Surgical Anatomy of the Ligamentous Attachments in the Superoposterior Scalp Region.

BACKGROUND: Hairline-lowering surgery has become increasingly popular in recent years, but little investigation into the surgical anatomy of the scalp has been performed. OBJECTIVES: The aim of this study was to describe findings based on clinical observation and anatomic study of ligamentous attachments in the superoposterior region of the scalp. METHODS: Six fresh cadaveric heads were dissected to identify connective tissue structures in the superoposterior scalp region. The areas of interest were along the sagittal suture towards the lambda, the obelion, and around the lambdoid suture. The location and dimensions of identified connective tissue attachments were documented with reference to described skeletal landmarks. RESULTS: Three distinct structures could be identified: (1) a cylindrical structure that sits at the posterior end of the sagittal suture with the parietal foramina in its base. This ligamentous structure extends from the pericranium into the galea, causes dimpling in the skin, and contains emissary veins. As this fulfills the criteria for an osseocutaneous retaining ligament, the term "cranial retaining ligament" is proposed. (2) Anterior to this ligament a connective tissue thickening was identified running along the sagittal suture and blending into the ligament, for which the term "sagittal adhesion" is proposed. (3) Another adhesion was identified just superior to the lambdoid suture, posterior to the retaining ligament, for which the term "supralambdoid adhesion" is proposed. CONCLUSIONS: Identification and better understanding of ligamentous structures in the superoposterior scalp allows for a safer and more effective advancement of the scalp in hairline-lowering surgery, which is a benefit to both patients and surgeons.

[Determining the age of the children from the cranial cranium vault fragments with the use of the modern investigative techniques]. / Opredelenie vozrasta detei po fragmentam svoda cherepa s ispol'zovaniem sovremennykh metodov issledovaniia.

The present study included 280 thin bone slices of the cranial vault fragments obtained from 70 children at the age of 2-3 weeks or above that and the subjects aged up to 21 years. The slices were prepared from the bone plates taken from the regions of the coronal (C2 - middle part), interparietal suture (S2 - apical and S3 - obelion parts), and occipital (L2 - middle part) sutures. The thickness of the cortical and spongy substances was measured with the use of an Olympus BX 51 microscope and an OlympusSC 30 digital camera supported by the ImageScope computer software - program. The Statistica 10 - package was used for the purpose of the step-by-step - step by step regression analysis to derive 20 multiple linear regression (MLR) equations. These equations are recommended to be used for the preliminary -indicative (up to the age of 21 years) and clarifying (for the age intervals from 1 to 1-7 years, from 7 to 14 years, and from 14 to 21 years) diagnostics of the children's age for the purpose of expertise of the fragmented cranial vault. Four MLR equations were calculated for various combinations of the features in each group. It was shown that the real verification of the children's age based on the multiple correlation coefficients was possible at the age up to 7 years. Such possibility is significantly lower within the age interval from 7 to 14 years and is practically absent at the age above 14 years. The confidence interval (±SD) of MLR equations for the age up to 1 year was calculated to be around ± 1 month and for the age from 1 to 7 years approximately ±1 year. The correction of the data obtained is possible within these intervals which may significantly increase the level of evidence of the conclusions based on them. The probable probable chronological age of the children deduced based on the results of the examination of the cranial vault fragments coincides in 68% of the cases within the range of ±SD with their biological age (Y) determined from the MLR equations. The accuracy of the method employed in the present study was verified with the use of an independent sample of 7 subjects of the known age. On the whole, the results proved to be close to the calculated ones.

New cases of trepanations from the 5th to 3rd millennia BC in Southern Russia in the context of previous research: Possible evidence for a ritually motivated tradition of cranial surgery?

OBJECTIVES: It is a big challenge to diagnose the motives behind trepanations in prehistoric crania. Surgical-therapeutic attempts may be apparent by the presence of fractures, however, ritual or nonmedical motives are rarely supported by visible evidence in the bones. This article presents data on the trepanations of several individuals from South Russia dating to the Eneolitic and Bronze Age that may indicate a ritual procedure. In these crania an operation was performed in the identical location, the midline, furthermore in one of the most dangerous places, on the obelion. No evidence for traumatic or other pathological reasons for performing the operations was observable. MATERIAL AND METHODS: Investigations of two nearby areas of South Russia revealed 13 individuals showing complete perforations in the midline of the cranium. Another one, displaying a depression in the same place, primarily diagnosed as an incomplete trepanation, is discussed considering all differential diagnoses. The trepanations were investigated macroscopically, by plain radiography and computed tomography. The lesions were described in detail, including data on technique, position, size, shape, state of healing, and complications. RESULTS: Males and females received the operation between the age of 10 years and mature/senile age. Only grooving and scraping techniques were used and their application differed between sexes. The majority of the patients survived the intervention for a long time. DISCUSSION: The region of Southern Russia seems to be a center for special trepanations performed by skilled surgeons, the specific position of the perforations implying more a ritual than therapeutic reason for trepanning. Am J Phys Anthropol 160:665-682, 2016. © 2016 Wiley Periodicals, Inc.

