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1
Catur, Kusumo, Suryaningtyas Wihasto, and Arifin Parenrengi M. "Apert Syndrome with Combination of Synostosis: A Case Report." INTERNATIONAL JOURNAL OF MULTIDISCIPLINARY RESEARCH AND ANALYSIS 07, no. 06 (2024): 2712–19. https://doi.org/10.5281/zenodo.12526505.
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Apert syndrome is a rare condition affecting the skull, face, hands and feet due to premature closure of cranial sutures. This case report describes a 6-month-old boy with Apert syndrome presenting with an abnormal head shape. A CT scan revealed craniosynostosis (fused sutures) of both the coronal and lambdoid sutures. Surgery involved removing a 1-2 cm section of the fused sutures along the coronal suture and across the lambdoid suture. After 4 months, the boy showed improvement in both clinical appearance and imaging scans. While Apert syndrome is typically classified based on the suture involved, the specific timing of surgery depends on various factors. This case demonstrates that minimally invasive surgery can be effective with minimal complications. Even though unilateral coronal and lambdoid suture fusion in Apert syndrome is uncommon, it can still be successfully treated with surgery.
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Jimenez, David F., Constance M. Barone, Ravelo V. Argamaso, James T. Goodrich, and Robert J. Shprintzen. "Asterion Region Synostosis." Cleft Palate-Craniofacial Journal 31, no. 2 (1994): 136–41. http://dx.doi.org/10.1597/1545-1569_1994_031_0136_ars_2.3.co_2.
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Posterior plagiocephaly historically has been associated with synostosis of the lambdoid suture. The incidence, diagnosis, and modes of treatment for stenosis of the lambdoid suture remain controversial. Commonly, the lambdoid suture is found to be open both on radiographic examination and at the time of surgery. The study reports on nine patients who presented with unilateral posterior plagiocephaly and who were found to have open lambdoid sutures, but a stenosed region of the asterion. The area of Involvement included the distal-most lambdoid suture, the parietomastoid, occipitomastoid, and proximal squamosal sutures. Positional molding or torticollis was ruled out in all patients. All the patients showed progressive involvement of the skull base, including anterior shifts of the ipsilateral ear, compensatory Ipsilateral frontal bossing and malar protrusion. Stenosis of the asterion was diagnosed with three-dimensional computed tomography scans, corroborated at the time of surgery and confirmed histologically. Surgical correction Involved resection of the affected asterion and reconstruction using a bandeau-technique, barrel staves of the occipital bone and bone graft transposition. This approach provided excellent esthetic results in all patients.
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Keshav Tumram, Nilesh, Soniya B.Parchake, Arun P. Kasote, and Meena M. Meshram. "Macroscopic Cranial Suture Closure in An Adult Population: Is It Reliable for Estimating Age?" 99 3, no. 1 (2021): 17–30. http://dx.doi.org/10.26735/ijjm2816.
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Background:- Age estimation is one of the important parameters for estimation of biological profile of an individual. Generally speaking, estimation of age of an individual whether living or dead is very important in Medicolegal and forensic scenario. The objective of the present study was to observe the chronology and pattern of union of cranial sutures namely coronal and lambdoid and to find out the relationship between closure of cranial suture and age of the deceased. An attempt was also made to see the applicability of Acsadi and Nemeskeri method in an Indian population. A total of 193 adult calvaria (133 males and 60 females) were studied from the autopsy cases. The extent of obliteration was studied ectocranially and endocranially in the two main sutures of the calvarium i.e. coronal and lambdoid. Results:- The results indicate that a strong positive correlation of ectocranial with endocranial suture closure is found in the age group of 30-39 years for right coronal, left coronal, while age group of 60-69 years shows a strong positive correlation for lambdoid sutures. This has also been confirmed in the study that the cranial suture obliteration starts endocranially and proceeds towards ectocranial surface. Statistically insignificant sex differences exist in suture closure. Conclusion:- The coronal and lambdoid sutures were closed in the age group of above 70 years with mean values of 3.54 for coronal and 3.7 for lambdoid suture. Acsadi and Nemeskeri’s method was found to be applicable to the Indian population for determination of age from cranial sutures.
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Wilkinson, C. Corbett, Nicholas V. Stence, Cesar A. Serrano, et al. "Fusion patterns of major calvarial sutures on volume-rendered CT reconstructions." Journal of Neurosurgery: Pediatrics 25, no. 5 (2020): 519–28. http://dx.doi.org/10.3171/2019.11.peds1953.
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OBJECTIVERecently, the authors investigated the normal course of fusion of minor lateral calvarial sutures on “3D” volume-rendered head CT reconstructions in pediatric trauma patients. While evaluating these reconstructions, they found many more fused sagittal sutures than expected given the currently accepted prevalence of sagittal craniosynostosis. In the present study, using the same set of head CT reconstructions, they investigated the course of fusion of the sagittal as well as the lambdoid, coronal, and metopic sutures.METHODSThey reviewed all volume-rendered head CT reconstructions performed in the period from 2010 through mid-2012 at Children’s Hospital Colorado for trauma patients aged 0–21 years. Each sagittal, lambdoid, coronal, or metopic suture was graded as open, partially fused, or fused. The cephalic index (CI) was calculated for subjects with fused and partially fused sagittal sutures.RESULTSAfter exclusions, 331 scans were reviewed. Twenty-one subjects (6%) had fusion or partial fusion of the sagittal suture. Four of the 21 also had fusion of the medial lambdoid and/or coronal sutures. In the 17 subjects (5%) with sagittal suture fusion and no medial fusion of adjacent sutures, the mean CI was 77.6. None of the 21 subjects had been previously diagnosed with craniosynostosis. Other than in the 21 subjects already mentioned, no other sagittal or lambdoid sutures were fused at all. Nor were other coronal sutures fused medially. Coronal sutures were commonly fused inferiorly early during the 2nd decade of life, and fusion progressed superiorly and medially as subjects became older; none were completely fused by 18 years of age. Fusion of the metopic suture was first seen at 3 months of life; fusion was often not complete until after 2 years.CONCLUSIONSThe sagittal and lambdoid sutures do not usually begin to fuse before 18 years of age. However, more sagittal sutures are fused before age 18 than expected given the currently accepted prevalence of craniosynostosis. This finding is of unknown significance, but likely many of them do not need surgery. The coronal suture often begins to fuse inferiorly early in the 2nd decade of life but does not usually complete fusion before 18 years of age. The metopic suture often starts to fuse by 3 months of age, but it may not completely fuse until after 2 years of age.
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Karthikeya Patil, Mahima VG, Poornima Chandran, SrishtiTayal, and Jaishankar HP. "Applications of Reverse Panoramic Radiography for Age and Gender Determination- A Radiographic Study." Indian Journal of Forensic Medicine & Toxicology 15, no. 3 (2021): 262–75. http://dx.doi.org/10.37506/ijfmt.v15i3.15315.
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Objectives: This study was conducted to establish if any correlation exists between individual’s chronological age and lambdoid sutures closure status in mortals through modified reverse panoramic radiograph.Materials and Methods: Total number of 140 subjects, 10 years and beyond were included in the study, and divided into seven groups with an age interval of 5 years. Assessment of lambdoid suture closure was done according to Frederic Rating Scale on modified reverse panoramic radiographs. Data obtained was subjected to statistical analysis using Cramer’s V test.Results: A significant correlation was observed between the age group and suture closure. Cramer’s test gave value of 0.000, and was interpreted as a good correlation between the age and suture closure status with a P value of <0.05Conclusion: Lambdoid suture can be very effective and reliable practical tool for age assessment in mortalsthrough modified reverse panoramic radiography (ectocranially)
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Cinalli, Giuseppe, Dominique Renier, Guy Sebag, Christian Sainte-Rose, Eric Arnaud, and Alain Pierre-Kahn. "Chronic tonsillar herniation in Crouzon's and Apert's syndromes: the role of premature synostosis of the lambdoid suture." Journal of Neurosurgery 83, no. 4 (1995): 575–82. http://dx.doi.org/10.3171/jns.1995.83.4.0575.
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✓ The incidence of chronic tonsillar herniation (CTH) was evaluated with magnetic resonance imaging in 44 patients with Crouzon's syndrome and 51 with Apert's syndrome; the incidence was 72.7% in Crouzon's syndrome and 1.9% in Apert's syndrome. All the patients with Crouzon's syndrome and progressive hydrocephalus had CTH, but of 32 individuals with Crouzon's syndrome and CTH, only 15 had progressive hydrocephalus. Five patients with Apert's syndrome were treated for progressive hydrocephalus; none had CTH. The patterns of suture closure in these two groups of patients were studied, and significant differences in coronal, sagittal, and lambdoid sutures were found between patients with Crouzon's and Apert's syndromes. In Crouzon's syndrome, significant differences in the pattern of lambdoid suture closure were found between the groups with and without CTH; in the group with CTH, the lambdoid closure appeared earlier. The authors propose that the high incidence of individuals with CTH who have Crouzon's syndrome is related to the premature synostosis of the lambdoid suture in the first 24 months of age.
