Asterion as a surgical landmark for lateral cranial base approaches

INTRODUCTION

When approaching the posterior fossa and posterolateral cranial base, surface landmarks are helpful in locating the junction of the transverse and the sigmoid sinus.

MATERIAL AND METHODS

On 100 skull halves a 2mm drill bit was externally placed over the asterion and was drilled through the bone perpendicular to the skull surface. Various positions of the asterion and its distance from the root of the zygomatic process of the temporal bone, from the suprameatal crest and the mastoid tip were investigated.

RESULTS

The position of the asterion has been found to be located superficial to the transverse-sigmoid sinus junction in 87% of all samples, inferior to the transverse-sigmoid sinus junction in 11% and superior to the transverse-sigmoid sinus junction in 2%. The distance from the asterion to the root of the zygoma has been determined to be 54.6+/-5.5mm. The distance between asterion and Henle's spine was 45.2+/-5.2, and from asterion to Frankfurt Horizontal Plane 15+/-7.5mm.

CONCLUSION

Asterion varies regarding its cephalocaudal position. The findings of this study might have direct consequences for transmastoid and retrosigmoid approaches for microvascular trigeminal root decompression and combined petrosal approaches.

Implant anchorage in orthodontic practice: the Straumann Orthosystem

Dental implants have been used to provide orthodontic anchorage. This article provides an overview of the Straumann Orthosystem implant system (Institut Straumann, Waldenburg, Switzerland) and its application, including the anatomy of the bony palate and contiguous structures. Considerations in placement of the Orthosystem implant include the avoidance of contiguous anatomic structures such as the nasal cavity, the degree of ossification of the palatal suture, and the quality and quantity of bone in the proposed implant site, all of which are discussed in this article.

Error estimation of the fractal dimension measurements of cranial sutures

The fractal exponents used to quantify the complexity of cranial sutures were computed for 17 coronal and 17 sagittal sutures of adults from different populations, using the box-counting algorithm. This paper discusses the main sources of error for the fractal exponents, and gives the error estimates. We then compare our results with those obtained by other authors. We suggest that the usual error estimates implied by the standard deviation for the regression line are too low. We emphasize the crucial role played by the choice of regression line in the log-log plot. For the coronal and sagittal sutures we found mean fractal dimensions of 1.48 and 1.56, respectively. Our values are close to the value for Brownian random walk.

Cranial suture complexity in white-tailed deer (Odocoileus virginianus)

Neurocranial expansion and mastication are commonly implicated as the two major biomechanical factors affecting suture morphology. In deer the antlers provide an additional source of biomechanical stress acting on the skull. Equivalent stresses are not found in females, who lack antlers. We analyzed the complexity and interdigitation of the interfrontal and coronal sutures that surround the antler-bearing frontal bones of (n = 67) white-tailed deer (Odocoileus virginianus) to 1) evaluate changes in suture morphology throughout ontogeny, and 2) test the hypothesis that male deer have more complex sutures than females. Two methods were used to quantify suture morphology: fractal analysis and length-ratios (actual suture length divided by direct straightline length). Both techniques produced similar results, although the two methods cannot be considered equivalent. Suture complexity increases markedly throughout ontogeny, but appears to level off after animals have reached adulthood. Cranial size in males, but not females, continues to increase in adults. No significant increase in suture complexity with age in the adult cohort was detected. While deer are highly dimorphic in size and the presence of antlers, no significant differences existed between males and females for any measure of suture complexity. No consistent patterns emerged between suture complexity and skull size or antler characteristics. The presence of antlers appears to have a minimal effect on suture complexity in white-tailed deer. Factors that may contribute to the lack of dimorphism in suture complexity are discussed.

In vivocranial suture function and suture morphology in the extant fishPolypterus: implications for inferring skull function in living and fossil fish

This study describes the mechanical role that cranial sutures play in fish during feeding. The long-term goal of our work is to establish relationships between suture form and function, so that functional inferences can be made from suture morphology in fossil taxa. To this end, strain gauges were surgically implanted across selected sutures in the skull roof of four individuals of Polypterus endlicherii. After surgery, bone and suture strains during feeding were recorded along with high-speed video of the feeding events. Each trial was designated as a suction feeding or biting on prey trial, and neurocranial elevation, hyoid position and gape were quantified to aid in interpreting the strain data. The strains due to suction feeding are different from those observed during biting. Suction feeding results in a fairly stereotyped strain pattern, with the interfrontal and frontoparietal sutures experiencing tension, while the interparietal suture is compressed. Biting causes much more variable strain patterns. However, both suction and biting result in compression in the back of the skull, and tension between the frontals. Peak strains, and the time at which they occur in the feeding cycle, were compared between suction and biting. In general, peak suture strains are higher during suction than during biting, but not all of these differences are significant. Peak suture and bone strains occur at or near maximum gape during both suction and biting, suggesting that these strains are caused by muscle contraction involved in mouth opening and closing. Micro-computed tomography (microCT) scans of the experimental specimens indicate that the interfrontal and frontoparietal sutures, typically loaded in tension, are less interdigitated in cross section than the interparietal suture, which experiences compression. This is consistent with published correlations of suture form and function in mammals, where interdigitated sutures indicate compression and lack of interdigitation is associated with tension.

