The findings suggest that the skull defect itself does not cause speech and language problems in children with metopic stenosis, but highlight the need for monitoring to assess long-term development in children who have undergone craniofacial surgery, according to Dr. Derick Amith Mendonca and colleagues of Birmingham Children's Hospital, Birmingham, United Kingdom.

Increased Risk of Speech Problems Not Tied to Severity of Skull Defect
Metopic synostosis is a type of craniosynostosis, in which the joints (sutures) between the bones of the skull close prematurely, resulting in abnormal growth of the skull and brain. Craniofacial surgeons, in concert with other professionals, design effective treatments to correct the skull deformity, prevent complications, and promote good long-term functioning. Metopic synostosis occurs when the metopic suture, which runs from the nose to the scalp, closes prematurely. This results in a triangular forehead, called "trigonocephaly."

Dr. Mendonca and colleagues performed detailed measurements of skull deformity in 20 infants with metopic synostosis. None had any other birth defects besides metopic synostosis (which sometimes occurs as part of a syndrome of abnormalities). At an average age of 16 months, the infants underwent craniofacial surgery to correct the skull deformity.

At age three to five, the children underwent routine speech and language assessment. The results showed delayed speech and language development in six cases—a rate of 30 percent. By comparison, the overall rate of speech and language difficulties among U.K. children is six percent.

However, the presence of speech problems was unrelated to any of the measurements of metopic synostosis severity. For all five severity measures, the average values were almost identical for children with or without language impairments. There was also no relationship between language development and age at surgery.

Follow-up Should Include Cognitive and Functional Assessments All affected children were referred for appropriate speech and language therapy. "This highlights again the importance of definitive and structured assessment and long-term monitoring to ensure that timely and appropriate intervention can be implemented," Dr. Mendonca and colleagues write. They noted "more subtle" speech problems emerging between the ages of three and five.

Past studies have reported cognitive and behavioral problems in children with metopic synostosis, but none have focused specifically on speech and/or language difficulties. Yet clinical experience suggests that children with this and other forms of craniosynostosis may have problems with language development.

The new results show an increased rate of speech and language impairments in children with metopic synostosis. However, this risk is not directly related to the severity of the skull defect, and therefore is probably not caused by pressure on the brain. Rather, the cause may be related to "a more systemic problem," the researchers believe.

In an accompanying editorial, Dr. Mutaz B. Habal, Director of Tampa Bay Craniofacial Center in Tampa, Fla., and Editor-in-Chief of JCS, highlights the need for ongoing assessment after surgery in children with craniofacial abnormalities. The goal is to achieve good functional and cognitive outcomes, rather than just establishing 'normal' skull measurements. "We are not in any way stressing that the measurements of the configuration are not important, but it will be of more value if it is linked to the functional aspect of either speech skills or cognitive development," Dr. Habal concludes.

About the The Journal of Craniofacial Surgery
The Journal of Craniofacial Surgery (www.jcraniofacialsurgery.com) serves as a forum of communication for all those involved in craniofacial and maxillofacial surgery. Coverage ranges from practical aspects of craniofacial surgery to the basic science that underlies surgical practice. Affiliates include 14 major specialty societies around the world, including the American Association of Pediatric Plastic Surgeons, the American Academy of Pediatrics Section of Pediatric Plastic Surgery, the American Society of Craniofacial Surgeons, the American Society of Maxillofacial Surgeons, the Argentine Society of Plastic Surgery Section of Pediatric Plastic Surgery, the Asian Pacific Craniofacial Association, the Association of Military Plastic Surgeons of the U.S., the Brazilian Society of Craniofacial Surgeons, the Chinese Craniomaxillofacial Society, the European Society of Craniofacial Surgery, the International Society of Craniofacial Surgery, the Japanese Society of Craniofacial Surgery, the Korean Society of Craniofacial Surgery, the Thai Cleft and Craniofacial Association, and the World Craniofacial Foundation.

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