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Whitton, Alaina, Sharon L. Hyzy, Chelsea Britt, Joseph K. Williams, Barbara D. Boyan, and Rene Olivares-Navarrete. "Differential spatial regulation of BMP molecules is associated with single-suture craniosynostosis." Journal of Neurosurgery: Pediatrics 18, no. 1 (2016): 83–91. http://dx.doi.org/10.3171/2015.12.peds15414.
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OBJECTIVE The aim of this study was to examine messenger RNA (mRNA) levels of bone morphogenetic protein (BMP) ligands, receptors, and soluble inhibitors in cells isolated from single-suture synostoses from fused coronal, metopic, sagittal, and lambdoid sutures. METHODS Cells were isolated from bone collected from patients undergoing craniotomies at Children's Healthcare of Atlanta. Real-time polymerase chain reaction was used to examine mRNA levels in cells isolated from fused sutures or patent sutures in comparison with levels in normal bone from the same patient. RESULTS Cells isolated from fused sutures in cases of sagittal and coronal synostosis highly expressed BMP2, while cells isolated from fused metopic or lambdoid synostosis expressed high BMP4. Noggin, a BMP inhibitor, was lower in fused sutures and had high expression in patent sutures. CONCLUSIONS These results suggest that BMPs and inhibitors play a significant role in the regulation of suture fusion as well in the maintenance of patency in the normal suture.
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V., Sharma, Jeewane S., Marskone S., and Soni R. "Os Inca Totum-Anthropological and Embryological Basis." PJSR 7, no. 1 (2014): 34–36. https://doi.org/10.5281/zenodo.8255605.
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Complete division of membranous and cartilaginous part of occipital bone by a transverse suture extending between the two lambdoid sutures at the level of highest nuchal line above the external occipital protuberance, results in a rare cranial variation presenting as Os Inca totum. During oesteological study of human skull in the central India region, one male skull showing complete undivided Inca bone was found. The interparital bone is formed by the part of the squamous occipital bone that is bounded by two lambdoid sutures on two sides and inferiorly by transverse suture. Such finding is rare in occurrence and have a significant anthropological and embryological basis.
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Asharani S K. "A STUDY ON THE OCCURRENCE OF WORMIAN BONES IN ADULT DRY SKULLS." International Journal of Anatomy and Research 8, no. 4.2 (2020): 7814–16. http://dx.doi.org/10.16965/ijar.2020.228.
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Background: Sutural or wormian bones are islands of bone that are commonly found in the sutures of the skull mainly along the lambdoid suture. These sutural bones which are irregular in size, shape and number may arise from separate centres of ossification. The prior knowledge about the Wormian bones is important because they are present in normal individuals as well as in various disorders such as osteogenesis imperfect, rickets, etc. Aim: To study the occurence of wormian bones in adult dry skulls Materials and Methods: The present study was carried out on 95 adult dry human skulls in the department of Anatomy, Adichunchanagiri Institute of Medical Sciences, B G Nagara. Skulls with fractures and deformities were excluded from the study. Intact skulls were cleaned thoroughly and observed for the presence of wormian bones along the sutures of skull. Results: Out of 95 skull bones studied, 24 (25.26%) skulls showed the presence of wormian bones. We also observed that maximum number of such bones (single or multiple) were present along the lambdoid suture followed by lambda, asterion, sagittal suture & coronal suture. A very small wormian bone was also found near the bregma of the skull. Conclusion: The awareness about the occurrence of wormian bones and their topographical distribution will guide the clinicians mainly neurosurgeons in their practice. These bones mimic fracture lines in radiograph; therefore radiologists must also be aware of this normal variation. KEY WORDS: Wormian bone, Lambdoid suture, skull.
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Boyajian, Michael K., Hanny Al-Samkari, Dennis C. Nguyen, Sybill Naidoo, and Albert S. Woo. "Partial Suture Fusion in Nonsyndromic Single-Suture Craniosynostosis." Cleft Palate-Craniofacial Journal 57, no. 4 (2020): 499–505. http://dx.doi.org/10.1177/1055665620902299.
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Introduction: Partial synostosis of cranial sutures has been shown to have clinical and diagnostic significance. However, there is limited published information about how suture fusion progresses over time. In this study, we evaluate patients with nonsyndromic single-suture synostosis. We aim to define the incidence of partial versus complete suture fusion and whether a correlation exists between the degree of suture fusion and age. Methods: Two hundred fifty-four patients with nonsyndromic single-suture synostosis were evaluated. Preoperative computed tomography (CT) scans were rendered in 3-dimensions, all sutures were visualized and assessed for patency or fusion, and length of fusion was measured. Findings were grouped according to suture type (sagittal, coronal, metopic, or lambdoid), the degree of fusion (full, >50%, or <50%), and patient age at time of CT scan (0-90, 91-180, 181-360, or >360 days). Data were analyzed to correlate patient age versus the degree of suture fusion. Results: For all patients, 72% had complete and 28% had partial synostosis. Ratios of full to partial fusion for each suture type were as follows: sagittal 97:36, coronal 35:22, metopic 46:4, and lambdoid 4:10. The sagittal, coronal, and metopic groups demonstrated greater probabilities of complete suture fusion as patient age increases ( P = .021, P < .001, P = .001, respectively). This trend was also noted when all sutures were considered together by age-group ( P < .001). Conclusion: We note a partial suture fusion rate of 28.3%. Our analysis shows a correlation between the extent of suture synostosis and patient age. Finally, we demonstrate that different sutures display different patterns of partial and complete fusion.
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A., Amadi-Ikpa H., Jacks T. W., Ajie P. C., et al. "Prevalence of Wormian Bones in Dry Adult Human Skull in University of Port Harcourt and Rivers State University." Scholars International Journal of Anatomy and Physiology 6, no. 04 (2023): 49–54. http://dx.doi.org/10.36348/sijap.2023.v06i04.003.
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Wormian bones, otherwise ‘Sutural’ bones, are accessory bones within or near cranial sutures. They are mostly found on lambdoid sutures and can be one or more in each suture. This study is aimed at examining the incidence and frequency of Wormian bones in the dry adult cadaveric skull in Rivers State, Nigeria. Forty-three (43) dry adult skulls were examined for the presence, number, and location of Wormian bone. Thirty-seven (37) of the skulls were from the osteological collections of the Department of Human Anatomy, Faculty of Basic Medical Sciences, College of Health Science, University of Port Harcourt, and six (6) from the osteological collections of the Department of Human Anatomy, Faculty of Basic Medical Sciences, College of Medical Sciences, Rivers State University. 13 (30.23%) of the calvarias had Wormian bones while sutural bones were absent in 30 (69.77%0). 8 (61.53%) calvarias with Wormian bones had sutural bones in the lambdoid suture; with 3 (23.08%) on the left arm and 5 (38.46%) on the right arm of the lambdoid suture. 2 (15.38%) of the calvarias with Wormian bone had sutural bone in the sagittal suture and 3 (23.08%) had Wormian bones in the lambda (Inca bone). The knowledge of incidence of Wormian bone and their calvaric distribution as described in this study is essentially useful to the Anatomist, Radiologist, Pediatrician, and Surgeon in their daily practice, as well as in forensic medicine.
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Beuriat, Pierre-Aurélien, Alexandru Szathmari, Julie Chauvel-Picard, et al. "Coronal and lambdoid suture evolution following total vault remodeling for scaphocephaly." Neurosurgical Focus 50, no. 4 (2021): E4. http://dx.doi.org/10.3171/2021.1.focus201004.
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OBJECTIVE Different types of surgical procedures are utilized to treat craniosynostosis. In most procedures, the fused suture is removed. There are only a few reports on the evolution of sutures after surgical correction of craniosynostosis. To date, no published study describes neosuture formation after total cranial vault remodeling. The objective of this study was to understand the evolution of the cranial bones in the area of coronal and lambdoid sutures that were removed for complete vault remodeling in patients with sagittal craniosynostosis. In particular, the investigation aimed to confirm the possibility of neosuture formation. METHODS CT images of the skulls of children who underwent operations for scaphocephaly at the Hôpital Femme Mère Enfant, Lyon University Hospital, Lyon, France, from 2004 to 2014 were retrospectively reviewed. Inclusion criteria were diagnosis of isolated sagittal synostosis, age between 4 and 18 months at surgery, and availability of reliable postoperative CT images obtained at a minimum of 1 year after surgical correction. Twenty-six boys and 11 girls were included, with a mean age at surgery of 231.6 days (range 126–449 days). The mean interval between total vault reconstruction and CT scanning was 5.3 years (range 1.1–12.2 years). RESULTS Despite the removal of both the coronal and lambdoid sutures, neosutures were detected on the 3D reconstructions. All combinations of neosuture formation were seen: visible lambdoid and coronal neosutures (n = 20); visible lambdoid neosutures with frontoparietal bony fusion (n = 12); frontoparietal and parietooccipital bony fusion (n = 3); and visible coronal neosutures with parietooccipital bony fusion (n = 2). CONCLUSIONS This is the first study to report the postoperative skull response after the removal of normal patent sutures following total vault remodeling in patients with isolated sagittal synostosis. The reappearance of a neosuture is rather common, but its incidence depends on the type of suture. The outcome of the suture differs with the incidence of neosuture formation between these transverse sutures. This might imply genetic and functional differences among cranial sutures, which still have to be elucidated.