Load transmission in the nasofrontal suture of the pig, Sus scrofa

The nasofrontal suture links the nasal complex with the braincase and is subject to compressive strain during mastication and (theoretically) tensile strain during growth of nasal soft tissues. The suture's ability to transmit compressive and tensile loads therefore affects both cranioskeletal stress distribution and growth. This study investigated the in vitro viscoelastic and failure properties of the nasofrontal suture in the pig, Sus scrofa. Suture specimens from two ages were tested in compression and tension and at fast and slow rates. In additional specimens, strain gauges were applied to the suture and nasal bone for strain measurement during testing. Relaxation testing demonstrated higher elastic moduli in tension than compression, regardless of test rate or pig age. In contrast, maximum elastic moduli from failure tests, as well as peak stresses, were significantly higher in compression than in tension. Sutures from older pigs tended to have higher elastic moduli and peak stresses, significantly so for tensile relaxation moduli. Strain gauge results showed that deformation at the suture was much greater than that of the nasal bone. These data demonstrate the viscoelasticity and deformability of the nasofrontal sutural ligament. The suture achieved maximal resistance to tensile deformation at low loads, corresponding with the low tensile loads likely to occur during growth of nasal soft tissues. In contrast, the maximal stiffness in compression at high loads indicates that the suture functions with a substantial safety factor during mastication.

[Suppositional sutural construction and application in the three-dimensional finite element model of craniofacial complex]

OBJECTIVE

The purpose of this study was to explore suppositional sutural construction and protraction in the three-dimensional finite element model of craniofacial complex.

METHODS

Combining spiral CT scanning technology with the three-dimensional finite element method, three-dimensional FEM model of craniofacial complex was developed for analysis. In the model, craniofacial sutures were constructed through the MSC. Patran program and different mechanical properties of sutures were applied. Under the same loading condition, bone displacements of the maxilla were calculated.

RESULTS

A three-dimensional FE model of craniofacial complex, comprising teeth and craniofacial sutures, was developed. The displacement of the skeletal structures with sutures was significantly larger than that without sutures.

CONCLUSIONS

The construction of craniofacial sutures in the three-dimensional finite element model of craniofacial complex could improve the accuracy of finite element model, which set up good foundation for biomechanical studies of craniofacial complex.

Geometry and cell density of rat craniofacial sutures during early postnatal development and upon in vivo cyclic loading

Cranial sutures are unique to skull bones and consist of multiple connective tissue cell lineages such as mesenchymal cells, fibroblast-like cells, and osteogenic cells, in addition to osteoclasts. Mechanical modulation of intramembranous bone growth in the craniofacial suture is not well understood, especially during postnatal development. This study investigated whether in vivo mechanical forces regulate sutural growth responses in postnatal rats. Cyclic compressive forces with a peak-to-peak magnitude of 300 mN and 4 Hz were applied to the maxilla in each of 17-, 23-and 32-day-old rats for 20 min/day over 5 consecutive days. Computerized histomorphometric analysis revealed that cyclic loading significantly increased the average geometric widths of the premaxillomaxillary suture (PMS) to 86 +/- 7 microm, 99 +/- 12 microm, and 149 +/- 30 microm, representing 32%, 50%, and 39% increases for P17, P23, and P32 in comparison with age-matched sham controls. For the nasofrontal suture (NFS), cyclic loading significantly increased the average sutural widths to 88 +/- 15 microm, 92 +/- 10 microm, and 100 +/- 14 microm, representing 33%, 24%, and 32% increases for P17, P23, and P32 relative to age-matched controls. The average PMS cell density upon cyclic loading was 10182 +/- 132 cells/mm(2), 9752 +/- 661 cells/mm(2), and 9521 +/- 628 cells/mm(2), representing 62%, 35%, and 30% increases for P17, P23, and P32 in comparison with age-matched controls. For the NFS, cyclic loading increased the average cell density to 9884 +/- 893 cells/mm(2), 9818 +/- 1091 cells/mm(2), 9355 +/- 661 cells/mm(2), representing 44%, 46% and 40% increases at P17, P23, and P32 respectively. Osteoblast-occupied sutural bone surface was significantly greater in cyclically loaded sutures for P17, P23, and P32 than corresponding controls for both the PMS and NFS. On the other hand, cyclic loading elicited significantly higher sutural bone surface populated by osteoclast-like cells by P17 and P23 days, but not P32 days, for the PMS. For the NFS, sutural osteoclast surface was significantly higher upon cyclic loading for P23 and P32 days, but not P17. The present data demonstrate that cyclic forces are potent stimuli for modulating postnatal sutural development, potentially by stimulating both osteogenesis and osteoclastogenesis. Cyclic loading may have clinical implications as novel mechanical stimuli for modulating craniofacial growth in patients suffering from craniofacial anomalies and dentofacial deformities.

