Dear parent,
I can understand your concerns. Your observations are accurate. The frontal bone suture is called the metopic suture. Usually, prominence of the metopic suture looks like a linear swelling.
In your daughter's case, she has a rounded swelling that is located a bit superiorly.
Swellings in this location could be of one of the following etiologies:
1. Encephalocele or Encephalomyelocele
2. Sebaceous cyst
3. Dermoids
4. Subcutaneous fat necrosis
5. Rarer congenital causes
For differentiating these causes, you have to provide answers to the following questions:
Does the swelling feel bony or hard to touch?
Does the swelling move along the surface of bone?
Is the swelling soft or reducible ?
Does the swelling a very small punctum or an opening?
I would be able to help you better if you can answer the above queries.
Regards
Dr. Saptharishi L G
Patient replied :
Thank you for your response.
To answer your questions, when touching the knot, it does not move. It just feels like skin over a round, raised, boney area. The boney area does not move either. The knot has no opening. It seems like her skull is raised in that are.
I hope these answers help. Does something like this require surgery to fix?
Dear Parent,
Thank you very much. Your answers to the queries have definitely clarified a number of things.
Based on your description, it looks like a bony swelling. Definitely not an encephalocele (which is the most dangerous of the various diagnoses I had listed). It could be a hardened sebaceous cyst, but even that is unlikely. So at this point, we need to proceed further. We need the following:
1. X ray Skull lateral view
2. Ultrasound local part (swelling)
Based on these two investigations, we will plan further management. Remember, the purpose of these tests is to rule out something sinister. If it turns out to be just a hematoma or fat necrosis, we would be relieved and happy.