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Khaleel N, Angadi A V, Muralidhar P S, Shabiya M, Chandrika C, and Shaik Hussain Saheb. "Study on Morphometric Features of Coronal Suture Along with it Absence and Craniosynostosis." International Journal of Anatomy and Research 9, no. 4 (2021): 8151–55. http://dx.doi.org/10.16965/ijar.2021.172.
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Background: Cranial sutures are syndesmosis between the cranial bones. The coronal suture is oblique in direction and extends between the frontal and the parietal bones. Craniosynostosis is a rare birth defect that occurs when the coronal suture in the skull fuses prematurely, but the brain continues to grow and develop. This leads to a misshapen head. There are a number of forms of this defect, such as coronal, sagittal, lambdoid, and metopic. Materials and Methods: Total 500 skulls were used for study, coronal suture length measured by thread method, distance between Nasion to bregma and midsupraorbital rim to coronal suture were measured. For finding skull with absence of coronal, sagittal, lambdoid, and metopic suture, we examined many skulls during routine osteology classes of Medical, Dental and other medical sciences students. Around 500 skull observed and we find only one skull with absence of left coronal suture completely. Results: The length of coronal suture was 24.8+1.4cm length, the distance between nasion to bregma was 126.7 +10.25 mm and Midsupraorbital rim to cranial suture was 102.76+8.64mm We have found only one skull with absence of coronal suture. Some of the skulls shows partly fusion of sagittal, coronal sutures. The skull with complete absence of coronal suture showing the features of other sutures clearly and right side of coronal suture is showing the complete suture. The skull was not damaged and it is in perfect condition which was using by students for their osteology study. Conclusion: We found the skull with absence of left coronal suture, which may resulted due to craniosynostosis. It may be due to hot climate in India also might be resulted for absence of suture. KEY WORDS: Birth defect, Skull, Coronal suture, Craniosynostosis.
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Tubbs, R. Shane, Marios Loukas, Mohammadali M. Shoja, Nihal Apaydin, Mohammad R. Ardalan, and W. Jerry Oakes. "Lateral lakes of Trolard: anatomy, quantitation, and surgical landmarks." Journal of Neurosurgery 108, no. 5 (2008): 1005–9. http://dx.doi.org/10.3171/jns/2008/108/5/1005.
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Object There is scant and conflicting information in the literature regarding the lateral lacunae, or lateral lakes of Trolard. As these venous structures can be encountered surgically, this study aimed at further elucidating their anatomy, identifying surgical landmarks, and associated quantitation. Methods Thirty-five adult cadavers were dissected of lateral lacunae. Following quantitation of the lacunae, these structures were measured, as were the distances from them to the coronal and sagittal sutures. Results A mean of 1.9 lacunae were identified on the right sides and 1.4 lacunae on the left sides. Although there tended to be slightly more lacunae on the right sides, this difference did not reach statistical significance (p > 0.05). The average lengths of the lacunae were 3.2 and 2.0 cm for the right and left sides, respectively. The mean widths of these venous lakes were 1.5 cm for the right sides and 0.8 cm for the left sides. Lacunae were variably positioned but tended to cluster near the vertex of the skull. None were identified posterior to the lambdoid sutures, and only 5 were found to lie anterior to the coronal suture, with 4 of these located on right sides (p < 0.05). When lacunae were identified anterior to the coronal suture, they were generally 5–6 cm from this structure. The majority of lacunae could be identified between the coronal and lambdoid sutures and within 3 cm of the midline. Conclusions Although the situation varies, lateral lacunae are concentrated posterior to the coronal suture and anterior to the lambdoid sutures. They are most often found within 3 cm of the sagittal suture. These previously unreported data could be useful to the neurosurgeon in planning surgical procedures that traverse the calvaria.
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Tye, Gary, Jeffrey Fearon, and Jennifer Rhodes. "Craniosynostosis of the Lambdoid Suture." Seminars in Plastic Surgery 28, no. 03 (2014): 138–43. http://dx.doi.org/10.1055/s-0034-1384809.
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Shadlinski V.B. and Abdullayev A.S. "Wormian bones: shape, location and relation to each other." Journal of Theoretical, Clinical and Experimental Morphology 2, no. 1-2 (2021): 86–91. http://dx.doi.org/10.28942/jtcem.v2i1-2.153.
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The material of the study was the skull of an 8-year-old girl. In the cranioscopy, the following were identified: on the right side, the bone of the sphenoid fontanel or epipteric bone; bones of lambdoid suture - on the right side in the amount of 5, on the left side -1 bone; preinterparietal bone, ospreinterparietale.By the craniometric method, the height and width of the bones were determined. The bone of the sphenoid fontanelle or epipteric bone is located between the frontal, parietal bones, the greater wing of the sphenoid bone, and the squama of the temporal bone. The width of the epipteric bone is 16.5 mm, height 9.5 mm. The bones of the lambdoid suture in the amount of 5 on the right and the 1st on the left were located in an elongated state.The largest bone was located in the middle of the right lambdoid suture; apparently, it was formed by the union of at least two Wormian bones. Preinterparietal bone has a triangular shape, the base of the triangle facing the sagittal suture, the tip, slightly rounded - in the direction of the occipital bone. The lateral angles of the preinterparietal bone are serrated, which, in principle, clearly distinguishes it from the parietal bones. The bone was single, no sutures or grooves dividing the preinterparietal bone into parts were observed. The width of the bone is 18.5 mm, height 13.8 mm.
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Rattani, Abbas, Coleman P. Riordan, John G. Meara, and Mark R. Proctor. "Comparative analysis of cranial vault remodeling versus endoscopic suturectomy in the treatment of unilateral lambdoid craniosynostosis." Journal of Neurosurgery: Pediatrics 26, no. 2 (2020): 105–12. http://dx.doi.org/10.3171/2020.2.peds19522.
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OBJECTIVEUnilateral lambdoid synostosis is the premature fusion of a lambdoid suture or sutures and represents the least common form of craniosynostosis, occurring in 1 in 40,000 births. Cranial vault remodeling (CVR) and endoscopic suturectomy with helmet therapy (ES) are surgical approaches that are used to allow for normal brain growth and improved craniofacial symmetry. The authors conducted a comparative outcomes analysis of patients with lambdoid synostosis undergoing either CVR or ES.METHODSThe authors conducted a retrospective consecutive cohort study of patients with nonsyndromic lambdoid synostosis who underwent surgical correction identified from a single-institution database of patients with craniosynostosis seen between 2000 and 2018. Cranial growth was measured in head circumference percentile and z score.RESULTSNineteen patients (8 female and 11 male) with isolated unilateral lambdoid synostosis were identified (8 right and 11 left). Six underwent CVR and 13 underwent ES. No statistically significant differences were noted between surgical groups with respect to suture laterality, the patient’s sex, and length of follow-up. Patients treated with ES presented and underwent surgery at a younger age than those treated with CVR (p = 0.0002 and p = 0.0001, respectively). Operating and anesthesia time, estimated blood loss, and ICU and total hospital days were significantly lower in ES (all p < 0.05). No significant differences were observed in pre- and postoperative head circumference percentiles or z scores between groups up to 36 months postoperatively. No patients required reoperation as of last follow-up.CONCLUSIONSEndoscopic management of lambdoid synostosis is safe, efficient, and efficacious in terms of intraoperative and long-term cranial growth outcomes when compared to CVR. The authors recommend this minimally invasive approach as an option for correction of lambdoid synostosis in patients presenting early in their course.
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Chelli, Sudhakara Babu, Bhimai Devi N., Anuradha P., Mohana Sandhya K., and Bhaskar K. "Topography and clinical implication of Wormian bones on dry adult human skulls in Telangana region." Biomedicine 43, no. 5 (2023): 1574–77. http://dx.doi.org/10.51248/.v43i5.2767.