Positional skull deformities in children: skull deformation without synostosis

BACKGROUND

Patients with craniosynostosis are readily diagnosed by clinical and neuroimaging findings. Surgical treatment is indicated for preventing neurological deficits and for correcting esthetically unacceptable head deformities. In recent years, we have witnessed a progressive number of neurosurgical consultations for abnormal head shapes unrelated to premature fusion of the cranial sutures, especially of positional plagiocephaly. There have been descriptions of abnormalities in the cerebrospinal fluid (CSF) spaces in children with craniosynostosis.

OBJECTIVES

The aim of the present study was to investigate the role of the changes of the CSF spaces in the development of positional skull deformities in children.

PATIENTS AND METHODS

The authors reviewed demographic, clinical, and neuroimaging data of 23 patients assessed for some form of nonsynostotic skull deformity (group A). The results were compared with those of a simultaneous group of nine infants diagnosed with benign extracerebral collections of fluid (group B).

RESULTS

The study group was composed of 11 boys and 12 girls, aged 3 years or younger. Seventeen children had plagiocephaly, four scaphocephaly, and two brachycephaly. Sixteen children (15 with plagiocephaly and 1 with brachycephaly) exhibited enlarged subarachnoid CSF spaces. In group B, the boy/girl ratio was of 7:2. Infants in group A presented at an older age (mean 12.7 months) than group B (mean age at presentation of 7.17 months). Children with benign extracerebral fluid collections were born with a head circumference (HC) greater than infants with positional skull deformities (p=0.005). The percentile of the children's HC at consultation was also larger for children of group B (p=0.03). The form of clinical presentation differed between the two groups. Most infants of group A were seen because of a type of head deformity, and children in group B were studied for macrocephaly. Long-term follow-up assessment showed better outcomes for patients in group B than for children of group A in regard to regression of initial symptoms (p=0.03).

CONCLUSIONS

Most positional head deformities appear to be related with the children's positioning for sleeping. We have not confirmed macrocephaly as a contributing factor for positional deformities. The distribution of extracerebral CSF and the presence of abnormal collections of fluid in children with positional head deformities do not seem to be related with the findings of pericerebral CSF encountered in children with benign extracerebral collections of fluid. In our view, brain pulsations, transmitted to these accumulations of CSF, play an important part in the development of the infants' skull deformities (p=0.02). The findings of enlarged CSF spaces in children with nonsynostotic skull deformation constituted an age-related event, as these collections tended to disappear as the children grew older (p=0.04).

Age-dependent properties and quasi-static strain in the rat sagittal suture

We measured the morphology of and performed tensile tests on sagittal sutures from rats of postnatal age 2 to 60 days. Using the properties measured ex vivo and a pressure vessel-based analysis, we estimated the quasi-static strain that had existed in the suture in vivo from 2 to 60 days. Sutural thickness, width, and stiffness per length were notable properties found to be age dependent. Sutural thickness increased 4.5-fold (0.11-0.50mm) between 2 and 60 days. Sutural width increased transiently between 2 and 20 days, peaking around 8 days; at 8 days, mean sutural width was 75% larger than mean sutural width at two days (0.35+/-0.07 (SD) vs. 0.20+/-0.06 mm). Sutural stiffness per length increased 4.4-fold (8.77-38.3N/mm/mm) between 2 and 60 days. The quasi-static sutural strain estimated to exist in vivo averaged 270+/-190 muepsilon between 2 and 60 days and was not age dependent. These findings provide data on the age-dependent sutural properties of infant to mature rats and provide the first estimate of quasi-static sutural strain in vivo in the rat. The findings show that during development the rat sagittal suture, as a structure, changes significantly and is exposed to quasi-static tensile strain in vivo due to intracranial pressure.

Former and present aspects in neuro-skull architecture

The classical authors considered the functional resistance of the neuro-skull to consist of arcs at the arch level, rafters at the base and pillars at the joint of the arcs and rafters, those last also connecting the neuro-skull framework and that of the viscero-skull. The new outlooks replace the term pillar with that of resistance node and assemble the arcs and rafters within common structures, named resistance belts. The belts are: one in transversal, three sagittal, two in frontal plane and two oblique positions. At the intersection of the belts, the resistance nodes are placed.

The ‘Sutured Skull’ and intracranial bleeding in infants

It is known that retinal haemorrhages can result in adults when elevated intrathoracic pressures due to coughing, cardiopulmonary resuscitation, etc., force blood into the head. In infants under one year of age retinal and intracranial haemorrhage commonly occur together, but the same is not true for the older child and adult. The role of the elasticity of the infant skull (resulting from suture and fontanelle stretching) compared to the rigid mature skull, was investigated in a computer aided method. This showed that although in the event of Valsalva-like situations very high lumen pressures may be present in both groups, in the rigid adult skull an immediate corresponding increase in intracranial pressure is produced which surrounds and supports vascular walls leaving transmural pressures little changed. No such support is provided in the eye, and retinal vessels may rupture. Within the skull there may be drastic effects on brain circulation, but since changes in vascular transmural pressure are minimal vessel distension is not induced. In the infant skull the sutures stretch as pressure rises. Since vascular volume is only about 5% of intracranial volume each 1% increase in skull volume permits a 20% increase in vascular volume. Quite small skull expansions will allow dangerous vascular distension and risk of wall damage. Until skull bones fuse, intra-cranial bleeding will be expected in the soft infant skull in any situation where retinal haemorrhage alone is known to occur in the adult or child.

