Abstract: Neruocognitive Effects of Metopic Synostosis Based on Severity of Deformity (Plastic Surgery 2015)

Saturday, October 17, 2015: 1:40 PM

Jenny F Yang, BS , Plastic Surgery, Yale University, New Haven, CT

Eric D Brooks, MD , Plastic Surgery, Yale University, New Haven, CT

Peter W Hashim, MD , Plastic Surgery, New York Presbyterian Hospital, New York, NY

Roberto Travieso, MD , Plastic Surgery, Yale University, New Haven, CT

Jordan Terner, MD , Plastic Surgery, Montefiore Medical Center, Bronx, NY

Hannah S Reuman, BA , Child Study Center, Yale University, New Haven, CT

Sarah M Persing, MD, MPH , Plastic Surgery, Yale University, New Haven, CT

Elizabeth G Zellner, MD , Plastic Surgery, Yale University, New Haven, CT

Rajendra Sawh-Martinez, MD, MBA , Plastic Surgery, Yale University, New Haven, CT

Emily J Levy, BA , Child Study Center, Yale University, New Haven, CT

Karen Law, BA , Child Study Center, Yale University, New Haven, CT

Linda C Mayes, MD , Child Study Center, Yale University, New Haven, CT

Charles Duncan, MD , Neurosurgery, Yale University School of Medicine, New Haven, CT

Derek M Steinbacher, MD, DMD , Plastic and Reconstructive Surgery, Yale School of Medicine, New Haven, CT

John A. Persing, MD , Plastic and Reconstructive Surgery, Boardman Bldg 3rd Floor, New Haven, CT

James C McPartland, PhD , Child Study Center, Yale University, New Haven, CT

Presentation PDF file

Purpose:

In recent years, metopic synostosis (MSO) has represented up to 25% of all non-syndromic craniosynostosis cases (1). The severity of MSO can be classified as moderate or severe based on the endocranial bifrontal angle (EBA), and degree of orbitofrontal deformity (2). However, it is unknown whether the degree of severity of anterior dysmorphology is proportionate to neurological dysfunction.

Given the reported correlation of abnormal auditory processing with future language dysfunction and poorer academic performance (3,4), the present study aims to evaluate auditory processing in untreated patients with moderate and severe MSO, as well as in control infants, to discern the neurological risk carried by different severities of trigonocephaly.

Methods:

Forty infants underwent evaluations of auditory processing: 9 patients with severe MSO, 7 with moderate MSO, 2 with metopic ridge (MR) but no synostosis, and 22 controls. Brain activity was recorded by electroencephalography (EEG) while the participants passively listened to auditory presentations of speech syllables. EEG data were analyzed to extract event related potentials (ERPs) evoked by the speech sounds. Analyses were carried out for the left brain hemisphere, as language processing preferentially localizes to the left (5).

Results:

Severe MSO patients demonstrated significantly attenuated ERP responses in the left frontal scalp region overlying the left frontal lobe compared to controls (p < 0.05; Figure 1). The moderate MSO patients did not show significantly different language processing compared to the control infants or the severe MSO patients in the frontal scalp region.

Conclusions:

Results suggest that untreated severe MSO is associated with reduced language response in the frontal cortex but not the temporal-parietal regions. These abnormalities may be related to the pronounced orbitofrontal deformity associated with this condition.

Figure 1.

Mean P150 peak amplitude over the frontal scalp region in infants with Severe MSO, Moderate MSO, MR without synostosis, and controls. Initial cortical response to speech is attenuated in patients with severe MSO, but not in moderate MSO or MR patients.

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