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Introduction and Aim: Wormian bones vary in size, form and quantity and their occurrence is influenced by both genetic and environmental variables. Wormian bones are also seen in foetus ultrasounds during the antenatal period. The occurrence of much more than one sutural bone at the pterion is radiographically significant. The current study aims at the occurrence and topography of Wormian bones in the Telangana region and correlates them to other population groups. Material and Methods: This study was carried out in 160 dry adult human skulls. Presence of these Wormian bones in sagittal, coronal, and Lambdoid sutures along with bregma, lambda, asterion and pterion were noted. The quantitative data is analyzed, and the images were captured. Results: Their incidence was 45 % while in 55% skulls they were absent. Their percentage was more in lambdoid suture (16.9%) followed by asterion (12.5%). They were also observed in sutures like coronal (5.6%) and sagittal (1.9%). In pterion their occurrence was 3.12%. In bregma, none of the skull showed Wormian bones. Conclusion: In the present study, incidence of Wormian bones (Wb’s) is 45% with a greater number of Wb’s observed in Lambdoid suture (16.9%). In the event of any interventions or investigations on the skull, topography of these bones is to be considered.
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RR, Bhabhor, AR Pandey, MS Yadav, and AP Parmar. "AUTOPSY-BASED STUDY FOR DETERMINATION AND EVALUATION OF AGE ESTIMATION THROUGH MACROSCOPIC EXAMINATION OF CRANIAL SUTURE CLOSURE BY ECTOCRANIAL METHOD AT MORTUARY COMPLEX OF SAURASHTRA REGION." Journal of Forensic Medicine and Toxicology 41, no. 1 (2024): 35–41. http://dx.doi.org/10.48165/jfmt.2024.41.1.8.
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Introduction: The lack of existing data pertaining to the Bhavnagar region, coupled with the inability to extrapolate findings from prior investigations, prompted the initiation of the present study. The primary objectives of this research were to elucidate the temporal progression of suture closure, ascertain sexual dimorphism, and evaluate the accuracy of age determination methods specific to the Bhavnagar region Materials and Methodology: A total of 100 cases of >20 years of age brought for medicolegal autopsy were analyzed. The coronal, sagittal, and lambdoid sutures were studied ectocranially. The degree of obliteration of sutures was scored ectocranially. Data were analyzed using Epi-info7 Software. Descriptive statistics were evaluated for continuous data, and categorical data were presented by frequency and percentages. An independent t-test was applied to find out the mean difference between the right and left sides of suture closure for ectocranial surfaces. Result: Regarding the chronology of suture closure, the present study found some variations compared to previous research. Notably, in the Sagittal suture, the anterior 1/ 3rd segment closed earlier in males, potentially due to lapsed union. Similarly, in the Coronal suture, the C1 segment closed first, followed by C2 and C3 in both genders. For the Lambdoid suture, L3 closed earlier than L2 and L1 in females, while L1 closed first in males. Conclusion: The present research highlights variations in gender and surface-based closure patterns. The erratic nature of suture obliteration necessitates caution when using it as the sole method for age estimation in forensic contexts.
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Jimenez, David F., and Constance M. Barone. "Multiple-suture nonsyndromic craniosynostosis: early and effective management using endoscopic techniques." Journal of Neurosurgery: Pediatrics 5, no. 3 (2010): 223–31. http://dx.doi.org/10.3171/2009.10.peds09216.
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Object The authors present the results of treating infants with multiple-suture nonsyndromic craniosynostosis in whom the authors used minimally invasive endoscopy-assisted techniques and postoperative cranial molding over an 11-year period. Methods A total of 21 patients who presented with multiple-suture (nonsyndromic) craniosynostosis were treated using minimally invasive endoscopy-assisted craniectomies. Surgery was followed by treatment with custommade cranial orthoses for up to 12 months. A total of 48 sutures were treated. The most common was the coronal suture (38 cases) and this was followed by the sagittal (11 cases), metopic (6 cases), and lambdoid (3 cases) sutures. There were 13 male and 8 female pediatric patients. Their ages ranged between 3 weeks and 9 months (mean 3.2 months, median 2.5 months). The sagittal suture was treated with a wide vertex craniotomy via 2 incisions located behind the anterior fontanel and in front of the lambda. The metopic suture underwent a suturectomy as did the coronal and lambdoid sutures. Results The mean follow-up duration was 61 months (range 3–135 months). There were no deaths. In patients with bicoronal synostosis, brachycephaly was corrected. Patients presenting with vertical dystopia or nasal deviation had these deformities corrected as well. The mean blood loss was 42 ml (range 10–120 ml). The mean hospital length of stay was 1 day. The intraoperative transfusion rate was 0%. The results indicate that nonsyndromic multiple-suture synostosis can be safely and effectively treated using endoscopic techniques. Conclusions Early treatment of complex multiple-suture synostosis with endoscopic techniques provides an excellent surgical alternative. The results of the present study indicate marked correction of skull base and craniofacial deformities. Endoscopy provides a safe and effective way to treat these patients.
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Delashaw, Johnny B., John A. Persing, William C. Broaddus, and John A. Jane. "Cranial vault growth in craniosynostosis." Journal of Neurosurgery 70, no. 2 (1989): 159–65. http://dx.doi.org/10.3171/jns.1989.70.2.0159.
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✓ Skull growth after single suture closure was described in 1851 by Virchow, who noted that growth in the plane perpendicular to a fused suture was restricted. However, this observation failed to predict compensatory growth patterns that produce many of the deformities recognized as features of individual syndromes. The deformities resulting from premature closure of a coronal, sagittal, metopic, or lambdoid suture can be predicted on the basis of the following observations: 1) cranial vault bones that are prematurely fused secondary to single suture closure act as a single bone plate with decreased growth potential; 2) asymmetrical bone deposition occurs mainly at perimeter sutures, with increased bone deposition directed away from the bone plate; 3) sutures adjacent to the prematurely fused suture compensate in growth more than those sutures not contiguous with the closed suture; and 4) enhanced symmetrical bone deposition occurs along both sides of a non-perimeter suture that is a continuation of the prematurely closed suture. These observations regarding growth in craniosynostosis are illustrated with clinical material in this report.
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Rawat, Laxmi, K. P. Badgujar, and Harshit Kumar. "An autopsy-based study on Cranial vault Suture fusion for estimation of Age in Ajmer region at J.L.N Medical College, Ajmer." International Journal of Medical, Pharmacy and Drug Research 8, no. 3 (2024): 01–06. http://dx.doi.org/10.22161/ijmpd.8.3.1.
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Introduction: Cranial suture closure is one trait that has been used since the 16th century for age estimation after the 2nd decade of life. To determine the pattern of cranial vault suture closure in relation to age among dead bodies of subjects (3rd to 5th decades of life) and identify any relationship between progression of the union of cranial suture and age. Materials and Methods: We conducted a cross-sectional observational study from January 2023 to June 2024 involving 150 cadavers. Cadavers were studied for ecto cranial and endo cranial closure pattern for sagittal-coronal and lambdoid sutures. Spearman coefficient was utilized to assess the correlation between the age of the subject and the stage of fusion of cranial sutures. Results: We noted that the process of endo-cranial fusion of cranial suture was more regular than ecto-cranial. The coronal suture was the first to fuse. Conclusion: No definite correlation was found to exist between age and suture closures.
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Sivakumaran, Rajitha. "The Impact of Sex and Ancestry on Cranial Sutures in the Hamann Todd Collection." NEXUS: The Canadian Student Journal of Anthropology 22 (November 11, 2014): 68–80. http://dx.doi.org/10.15173/nexus.v22i1.11.
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Cranial suture closure has been regarded as an unreliable method for age estimation due to the large amount ofvariability in the commencement, progression and termination of fusion. The Hamann Todd Osteological Collectionwas used to examine the sagittal, coronal and lambdoid sutures in an attempt to determine the impact of sex and ancestry on synostosis. The sagittal does not appear to be impacted by sex, but in the coronal and lambdoid sutures,significant sex-based differences were noted. Generally, females exhibited greater progression than males, butsynostosis was more strongly related to age in males. Stronger age-score correlations were present in black individuals compared to white individuals. This questions the application of current cranial aging methods, which do not address sex- and population-based differences in the commencement, progression and termination ofsutural fusion.
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Buzdar, Zulfiqar Ali, and Mubarak Mehmood Ahmad Khan. "An Autopsy based unaided Eye Study of Lambdoid Suture of Skull– the Science of Forensic Estimation of Age." Pakistan Journal of Medical and Health Sciences 16, no. 12 (2022): 206–8. http://dx.doi.org/10.53350/pjmhs20221612206.