Fusion patterns of craniofacial sutures in rhesus monkey skulls of known age and sex from Cayo Santiago

Bones of the face and cranial vault meet at sutural boundaries. These sutures are of great importance for craniofacial growth. Although the effects that the sutures have on modulating craniofacial strains have been investigated, how sutural fusion influences primate craniofacial biomechanics and adaptation are less considered. Confounding this problem is the lack of any systematic data on patterns of craniofacial sutural fusion from animals of known age and sex. This study examined the status of 28 sutures in Macaca mulatta skulls from a collection of animals of known age and sex from Cayo Santiago, Puerto Rico. Survival analysis showed that most animals died before all sutures fused. There was high variation in the age at which individual sutures or sutural sections were fused in M. mulatta, and significant differences in the amount of sutural fusion among regions and between males and females. Intensive fusion of sutures took place between ages 5 and 15. Sutures in the facial area tended to be less fused than in the cranial vault. Between adolescence and adulthood, males tended to have more sutural fusion than females, especially in the facial area. These differences might be biomechanical adaptations during ontogeny to craniofacial sexual dimorphism. These findings enrich our understanding of variation in sutural morphology in rhesus monkeys. Comparative information across primate species is essential for understanding the biomechanics of craniofacial form throughout primate evolution.

A study of family head shape: environment alters cranial shape

A change in the type of cranial deformities (plagiocephaly) presenting to certain clinics has occurred. The purpose of this study was to compare infant head shapes against head shapes of their biologic parents to explore the roles of heredity and environment on cranial shape. Standardized family photographs and anthropometric measurements demonstrated that 30% of the infants had cranial widths 2 standard deviations above norm, while 4.6% had widths exceeding 3 standard deviations. Despite a mean age of only 8 months, 11.6% had widths that were already greater than that of 1 parent. These results demonstrate that plagiocephaly has taken on a new configuration, presenting not only with asymmetry, but also with excessive cranial width.

Headache and altitude decompression sickness: joint pain or neurological pain?

INTRODUCTION

Exposure to reduced ambient pressure may result in decompression sickness (DCS). Headache is among the DCS symptoms encountered and is usually regarded as neurological DCS, which is traditionally classified as serious DCS. Since cranial sutures may be considered joints, it is possible that some headaches are actually joint pain and when associated with decompression sickness need not be neurological DCS.

METHODS

Records were individually recovered from the Davis Hyperbaric Laboratory at Brooks City-Base, TX. Information was extracted using a detailed survey instrument. Possible joint pain headache cases were identified using three criteria: headache localized at a suture, normal neurologic exam, and resolution within 30 min of hyperbaric oxygen treatment.

RESULTS

A total of 729 records documenting treatment for DCS were scrutinized. Of these, 70 cases of altitude DCS with headache were examined. Analysis, using the three criteria, showed 23% (16 cases) of altitude headache DCS symptoms could potentially be re-classified as joint pain.

CONCLUSION

Generally, headache DCS is considered neurological DCS. However, since cranial sutures are joints, both histologically and functionally, and since DCS most commonly affects joints, headache DCS may, at times, be joint pain DCS. Indeed, retrospective data analysis suggests that this possibility exists. Such a reclassification from neurological to joint pain DCS would lessen the aeromedical impact of a DCS headache.

Using finite-element analysis to investigate suture morphology: a case study using large carnivorous dinosaurs

Finite-element analysis (FEA) can be used to investigate the mechanical significance of sutures and regions of intracranial flexibility in skulls. By modeling the stress response to feeding forces in a finite-element skull model (with appropriate boundary conditions), one can compare the axis of distortion and orientation of stress and strain in the model to the degree of movement at actual sutural contacts in the real skull. Hypotheses detailing the effect of introducing patency or flexibility on mechanical performance can be constructed and subsequently tested. In this study, the correlation between stress environment, cranial strength, and sutural morphology and mobility is investigated in the cranium of the large theropod dinosaur Allosaurus fragilis. Theropods are an especially interesting model system as their skulls were massive (over 100 cm in some cases), may have generated extremely large bite forces, yet patent sutures persisted between many of the facial bones. In this analysis, it was discovered that Allosaurus cranial sutures appear generally capable of accommodating stress and strain patterns generated during biting. This study highlights the potential of FEA in devising and testing hypotheses of form and function and argues that useful information can be obtained from finite-element models of extinct animals, providing that adequate assumptions are made and appropriate questions asked.

[The degree of closure of the cranial sutures as a quick method for adult age evaluation in autopsy]

The aim of this paper was to test a method of quick evaluation of age of deceased during autopsies based on examination of cranial suture closure. The age of 20 males and 20 females was evaluated based on sagittal and fragments of the coronal and lambdoid sutures. The results were compared with the actual chronological age of the deceased calculated on the basis of their dates of birth and demise. In many cases, a slight overestimation occurred in evaluating the age by analyzing the sutures. Thus the results show that a precise and thorough evaluation of the deceased's age is not possible on the basis of the cranial suture closure without maceration of the skull.

