Frontal bossing is a medical term used to describe a
prominent, protruding forehead that’s also often associated with a heavy brow
ridge. This symptom is the main marker of many conditions, including issues that
affect a person’s hormones, bones, or stature. A doctor typically identifies it
in infancy or early childhood.
Treatments can address the condition that’s causing the
frontal bossing. However, you can’t correct a protruding forehead because
frontal bossing changes the way the bone and tissues of the face and skull
Frontal bossing causes your child to have an enlarged or
protruding forehead or an enlarged eyebrow ridge. This symptom may be mild in
the early months and years of your child’s life. However, it may become more
noticeable as they age.
Frontal bossing may be a symptom of a genetic disorder or
congenital defect, meaning a problem that’s present at birth. The cause of the
bossing may also cause other symptoms, such as physical deformities.
Causes Frontal Bossing?
Frontal bossing is usually due to conditions that affect
your child’s growth hormones.
The most common underlying cause is acromegaly. This is a
chronic disorder that leads to an overproduction of growth hormone. People with
acromegaly have larger-than-normal:
Other potential causes of frontal bossing include
- use of the antiseizure drug trimethadione during
- basal cell nevus syndrome
- congenital syphilis
- cleidocranial dysostosis
- Russell-Silver syndrome
- Rubinstein-Taybi syndrome
- Pfeiffer syndrome
- Hurler syndrome
- Crouzon syndrome
- abnormal growths in the forehead or skull
Abnormalities in an infant’s PEX1, PEX13, and PEX26 genes
can also cause frontal bossing.
Is Frontal Bossing Diagnosed?
Your child’s doctor can diagnose frontal bossing by
examining your child’s forehead and brow ridge. However, the cause of the
condition may not be so clear. Since frontal bossing often signals a rare
disorder, other symptoms or deformities may offer clues as to its underlying
Your doctor will physically inspect your child’s forehead
and take down their medical history. You should be ready to answer questions
about when you first noticed the frontal bossing and about any other unusual
characteristics or symptoms your child might have.
Your doctor may order blood tests to check your child’s
hormone levels and to look for genetic abnormalities. They may also order imaging
scans to help determine the cause of frontal bossing. Imaging scans commonly
used for this purpose include X-rays and MRI scans.
An X-ray can reveal deformities in the skull that may be
causing the forehead or brow region to protrude. A more detailed MRI scan can
show deformities or abnormalities in the surrounding bones and tissues.
Abnormal growths may be causing the forehead protrusion. Imaging scans are the
only way to rule out this potential cause.
Are the Treatment Options for Frontal Bossing?
There’s no treatment to reverse frontal bossing. The only
available treatments focus on lessening symptoms of the underlying condition
and reducing any pain. Frontal bossing doesn’t usually improve with age.
However, it doesn’t worsen in most cases.
Cosmetic surgery can be helpful in treating many facial
deformities. However, there are no current guidelines recommending cosmetic
surgery to improve the appearance of frontal bossing.
Can I Prevent Frontal Bossing?
There are no known ways to prevent your child from
developing frontal bossing. However, genetic counseling may help you determine
if your child is likely to be born with one of the rare conditions that cause
Genetic counseling may include blood and urine tests for
both parents. If you’re a known carrier of a genetic disease, your doctor may
recommend certain fertility medications or treatments. Your doctor will discuss
which treatment option is right for you.
Always avoid the antiseizure medication trimethadione during
pregnancy to reduce the risk of your child being born with frontal bossing.