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Background: The criminal investigation starts at crime scene and ends in the laboratory. The most vital of which is mortuary where the postmortem examination of the deceased is carried out to answer the questions of interest in that investigatory menu. Aim: Unaided eye estimation of age from the lambdoid suture of skull on autopsy. Methods: The subjects under study were taken from mortuary of the department of Forensic Medicine and Toxicology in the King Edward Medical University Lahore during the year 2016. The targeted population for study was the draining are of the mortuary of King Edward Medical College having designated police station. A pretested questionnaire was used to collect the calculated sample among the research population as a research method. A non-probability convenient consecutive sampling technique was applied to collect the data. The comparative descriptive study design was utilized to analyze the results. Results: The study revealed that among the targeted population a higher percentage more than third of the sample size were adolescents of age between 21 – 30 years being 35% followed by elderlies of age between 41 – 50 years amount to 20%. The research depicted that age can be determined from degree of closure of lambdoid suture in the dead body on the autopsy table with closure taking place earlier in males as compared to that of females. Conclusion: This study concludes that it is possible to estimate age from the degree of lambdoid suture closure of the deceased skull vault during the postmortem examination. Keywords: Age, Lambdoid, Suture, Autopsy, Cranial, Post-mortem Examination, Skull
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Kumar, A. Arun, B. Rajesh, K. Arumugam, and V. Tamilalagan. "SUTURAL BONES ASSOCIATED WITH LAMBDOID SUTURE OF HUMAN SKULL: PRESENCE, VARIATIONS AND CLINICAL IMPORTANCE." International Journal of Anatomy and Research 4, no. 2.2 (2016): 2331–36. http://dx.doi.org/10.16965/ijar.2016.208.
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Reardon, Taylor, Brian Fiani, Jacob Kosarchuk, Anthony Parisi, and Nathan A. Shlobin. "Management of Lambdoid Craniosynostosis: A Comprehensive and Systematic Review." Pediatric Neurosurgery 57, no. 1 (2021): 1–16. http://dx.doi.org/10.1159/000519175.
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Background: Craniosynostosis is a condition characterized by the premature fusion of 2 or more skull bones. Craniosynostosis of the lambdoid suture is one of the rarest forms, accounting for 1–4% of all craniosynostoses. Documented cases are separated into simple (single suture), complex (bilateral), and associated with adjacent synostoses (“Mercedes Benz” Pattern) or syndromes (i.e., Crouzon, Sathre-Chotzen, Antley-Bixler). This condition can manifest phenotypic deformities and neurological sequelae that can lead to impaired cognitive function if improperly treated or left undiagnosed. Preferred surgical techniques have varied over time but all maintain the common goals of establishing proper head shape and preventing of complications that could contribute to aforementioned sequelae. Summary: This comprehensive review highlights demographic distributions, embryological development, pathogenesis, clinical presentation, neurological sequelae, radiologic findings, surgical techniques, surgical outcomes, and postoperative considerations of patients with lambdoid craniosynostosis presentation. In addition, a systematic review was conducted to explore the operative management of lambdoid craniosynostosis using PubMed, Embase, and Scopus databases, with 38 articles included after screening. Key Messages: Due to a low volume of published cases, diagnosis and treatment can vary. Large overlap in presentation can occur in patients that display lambdoid craniosynostosis and posterior plagiocephaly, furthering the need for comprehensive analysis. Possessing the knowledge and tools to properly assess patients with lambdoid craniosynostosis will allow for more precise care and improved outcomes.
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Lapehn, Samantha, Jonas A. Gustafson, Andrew E. Timms, Michael L. Cunningham, and Alison G. Paquette. "Transcriptomic Signatures of Single-Suture Craniosynostosis Phenotypes." International Journal of Molecular Sciences 24, no. 6 (2023): 5353. http://dx.doi.org/10.3390/ijms24065353.
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Craniosynostosis is a birth defect where calvarial sutures close prematurely, as part of a genetic syndrome or independently, with unknown cause. This study aimed to identify differences in gene expression in primary calvarial cell lines derived from patients with four phenotypes of single-suture craniosynostosis, compared to controls. Calvarial bone samples (N = 388 cases/85 controls) were collected from clinical sites during reconstructive skull surgery. Primary cell lines were then derived from the tissue and used for RNA sequencing. Linear models were fit to estimate covariate adjusted associations between gene expression and four phenotypes of single-suture craniosynostosis (lambdoid, metopic, sagittal, and coronal), compared to controls. Sex-stratified analysis was also performed for each phenotype. Differentially expressed genes (DEGs) included 72 genes associated with coronal, 90 genes associated with sagittal, 103 genes associated with metopic, and 33 genes associated with lambdoid craniosynostosis. The sex-stratified analysis revealed more DEGs in males (98) than females (4). There were 16 DEGs that were homeobox (HOX) genes. Three TFs (SUZ12, EZH2, AR) significantly regulated expression of DEGs in one or more phenotypes. Pathway analysis identified four KEGG pathways associated with at least one phenotype of craniosynostosis. Together, this work suggests unique molecular mechanisms related to craniosynostosis phenotype and fetal sex.
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Walulkar, S.M., M.S. Walulkar, and V. M. Paikrao. "Incidence and Morphometrics Analysis of Sutural, Inca and Epipteric Bones in Adult Human Skulls from Central India." International Journal of Pharmaceutical and Clinical Research 15, no. 11 (2023): 372–80. https://doi.org/10.5281/zenodo.11215118.
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<strong>Background: </strong>Sutural, Inca, and Epipteric bones are intrinsic components of the cranial structure in various mammals and reptiles. Additional ossification centres may occur in or near sutures, giving rise to isolated sutural bones. Usually irregular in size and shape, and most frequent in lambdoid suture, they sometime occur at fontanelles. There are often only two or three, but they appear in great numbers in hydrocephalic skull. <strong>Aims and Objectives: </strong>The study aims to investigate the prevalence, sexual dimorphism, morphological variations, and clinical implications of cranial sutural, Inca, and epipteric bones in adult human skulls from Vidarbha, India. <strong>Methodology: </strong>The 430 adult human skulls were collected from various medical colleges in the Vidarbha region, each skull and recording the presence, gross incidence, and distribution of sutural bones, inca, and epipteric bones. The observations were made regarding their occurrence in specific cranial sites, suture locations, and shapes. Anthropometric measurements were taken to determine the maximum length and breadth of each bone. The sexual dimorphism and conducted statistical analyses to identify patterns and trends in the collected data. <strong>Result:</strong> In our analysis, Wormian bones were present in 34.18% of the 430 examined skulls, with 38.76% incidence in males and 25.97% in females. These bones were most frequently located in the lambdoid suture and Lambda. Irregular-shaped Wormian bones were predominant. Inca bones were found in 2.33% of skulls, with variations in type, size, and shape. Epipteric bones appeared in 18.37% of skulls, demonstrating sexual dimorphism and a range of symmetry patterns. <strong>Conclusion:</strong> In our comprehensive cranial bone study, Wormian bones were most frequent in the lambdoid suture, primarily on the left side, while Inca bones displayed variations in form and incidence, slightly higher in males. Epipteric bones at the pterion can complicate procedures.
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Haravu, Pranav N., Miguel Gonzalez, Shelby L. Nathan, Callum F. Ross, Olga Panagiotopoulou, and Russell R. Reid. "The biomechanics of chewing and suckling in the infant: A potential mechanism for physiologic metopic suture closure." PLOS Computational Biology 19, no. 6 (2023): e1011227. http://dx.doi.org/10.1371/journal.pcbi.1011227.
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Craniosynostosis is a condition with neurologic and aesthetic sequelae requiring invasive surgery. Understanding its pathobiology requires familiarity with the processes underlying physiologic suture closure. Animal studies have shown that cyclical strain from chewing and suckling influences the closure of cranial vault sutures, especially the metopic, an important locus of craniosynostosis. However, there are no human data correlating strain patterns during chewing and suckling with the physiologically early closure pattern of the metopic suture. Furthermore, differences in craniofacial morphology make it challenging to directly extrapolate animal findings to humans. Eight finite-element analysis (FEA) models were built from craniofacial computer tomography (CT) scans at varying stages of metopic suture closure, including two with isolated non-syndromic metopic craniosynostosis. Muscle forces acting on the cranium during chewing and suckling were simulated using subject-specific jaw muscle cross-sectional areas. Chewing and suckling induced tension at the metopic and sagittal sutures, and compressed the coronal, lambdoid, and squamous sutures. Relative to other cranial vault sutures, the metopic suture experienced larger magnitudes of axial strain across the suture and a lower magnitude of shear strain. Strain across the metopic suture decreased during suture closure, but other sutures were unaffected. Strain patterns along the metopic suture mirrored the anterior to posterior sequence of closure: strain magnitudes were highest at the glabella and decreased posteriorly, with minima at the nasion and the anterior fontanelle. In models of physiologic suture closure, increased degree of metopic suture closure correlated with higher maximum principal strains across the frontal bone and mid-face, a strain regime not observed in models of severe metopic craniosynostosis. In summary, our work provides human evidence that bone strain patterns from chewing and suckling correlate with the physiologically early closure pattern of the metopic suture, and that deviations from physiologic strain regimes may contribute to clinically observed craniofacial dysmorphism.
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Chumas, Paul D., Giuseppe Cinalli, Eric Arnaud, Daniel Marchac, and Dominique Renier. "Classification of previously unclassified cases of craniosynostosis." Neurosurgical Focus 1, no. 6 (1996): E1. http://dx.doi.org/10.3171/foc.1996.1.6.1.