Variations of the location of the greater palatine foramina in dry human skulls

Seventy-one adult skulls (58 dentulous skulls: 56 bilateral and 2 unilateral, 13 edentulous: 11 bilateral and 2 unilateral) of unknown sex were examined for the variations of the location of the greater palatine foramen. The location of greater palatine foramen (GPF) was noted with relation to mid sagittal suture (MSS), posterior palatal border (PPB), and maxillary molars by measuring the distances using a sliding caliper to the nearest millimeter. Difference in the distance of the foramen from MSS and PPG in both the skull types was found to be statistically insignificant. Commonest location of the foramen was found to be opposite to third molar tooth (85.95%), followed by the interval between second and third molar teeth (13.15%), and opposite to the second molar tooth (only one case - 0.88%). Well-formed bony canals were found along the groove for the palatine nerves and vessels unilaterally in the right side in two skulls. These observation may be of help to the dental surgeon during the peripheral block of maxillary nerve for the maxillo-facial surgery.

Internal cranial features of the Mojokerto child fossil (East Java, Indonesia)

The island of Java, Indonesia, has produced a remarkable number of fossil hominid remains. One of the earliest specimens was found in Perning and consists of an almost complete calvaria belonging to a juvenile individual, known as the Mojokerto child (Perning I). Using computed tomography, this study details its endocranial features. The specimen is still filled with sediment, but its inner surface is well preserved, and we were able to reconstruct its endocranial features electronically. The Mojokerto endocast is the only cerebral evidence available for such a young Homo erectus individual. We provide an analytical description, make comparisons with endocasts of other fossil hominids and modern humans, and discuss its individual age and taxonomic affinities. The ontogenetic pattern indicated by the Mojokerto child suggests that the growth and development of the Homo erectus brain was different from that of modern humans. The earliest stages of development, as characterized by this individual, correspond to important supero-inferior expansion, and relative rounding of the cerebrum. The following stages differ from that of modern humans by marked antero-posterior flattening of the brain and particularly antero-posterior development of the frontal lobes, resulting in the adult H. erectus morphology.

Time of closure of cranial sutures in northwest Indian adults

Time of closure of sagittal, coronal and lambdoid sutures was studied at autopsy in 538 male and 127 female adults of known ages belonging to Chandigarh zone of northwest India. The sagittal suture was divided into four segments and each side of the coronal and lambdoid sutures into three segments. Whether a segment was open or closed on either surface was recorded. On analysing the record, the authors came to the conclusions: (1) obliteration of sutures commences earlier in the males than in females, (2) suture obliteration starts earlier on endocranial surface than on the ectocranial and (3) commencement and complete obliteration of a segment or the entire suture is so erratic that it is not useful for estimating the age of a skull.

The Zebrafish (Danio rerio): A Model System for Cranial Suture Patterning

The zebrafish (Danio rerio) is an alluring model system currently used to study early embryonic development, organogenesis and gene functional analysis. However, few studies have been devoted to post-embryonic development. We have explored the possibility of using this organism to analyze how cranial suture patterning occurs. This study reports on the establishment of the zebrafish skull vault anatomy, calvarial osteogenesis, and cranial suture morphology. Our results demonstrate that the anatomy of the zebrafish cranial vault and cranial sutures is very similar to that of mammalian organisms. Indeed, the zebrafish represents a versatile and valuable model system for the study of the biogenesis of cranial sutures.

A note on the morphology of the metopic suture in the human skull

The metopic suture of 24 adult skulls investigated showed recognisable varied morphological patterns. The metopic suture resembled wavy lines and was sometimes highly convoluted, especially in the superior part of the frontal bone. The mean suture length was computed as 123.1 mm (SD = 5.307) and the mean fractal dimension was 1.17 (SD = 0.076). Visual inspection of the morphological character of the metopic sutures revealed complex variation in their course between the nasion and the bregma. Comparison of the fractal dimensions indicated a two-fold increase in complexity between the anterior half of the suture terminating in the nasion (FD = 1.10) and the second half of the suture beginning in the bregma (FD = 1.21). The Mann-Whitney test confirmed the statistical significance of the differences in the fractal dimensions calculated. The variety and complexity of the interdigitations in the anterior and posterior part of the suture point to possible alterations to local strains, which occur during the growth of the braincase.

