Anatomical Study of the Pterion in a South African Population of KwaZulu-Natal / Estudio Anatómico del Pterion en una Población Audafricana de KwaZulu-Natal

SUMMARY: Morphologically the Pterion marks the location of the four cranial bones, viz. frontal bone, sphenoid angle of the parietal bone, squamous part of the temporal bone and the greater wing of the sphenoid bone. Population-specific differences exists in the position and union of the Pterion. The Pterion is also an important neurosurgical landmark for surgical procedures, viz. Pterional/lateral approach, as it provides wide access to the base of the skull. This study aimed to determine the position and incidence of the various sutural patterns of the Pterion in a South African population of KwaZulu-Natal. This retrospective study was conducted bilaterally on 36 dry human skulls (11 females and 25 males) obtained from the Department of Clinical Anatomy at University of KwaZulu-Natal. Ethical clearance obtained from the Biomedical Research Ethics Committee. The morphometric parameters of the Pterion were measured using a digital Vernier caliper, while the morphological characteristics were examined using Murphy's classification scheme to determine (if any) laterality or sex differences exists. The mean distance of the Centre of the pterion from midpoint of zygoma was 44.4+/-4.1 mm in males and 45.1+/-4.6 mm in females. While the distance from frontozygomatic suture was 32.7+/-4.7 mm and 32.6+/-4.8 mm in males and females, respectively. Sphenoparietal type of pterion was most prevalent at 55.6 %, followed by the frontotemporal, stellate and epipteric type with an incidence of 27.8 %; 11.1 % and 5.6 %, respectively. No statistically significant difference for sex or laterality were documented in this study. The present study concluded that the sphenoparietal type of sutural pattern was most prevalent with an incidence of 55.6 %. While the epipteric type was the least prevalent. The comprehensive data about the position of the Pterion is important to neurosurgeons, forensics scientists and anthropologists.

Morfológicamente, el pterion marca la ubicación de los cuatro huesos craneales: hueso frontal, ángulo esfenoidal del hueso parietal, parte escamosa del hueso temporal y el ala mayor del hueso esfenoides. Existen diferencias específicas de la población en la posición y unión del pterion. El pterion es también un hito neuroquirúrgico importante para los procedimientos quirúrgicos en el bordaje pterional/lateral, ya que proporciona un amplio acceso a la base del cráneo. Esta investigación tuvo como objetivo determinar la posición y la incidencia de los diversos patrones suturales del pterion en una población sudafricana de KwaZulu-Natal. Este estudio retrospectivo se realizó bilateralmente en 36 cráneos humanos secos (11 mujeres y 25 hombres) obtenidos del Departamento de Anatomía Clínica de la Universidad de KwaZulu-Natal. ALa autorización ética fue otorgada porel Comité Ético de Investigación Biomédica. Los parámetros morfométricos del pterion se midieron usando un calibrador Vernier digital, mientras que las características morfológicas se examinaron usando el esquema de clasificación de Murphy para determinar, si existe alguna lateralidad o diferencias sexuales. La distancia media del centro del pterion desde el punto medio del cigoma fue de 44,4+/- 4,1 mm en hombres y de 45,1+/-4,6 mm en mujeres. Mientras que la distancia desde la sutura frontocigomática fue de 32,7+/-4,7 mm y 32,6+/-4,8 mm en hombres y mujeres, respectivamente. El tipo de pterion esfenoparietal fue el más prevalente con un 55,6 %, seguido del tipo frontotemporal, estrellado y epiptérico con una incidencia del 27,8 %; 11,1 % y 5,6 %, respectivamente. En el estudio no se documentaron diferencias estadísticamente significativas para el sexo o la lateralidad. Concluimos que el tipo de patrón de sutura esfenoparietal fue el más prevalente con una incidencia del 55,6 %. Mientras que el tipo epiptérico fue el menos prevalente. Los datos completos sobre la posición del pterion son importantes para los neurocirujanos, los científicos forenses y los antropólogos.

Are the Ethmoidal Foramina Through the Frontal Bone, Ethmoid Bone, or Frontoethmoidal Suture?

INTRODUCTION: To investigate the locations of the anterior, middle, and posterior ethmoidal foramina and their relationships to the frontoethmoidal suture. METHODS: One hundred twenty sides from sixty adult human skulls were used. Specimens with significant damage to the medial orbit wall were excluded. The number of ethmoidal foramina (anterior, middle, and posterior) on the medial orbital wall and the relationship of each foramen to the frontoethmoidal suture were recorded and classified as follows: Type I: superior to the frontoethmoidal suture; Type II: on the frontoethmoidal suture; Type III: inferior to the frontoethmoidal suture. RESULTS: Of the ninety-four sides, fourteen (14.9%) had one foramen, sixty-two (66.0%) had two , and eighteen (19.1%) had three. In total, 192 ethmoidal foramina were observed. Among the fourteen sides with one foramen, eight foramina were anterior and six were posterior. Among the 192 ethmoidal foramina, 162 were eligible for fur ther classification (74 anterior, 14 middle, and 74 posterior). Types I, II, and III ethmoidal foramina were found in 38.3% (62/162), 61.7% (100/162), and 0% (0/162), respectively. CONCLUSIONS: Our current study found a higher incidence of type I than previously reported. It is important to be aware of the significant incidence of foramen variations when the medial orbit wall is manipulated during surgery. Unless caution is observed, an inadvertent surgical injury can occur and lead to life-threatening complications. Therefore, a good understanding of orbital anatomy and its potential variations is critical for improving patient out comes.

Wormian Bones: Prevalence, Topography, and Implications.