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Cases of craniosynostosis usually fall into well-demarcated categories: those related to a syndrome or identified by a combination of suture involvement and morphological appearance. Between 1976 and 1995, 53 (3.6%) of 1474 cases in the craniofacial databank were assessed and designated as nonsyndromic but unclassifiable. The records and radiological studies obtained in these patients were retrospectively analyzed and comparisons were made with patients classified in the databank as having simple craniosynostoses. It proved possible to divide the formerly unclassifiable cases into two groups: those with “two-suture disease” (Group A) and a “complex” group (Group B) in which more than two sutures were affected. Group A consisted of 36 cases (68%) of patients presenting with clear evidence of simultaneous involvement of two sutures but with no progression over time to suggest a more diffuse pansynostosis. Suture involvement was as follows: 17 of 36 sagittal plus one coronal; seven of 36 sagittal plus metopic; six of 36 sagittal plus one lambdoid; and six of 36 metopic plus one coronal. The only significant difference between the Group A cases and the cases of simple craniosynostoses was in the percentage requiring a second operation (24% vs. 5%, p < 0.0001). Group B consisted of 17 cases in which the patients presented at a slightly earlier age (mean 1 year) with severe morphological changes and multiple suture involvement. At the time of surgery, six of 17 patients showed large areas of lacunae within the cranial vault, making craniectomy the only option. In Group B, 10 of 17 patients displayed bilateral lambdoid plus sagittal suture involvement resulting in marked occipital recession posteriorly, whereas anteriorly in six of these 10 patients there was a massive frontal bone associated with posteriorly located coronal sutures. In contrast, there were also four patients in Group B with bilateral coronal plus metopic involvement resulting in a small frontal bone. There was a trend toward a lower intelligence quotient and a worse morphological outcome in the patients in Group B, but again the only result attaining statistical significance when compared to the databank was the rate of second operation (37.5 vs. 5%, p < 0.0001). “Two-suture synostosis” is a relatively straightforward condition and is treatable with standard craniosynostosis techniques. However, possibly as a result of surgical compromise when two sutures are involved, the rate of reoperation is far higher than in simple suture cases. In contrast, patients in the “complex” group presenting with severe multisuture involvement require a more tailor-made approach to their management that often entails a second procedure.
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Chumas, Paul D., Giuseppe Cinalli, Eric Arnaud, Daniel Marchac, and Dominique Renier. "Classification of previously unclassified cases of craniosynostosis." Journal of Neurosurgery 86, no. 2 (1997): 177–81. http://dx.doi.org/10.3171/jns.1997.86.2.0177.
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✓ Cases of craniosynostosis usually fall into well-demarcated categories: those related to a syndrome or those identified by a combination of suture involvement and morphological appearance. Between 1976 and 1995, 53 (3.6%) of 1474 cases in the craniofacial databank were assessed and designated as nonsyndromic but unclassifiable. The records and radiological studies obtained in these patients were retrospectively analyzed and comparisons were made with patients classified in the databank as having simple craniosynostoses. It proved possible to divide the formerly unclassifiable cases into two groups: those with “two-suture disease” (Group A) and a “complex” group (Group B) in which more than two sutures were affected. Group A consisted of 36 cases (68%) of patients presenting with clear evidence of simultaneous involvement of two sutures but with no progression over time to suggest a more diffuse pansynostosis. Suture involvement was as follows: 17 of 36 sagittal plus one coronal; seven of 36 sagittal and metopic; six of 36 sagittal plus one lambdoid; and six of 36 metopic plus one coronal. The only significant difference between the Group A cases and the cases of simple craniosynostoses was in the percentage requiring a second operation (24% vs. 5%, p < 0.0001). Group B consisted of 17 cases in which the patients presented at a slightly earlier age (mean 1 year) with severe morphological changes and multiple suture involvement. At the time of surgery, six of 17 patients showed large areas of lacunae within the cranial vault, making craniectomy the only option. In Group B, 10 of 17 patients displayed bilateral lambdoid plus sagittal suture involvement resulting in marked occipital recession posteriorly, whereas anteriorly in six of these 10 patients there was a massive frontal bone associated with posteriorly located coronal sutures. In contrast, there were also four patients in Group B with bilateral coronal plus metopic involvement resulting in a small frontal bone. There was a trend toward a lower intelligence quotient and a worse morphological outcome in the patients in Group B, but again the only result attaining statistical significance when compared to the databank was the rate of second operation (37.5 vs. 5%, p < 0.0001). “Two-suture synostosis” is a relatively straightforward condition and is treatable with standard craniosynostosis techniques. However, possibly as a result of surgical compromise when two sutures are involved, the rate of reoperation is far higher than in simple suture cases. In contrast, patients in the “complex” group presenting with severe multisuture involvement require a more tailor-made approach to their management that often entails a second procedure.
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Eppley, Barry L., James M. Platis, and A. Michael Sadove. "Experimental Effects of Bone Plating in Infancy on Craniomaxillofacial Skeletal Growth." Cleft Palate-Craniofacial Journal 30, no. 2 (1993): 164–69. http://dx.doi.org/10.1597/1545-1569_1993_030_0164_eeobpi_2.3.co_2.
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The potential effects of mini- and microfixation on craniofacial development was investigated in an animal model. Twenty-four rabbits had amalgam markers placed bilaterally at the lambdoid, coronal, and frontonasal sutures at 28 days of age. In group 1, plating was not done and served as controls. In groups 2 to 4, single 2- and 4-hole microplates and 4-hole miniplates were fixed across the left coronal suture. The right suture was not plated. After 6 months, intermarker distances and craniofacial angles were measured radiographically. Coronal sutures underneath the plates were also histologically evaluated. Plating across the coronal suture resulted in local anteroposterior constriction of marker distances that did not differ with the type of fixation used. More distant markers, however, were increased in all specimens as a compensation and, as a result, the cranionasal length of all groups were similar. No change in craniofacial angles was observed from that of the controls. Sutural morphology on the side of fixation was altered with decreased widths, cellular numbers, and bone deposition. These experimental results demonstrate that early plate application in a normal calvarium results in local growth restriction that can be overcome by regional bone growth compensation.
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Aragão, José Aderval, Roberto Ferreira De Oliveira, Smilly Oliveira De Sousa Silva, et al. "Multiple Wormian Bones in the Lambdoid Suture: A Report of Rare Occurrence." Brazilian Journal of Case Reports 4, no. 4 (2024): 141–49. http://dx.doi.org/10.52600/2763-583x.bjcr.2024.4.4.141-149.
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Wormian bones are irregular bony structures developed from independent ossification centers located at the junction of the sutures between the cranial bones. Although they are commonly found in healthy individuals, their presence can be associated with pathological conditions. Their number above 10, large size, or mosaic pattern are clinically considered as indicators of several pathological conditions, such as abnormalities in the central nervous system, musculoskeletal system, or metabolic changes throughout the body. Our study aims to report a rare occurrence of 40 Wormian bones found in the lambdoid suture of an adult human skull and provide a literature review. Understanding the presence of Wormian bones is crucial for professionals such as neuroanatomists, neurosurgeons, radiologists, anthropologists, and morphologists, as they may be mistaken for fractures in cases of traumatic brain injury.
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Magalhães, Carolina, Maria Ferreira, Rita Reis, Fernanda Silva, Taciana Santos, and Renata Campina. "Existence of Enlarged Parietal Foramina in Bone Collections." Journal of Morphological Sciences 35, no. 02 (2018): 125–28. http://dx.doi.org/10.1055/s-0038-1669433.
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Introduction The enlarged parietal foramen (EPF) is a defect in the ossification of the parietal bone that is well described in the literature using a variety of nomenclatures. Individuals with EPF can present symptoms such as migraines, vomiting and intense pain when light pressure is applied to the skull. However, it can go unnoticed for a lifetime. Materials and Methods At the Human Bone Collection department of the Universidade Federal de Pernambuco, 2 craniums (CAV 90, 96 years old and CAV 16, 81 years old) and were identified as having EPF, both from females. Results There was no apparent kinship between both craniums. The sagittal length, the coronal width, the sagittal suture distance, the coronal suture distance and the lambdoid suture distance of each enlarged parietal foramen were evaluated, with the following results: sagittal length: 5.5 cm (CAV 90), and 5.0 cm (CAV 16); coronal width: 3.1 cm (CAV 90),and 3.4 cm (CAV 16); sagittal suture distance: 2.9 cm (CAV 90), and 2.3 cm (CAV 16); coronal suture distance: 1.8 cm (CAV 90), and 4.6 cm (CAV 16); and lambdoid suture distance: 5.0 cm (CAV 90), and 3.0 cm (CAV 16). The parietal foramen of both craniums exhibited equivalent measurements. Conclusion Due to the low incidence of EPF, the identification of the 2 craniums with this condition in a collection of 105 skeletons makes the discovery relevant. In reference to craniums exhibiting EPF, this is an important tool for study and forensic research, since its appearance is linked to heredity.