Cranial sutures and craniometric points detected on MRI

The main goal of the study was to determine on MRI the cranial sutures, the craniometric points and craniometric measurements, and to correlate these results with classical anthropometric measurements. For this purpose, we reviewed 150 cerebral MRI examinations considered as normal (Caucasian population aged 20-49 years). For each examination we individualized 11 craniometric landmarks (Glabella, Bregma, Lambda, Opisthocranion, Opisthion, Basion, Inion, Porion, Infra-orbital, Eurion) and three measurements. Measurements were also calculated independently on 498 dry crania (Microscribe 3-DX digitizer). To validate the MRI procedure, we measured four dry crania by MRI and with compass or digital caliper gauges. Cranial sutures always appeared without signal (black), whatever the MRI sequence used, and they are better visualized with a 5 mm slice thickness (compact bone overlapping). Slice dynamic analysis and multiplanar reformatting allowed the detection of all craniometric points, some of these being more difficult to detect than others (Porion, Infra-orbital). The measurements determined by these points were as follows: Vertex-Basion height=135.66+/-6.56 mm; Eurion-Eurion width=141.17+/-5.19 mm; Glabella-Opisthocranion length=181.94+/-6.40 mm. On the midline T1-weighted sagittal image, all median craniometric landmarks can be individualized and the Glabella-Opisthocranion length, Vertex-Basion height and parenchyma indices can be calculated. Craniometric points and measurements between these points can be estimated with a standard cerebral MRI examination, with results that are similar to anthropometric data.

Transethmoidal approach to the optic canal: surgical and radiological microanatomy

BACKGROUND

The purpose of the study is to describe anatomic topographic landmarks for transethmoidal approach to optic canal for optic nerve decompression. The study focuses on microsurgical/radiologic anatomies and their relationships in the region of the optic canal and orbit.

METHODS

Human optic canal and related anatomic structures were studied in orbits of 6 formalin preserved adult human cadavers. In addition, anatomic measurements were made with digital vernier caliper on the orbits of 25 adult human skulls. The relation between ethmoidal and sinus was assessed with computed tomography (CT) scan in 25 living human heads needing cranial CT scan for any reason.

RESULTS

The suture on the conjunction of frontal, maxilla, and lacrimal bones with a location in medial side of the orbit was accepted as a landmark. When the measurements were taken from this landmark, the distances to supraorbital margin were: right(R): 16.76 +/- 2.62 mm, left (L): 17.10 +/- 1.97 mm, and to infraorbital margin were R: 20.18 +/- 3.24 mm, L: 18.94 +/- 2.19 mm. The distances to the anterior ethmoidal foramen were R: 19.66 +/- 3.96 mm, L: 19.11 +/- 2.84 mm, and to the posterior ethmoidal foramen were R: 32.01 +/- 2.90 mm, L: 32.62 +/- 3.33 mm. Mean distance between the anterior and posterior ethmoidal foramen were R: 12.55 +/- 3.4 mm, L: 13.51 +/- 4.2 mm. The posterior ethmoidal foramen and optic ring were separated only by the mean distances of R: 5.34 +/- 2.81 mm, L: 4.9 +/- 3.35 mm. The distance from the suture to the distal (orbital) opening of the optic canal was R: 37.35 +/- 2.73 mm, L: 37.52 +/- 3.47 mm and to proximal (intracranial) opening of the canal were R: 49.52 +/- 2.62 mm, L: 50.94 +/- 3.35 mm. The average widths of proximal (intracranial) canal measured were R: 7.43 +/- 1.95 mm, L: 7.38 +/- 2.01 mm and those of distal canal (orbital) were R: 5.12 +/- 1.1 mm, L: 4.95 +/- 1.32 mm. The mean lengths of the optic canal were R: 11.19 +/- 2.68 mm, L: 12.42 +/- 3.38 mm. In radiologic examinations, the mean numbers of anterior group ethmoidal cells were R: 7, L: 6 and those of posterior group ethmoidal cells were R: 4, L: 3. The results of CT demonstrated 7 (14%) Onodi or sphenoethmoidal cells in 50 orbits of living humans.

CONCLUSION

The examination of radiologic anatomy in addition to microanatomy can significantly contribute to preoperative and postoperative evaluation of the patients.

Cranial sutures and bones: growth and fusion in relation to masticatory strain

Cranial bones and sutures are mechanically loaded during mastication. Their response to masticatory strain, however, is largely unknown, especially in the context of age change. Using strain gages, this study investigated masticatory strain in the posterior interfrontal and the anterior interparietal sutures and their adjacent bones in 3- and 7-month-old miniature swine (Sus scrofa). Double-fluorochrome labeling of these animals and an additional 5-month group was used to reveal suture and bone growth as well as features of suture morphology and fusion. With increasing age, the posterior interfrontal suture strain decreased in magnitude and changed in pattern from pure compression to both compression and tension, whereas the interparietal suture remained in tension and the magnitude increased unless the suture was fused. Morphologically, the posterior interfrontal suture was highly interdigitated at 3 months and then lost interdigitation ectocranially in older pigs, whereas the anterior interparietal suture remained butt-ended. Mineralization apposition rate (MAR) decreased with age in both sutures and was unrelated to strain. Bone mineralization was most vigorous on the ectocranial surface of the frontal and the parietal bones. Unlike the sutures, with age bone strain remained constant while bone MARs significantly increased and were correlated with bone thickness. Fusion had occurred in the interparietal suture of some pigs. In all cases fusion was ectocranial rather than endocranial. Fusion appeared to be associated with increased suture strain and enhanced bone growth on the ectocranial surface. Collectively, these results indicate that age is an important factor for strain and growth of the cranium. .