BACKGROUND: Wormian bones also known as sutural bones are asymmetrical and shapeless bones occurring in cranial sutures and fontanelle of the skull. Their incidence is reported to vary in population. The exact etiology is debatable, but their formation is under the control of both genetic and environmental factors and has great anthropological and clinical implications related to the cranium. Due to high clinical relevance of Wormian bones, the study was carried out. The aim of the study is to expound the incidence and topography of Wormian bones along with clinical significance in dry adult skulls of Indian origin. METHODS: The study was conducted in the Department of Anatomy using 200 complete adult dry skulls of unknown age and sex. All the sutures in the skull were inspected for the presence of Wormian bones. The Wormian bones were classified into 10 categories, and associated implications were brought out. The Wormian bones were photographed, and details were compared with the available literature. RESULTS: The Wormian bones were observed in 190 (380 sides) skulls with 186 on the right side and 108 on the left side. The predominance site of sutural bone was lambdoid suture followed by sagittal suture. The least common site of Wormian bone was lambda. CONCLUSION: The detailed information of precise topography, frequency, and number of Wormian bones is of utmost use for surgeons performing surgery on the skull, anthropologists for identifying races, and forensic scientists for investigating child abuse cases.

Analysis of the Asterion Morphology in Relation to Its Clinical Significance / Análisis de la Morfología del Asterion en Relación con su Importancia Clínica

SUMMARY: The asterion presents a significant anthropological marking and meeting point between three sutures. It is a surface landmark for the transverse-sigmoid venous sinus complex and is also a surgical landmark for access to the posterior cranial fossa, giving it clinical importance. The aim of this research was to analyze the shape of the asterion and to set the measurement methods that will determine distance between the asterion and surrounding features. The study sample, as a part of the Osteological collection of the Department of Anatomy, Faculty of Medicine Novi Sad, consisted of 43 skulls. Morphometric analysis was related to the measurement of the defined parameters and descriptive analysis presented the classification of asterion in relation to the presence of sutural bones, as well as the determination of the position of the asterion according to the transverse-sigmoid venous complex. There was a statistically significant difference between male and female skulls for all the measured parameters. The results show that 34.88 % were type 1 (one or more sutural bones are present) and 65.12 % were type 2 asteria (no sutural bones are present). More frequent occurrence of asteria type 2 was seen on both, male and female skulls. The most frequent position of the asteria on both sides of the skull was in the transverse- sigmoid venous complex (76.92 % on the right side vs. 72.22 % on the left cranial side). Clinical significance of knowing the area of asterion is reflected in order to make the surgical, as well as diagnostic procedures, as successful as possible.

El asterion presenta una importante marca antropológica y punto de encuentro entre tres suturas. Es un punto de referencia de superficie para el complejo del seno venoso sigmoideo transverso y también es un punto de referencia quirúrgico para el acceso a la fosa craneal posterior, lo que le confiere importancia clínica. El objetivo de esta investigación fue analizar la forma del asterión y establecer los métodos de medición que determinarán la distancia entre el asterión y las características circundantes. La muestra del estudio, que forma parte de la colección osteológica del Departamento de Anatomía de la Facultad de Medicina de Novi Sad, estuvo compuesta por 43 cráneos. El análisis morfométrico se relacionó con la medición de los parámetros definidos y el análisis descriptivo presentó la clasificación del asterion en relación a la presencia de huesos suturales, así como la determinación de la posición del asterion según el complejo venoso transverso-sigmoideo. Hubo una diferencia estadísticamente significativa entre los cráneos masculinos y femeninos para todos los parámetros medidos. Los resultados muestran que el 34,88 % eran tipo 1 (hay uno o más huesos suturales presentes) y el 65,12 % eran asteria tipo 2 (no hay huesos suturales presentes). Se observó una aparición más frecuente de asteria tipo 2 en cráneos tanto masculinos como femeninos. La posición más frecuente de la asteria en ambos lados del cráneo fue en el complejo venoso sigmoideo transverso (76,92 % en el lado derecho vs. 72,22 % en el lado craneal izquierdo). La importancia clínica de conocer el área de asterion se refleja en que los procedimientos quirúrgicos y de diagnóstico tengan el mejor resultado posible.

Osteological Study of the Parietal Foramen in the Adult Human Skull Bones and its Clinical and Surgical Correlations / Estudio Osteológico del Foramen Parietal en los Huesos del Cráneo Humano Adulto y sus Correlaciones Clínicas y Quirúrgicas

SUMMARY: Parietal emissary foramina (PEF) are small holes, which are localized between the middle and posterior thirds of the parietal bone posterior surface close to the sagittal suture. PEF are important structures that protect the parietal emissary vein, which passes through it. During neurosurgery procedures, parietal foramina (PF) knowledge is crucial. This work aimed to evaluate presence and location of the PF in the skull of an adult human. Moreover, measure the distance amidst PF and the sagittal suture's midline to ascertain its clinical repercussions. 74 adult human skulls, without gross pathology, were observed for the PF's existence. The PF's and sagittal suture's midline distance were measured. According to the PF patterns of presence, five groups were distributed. Finally, specimens were photographed and subjected to statistical analysis. The PF was absent in 7 skulls (9.5 %). There were 9 skulls (12.2 %) exhibited central parietal foramen where the parietal foramen lies on the sagittal suture. 17 skulls (23 %) showed right unilateral parietal foramen, whereas 15 skulls (20.3 %) demonstrated left unilateral parietal foramen. The final 26 skulls (35.1 %) exhibited bilateral parietal foramen. This descriptive study supplies valuable information of PF variations, which is crucial for neurosurgeons in modifying surgical techniques and procedures to alleviate injury to PF-emerging structures such as emissary veins.

