OBJECTIVE: The purpose of this study was to elucidate the anatomical development of physiologic suture closure processes in infants using three dimensional reconstructed computed tomography (CT). METHODS: A consecutive series of 243 infants under 12 months of age who underwent three dimensional CT were included in this study. Four major cranial sutures (sagittal, coronal, lambdoidal and metopic suture) were classified into four suture closure grades (grade 0=no closure along the whole length, grade 1=partial or intermittent closure, grade 2=complete closure with visible suture line, grade 3=complete fusion (ossification) without visible suture line), and measured for its closure degree (suture closure rates; defined as percentage of the length of closed suture line divided by the total length of suture line). RESULTS: Suture closure grade under 12 months of age comprised of grade 0 (n=195, 80.2%), grade 1 (n=24, 9.9%) and grade 2 (n=24, 9.9%) in sagittal sutures, whereas in metopic sutures they were grade 0 (n=61, 25.1%), grade 1 (n=167, 68.7%), grade 2 (n=6, 24%) and grade 3 (n=9, 3.7%). Mean suture closure rates under 12 months of age was 58.8% in metopic sutures, followed by coronal (right : 43.8%, left : 41.1%), lambdoidal (right : 27.2%, left : 25.6%) and sagittal sutures (15.6%), respectively. CONCLUSION: These quantitative descriptions of cranial suture closure may help understand the process involved in the cranial development of Korean infants.
Cranial Sutures ; Growth and Development ; Humans ; Infant ; Sutures

Craniosynostosis is a congenital anomaly characterized by premature closure of cranial sutures. Surgical intervention should be performed during infancy. However, surgical correction of craniosynostosis remains bone defect and secondary angle occasionally. Currently, publications investigating solutions to bone defect and secondary angle created by cranioplasty are getting much interest. We have used BoneSource(R) which is relatively safe as an implantable substance for providing solutions for this problem. From June 2002 to January 2004, five children with craniosynostosis underwent frontocalvarial contouring using BoneSource(R) and concurrent cranial vault remodeling. The patient ages ranged from 8.0 months to 4.9 years(mean, 2.5 years). The quantity of BoneSource(R) implanted ranged from 10 to 25g, with a mean of 13g. This paper presents the first series of children treated with BoneSource(R) for frontocalvarial contouring in the surgical correction of craniosynostosis. No patients experienced any complications. Our results shows excellent retention of contour without causing asymmetry or irregularity. No visible evidence of interference with craniofacial growth were observed. Through our experiences, BoneSource(R) is found to be very useful for frontocalvarial contouring in children undergoing correction of craniosynostosis.
Child ; Cranial Sutures ; Craniosynostoses* ; Humans

OBJECTIVETo explore a methods of 3-Dimension expansion of zygomatic suture in a goat model.

METHODSSeven goats were used in this study. The 3-D extensive applicator was designed and used to extend the zygomatic suture of the goats by placing it in the zygomatic bone through an infraorbital incision. Ten days after the first operation, it was gradually extended on a speed of 0.09 cm/d for 7 days. The zygomatic movement and the osteogenesis of the suture was evaluated in two weeks.

RESULTSThe zygomatic bone was extended for 0.6 cm long in average, and the osteogenesis was also shown significantly in the suture.

CONCLUSIONThe above mentioned technique could be a safe and effect method to be applied for the zygomatic extension.

Animals ; Cranial Sutures ; Goats ; Humans ; Osteogenesis, Distraction ; instrumentation ; methods ; Zygoma

The mechanism underlying cranial suture fusion remains yet unknown. An in vitro tissue culture model of cranial sutures permits exclusion of biomechanical factors that may affect the fusion and patency of cranial sutures. The posterior frontal cranial sutures were placed in a tissue culture model. The experimental groups consisted of control group, and two groups cultured in TGF-beta enriched medium with and without the underlying dura mater. Results showed in vitro fusion of the explanted cranial sutures in vitro 39 days postnatal. Cranial suture fusion was accelerated in the TGF- beta < treated group with intact dura mater(postnatal 32days). Cranial suture fusion in the TGF- beta treated dura denuded group occurred, though in a delayed manner compared to the dura intact group.
Animals ; Cranial Sutures ; Dura Mater ; Mice* ; Sutures* ; Transforming Growth Factor beta

