Relationship of a Metopic Ridge and Anterior Cranial Volume Measured by a Noninvasive Laser Shape Digitizer

Abstract

Cranial dysmorphology observed in patients with metopic craniosynostosis varies along a spectrum of severity including varying degrees of metopic ridging, bitemporal narrowing, and trigonocephaly. Management has been based upon the subjective clinical impression of presence and severity of trigonocephaly. Severity of cranial dysmorphology does not predict the occurrence or severity of associated abnormal neurodevelopment, as children with mild-to-moderate trigonocephaly may also experience developmental delays. The authors sought to determine the relationship between mild-to-moderate trigonocephaly and anterior cranial volume using a noninvasive laser shape digitizer (STARscanner) in patients with abnormal head shape.An IRB-approved retrospective review of a prospectively maintained database and medical records was performed. Two hundred three patients less than 1 year of age with abnormal head shape were categorized as having a metopic ridge with mild-to-moderate trigonocephaly, metopic ridge without trigonocephaly, or no ridge. Measurements of cranial volume, circumference, and symmetry were calculated by the STARscanner, which quantifies three-dimensional shape of the cranial surface. Measures were analyzed using a series of analyses of variance and post-hoc Tukey honest significant difference.The authors results showed ACV was significantly reduced in patients with mild-to-moderate trigonocephaly compared with those without metopic ridge (P = 0.009), and trended toward significance compared with those with a ridge but without trigonocephaly (P = 0.072). The ratio of anterior-to-posterior cranial volume was significantly reduced in those with mild-to-moderate trigonocephaly compared with those without metopic ridge (P = 0.036).In conclusion, patients with milder anterior cranial deformities demonstrated an association between a metopic ridge with mild-to-moderate trigonocephaly and reduced anterior cranial volume.

Consistency of Cranial Shape Measures Obtained From Laser Surface and Computed Tomography Imaging

“…This paper follows another from University of Missouri by Applegren et al, 23 whose findings demonstrated STARscanner's utility in identifying reduced anterior cranial volume in children with a metopic ridge and mild-to- moderate trigonocephaly. In patients who do not show the classic signs of severe head shape abnormalities, management decisions are difficult, variable, and prompt further investigation.…”

“…Limitations inherent to the STARscanner have been described previously 23 . First, placement of soft tissue landmarks serving as the foundation for all measurements is rater-dependent.…”

“…Limitations inherent to the STARscanner have been described previously. 23 First, placement of soft tissue landmarks serving as the foundation for all measurements is rater-dependent. Incorrect landmark identification results in inaccuracy of all subsequent measures; this error is minimized by having an appropriately trained rater.…”

The Use of Eye Tracking to Discern the Threshold at Which Metopic Orbitofrontal Deformity Attracts Attention

“…The literature shows different ways of quantifying the midline ridge and supraorbital retrusion classically associated with a metopic synostotic head shape using angles, linear distances, and ratios (Srivilasa et al, 2006; Ruiz-Correa et al, 2008; Beckett et al, 2012; Kellogg et al, 2012; Anolik et al, 2016; Cho et al, 2016; Wang et al, 2016; Applegren et al, 2018). Because of the heterogeneity in decision-making stated in the literature (Birgfeld et al, 2013; Cho et al, 2016; Cho et al, 2018), this study chose a deformable mask spectrum of pathology.…”

Comparison of aesthetic outcomes between open and endoscopically treated sagittal craniosynostosis

“…At the time of study inclusion, all patients underwent cranial measurement using the STARScanner laser data acquisition system (Orthomerica Products Inc.). 14 During the same visit, all patients underwent standardized full-face photography that included anterior, lateral, and top views of the face and head for subjective assessment. 13 These cross-sectional data were then combined with clinical data obtained via retrospective chart review, which included operative time, estimated blood loss, hospital length of stay, need for intraoperative transfusion, and surgical complications.…”