Los forámenes emisarios parietales (FEP) son pequeños orificios que se localizan entre los tercios medio y posterior de la superficie posterior del hueso parietal, cerca de la sutura sagital. Los FEP son estructuras importantes que protegen la vena emisaria parietal, que lo atraviesa. Durante los procedimientos de neurocirugía, el conocimiento de los forámenes parietales (FP) es crucial. Este trabajo tuvo como objetivo evaluar la presencia y ubicación del FP en el cráneo de hombres adultos, además, medir la distancia entre el FP y la línea mediana de la sutura sagital para conocer su repercusión clínica. Se examinaron 74 cráneos humanos adultos, sin patología grave, para determinar la existencia del FP. Se midió la distancia de la línea mediana de la sutura sagital y del FP. De acuerdo con los patrones de presencia del FP, se distribuyeron en cinco grupos. Finalmente, los especímenes fueron fotografiados y sometidos a análisis estadístico. El PF estaba ausente en 7 cráneos (9,5 %). Hubo 9 cráneos (12,2 %) que presentaban un PF central localizándose en la sutura sagital. 17 cráneos (23 %) presentaban un FP unilateral derecho, mientras que 15 cráneos (20,3 %) se observó un FP unilateral izquierdo. Los 26 cráneos restantes (35,1 %) exhibieron FP bilaterales. Este estudio descriptivo proporciona información valiosa sobre las variaciones del FP, que es fundamental para los neurocirujanos en el momento de modificar las técnicas y los procedimientos quirúrgicos para aliviar las lesiones de las estructuras emergentes del FP, como las venas emisarias.

Frequency Morphologic and Morphometric Properties and Osseous Relationships of Whitnall's Tubercle.

Whitnall tubercle (WT) of the zygomatic bone is used as an anatomical landmark in some surgical approaches to the orbit. The authors aimed to determine the localization of WT by using some palpable bony landmarks and to reveal its morphological and morphometric features. Three hundred twenty-two zygomatic bones (167 right and 155 left) belonging to adults of unknown sex, were examined. An acetate prepared by drawing a clock with a dial on it was used to determine the localization of WT according to marginal tubercle and zygomatic arch. Distances between WT and frontozygomatic suture and lateral margin of the orbital rim were measured with digital calipers. One zygomatic bone had double tubercles, thus 321 bones were taken into consideration. Whitnall tubercle was determined in 284 of 321 zygomatic bones. 181 were classified as small, 10 as medium, and 93 as large. The position of the WT according to the marginal tubercle was at the 8, 9, and 10 o'clock positions on the left, and at 2, 3, and 4 o'clock on the right. The position of the WT according to the zygomatic arch was at the 9,10 and 11 o'clock positions on the left, and at the 1 and 2 o'clock positions on the right. Distances between the WT and lateral margin of the orbital rim and the frontozygomatic suture were measured meanly as 1.94±0.31 mm and 8.17±5.82 mm, respectively. The authors believe that the data obtained regarding WT will contribute to anatomy and surgical procedures of the related region.

Anatomical study of a human skull with multiple osteomas in a seventeenth-century Dutch still-life painting: bone morphology and artistic intention.

Skulls were frequently depicted in seventeenth-century Dutch still-life paintings. Skulls were interpreted as symbols of vanitas-meaning the evanescence of life-but their morphological features have received little attention. This study analyzed a skull with abnormal tumors in a seventeenth-century Dutch still-life painting by a renowned artist, Edwaert Collier (ca. 1642-1708), from anatomical, forensic, and pathological perspectives. The morphology of the cranium and teeth indicated that the skull likely belonged to a middle-aged female. We carefully diagnosed the abnormal masses as multiple osteomas on the skull and left femur, based on clinical studies and paleopathological literature, which reported lesions with a similar appearance to those observed in Collier's work. Furthermore, detailed observations of the cranial sutures and epiphyses of the long bones in his paintings revealed that the artist may have selected bones with a morphology that was suitable for the subject of vanitas. Collier repeatedly depicted the skull with metopism, the rare condition of having a persistent metopic suture in adulthood. A skull with a metopic suture is called Kreuzschädel, meaning the cross skull, because it forms a cruciform by connecting with the sagittal and coronal sutures. The artist might have chosen skulls with metopic sutures, which is reminiscent of the crucifixion of Christ, as an appropriate motif for the vanitas painting. This paper argues that anatomical analysis could explain the hidden meaning of the painting and disclose the fascinating collaborations between anatomy and art in the seventeenth-century Dutch Republic.

Estimating the Person-Specific Location of Pterion Based on Cranial Morphometry.

OBJECTIVE: Due to being the weakest sutural junction of the crania and relations with intracranial anatomical structures, the accurate location of the pterion is important for surgical approaches such as in pterional craniotomy. The aim of the study was to develop regression equations to estimate the person-specific accurate location of the pterion based on the cranial morphometry. MATERIALS AND METHODS: The study was conducted on 22 pterions located 11 dry skulls belonging to Anatomy Department of the Harran University, Medical Faculty. Twelve parameters related to pterion and 23 parameters related to the skull was measured using ImageJ software. SPSS 20.0 was performed for statistical analyses such as descriptive and comparative statistics and developing regression equations. RESULTS: Statistically significant difference wasn't observed between right and left sides. The 12 equations, such as P8:distance between pterion and the tip of the mastoid process= 63,780 + (1,366 × K6) - (2,786 × K7) + (1,342 × K11) - (1,029 × K13) + (2,102 × K14) - (1,710 × K15) - (0,517 × 22) Adjusted R2= 0.995 and Standard Errors = 1.221 were developed to estimate the accurate location of the pterion based on the cranial morphometry. CONCLUSIONS: In the previous studies, the mean distances of the pterion to certain landmarks on the crania were given. The authors developed formulas in order to estimate the accurate person-specific location of the pterion. The authors are convinced that the equations they have developed will help neurosurgeons in terms of surgical approaches.

