Pseudoclosure of Anterior Fontanelle by Wormian Bone in Isolated Sagittal Craniosynostosis

Abstract

Aims and Objectives: Although syndromic craniosynostosis is one of the causes for early closure of the anterior fontanelle, there is no literature on the incidence and causes of fontanelle closure in isolated single-suture craniosynostosis. The objective of this study was to review the incidence of fontanelle closure by a wormian bone in isolated, nonsyndromic sagittal craniosynostosis. Materials and Methods: Intraoperative records of 100 consecutive children under 1 year of age, operated for isolated sagittal synostosis over a 14-year period (1987– 2000), were reviewed to identify the presence of a wormian bone closing the anterior fontanelle. Results: The median age at surgery was 4.2 months with a range of 1.9–11.7 months. Intraoperatively, a wormian bone was seen replacing the anterior fontanelle in 4 cases giving an incidence of 4%. Conclusions: A wormian bone can occupy the anterior fontanelle in children with isolated sagittal craniosynostosis giving the appearance of a ‘closed fontanelle’.

The Incidence and Topographic Distribution of Sutures Including Wormian Bones in Human Skulls

“…19 The incidence of the WBs varies in different ethnic groups, whereas the highest incidence (80.32%) is found in Chinese population. 8 The rate of sutures including WBs was found as 59.3% in West Anatolian skulls; furthermore, the rates of these sutures among different populations are compared in Table 5.…”

A review and dental management of persons with craniosynostosis anomalies

“…Clinical characteristics include skull malformations such as brachycephaly, scaphocephaly, or trigonocephaly 22 . Because of higher intracranial pressure, the skull of affected individuals can present in a clover form, with flat orbits, proptosis, and hypertelorism 6 . Protruding eyes are an illusion because the region below them has not been adequately developed.…”

“…Additionally, due to the influence of gravity, the tongue takes a retro‐position, which obstructs the pharynx 2 . Since the tongue cannot progress forward and downward, the posterior plates of the palate do not fuse normally along the median line 6 . Another hypothesis is that intrauterine constriction will compress the mental protuberance and limit its growth before the fusing of the palate occurs 24 …”

“…There is little information in the published literature about the dental needs of patients with craniosynostosis 1,6 . This article reviews and discusses the oral manifestations of craniofacial anomalies and recommends guidelines that dentists should use when treating patients with craniosynostosis.…”

The earliest evidence of true lambdoid craniosynostosis: the case of “Benjamina”, a Homo heidelbergensis child

“…It is very noticeable that the compensatory alteration on the frontal bone produced a verticalization of the forehead, giving a final shape that closely resembles the frontal region of modern humans. Interestingly, there is, at least, one small wormian bone on the right lambdoid suture, a finding that has been reported to be relatively frequent in human cases of craniosynostosis [1,37] (Figs. 2 and 3a, b).…”