Small Mid-Pleistocene Hominin Associated with East African Acheulean Technology

Hominin fossils from the African mid-Pleistocene are rare despite abundant Acheulean tools in Africa and apparently African-derived hominins in Eurasia between 1.0 and 0.5 million years ago (Ma). Here we describe an African fossil cranium constrained by 40Ar/39Ar analyses, magnetostratigraphy, and sedimentary features to 0.97 to 0.90 Ma, and stratigraphically associated with Acheulean handaxes. Although the cranium represents possibly the smallest adult or near-adult known between 1.7 and 0.5 Ma, it retains features observed in larger Homo erectus individuals, yet shows a distinct suite of traits indicative of wide population variation in the hominins of this period.

Microfocal CT: a method for evaluating murine cranial sutures in situ

INTRODUCTION

The murine model is a well-established surrogate for studying human cranial suture biology. In mice, all sutures with the exception of the posterior frontal (PF) suture remain patent throughout life. Histology is regarded as the gold standard for analyzing sutures. On this basis, PF suture fusion begins on day of life 25 and is complete by day 45. Cranial suture histology, however, requires sacrifice of the animal to obtain tissue for analysis. As a result, knowledge of the kinetics of cranial suture fusion is based on a patchwork analysis of many sutures from many different animals. The behavior of a single suture through time is unknown. Our goal is to develop a noninvasive means to repeatedly image mouse cranial sutures in vivo. As a first step, the present study was performed to evaluate microfocal computer tomography (micro-CT) technology for the use of capturing images of a mouse cranium in situ.

METHODS

The micro-CT system consists of a microfocal X-ray source and a large format CCD camera optically coupled to a high-resolution X-ray image intensifier, digitally linked to a computer. The PF and sagittal sutures lie in continuity along the midline of the skull. Holes were drilled in the calvaria on both sides of the PF and sagittal sutures of a 45-day-old euthanized mouse. A micro-CT scan of this animal was performed and hundreds of cross-sectional images were generated for the cranium. These images were used to reconstruct three-dimensional volumetric images of the entire cranium. Comparisons were made between (1). the gross specimen and the three dimensional reconstructions; (2). two-dimensional coronal images obtained by micro-CT and those obtained by histology.

RESULTS

Analysis of PF and sagittal sutures demonstrated the following: (1). The drilled holes were accurately rendered by micro-CT, when compared to both the gross specimen and the histology. (2). The sagittal suture was found to be patent by both micro-CT and histology. (3). The PF suture is fused by histology, but unexpectedly, the PF suture appears incompletely fused by micro-CT. By micro-CT, however, the anterior and endocranial regions appear more extensively fused than the remainder of the PF suture, a finding consistent with published histologic analysis.

CONCLUSIONS

We successfully imaged 45-day-old mouse cranial sutures in situ using micro-CT technology. Precise correlation between histologic sections and radiologic images is difficult, but convincing similarities exist between the gross specimen and images from micro-CT and histology. PF suture fusion in a 45-day-old animal appears different by micro-CT than by histology. One possible explanation for this apparent discrepancy is that suture fusion in histology is determined based on the appearance of bone morphology and not tissue density, as the specimens are necessarily decalcified to section the bone. Micro-CT, on the other hand, distinguishes tissues on the basis of density. Newly forming bone may require bone matrix formation prior to complete calcification; PF suture in 45-day-old mice may be morphologically complete but incompletely ossified. Studies correlating histologic and micro-CT assessment of suture development are underway. Micro-CT appears to be a promising method for noninvasive imaging of mouse cranial suture.

A preliminary study on the relationship between the complexity of the sagittal suture and cranial dimensions

The paper presents the results obtained from analysis of the correlation between cranial dimensions (length, width, and height) and indices against the complexity of the sagittal suture, which was expressed as the ratio between absolute sutural length to the linear length of the suture. The statistical study on 29 skulls shows a significant negative correlation between the height/width index of all skulls and suture complexity (r = -0.78 for male, r = -0.70 for female skulls) and a negative correlation between cranial height and suture complexity in male skulls only (r = -0.49). This implies that lower and broader skulls have a more complicated sagittal suture. Correlations of the height/length and width/length ratios were assessed as statistically insignificant in both sexes.

Effects of increased muscle mass on mouse sagittal suture morphology and mechanics

The purpose of this study is to test predicted form-function relationships between cranial suture complexity and masticatory muscle mass and biomechanics in a mouse model. Specifically, to test the hypothesis that increased masticatory muscle mass increases sagittal suture complexity, we measured the fractal dimension (FD), temporalis mass, and temporalis bite force in myostatin-deficient (GDF8(-/-)) mice and wild-type CD-1 mice (all male, 6 months old). Myostatin is a negative regulator of muscle mass, and myostatin-deficient mice show a marked increase in muscle mass compared to normal mice. We predicted that increased sagittal suture complexity would decrease suture stiffness. The data presented here demonstrate that increased suture complexity (measured as FD) was observed in a hypermuscular mouse model (GDF8(-/-)) with significantly increased temporalis muscle mass and bite forces. Hypermuscular mice were also found to possess suture connective tissue that was less stiff (i.e., underwent more displacement before failure occurred) when loaded in tension. By decreasing stiffness, suture complexity apparently helps to dissipate mechanical loads within the cranium that are related to chewing. These results suggest that cranial suture connective tissue locally adapts to functional demands of the biomechanical suture environment. As such, cranial sutures provide a novel model for studies in connective tissue mechanotransduction.