Anatomic position of the asterion and implication for neurosurgical procedure / Posición anatómica del asterion y sus implicancias en el procedimiento neuroquirúrgico

SUMMARY: The asterion is the joining of the lambdoid, parietomastoid, and occipitomastoid sutures. It is classified into two types, type I shows small bones or woven bones, while in type II, woven bones are non-existent. In this study, forty cadavers were conducted and observed the asterion on both sides of skulls showing the approximate ratio of type II and type I was 3:2. The asterion was located by measuring the distances from the asterion to skull landmarks, including inion, the root of zygoma, and mastoid tip. The mean distance between asterion and inion was 62.9 ? 6.0 mm. The mean distance between asterion and the root of zygomatic arch was 58.3 ? 6.1 mm, whereas the mean distance between asterion and mastoid tip was 51.1 ? 5.3 mm. The most common location related to the asterion was the dural venous sinuses on 65 % of tested sides, followed by infratentorial dura and supratentorial dura (25 % and 10 %, respectively). However, the authors found no differences between sexes, sides, and types in any underlying structures.

RESUMEN: El asterion es la unión de las suturas lambdoidea, parietomastoidea y occipitomastoidea. Clasificado en dos tipos, el tipo I muestra huesos pequeños o hueso laminar, mientras que en el tipo II, el hueso laminar es inexistente. En este trabajo se estudiaron 40 cadáveres y se observó el asterion en ambos lados de los cráneos correspondientes, mostrando una proporción aproximada de tipo II y tipo I de 3:2. El asterion se localizó midiendo las distancias asociadas a puntos de referencia del cráneo: el inion, la raíz del arco cigomático y el ápice del proceso mastoides. La distancia media entre el asterion y el inion fue de 62,9 ? 6,0 mm. La distancia media entre el asterion y la raíz del arco cigomático fue de 58,3 ? 6,1 mm, mientras que la distancia media entre el asterion y el ápice del proceso mastoides fue de 51,1 ? 5,3 mm. La localización más común relacionada con el asterion fueron los senos venosos durales en el 65 % de los lados evaluados, seguido de la duramadre infratentorial y la dura supratentorial (25 % y 10 %, respectivamente). Sin embargo, los autores no encontraron diferencias entre sexo, lados y tipo en ninguna estructura subyacente.

The morphometric study of parietal emissary foramen related with clinical implications in Thais / Estudio morfométrico del foramen emisario parietal relacionado con las implicaciones clínicas en tailandeses

SUMMARY: Parietal emissary foramina (PEF) are an important structure which the parietal emissary vein passes through. Aims of this study were to study morphometry of the PEF and its clinical implications. The present study examined in 800 parietal bones (400 Thai skulls; 200 males and 200 females). A total of 587 emissary foramina were found in 344 skulls. The PEF were found on the right side (298), left side (256). One hundred fifty-five unilateral, 189 bilateral, and 33 center of PEF were found in our study. The average of foramina to sagittal suture were 5.67 ? 2.73 mm on the right and 5.91 ? 2.37 mm on the left in male, while in female it was 5.28 ? 2.61 mm on the right and 5.48 ? 2.54 mm on the left. The shape was mostly circular with mean diameter of 1.27 ? 0.56 mm on the right, 1.23 ? 0.52 on the left and 1.11 ? 0.49 mm at the center in male. In female, the mean diameter of 1.19 ? 0.42 mm on the right, 1.12 ? 0.41 mm on the left and 1.60 ? 0.92 mm at the center. The ratio of distance from the external occipital protuberance (EOP)to PEF and to glabella in males on the right side is 0.342 cm. (3/8) and 0.349 cm. (3/8) on the left side. While the ratio of females is 0.367 cm. (3/8) and 0.388 cm. (3/8), respectively. Our finding obtained in this study scientists can be essentially benefited for anatomists, radiologists, neurosurgeons, and forensic to aware this anatomical structure.

RESUMEN: El foramen emisario parietal (FEP) es una importante estructura a través de la cual atraviesa la vena emisaria parietal. Los objetivos de este estudio fueron estudiar la morfometría del FEP y sus implicaciones clínicas. Se examinaron 800 huesos parietales (400 cráneos tailandeses pertenecientes a 200 hombres y 200 mujeres). Se encontró un total de 587 FEP en 344 cráneos, de los cuales 298 estaban presentes en el lado derecho y 256 en el lado izquierdo, siendo 155 FEP unilaterales, 189 bilaterales y 33 localizados en el centro. El promedio de la distancia de los FEP a la sutura sagital en los hombres fue de 5,67 ? 2,73 mm a la derecha y 5,91 ? 2,37 mm a la izquierda, mientras que en las mujeres fue de 5,28 ? 2,61 mm a la derecha y 5,48 ? 2,54 mm a la izquierda. La forma era mayoritariamente circular con un diámetro medio de 1,27 ? 0,56 mm en el lado derecho, 1,23 ? 0,52 en el lado izquierdo y 1,11 ? 0,49 mm en el centro en los cráneos de los hombres. En las mujeres, el diámetro medio del FEP en el lado derecho fue de 1,19 ? 0,42 mm, en el lado izquierdo 1,12 ? 0,41 mm 1,60 ? 0,92 mm en el centro. La relación de la distancia desde la protuberan- cia occipital externa al FEP y a la glabela en el lado derecho en los hombres fue de 0,342 cm (3/8) y en el lado izquierdo 0,349 cm (3/8). Mientras en las mujeres fue de 0,367 cm (3/8) y 0,388 cm (3/8), respectivamente. Nuestros hallazgos obtenidos en este estudio puede ser útil para que los anatomistas, radiólogos, neurocirujanos y científicos forenses conozcan esta estructura anatómica.

