Background: There are a wide variety of shape deformations that can occur in the forehead. Most of these are caused or influenced by some congenital or developmental influence on the frontal bone forms. Bump, lumps, prominences, flatness and asymmetries are how they present which are readily apparent give the very visible and broad surface of the forehead.
One unique type of aesthetic forehead deformity is that of the midline ridge. Always seen at the upper part of the forehead, it is a raised ridge that comes down below the front edge of the hairline. It ends down the middle of the forehead and usually stops about the middle between the hairline and the glabellar region. it always has a ridge extension that goes back behind the hairline to some degree.
This midline forehead ridge is known as microform metopic craniosynostosis or a metopic ridge. It is a very minor expression of a limited premature closure of the metopic or frontal suture. The frontal suture is the fibrous joint that exists in utero and shortly after birth between the two halfs of the frontal bone. It nornally closes by 9 to 12 months after birth if not sooner. But if the suture is not present at birth the frontal bone halfs unite prematurely and a keel-shaped deformity known as trigonocephaly occurs. In minor metopic ridges just a very small portion of the suture closes too soon creating a much more minor expression of a frontal keel.
Case Study: This 35 year male presented with a visible ridge extending down from his hairline in the center of his forehead. It had bothered him his whole life.
Under general anesthesia an irregular frontal hairline incision was made of 3.5 cms. The bone was exposed and burred down to the level of the surrounding bone down into the forehead as well as back behind the the hairline to reduce the prominent ridge or small keel.
Because the metopic ridge is always thicker than the surrounding frontal bone, which is part of its natural pathology, it can be safely eliminated to create a smoother upper forehead contour. A frontal hairline incision provides direct access so ‘line of sight’ bone reduction can be most effectively done.
Highlights:
- The metopic ridge is an aesthetic forehead deformity that is the result of a minor frontal suture abnormality.
- Open burring reduction of the metopic ridge is the most effective reduction method.
- Surgical access is best done through a hairline incision.
Dr. Barry Eppley
Indianapolis, Indiana