Relationship of the parietal foramen and complexity of the human sagittal suture / Relación del foramen parietal y la complejidad de la sutura sagital humana

The purpose of this paper is to report on the relationship between the parietal foramen and complexity of the human sagittal suture. Examination of 110 Japanese human skulls (males=67, females=43) with at least one parietal foramen revealed that the sagittal suture in the area of the Obelion was the simplest portion (i.e., fewest interdigitations and shortest length) of the suture (paired t-test, P<0.0005), when compared to the outstretched suture length of three established sections: 1. Parietal foramen section (P); 2. Anterior to section P (B); and 3. Posterior to section P (L). Sutural complexity was also compared between individuals with unilateral foramen (n=48) and bilateral foramina (n=62) to see if there was a statistically significant difference. The results revealed a slight difference in section P (ANOVA Bonferroni, P<0.05), denoting that the sagittal suture at the Obelion in individuals with unilateral parietal foramen is more complex than in individuals with bilateral foramina. While no difference in sex was noted, this simplicity in part likely reflects redirected bone stresses around a circular opening resulting in reduced tensile stresses and increased compressive stresses adjacent to the parietal foramen. This phenomenon warrants additional research and has implications for bone biomechanics and development of the cranial sutures.

El propósito de este trabajo es informar sobre la relación entre el foramen parietal y la complejidad de la sutura sagital en humanos. Se examinaron 110 cráneos humanos de individuos japoneses (hombres = 67, mujeres = 43) con al menos un foramen parietal, revelando que la sutura sagital en el área del obelion fue la parte más simple (es decir, menos interdigitaciones y menor longitud) de la sutura (vinculado la prueba t, p <0,0005). Cuando se comparó la extensión de la longitud de la sutura se establecieron tres secciones: 1. Sección foramen parietal (P); 2. Anterior a la sección P (B), y 3. Posterior a la sección P (L). La complejidad de la sutura también fue comparada entre los individuos con foramen unilateral (n = 48) y forámenes bilaterales (n = 62) para ver si había una diferencia estadísticamente significativa. Los resultados revelaron una ligera diferencia en la sección P (ANOVA Bonferroni, P <0,05), que indica que la sutura sagital a nivel del obelion en los individuos con foramen parietal unilateral es más compleja que en los individuos con forámenes bilaterales. Si bien no hubo diferencia según sexo, esta simplicidad en parte, probablemente refleja la redirección de las fuerzas del hueso alrededor de una abertura circular, lo que reduce la resistencia a la tracción y aumenta la fuerza de compresión adyacente al foramen parietal. Este fenómeno justifica la investigación adicional y tiene implicaciones para el desarrollo óseo y biomecánica de las suturas craneales.

Developmental age and taxonomic affinity of the Mojokerto child, Java, Indonesia.

An increasing number of claims place hominids outside Africa and deep in Southeast Asia at about the same time that Homo erectus first appears in Africa. The most complete of the early specimens is the partial child's calvaria from Mojokerto (Perning I), Java, Indonesia. Discovered in 1936, the child has been assigned to Australopithecus and multiple species of Homo, including H. modjokertensis, and given developmental ages ranging from 1-8 years. This study systematically assesses Mojokerto relative to modern human and fossil hominid growth series and relative to adult fossil hominids. Cranial base and vault comparisons between Mojokerto and H. sapiens sapiens (Hss) (n = 56), Neandertal (n = 4), and H. erectus (n = 4) juveniles suggest a developmental age range between 4 and 6 years. This range is based in part on new standards for assessing the relative development of the glenoid fossa. Regression analyses of vault arcs and chords indicate that H. erectus juveniles have more rounded frontals and less angulated occipitals than their adult counterparts, whereas Hss juveniles do not show these differences relative to adults. The growth of the cranial superstructures and face appear critical to creating differences in vault contours between H. erectus and Hss. In comparison with adult H. erectus and early Homo (n = 27) and adult Hss (n = 179), the Mojokerto child is best considered a juvenile H. erectus on the basis of synapomorphies of the cranial vault, particularly a metopic eminence and occipital torus, as well as a suite of characters that describe but do not define H. erectus, including obelion depression, supratoral gutter, postorbital constriction, mastoid fissure, lack of sphenoid contribution to glenoid fossa, and length and breadth ratios of the temporomandibular joint. Mojokerto is similar to other juvenile H. erectus in the degree of development of its cranial superstructures and its vault contours relative to adult Indonesian specimens. The synapomorphies which Mojokerto shares with H. erectus are often considered autapomorphies of Asian H. erectus and confirm the early establishment and long-term continuity of the Asian H. erectus bauplan. This continuity does not, however, necessarily reflect on the pattern of origin of modern humans in the region.

[Giant parietal foramina. A surgical defect?]. / I foramina parietalia permagna. Una lesione chirurgica?

Sinus pericranii is unusually demonstrated in the region of the obelion. The radiological findings are those of large parietal foramina and the overlying soft tissue is bulging, suggesting vascular collection. The possible relationship between ossification of parietal bone and vascular anomaly is discussed.

Epicranial arachnoid cyst.

We have reported a case of epicranial arachnoid cyst, a developmental abnormality that occurs at the obelion, and have reviewed characteristic clinical and radiologic features that facilitate diagnosis.

Normal variants and congenital anomalies in the region of the obelion.

A number of anatomic bony variants and several congenital anomalies are known to occur at the level of the obelion, that is, in the posterior interparietal region of the head, a short distance in front of the lambda. Among them are: (1) remnants of the embryonic parietal incisura, including parietal fissure, small and large parietal fontanelle, obeliac bones, persistant midline parietal foramen, and small and large parietal foramina; (2) encephalomeningoceles and related defects, including true encephaloceles, herniation of midline intracranial cysts (diencephalic and Dandy Walker cyst), epicranial arachnoid cysts, and scalp defects with ectopic glial tissue; and (3) congenital scalp and skull defects (cutis aplasia congenita). A review of these defects is presented with some illustrative examples not previously reported.