Unusual Accessory Cranial Sutures in Pediatric Head Trauma. Case Report.

Nakahara, Kuniaki; Miyasaka, Yoshio; Kan, Shinichi; Fujii, Kiyotaka

doi:10.2176/nmc.43.80

Cited by 20 publications

(5 citation statements)

References 4 publications

(2 reference statements)

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“…The prevalence of WBs has been estimated as 52.99% in the lambdoid suture and multiple WBs were seen in lambdoid suture in 0.01% ISSN 2563-7142 [16]. In the occipital region, the accessory bones can be multiple and bilateral [17]. In the present study, the prevalence of WBs is approximately 13.2%, out of which multiple and bilateral WBs were seen in the lambdoid suture.…”

Section: Discussionsupporting

confidence: 42%

The Morphometric analysis of accessory sutural bones with an emphasis on association with parietal emissary foramina

Jyothi,

Muraleedharan

et al. 2022

Int J Cadaver Stud Ant Var

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Background: The sutural bones and fontanelle of the skull display unique morphological characters. Sutural bones are also called supernumerary bones or ossicles or Wormian bones (WB). These are irregular and develop from the independent ossification centers present along the cranial sutures. They appear on periosteal and endosteal surfaces of the skull with variations in size, number, shape, and location. In the present study, we aimed to determine the morphological characteristics of sutural bones and emphasize the significance of the same. One interesting entity of skull near the posterior fontanelle is the presence of Inca bones. Methods: The present study was done on 128 dry human skulls by a convenient sampling method. The skulls were collected from the Department of Anatomy and significant characteristic features of Inca and Wormian bones like shape, number, size and location were recorded. Results: Of the 128 dry skulls examined Wormian bones were seen in 13.2 % of skulls and Inca bones in 5.4 % of skulls. Incorporation of Wormian bones in lambdoid suture was noted in 12.5 % in sagittal suture in 0.7 % skulls respectively. The Wormian bones were found frequently on the left side (n=12) as compared to the right side (n=5). The morphometry of the accessory bones showed quadrilateral as the most common shape (n=9, 37.5 %) followed by triangular (n=4, 16.6 %). Radiological examination of all 24 skulls with accessory bones showed a zigzag pattern of accessory suture lines. Conclusions: The presence of Wormian and Inca bones can be easily confused with fractures of the related bony regions. The surgeons need to be aware of this fact in order to make a proper and accurate diagnosis. The knowledge regarding these bones is highly beneficial to the clinician, radiologist, and neurosurgeon.

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Section: Discussionsupporting

confidence: 42%

The Morphometric analysis of accessory sutural bones with an emphasis on association with parietal emissary foramina

Jyothi,

Muraleedharan

et al. 2022

Int J Cadaver Stud Ant Var

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“…In terms of bilaterality, accessory sutures are often present on both sides and are fairly symmetric especially in the parietal bones [ 2 ]. Occipital accessory sutures can be complex and multiple but are also frequently bilateral [ 5 ]. However, skull fractures can be also bilateral.…”

Section: Radiographic Differentiation Of Skull Fracture and Accessorymentioning

confidence: 99%

Skull fracture vs. accessory sutures: how can we tell the difference?

et al. 2010

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“…Accessory sutures are considered rare findings; however, since they are asymptomatic, their true prevalence is not known [ 4 ]. To further complicate matters, rudimentary sutures are often mistaken for cranial fractures due to their high resemblance [ 4 , 5 , 7 , 8 , 9 , 11 , 14 , 15 ]. The replacement of plain films by CT scanning decreased the incidence of misdiagnosis between the two; however, additional imaging may be necessary to differentiate questionable cases [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

Imaging Findings in Pediatric Accessory Cranial Sutures using 3D CT Reconstruction: Fracture or Rudimentary Suture

Falconi,

Laszlo,

Jacob

2023

Cureus

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Objective: Although accessory sutures are considered to be relatively rare, the consequences of a missed diagnosis are profound. Distinguishing between accessory sutures and cranial fractures can be difficult, especially in cases of suspected non-accidental trauma. High-resolution imaging is the best way to discern between two- and three-dimensional computerized tomography (3D CT) is considered the preferred method for evaluation. The goal of this study was to determine the impact of 3D CT scans in distinguishing between accessory sutures and cranial fractures in suspected child abuse cases in a rural community and the importance of early detection in such cases, as well as call attention to the consequences of initial misinterpretation. Materials and methods: The researchers conducted a retrospective chart review of all pediatric patients diagnosed with cranial fractures (265 in total) at University Medical Center between May 30, 2016, and May 30, 2021. Initial computed tomography (CT) scans and subsequent 3D CT scans were evaluated for each patient that fit the inclusion criteria, 13 in total. Patients were then categorized into two groups based on the final diagnosis on the radiology report: accessory cranial suture or cranial fracture. Once these patients were identified, the etiology and structural components of each were evaluated, and the key differences were highlighted. Results: Our results showed that, of the 11 cases of suspected non-accidental trauma, six were finally diagnosed with accessory sutures with the use of 3D CT scans, and of those six, four were diagnosed with cranial fractures from the initial CT scan report due to a similar presentation and asymmetric nature. Conclusion: Discerning between fracture and accessory suture is essential in evaluating pediatric patients presenting with signs of cranial fracture due to the increased risk of misinterpretation that can lead to severe legal consequences considering that cranial suture variants may mimic intentional injury and be mistaken for child abuse, causing significant distress for patients and their families.

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Unusual Accessory Cranial Sutures in Pediatric Head Trauma. Case Report.

Cited by 20 publications

References 4 publications

The Morphometric analysis of accessory sutural bones with an emphasis on association with parietal emissary foramina

The Morphometric analysis of accessory sutural bones with an emphasis on association with parietal emissary foramina

Skull fracture vs. accessory sutures: how can we tell the difference?

Imaging Findings in Pediatric Accessory Cranial Sutures using 3D CT Reconstruction: Fracture or Rudimentary Suture

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