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Minor cranial suture closure: A morphological study.
Wayne Ledinh MD, Francis A Papay MD, Gaby Doumit MD
Cleveland Clinic
2013-02-20
Presenter: Wayne Ledinh MD
Affidavit:
Director Name: Steven Bernard MD
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial
Context
Craniosynostosis is a premature fusion of one or more cranial sutures. The more common synostoses involve the sagittal and coronal sutures, both major cranial sutures. There have been few reports of craniosynostosis involving minor cranial sutures. Controversy exists in the literature regarding the use of cranial suture closure for age determination.
Objectives
To determine whether and at what age the minor cranial sutures close.
Materials & Methods
114 skulls in the Hamann-Todd collection at the Cleveland Museum of Natural History (ages 1-50) were examined. Closure of the minor sutures was graded. Cranial dimensions were measured and cephalic indices were calculated.
Results
Data analysis indicates that the intraoccipital suture is the only minor suture to close in the pediatric age group. Median closure is at age 4 (95% confidence interval between ages 1 and 5). The median closure for the sphenofrontal suture is age 26 (95% confidence interval between ages 26 and 44). Closure of the occipitomastoid suture is at the median age of 20 (95% confidence interval between ages 17 and 32). The remaining minor cranial sutures show no evidence of closure in our skull model.
Conclusions
Closure of the minor cranial sutures, excepting the intraoccipital suture, in the pediatric population may be abnormal. Minor suture craniosynostosis should be investigated in the following patient populations: (1) those diagnosed with positional plagiocephaly for whom conservative management has been ineffective and (2) patients with abnormal skull shapes that do not fit any of the classically described morphologies for the varying craniosynostoses.
