento cognoscitivo en esta edad no tienen grupo control [32][33][34][35] y algunos las muestras son pequeñas para establecer una relación causal entre las alteraciones encontradas y la craneosinostosis 34,35 , además el estudio de Mendonca 35 no establece el instrumento que utilizó para evaluar el lenguaje. …”

Need for standard outcome reporting systems in craniosynostosis

“…Some surgeons have speculated that premature cranial suture fusion leads to alterations in cerebral blood flow, which in turn result in cognitive, speech, language, and/or behavioral problems, but this suggestion remains a point of controversy. 4,5,[14][15][16]20,22,[24][25][26]32,33 Others have speculated that reduced intracranial volume and/ or elevated intracranial pressure impair brain development. 9 However, Hill et al 12 recently demonstrated that intracranial volume constraint was not responsible for alterations in brain function.…”