Anatomical variations and morphometric study of pterion in a Thai population associated with clinical implications / Variaciones anatómicas y estudio morfométrico del pterion en una población tailandesa asociada con implicaciones clínicas

SUMMARY: The objective of this study was to consider the type of variation and to estimate the landmarks for localizing the pterion. One hundred twenty Thai dry skulls were selected randomly from the Forensic Osteology Research Center, Faculty of Medicine, Chiang Mai University. The distances of the parameters were measured via Vernier caliper. The sphenoparietal type is the most dominant in the Thai population with 88.75 %. In the male, the distance of the midglabella to the pterion was 9.94?0.64 mm The distance of the frontozygomatic suture to the pterion was 35.41?4.38 mm The distance of the zygomatic arch to the pterion was 39.39?4.69 mm and the distance of the mastoid process tip to the pterion was 86.88?4.44 mm In the female, the distance of the midglabella to the pterion was 9.27?0.63 mm The distance of the frontozygomatic suture to the pterion was 33.08?4.12 mm The distance of the zygomatic arch to the pterion was 33.08?4.12 mm and the distance of the mastoid process tip to the pterion was 83.62?5.16 mm. The pterion approach is the most popular method for neurosurgical procedures, and it provides anatomical variations in the pattern. The sphenoparietal type of pterion is the most common form and the stellate type of pterion is the least common form in Thai skulls. Sex influences the location of the pterion. These findings will be of importance to predict the pterion type in Thai skull and estimate the localization of pterion by using a bony landmark. Knowledge of the precise location of the pterion is an important landmark in the neurosurgical approach.

RESUMEN: El objetivo de este estudio fue considerar el tipo de variación del pterion y estimar los puntos de referencia para localizarlo. Se seleccionaron al azar 120 cráneos secos de individuos tailandeses del Centro de Investigación de Osteología Forense de la Facultad de Medicina de la Universidad de Chiang Mai. Las distancias de los parámetros se midieron mediante un caliper Vernier. El tipo esfenoparietal es el más dominante en la población tailandesa con 88,75 %. En el hombre, la distancia de la glabella al pterion fue de 9,94 ? 0,64 mm. La distancia de la sutura frontocigomática fue de 35,41 ? 4,38 mm La distancia del arco cigomático fue de 39,39 ? 4,69 mm y la distancia del ápice del proceso mastoideo al pterion fue de 86,88 ? 4,44 mm. En la mujer, la distancia de la glabella al pterion fue de 9,27 ? 0,63 mm. La distancia de la sutura frontocigomática al pterion fue de 33,08 ? 4,12 mm. La distancia del arco cigomático al pterion fue de 33,08 ? 4,12 mm y la distancia del ápice proceso mastoideo al pterion fue de 83,62 ? 5,16 mm. El abordaje del pterion es el método más utilizado para procedimientos neuroquirúrgicos y proporciona variaciones anatómicas en el patrón. El tipo esfenoparietal del pterion es la forma más común y el tipo estrellado del pterion es la forma menos común en los cráneos tailandeses. El sexo influye en la ubicación del pterion. Estos hallazgos serán importantes para predecir el tipo de pterion del cráneo en tailandeses y a la vez estimar su localización mediante el uso de un punto de referencia óseo. El conocimiento de la ubicación precisa del pterion es un hito impor- tante en el abordaje neuroquirúrgico.

Propuesta de clasificación de huesos suturales / Classification proposal of sutural bones

RESUMEN: Los huesos suturales tienen importancia anatómica y médico-legal. Se observan en las suturas de la cabeza ósea y tradicionalmente son descritos como planos, supernumerarios, irregulares, inconstantes, independientes y de variable morfología y frecuencia. Actualmente, no existe una clasificación única de estos huesos que incorpore todas las categorías descritas en la literatura. El objetivo de este trabajo fue proponer una clasificación actualizada de estos elementos, en función de una revisión bibliográfica exhaustiva y el análisis de cráneos de individuos chilenos. La muestra utilizada correspondió a 113 huesos suturales presentes en 12 cráneos secos, de individuos adultos chilenos. En la clasificación se consideró su ubicación en la cabeza (cráneo o cara), su origen embrionario, su relación con una fontanela, su forma, su posición en la cara y su relación con las tablas óseas. Los datos obtenidos se registraron en formulario especialmente diseñado y se tomaron fotografías digitales. Como resultado general, pudimos desarrollar una propuesta de clasificación de huesos suturales completa y satisfactoria y con ella se analizó los huesos de la muestra, pudiendo evidenciar la presencia de todas las categorías del instrumento. También pudimos constatar que en la totalidad de los cráneos utilizados se observaron huesos suturales, que los cráneos masculinos presentan un mayor número de estos huesos, pero que en los cráneos femeninos fue posible reconocer todas los tipos de huesos suturales, entre otros resultados. También se evidenció un tipo de hueso sutural no descrito anteriormente, el hueso sutural craneal puntiforme. Como conclusión de este trabajo, es importante destacar que los huesos suturales presentan características comunes a otras estructuras utilizadas en identificación forense, es decir, son perennes, únicos, de fácil observación, de fácil comparación y gran variabilidad, por estas razones la presente propuesta de clasificación permite ser planteada como una metodología auxiliar en la identificación humana.