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Rollins, N., and F. Sklar. "Factitious lambdoid perisutural sclerosis: Does the ?sticky suture? exist?" Pediatric Radiology 26, no. 5 (1996): 356–58. http://dx.doi.org/10.1007/bf01395715.
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Brill, Charles B., Veena Jarath, and Perry Black. "Occipital Interhemispheric Acute Subdural Hematoma Treated by Lambdoid Suture Tap." Neurosurgery 16, no. 2 (1985): 247–51. http://dx.doi.org/10.1227/00006123-198502000-00025.
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Abstract We present the case of a 6-week-old infant with acute subdural hematoma secondary to hemorrhagic disease of the newborn. Computed tomographic scan localization of the collection in the posterior portion of the supratentorial compartment allowed for its removal by lambdoid suture taps. The procedure is described.
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Bonfield, Christopher M., D. Douglas Cochrane, Ash Singhal, and Paul Steinbok. "Preoperative ultrasound localization of the lambda in patients with scaphocephaly: a technical note for minimally invasive craniectomy." Journal of Neurosurgery: Pediatrics 16, no. 5 (2015): 564–66. http://dx.doi.org/10.3171/2015.5.peds15157.
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Sagittal craniosynostosis, the most common single suture craniosynostosis, is treated by numerous surgical techniques. Minimally invasive endoscopy-assisted procedures with postoperative helmeting are being used with reports of good cosmetic outcomes with decreased morbidity, shortened hospital stay, and less blood loss and transfusion. This procedure uses small skin incisions, which must be properly placed to provide safe access to the posterior sagittal and lambdoid sutures. However, the lambda is often hard to palpate through the skin due to the abnormal head shape. The authors describe their experience with the use of intraoperative, preincision ultrasound localization of the lambda in patients with scaphocephaly undergoing a minimally invasive procedure. This simple technique can also be applied to other operations where proper identification of the cranial sutures is necessary.
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Ahn, Edward S., and Archis R. Bhandarkar. "Single incision endoscopic strip craniectomy for sagittal craniosynostosis." Neurosurgical Focus: Video 4, no. 2 (2021): V10. http://dx.doi.org/10.3171/2021.1.focvid20120.
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The authors describe an endoscopic strip craniectomy through a single incision for the treatment of sagittal craniosynostosis in a young infant. The endoscopic strip craniectomy was first introduced with the use of two incisions on either end of the fused suture. This single-incision technique offers several advantages. There is a cosmetic advantage and a reduced risk of wound complications. This technique also allows for early control of emissary veins and an inside-out identification of the lambdoid sutures. Endoscopic visualization is optimized to reduce the risk of blood loss, especially because circulating blood volume is very limited in these young infants. The video can be found here: https://vimeo.com/514366415
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Yan, Han, Taylor J. Abel, Naif M. Alotaibi, et al. "A systematic review of endoscopic versus open treatment of craniosynostosis. Part 2: the nonsagittal single sutures." Journal of Neurosurgery: Pediatrics 22, no. 4 (2018): 361–68. http://dx.doi.org/10.3171/2018.4.peds17730.
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OBJECTIVEDespite increasing adoption of endoscopic techniques for repair of nonsagittal single-suture craniosynostosis, the efficacy and safety of the procedure relative to established open approaches are unknown. In this systematic review the authors aimed to directly compare open surgical and endoscope-assisted techniques for the treatment of metopic, unilateral coronal, and lambdoid craniosynostosis, with an emphasis on quantitative reported outcomes.METHODSA literature search was performed in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Relevant articles were identified from 3 electronic databases (MEDLINE, EMBASE, and CENTRAL [Cochrane Central Register of Controlled Trials]) from their inception to August 2017. The quality of methodology and bias risk were assessed using the Effective Public Health Practice Project (EPHPP) Quality Assessment Tool for Quantitative Studies.RESULTSOf 316 screened records, 7 studies were included in a qualitative synthesis of the evidence, of which none were eligible for meta-analysis. These reported on 111 unique patients with metopic, 65 with unilateral coronal, and 12 with lambdoid craniosynostosis. For all suture types, 100 (53%) children underwent endoscope-assisted craniosynostosis surgery and 32 (47%) patients underwent open repair. These studies all suggest that blood loss, transfusion rate, operating time, and length of hospital stay were superior for endoscopically treated children. Although potentially comparable or better cosmetic outcomes are reported, the paucity of evidence and considerable variability in outcomes preclude meaningful conclusions.CONCLUSIONSLimited data comparing open and endoscopic treatments for metopic, unilateral coronal, and lambdoid synostosis suggest a benefit for endoscopic techniques with respect to blood loss, transfusion, length of stay, and operating time. This report highlights shortcomings in evidence and gaps in knowledge regarding endoscopic repair of nonsagittal single-suture craniosynostosis, emphasizing the need for further matched-control studies.
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Singh, Neetu. "A CADAVERIC STUDY OF SEEMANTA MARMA." International Journal of Research in Ayurveda and Pharmacy 13, no. 5 (2022): 67–69. http://dx.doi.org/10.7897/2277-4343.1305125.
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Background: The marma sharira is a prime territory of Rachana sharira. Sushruta had elaborated marma sharira at a certain depth. Marma (vital area) is described in the Hindu scripture Atharva Veda. During the Vedic era, the Marma Sharira had particular importance in the case of war field. The seemanta marma is shira marma, kalantara pranahara. The nature of this marma is sandhi marma. Aims: There are very few studies regarding the cadaveric study of seemanta marma. This study aims to identify the possible anatomical structure and analyze those structures. Perhaps it could be helpful for future scholars of Ayurveda. Material and method: The review was performed based on traditional Ayurvedic classics and contemporary medical sciences, journals, publications, articles, e-journals etc. The region of seemanta marma and surrounding area was dissected, and complete anatomical study was done. Discussion: The term seemanta indicates that the bony joint is present in the skull region. The joints present in the skull region are mainly sutural joints and fibrous, which provide malleable head quality. There are five major sutures in adult like coronal suture, sagittal suture, lambdoid suture and two squamous sutures, the frontal sutures present in infant and children. Conclusion: It has a significant role during delivery and brain development, which allows normal vaginal birth of the head. It also offers normal cranial growth by proper fusion if the premature fusion of sutures occurs (craniosynostosis), which results in cranial malformation.
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Brill, C. B., V. Jarath, and P. Black. "Occipital interhemispheric acute subdural hematoma treated by lambdoid suture tap." Neurosurgery 16, no. 2 (1985): 247???51. http://dx.doi.org/10.1097/00006123-198502000-00025.
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Ghali, G. E. "Posterior cranial vault reconstruction for sagittal and lambdoid suture craniosynostosis." International Journal of Oral and Maxillofacial Surgery 46 (March 2017): 21. http://dx.doi.org/10.1016/j.ijom.2017.02.074.
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Indira, CK, Vennila G., and Santhini Arulselvi K. "Identification and Variation of Sutural Bones in Indian Dry Cranium." International Journal of Pharmaceutical and Clinical Research 14, no. 6 (2022): 1–9. https://doi.org/10.5281/zenodo.13623914.
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<strong>Background: </strong>Sutural bones are supranumary bones occurring along the sutures and completely surrounded by sutures of the skull. Their number, morphology and location in skull vary in skulls. The knowledge of these bones is imperative in surgery, medicolegal cases involving child abuse or fracture of skulls and for anthropologic identification of human populations. Also, the prior knowledge about the Wormian bones is important because they are present in normal individuals as well as in various disorders such as osteogenesis imperfect, rickets, etc. Very few studies have been undertaken to study the anatomical aspects of sutural bones in dry human cranium. <strong>Objective: </strong>The current study aimed to estimate the presence and variations of sutural bones in dry human cranium. <strong>Materials and Methods: </strong>This retrospective, observational and single-center study carried out in the J. K. K. Nattraja Dental College, Kumarapalayam, Namakkal district and Vinayaka Missions Medical College, Karaikal from August 2021 to December 2021. A total of 110 dry cranium of unknown sex was collected from above institutions. All the dry cranium was observed carefully for sutural bones. Presence of sutural bones was noticed in unilateral and bilateral location and shape of sutural bones was identified. Data was entered in Microsoft Excel® and statistical analysis for descriptive variables was performed in IBM SPSS (Version 16.0). <strong>Results: </strong>Out of 110 dry crania, sutural bones were found in 69 crania (62.72%) with highest number of sutural bones found at lambdoid suture and asterion part of dry cranium, whereas 9-12 sutural bones were present in three cranium at lambdoid suture and finally, 3-5 sutural bones were recorded at asterion in five bones. Among the unilateral and bilateral occurrence of sutural bones, this study noted lambdoid (60/54.54) and asterion (48 /43.63) areas with more sutural bones than at other sites. Pterion was another common site of sutural bones that showed higher frequency than the bones of parietal notch. At the parietal notch, this study recorded 2-3 sutural bones. Also, this study reported (6/ 5.45) sutural bones in lateral wall of orbit between zygomatic bone and greater wing of sphenoid. <strong>Conclusion: </strong>Anatomical knowledge of sutural bones is clinically important, because their presence refers mainly to bone dysplasia like craniosynostosis and imperfect osteogenesis and used as a useful marker of some congenital disorders.