Sex estimation is one of the crucial procedures in the biological profile identification of human skeletal remains. Knowing sex of unknown case can lead to accurate and appropriate methods for predicting age, stature, ancestry, or even personal identification. Skull is one of the most reliable one among other skeletons and it is usually retained for both archaeological and forensic contexts. Although many morphological features and metric measurements of skull have been studied for sexing, but to the best of our knowledge is no study on maxillary suture length for sex estimation. Therefore, this study aims to develop a new sex estimation method for a Thai population by determining three maxillary suture lengths: anterior, transverse, and posterior maxillary suture, by computerizing amount of pixel obtained from photographs of these sutures. The present study was conducted on 190 Thai bone samples of which 96 were males and 94 were females. Independent t test revealed statistically significant difference (P < 0.01) between males and females in all maxillary suture measurements. Equations derived from prediction model, which required three maxillary suture lengths gave 76.8421% accuracy from the leave-one-out cross validation in estimating sex percentage accuracies in predicting sex from these equations, which were relatively moderate. This study provides a novel and objective sex estimation method for Thais. It suggests that maxillary suture length can be applied for sex estimation. The new computerized technique will contribute basis knowledge and method for sex estimation, especially when only base of skull is available in forensic circumstance.
Asian Continental Ancestry Group* ; Cranial Sutures ; Female ; Humans ; Male ; Methods* ; Sex Determination Analysis ; Skeleton ; Skull ; Skull Base ; Sutures* ; Thailand

Craniosynostosis is defined as the premature fusion of one or more of the cranial sutures. It leads not only to secondary distortion of skull shape but to various complications including neurologic, ophthalmic and respiratory dysfunction. Craniosynostosis is very heterogeneous in terms of its causes, presentation, and management. Both environmental factors and genetic factors are associated with development of craniosynostosis. Nonsyndromic craniosynostosis accounts for more than 70% of all cases. Syndromic craniosynostosis with a certain genetic cause is more likely to involve multiple sutures or bilateral coronal sutures. FGFR2, FGFR3, FGFR1, TWIST1 and EFNB1 genes are major causative genes of genetic syndromes associated with craniosynostosis. Although most of syndromic craniosynostosis show autosomal dominant inheritance, approximately half of patients are de novo cases. Apert syndrome, Pfeiffer syndrome, Crouzon syndrome, and Antley-Bixler syndrome are related to mutations in FGFR family (especially in FGFR2), and mutations in FGFRs can be overlapped between different syndromes. Saethre-Chotzen syndrome, Muenke syndrome, and craniofrontonasal syndrome are representative disorders showing isolated coronal suture involvement. Compared to the other types of craniosynostosis, single gene mutations can be more frequently detected, in one-third of coronal synostosis patients. Molecular diagnosis can be helpful to provide adequate genetic counseling and guidance for patients with syndromic craniosynostosis.
Acrocephalosyndactylia ; Antley-Bixler Syndrome Phenotype ; Cranial Sutures ; Craniofacial Dysostosis ; Craniosynostoses* ; Diagnosis ; Genetic Counseling ; Humans ; Skull ; Sutures ; Synostosis ; Wills

OBJECTIVEThe purpose of the study is to detect the expression of TGF-beta1 mRNA in the maxillary sutures of puberty rhesus during different periods of the loading of intermaxillary class III orthopedic force.

METHODSThe animal model was established with 6 puberty female rhesus, which were randomly divided into experimental group (wearing class III twin-block magnet appliance, each 2 rhesus for 3 and 6 month respectively) and control group (not wearing any appliance, each 1 rhesus for 3 and 6 month respectively). Tissue sections were obtained perpendicular to the sutures. In situ hybridization was used to the expression of TGF-beta1 mRNA, and the expression intensity was measured and statistics was performed by SPSS 11.0.

RESULTSThere were no statistic differences of cellular density between palatomaxillary suture in vertical group and pterygomaxillary suture in horizontal group, but statistic differences were found between other groups. The expression of TGF-beta1 mRNA was detected in the control group, but the expression intensity was obviously increased after the load of intermaxillary class III orthopedic force. Statistically significant differences were found among all groups except the six months experimental group and control group of temporozygomatic sutures and pterygomaxillary sutures. Experimental groups were more intensive than the control group and three months group was more intensive than the six months group.

CONCLUSIONThe active tissue remodeling happened in the circummaxillary sutures by the effect of class III intermaxillary orthopedic force. Cell proliferation, extracellular matrix synthesis and bone formation were accelerated. During the different remodeling periods, the expression intensities were different, which may be related to the different force loading manners, the different reaction of sutures to the orthopedic force and the different biological function of TGF-beta1 in the different periods.