SUMMARY: The sutural bones have anatomical and medico-legal importance. They are observed in the sutures of the bony head and are traditionally described as flat, supernumerary, irregular, inconstant, independent and of variable morphology and frequency. Currently, there is no single classification of these bones that incorporates all the categories described in the literature. The objective of this work was to propose an updated classification of these elements, based on an exhaustive bibliographic review and the analysis of the skulls of Chilean individuals. The sample used corresponds to 113 sutural bones present in 12 dry skulls of Chilean adults. The classification considers its location on the head (skull or face), its embryonic origin, its relationship to a fontanelle, its shape, its position on the face, and its relationship to bone tables. The data obtained was recorded in a specially designed format and digital photographs were taken. As a general result, we were able to develop a complete and satisfactory classification of sutural bones proposal and with it, the bones of the sample were analyzed, showing the presence of all categories of the instrument. We were also able to verify that sutural bones were observed in all the skulls used, that male skulls present a greater number of these bones, but that in the female skulls it was possible to recognize all types of sutural bones, among other results. A type of sutural bone not previously described, the shaped point cranial sutural bone, was also evidenced. As a conclusion to this work, it is important to highlight that sutural bones present characteristics common to other structures used in forensic identification, that is, they are perennial, unique, easily observed, easily compared and great variability, for these reasons the present classification proposal allows it to be proposed as an auxiliary methodology in human identification.

Identifying the Misshapen Head: Craniosynostosis and Related Disorders.

Pediatric care providers, pediatricians, pediatric subspecialty physicians, and other health care providers should be able to recognize children with abnormal head shapes that occur as a result of both synostotic and deformational processes. The purpose of this clinical report is to review the characteristic head shape changes, as well as secondary craniofacial characteristics, that occur in the setting of the various primary craniosynostoses and deformations. As an introduction, the physiology and genetics of skull growth as well as the pathophysiology underlying craniosynostosis are reviewed. This is followed by a description of each type of primary craniosynostosis (metopic, unicoronal, bicoronal, sagittal, lambdoid, and frontosphenoidal) and their resultant head shape changes, with an emphasis on differentiating conditions that require surgical correction from those (bathrocephaly, deformational plagiocephaly/brachycephaly, and neonatal intensive care unit-associated skill deformation, known as NICUcephaly) that do not. The report ends with a brief discussion of microcephaly as it relates to craniosynostosis as well as fontanelle closure. The intent is to improve pediatric care providers' recognition and timely referral for craniosynostosis and their differentiation of synostotic from deformational and other nonoperative head shape changes.

Morphologic and morphometric evaluation of the wormian bones / Evaluación morfológica y morfométrica de los huesos wormianos

Wormian (sutural) bones are accessory small bones located on the skull. These bones consist of extra ossification centers around cranial sutures. This study was carried out in 28 dry human skulls with unknown age and sex in the Department of Anatomy, Cukurova University. The aim of the study was to investigate incidence and to determine morphologic and morphometric characteristics of wormian (sutural) bones. Total incidence of wormian bone presence was 42.86 % (n=12) and most of them were located on lambdoid suture (57.14 %). Wormian bones were seen at lambdoid suture at a rate of 62.5 %, occipito-mastoid suture 9.37 %, asterion 18.76 %, lambda 9.37 %, and were not seen on pterion, bregma, parietotemporal, sagittal and coronal sutures. Wormian bones were seen on left side at a rate of 65.62 % and 34.38 % on right side of skull. According to our study, wormian bone shapes were seen as quadrangular (56.26 %), triangular (15.62 %) and irregular (28.12 %). The mean values of wormian bones were as follows; vertical diameter: 12.29±4.48 mm and horizontal diameter: 10.93±4.39 mm. For cephalic index, the result of our study shows that most of our skulls with or without wormian bones belong to dolichocephalic group. Knowledge of variations and characteristics of skull is important for forensic medicine, anatomy, radiology and neurosurgery fields and for literature data or clinical practices.

Los huesos wormianos o huesos suturales, son pequeños huesos accesorios ubicados en el cráneo. Estos huesos consisten en centros de osificación adicionales alrededor de las suturas craneales. Este estudio se realizó en 28 cráneos humanos secos con edad y sexo desconocidos en el Departamento de Anatomía de la Universidad de Cukurova. El objetivo del estudio fue investigar la incidencia y determinar las características morfológicas y morfométricas de los huesos wormianos. La incidencia total de presencia de hueso wormiano fue del 42,86 % (n = 12) y la mayoría de estos se localizó en sutura lambdoidea (57,14 %). Los huesos wormianos se observaron en la sutura lambdoidea a una tasa del 62,5 %, sutura occipito-mastoidea 9,37 %, asterion 18,76 %, lambda 9,37 %, y no se observaron en suturas pterion, bregma, parietotemporal, sagital y coronal. Los huesos wormianos se observaron en el lado izquierdo a una tasa del 65,62 % y del 34,38 % en el lado derecho del cráneo. Según nuestro estudio, las formas óseas se consideraron cuadrangulares (56,26 %), triangulares (15,62 %) e irregulares (28,12 %). Los valores medios de los huesos wormianos fueron los siguientes; diámetro vertical: 12,29 ± 4,48 mm y diámetro horizontal: 10,93 ± 4,39 mm. Referente al índice cefálico, el resultado de nuestro estudio muestra que la mayoría los cráneos con o sin huesos wormianos pertenecen al grupo dolicocefálico. El conocimiento de las variaciones y características del cráneo es importante para la medicina forense, la anatomía, la radiología y los campos de neurocirugía, como asimismo para los datos de la literatura o las prácticas clínicas.