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Zulfiqar Ali Buzdar, Tasneem Murad, Sheeba Shabbir, Anwaar Ahmed, Tufail Ahmed Soomro, and Riffat Masood. "Estimating Age on the Autopsy Table: A Postmortem Study of Forensic Investigations." Journal of Saidu Medical College, Swat 14, no. 4 (2024): 353–58. http://dx.doi.org/10.52206/jsmc.2024.14.4.995.
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Background: Forensic investigation are sensitive and needs to be accurate before presentation to the court of law like determination of exact age on autopsy. Establishing identification of unknown individual amid criminal investigation is vital to hold the actual perpetrator accountable. The first and foremost in such investigation is the determination of age.Objectives: To estimate the age of a deceased within a ±10 years range by quantitatively assessing cranial suture closure using standardized techniques, aiming to complete data collection and analysis within 9 months.Materials and Methods: This was a descriptive cross-sectional study to analyze the degree of suture closure (by Acsádi Nemeskéri scoring scale) of the cranial vault of 90 human cadavers by utilizing non-probability consecutive convenient sampling technique from January 15, 2016 to September 30, 2016 in the mortuary of the department of Forensic Medicine and Toxicology of King Edward Medical University, Lahore, Pakistan.Results: The study evaluated the degree of suture closure showing complete closure across all the subsections of the sagittal suture with complete closure showing that the age was less than 60 years in deceased individuals. Complete closure of more than two third of the area of the coronal and lambdoid suture suggested that the age was somewhere between 51 to 60 years. Conclusion: The study concluded that the age can be estimated from the status of fusion of the cranial sutures of the vault with certain degree of accuracy. The closure was evident as incipient closure in thirties to advanced closure or closure in progress in forties. Complete closure was observed after 60 years of age in all the sutures.Keywords: Age, Cranium, Forensic Investigation, Forensic Autopsy, Skull, Suture, Vault.
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Hasan, Rakibul, Maarit Takatalo, Hongqiang Ma, et al. "Rab23 deficient mice exhibit lambdoid suture craniosynostosis through aberrant Fgf signaling." Mechanisms of Development 145 (July 2017): S30. http://dx.doi.org/10.1016/j.mod.2017.04.028.
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Lukin, M. V., Ya A. Filin, A. V. Zvezdin, D. A. Beregovskiy, A. Yu Efimtsev, and G. E. Trufanov. "Dynamic contrast-enhanced magnetic resonance perfusion of the brain in children with craniosynostosis." Bulletin of the Medical Institute "REAVIZ" (REHABILITATION, DOCTOR AND HEALTH) 14, no. 6 (2024): 151–58. https://doi.org/10.20340/vmi-rvz.2024.6.mim.1.
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Craniosynostosis is the premature closure of cranial sutures, leading to skull deformation, cranio-cerebral disproportion, and potentially resulting in the development of intracranial hypertension, persistent neurological, and cognitive impairments. Magnetic resonance imaging (MRI) complemented by dynamic contrast-enhanced MR perfusion, allows for a detailed assessment of intracardiac structures, as well as evaluation of cerebral blood flow parameters in areas of suspected brain compression in children with craniosynostosis. Purpose of the study: еvaluate cerebral blood flow parameters (CBV and CBF) in children with craniosynostosis using contrast-enhanced dynamic MR perfusion in the preoperative stage. Object and methods. Forty-eight children with various types of craniosynostosis were examined: 10 (20%) had sagittal suture synostosis, 15 (31%) had metopic suture synostosis, 9 (19%) had unilateral coronal suture synostosis, 6 (13%) had bicoronal synostosis, 2 (4%) had lambdoid synostosis, and 6 (13%) had involvement of all sutures. Color perfusion maps of CBF and CBV were constructed using the syngo.via system (Siemens). Results. According to MR perfusion data, in areas of compression (frontal lobes) relative rCBV and rCBF indices in metopic craniosynostosis were 88.3 ± 24.6% and 85.5 ± 19.6% respectively, compared to the occipito-parietal regions. In cases of unilateral coronal synostosis, in the compression zone (ipsilateral frontal lobe) relative to the contralateral frontal lobe, they were 95.3 ± 3.1% (rCBV) and 93.1 ± 2.2% (rCBF), and relative to the occipital lobes, 84.4 ± 5.2% (rCBV) and 87.3 ± 8.2% (rCBF). In cases of bicoronal synostosis, in the frontal lobes they were 86.2 ± 19.7% (rCBV) and 86.4 ± 14.7% (rCBF) relative to the occipito-parietal regions. In cases of sagittal suture closure, in the temporal lobes relative to the frontal and occipital lobes, they were 99.1 ± 3.2% (rCBV) and 98.1±2.4% (rCBF).
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&NA;. "Ultrasound Screening of the Lambdoid Suture in the Child with Posterior Plagiocephaly." Ultrasound Quarterly 20, no. 1 (2004): 30. http://dx.doi.org/10.1097/00013644-200403000-00033.
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Sze, Raymond W., Marguerite T. Parisi, Manrita Sidhu, et al. "Ultrasound screening of the lambdoid suture in the child with posterior plagiocephaly." Pediatric Radiology 33, no. 9 (2003): 630–36. http://dx.doi.org/10.1007/s00247-003-1009-3.
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Ravindra, Vijay M., Al-Wala Awad, Cordell M. Baker, et al. "Preoperative imaging patterns and intracranial findings in single-suture craniosynostosis: a study from the Synostosis Research Group." Journal of Neurosurgery: Pediatrics 28, no. 3 (2021): 344–50. http://dx.doi.org/10.3171/2021.2.peds2113.
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OBJECTIVE The diagnosis of single-suture craniosynostosis can be made by physical examination, but the use of confirmatory imaging is common practice. The authors sought to investigate preoperative imaging use and to describe intracranial findings in children with single-suture synostosis from a large, prospective multicenter cohort. METHODS In this study from the Synostosis Research Group, the study population included children with clinically diagnosed single-suture synostosis between March 1, 2017, and October 31, 2020, at 5 institutions. The primary analysis correlated the clinical diagnosis and imaging diagnosis; secondary outcomes included intracranial findings by pathological suture type. RESULTS A total of 403 children (67% male) were identified with single-suture synostosis. Sagittal (n = 267), metopic (n = 77), coronal (n = 52), and lambdoid (n = 7) synostoses were reported; the most common presentation was abnormal head shape (97%), followed by a palpable or visible ridge (37%). Preoperative cranial imaging was performed in 90% of children; findings on 97% of these imaging studies matched the initial clinical diagnosis. Thirty-one additional fused sutures were identified in 18 children (5%) that differed from the clinical diagnosis. The most commonly used imaging modality by far was CT (n = 360), followed by radiography (n = 9) and MRI (n = 7). Most preoperative imaging was ordered as part of a protocolized pathway (67%); some images were obtained as a result of a nondiagnostic clinical examination (5.2%). Of the 360 patients who had CT imaging, 150 underwent total cranial vault surgery and 210 underwent strip craniectomy. The imaging findings influenced the surgical treatment 0.95% of the time. Among the 24% of children with additional (nonsynostosis) abnormal findings on CT, only 3.5% required further monitoring. CONCLUSIONS The authors found that a clinical diagnosis of single-suture craniosynostosis and the findings on CT were the same with rare exceptions. CT imaging very rarely altered the surgical treatment of children with single-suture synostosis.
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Friedrich, Reinhard E., Pedram Emami, Christian Hagel, Johannes Wikner, and Henning Hanken. "Repair of Occipital Bone Defects in Neurofibromatosis Type 1 by Means of CAD/CAM Prefabricated Titanium Plates." Craniomaxillofacial Trauma & Reconstruction 11, no. 4 (2018): 324–30. http://dx.doi.org/10.1055/s-0037-1608699.
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Certain skeletal defects may develop in neurofibromatosis type 1 (NF1), a common tumor-suppressor syndrome, such as cranial lesions confined to the lambdoid suture region. Here, we report on the repair of osseous defects of occipital bone in a NF1 patient with history of skull trauma and tumorous hemorrhage. Computer-aided design and computer-aided manufacturing (CAD/CAM)-assisted devices were applied to safely close the bone defects. The variable phenotype of NF1 in the occipital skull region is discussed and a brief review is presented on NF1-related therapies for tumors and malformations of the occipitoparietal skull region.