Animals ; Cranial Sutures ; Female ; In Situ Hybridization ; Macaca mulatta ; Maxilla ; Puberty ; RNA, Messenger ; metabolism ; Skull ; Sutures ; Transforming Growth Factor beta1 ; metabolism

OBJECTIVE: To investigate the correlation between morphological stages of midpalatal suture (MPS) and Demirjian dental age. METHODS: In this retrospective study, 1 076 cone-beam CT (CBCT) images (female: 675, male: 401; age range: 6.0 to 21.0 years) were included. Horizontal view of each sample's CBCT images was observed, each sample's MPS stage was recorded, and dental age. MPS stage and dental age were ordered with categorical variables. Therefore, their correlation was investigated through Spearman correlation coefficient analysis and diagnostic test analysis. RESULTS: (1) For left lower second premolar: 95.2% of those in dental age stage B-D were in MPS 1-2, accounting for the largest proportion. 85.3% of those in dental age stage E were in MPS 1-2, still accounting for the largest proportion. Another 14.7% were in MPS 3.45.1% of those in dental age stage F were in MPS 3, 46.1% in MPS 1-2, and another 8.8% in MPS 4s1.49.8% of those in dental age stage G were in MPS 3.24.9% in MPS 4s1, and 18.9% in MPS 1-2.80.1% of those in dental age stage H were in MPS 4-5. Another 16.3% were in MPS 3. (2) For left lower second molar: 89.7% of those in dental age stage B-D were in MPS 1-2, accounting for the largest proportion. 67.4% of those in dental age stage E were in MPS 1-2, still accounting for the largest proportion. Another 26.1% were in MPS 3.55.3% of those in dental age stage F were in MPS 3, 34.2% in MPS 1-2, and another 10.5% in MPS 4s1.50.7% of those in dental age stage G were in MPS 3, 24.3% in MPS 4s1, and 16.8% in MPS 1-2.83.8% of those in dental age stage H were in MPS 4-5, another 14.2% were in MPS 3. (3) To diagnose MPS stage with dental age, diagnostic pairs with good performance included: Dental age of left lower second molar-MPS: H-4s2, H-5, D-1; Dental age of left lower second premolar-MPS: H-4s2, H-5, G-3. Other diagnostic pairs were of ordinary diagnostic efficiency. (4) For dental age-MPS Spearman correlation analysis, dental age of left lower second molar-MPS had the highest Spearman coefficient (0.68), dental age of left lower second premolar-MPS was the second high (0.64). (5) Dental age stage H of left lower second molar or left lower second premolar indicated that the individual was later than MPS 4s2. CONCLUSION Dental age's diagnostic efficiency for MPS stage is ordinary on the whole, except for some pairs with good performance. Therefore, pre-treatment CBCT examination should be considered as assistance for evaluating maturation and fusion status of midpalatal suture.
Adolescent ; Adult ; Child ; China ; Cone-Beam Computed Tomography ; Cranial Sutures/diagnostic imaging* ; Female ; Humans ; Male ; Retrospective Studies ; Sutures ; Young Adult

OBJECTIVETo study the technique of total calvaria reconstruction for sagittal synostosis.

METHODS11 children with sagittal synostosis were treated. The David II procedure was used to reconstruct the calvarial gap in 6 cases; Osteotomies with reversal change was performed on 2 cases; Plum-plasty of the calvaria was performed on 3 cases.

RESULTSThe 11 cases were cured with satisfactory head shape.

CONCLUSIONSThe David II procedure is applicable for patient of 1 approximately 3 months. The technique of floating skull flap plasty and plum-plasty of the calvaria can be performed on patients older than 3 months.

Cranial Sutures ; abnormalities ; Craniosynostoses ; surgery ; Female ; Humans ; Infant ; Male ; Reconstructive Surgical Procedures ; methods

The purpose of this article is to review imaging findings and to discuss the optimal imaging methods for craniosynostosis. The discussion of imaging findings are focused on ultrasonography, plain radiography, magnetic resonance imaging and computed tomography with 3-dimensional reconstruction. We suggest a strategy for imaging work-up for the diagnosis, treatment planning and follow-up to minimize or avoid ionized radiation exposure to children by reviewing the current literature.
Child ; Cranial Sutures ; Craniosynostoses* ; Diagnosis* ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging ; Radiography ; Skull ; Ultrasonography