Estudio morfométrico del punto asterional y su relación con los senos venosos durales / Morphometric study of the asterional point and its relationship with the dural venous sinuses

INTRODUCCIÓN: la importancia de conocer las diferentes reparaciones anatómicas que involucran la parte ósea de la fosa posterior con estructuras neurovasculares, disminuye la incidencia de complicaciones relacionadas con su acceso dentro del procedimiento neuroquirúrgico. MATERIALES Y MÉTODOS: estudio descriptivo basado en la evaluación de 90 hemicráneas secas, del Museo de Anatomía de la Universidad Mayor de San Andrés. RESULTADOS: la prevalencia de asterión tipo I fue de 28.9%, mientras que la de tipo II fue de 71.1%. La prevalencia del número de venas emisarias fue: una vena 54.4%, dos venas 42.2% y tres venas 3.3%. Los promedios para las características morfométricas son los siguientes: de Asterion a protuberancia occipital externa de 68.8 mm, de Asterion a cresta suprameatal de 50.1 mm, de Asterion a vena emisaria de 54.1 mm, de Asterion a Vértice del proceso mastoideo de 54.1 mm y de asterion a plano horizontal de Francfort 14.6 mm. La ubicación del asterión en el seno transverso fue la siguiente: al mismo nivel del seno, 47.8% de los casos, en el codo en 13.3%, superior al seno 31.1% e inferior a este en el 7.8%. CONCLUSIONES: hay una diferencia en algunos resultados morfométricos del asterión con respecto a otros autores, lo que podría determinar una configuración craneal diferente para nuestra población. Esto debe considerarse para evitar complicaciones durante el período transoperatorio en una cirugía de fosa posterior. Estos resultados reflejan la necesidad de realizar un estudio con una población más grande para obtener resultados reales, estableciendo así parámetros de corte que nos permitirán tener nuestra propia bibliografía sobre cómo proceder en nuestra actividad quirúrgica.

INTRODUCTION: the importance of knowing the different anatomical repairs that involve the bony part of the posterior fossa with neurovascular structures, decreases the incidence of complications related to its access within the neurosurgical procedure. MATERIALS AND METHODS: descriptive study based on the evaluation of 90 dry hemicranial, from the Anatomy Museum of the Universidad Mayor de San Andrés. RESULTS: the prevalence of asterion type I was 28.9%, while that of type II was 71.1%. The prevalence of the number of emissary veins was: One vein 54.4%, Two veins 42.2% and Three veins 3.3%. The averages for morphometric characteristics are as follows: from Asterion to external occipital protuberance 68.8 mm, from Asterion to suprameatal crest 50.1 mm, from Asterion to emissary vein 54.1 mm, from Asterion to Vertex from the mastoid process 54.1 mm and from asterion to horizontal plane of Frankfurt 14.6 mm. The location of asterion in the transverse sinus was the following: at the same level of the sinus 47.8% of the cases, in the elbow in 13.3%, superior to the sinus 31.1% and inferior to this in the 7.8%. CONCLUSIONS: there is a difference in some morphometric results of the asterion with respect to other authors, which could determine a different cranial configuration for our population. This should be considered to avoid complications during the transoperative period in a posterior fossa surgery. These results reflect the need to carry out a study with a larger population, in order to have real results, thus establishing cutting parameters that will allow us to have our own bibliography on how to proceed in our surgical activity.

Relationship of the posterior septal angle to the anterior nasal spine in the Caucasian nasal septum.

OBJECTIVE: This study aimed to determine the distance between the most anterior part of the anterior nasal spine and the posterior septal angle. METHODS: Sinus computed tomography images from February to April 2016 were retrospectively analysed. Scans from adult Caucasians were included. Those with evidence of previous surgery, large slices or poor quality were excluded. The distance between the posterior septal angle and the most anterior part of the anterior nasal spine was measured digitally by two independent raters. RESULTS: Of 122 scans, 100 met the inclusion criteria (49 males and 51 females; mean age of 52.5 years). The mean distance measured was 5.13 mm (standard deviation = 1.24 mm, range = 1.85-8.00 mm). Measurements between male and female patients were not significantly different (t=0.450, p=0.654, 95 per cent confidence interval = -0.382 to 0.606). CONCLUSION: There is variability in the distance between the anterior nasal spine and the posterior septal angle. Surgeons should observe this relationship intra-operatively to avoid instability and unintended aesthetic changes.

Premaxilla: up to which age it remains separated from the maxilla by a suture, how often it occurs in children and adults, and possible clinical and therapeutic implications: Study of 1,138 human skulls

ABSTRACT Objective: To evaluate topographic and temporal aspects of premaxillary bone and premaxillary-maxillary suture, since they are fundamental anatomical elements little explored clinically. Methods: 1,138 human dry skulls were evaluated, of which 116 (10.19%) of the specimens were children, and 1,022 (89.81%) were adults. The skulls were photographed and the percentage of premaxillary-maxillary suture opening was determined. Subsequently the data were tabulated and submitted to statistical analysis, adopting a level of significance of 5%. Results: The progression of premaxillary suture closure from birth to 12 years of age was 3.72% per year. In 100% of the skulls up to 12 years, the premaxillary-maxillary suture open in the palatal region was observed, while 6.16% of adults presented different degrees of opening. Conclusions: The premaxilla exists in an independent way within the maxillary complex and the presence of the premaxilla-maxillary suture justifies the success of anteroposterior expansions to stimulate the growth of the middle third of the face, solving anatomical and functional problems.

RESUMO Objetivo: avaliar aspectos topográficos e temporais do osso pré-maxilar e da sutura pré-maxilar/maxilar, por serem elementos anatômicos fundamentais pouco explorados clinicamente. Métodos: foram avaliados 1.138 crânios secos humanos, sendo 116 (10,19%) dos espécimes crianças e 1.022 (89,81%) adultos. Os crânios foram fotografados e determinou-se a porcentagem de abertura da sutura pré-maxilar/maxilar. Posteriormente, os dados foram tabulados e submetidos a análise estatística, adotando-se nível de significância de 5%. Resultados: a progressão de fechamento da sutura pré-maxilar/maxilar do nascimento aos 12 anos de idade foi de 3,72% ao ano. Em 100% dos crânios até 12 anos, observou-se a sutura pré-maxilar/maxilar aberta na região palatina, enquanto 6,16% dos adultos apresentavam diferentes graus. Conclusões: a pré-maxila existe de forma independente dentro do complexo maxilar e a presença da sutura pré-maxilar / maxilar justifica o sucesso de expansões anteroposteriores para estimular o crescimento do terço médio da face, solucionando problemas anatômicos e funcionais.

Zygomaticofacial, Zygomaticoorbital, and Zygomaticotemporal Foramina.

This study aimed to assess the anatomical and morphometric characteristics of the main zygomaticofacial (ZFF), zygomaticoorbital (ZOF), and zygomaticotemporal (ZTF) foramina in Brazilian dry skulls. 61, 69, and 42 skulls for ZFF, ZOF, and ZTF were evaluated by a single calibrated examiner for format, transverse and vertical diameters, and distances from the foramina to anatomical landmarks. Paired t test, Wilcoxon test, Pearson and Spearman correlations were used. Circular outline was the predominant format for ZFF and ZTF, while oval format was the most frequent for ZOF. Median distances from ZFF to frontozygomatic and zygomaticomaxillary sutures were higher on right and left sides of the skulls, respectively (P < 0.005). Mean ZOF transverse diameter was significantly higher on the right sides of the skulls and presented positive correlation between sides (P < 0.05). No differences were observed for mean vertical diameter and distance from the ZOF to the inferolateral angle of the orbit (P > 0.05). No significant difference was found for distance from the ZTF to zygomatic arch between sides (P > 0.05), although there was a positive correlation (P < 0.05). Significant differences were found when analyzing the anatomical and morphometric aspects of ZFF, ZOF, and ZTF.

The Morphological Grading and Comparison of Sutural Patency Among Cranial Sutures in Dry Human Skulls.

OBJECTIVE: To investigate the degree of fusion (patency) among cranial sutures in human dry skulls in the Anatolia. METHODS: One-hundred fifty-eight human dry skulls that were accepted as adults according to the teeth eruption were macroscopically examined and photographed with Canon 400B (55 mm objective). The grades of fusion of coronal, sagittal, and lambdoid were quantitatively analyzed by using the modified grading scale. According to the extent of patency, the sutures were graded as grade-0 (open), grade-1 (fused but not obliterated), grade-2 (50%< obliterated), grade-3 (50% > obliterated), and grade-4 (100% obliterated). The authors determined and compared the rate for each grade of sutural patency on coronal, sagittal, and lambdoid sutures. RESULTS: The cranial sutures of 4 cranii (4/158; 2.53%) had grade-4 fusion, whereas there were no any cranii with sutures of grade-0 fusion. The number of each grade of fusion among cranial sutures of 158 skulls, in descending order, was as follows: 171 (grade-3), 145 (grade-1), 133 (grade-2), and 25 (grade-4). The grade-4 fusion was significantly less observed than the others. The grade-1 and grade-4 fusion of lambdoid sutures were established as the most (66/41.8%) and least (5/3.2%) common fusions among cranial sutures, respectively. The frequencies of each grade of fusion for each cranial suture were determined in a descending order: coronal (grade-3 > 2 > 1 > 4), sagittal (grade-3 > 2 > 1 > 4), and lambdoid sutures (grade-1 > 3 > 2 > 4). The frequency of grade-1 fusion of lambdoid suture (66/41.8%) was significantly different when compared with coronal (39/24.7%) and sagittal sutures (40/25.3%), respectively. CONCLUSION: The grades of fusion (or sutural patency) vary among cranial sutures.

Microsurgical anatomy of the superior sagittal sinus and draining veins.

BACKGROUND: The superior sagittal sinus and the draining cerebral veins are often encountered during the surgery for parasagittal and falx meningiomas and during the interhemisperic transcallosal approaches. A knowledge about the variations from the normally described anatomy helps in anticipating and avoiding problems related to these structures during surgery. AIM: The normal variations in the disposition of the superior sagittal sinus and the number and direction of the draining veins in the Indian population have been studied. SETTINGS AND DESIGN: This is an anatomical study in the fresh cadavers. MATERIALS AND METHODS: Sixty fresh cadavers were examined in the autopsy theatre of the Forensic Medicine Department of the Hospital between March 2011 and February 2013. STATISTICAL ANALYSIS USED: Epi-Info, MS-Excel, and the Statistical Package for the Social Sciences (SPSS) were used for data analysis. RESULTS: The position of the superior sagittal sinus was variable and was up to within 1cm on either side of the sagittal suture. The origin of the superior sagittal sinus varied from the level of foramen caecum to a little posterior from the foramen caecum. The total length of the superior sagittal sagitttal sinus varied from 321 mm to 357 mm (average length 338.77mm); vertical compartments of the sinus were found in three-fourth of the cases studied. Tributaries were found in the herringbone pattern and varied from 13 to 19 on the right and 14 to 19 on the left. The Rolandic vein was the largest draining vein in most of the cases. The superior sagittal sinus drained predominantly to the right transverse sinus in three-fourth of the cases studied. The position of the torcula was variable; often towards the right side and at a higher level. The central sulcus was 49.93 mm posterior to the coronal suture and 130.78 mm anterior to the lambdoid suture. CONCLUSIONS: This is the first study of its kind in Indian population studying the anatomical variations in the anatomy of the superior sagittal sinus that may have a significant bearing on the neurosurgical approaches adopted.