[Anatomic facial and behavioral features of Australopithecus africanus. Apropos of the Taung child]

INTRODUCTION

Taung's skull was first Australopithecus described. The initial description did not mentioned premaxillary bone (os incisivum).

MATERIALS AND METHODS

Photographs of Taung's skull were studied to investigate the presence of a suture between a maxillary bone and a premaxillary bone. These photographs were compared to a dissected macaca's head and earlier publications.

RESULTS

A suture is clearly visible on the anterior aspect of the face of Taung's skull as it is on the non-human primate face.

DISCUSSION

Among the anatomic features of Australopithecus africanus, some are humanoid (the cranium is over the face), others are anthropoid (presence of a separate premaxilla, presence of a supra-orbital torus, absence of a mental prominence). Unlike homo individuals, there is no proof Australopithecus africanus made tools. The definition of Man is not an anatomic definition but rather a socio-cultural definition.

Prenatal Organization and Morphogenesis of the Sphenofrontal Suture in Humans

OBJECTIVE

The aim of this study was to describe the prenatal structure and morphogenesis of the sphenofrontal suture.

METHODS

Eleven human specimens, two embryos and nine fetuses, were prepared for light microscopy study of the sphenofrontal suture. Ten-micrometer sections were made with the microtome in the sagittal plane from the midline to the sphenoidal fontanelle.

RESULTS

At the end of the fetal period, the sphenofrontal suture had a five-layer structure like the cranial sutures, and was formed by two different morphogenetic unities. The orbitosphenofrontal suture was formed between the membranous ossification of the orbital part of the frontal bone and the endochondral ossification of the lesser wing of the sphenoid bone, i.e. the ala orbitalis. In the early stage, a transient sphenoethmoidal cartilage was inserted between these two ossifications. The second unit, the lateral sphenofrontal suture, was formed between the frontal bone and the greater wing of the sphenoid, and the ossification was membranous in this portion. It is formed like the cranial suture, directly from the mesenchyme.

CONCLUSION

The sphenofrontal suture is a typical fibrous suture arising from two morphogenetic unities.

Age-Dependent Changes in Material Properties of the Brain and Braincase of the Rat

Clinical and biomechanical evidence indicates that mechanisms and pathology of head injury in infants and young children may be different from those in adults. Biomechanical computer-based modeling, which can be used to provide insight into the thresholds for traumatic tissue injury, requires data on material properties of the brain, skull, and sutures that are specific for the pediatric population. In this study, brain material properties were determined for rats at postnatal days (PND) 13, 17, 43, and 90, and skull/suture composite (braincase) properties were determined at PND 13, 17, and 43. Controlled 1 mm indentation of a force probe into the brain was used to measure naive, non-preconditioned (NPC) and preconditioned (PC) instantaneous (G(i)) and long-term (G( infinity )) shear moduli of brain tissue both in situ and in vitro. Brains at 13 and 17 PND exhibited statistically indistinguishable shear moduli, as did brains at 43 and 90 PND. However, the immature (average of 13 and 17 PND) rat brain (G(i) = 3336 Pa NPC, 1754 Pa PC; G( infinity )= 786 Pa NPC, 626 Pa PC) was significantly stiffer (p < 0.05) than the mature (average of 43 and 90 PND) brains (G(i) = 1721 Pa NPC, 1232 Pa PC; G( infinity ) = 508 Pa NPC, 398 Pa PC). A "reverse engineering" finite element model approach, which simulated the indentation of the force probe into the intact braincase, was used to estimate the effective elastic moduli of the braincase. Although the skull of older rats was significantly thicker than that of the younger rats, there was no significant age-dependent change in the effective elastic modulus of the braincase (average value = 6.3 MPa). Thus, the increase in structural rigidity of the braincase with age (up to 43 PND) was due to an increase in skull thickness rather than stiffening of the tissue. These observations of a stiffer brain and more compliant braincase in the immature rat compared with the adult rat will aid in the development of age-specific experimental models and in computational head injury simulations. Specifically, these results will assist in the selection of forces to induce comparable mechanical stresses, strains and consequent injury profiles in brain tissues of immature and adult animals.

Brief communication: age and fractal dimensions of human sagittal and coronal sutures

The fractal dimensions of human sagittal and coronal sutures were calculated on 31 complete skulls from the Terry Collection. The aim was to investigate whether the fractal dimension, relying on the whole sutural length, might yield a better description of age-related changes in sutural morphology, as opposed to other methods of quantification, which generally rely on more arbitrary scoring systems. However, the fractal dimension did not yield better age correlations than other previously described methods. At best, the results reflected the general observation that young adults below age 40 years display an age-related development, but that it is impossible to arrive at any precise age determinations for older adults. It seems that for some individuals, suture obliteration simply does not take place, even at an advanced age, whereas for others, suture obliteration progresses rapidly. Until a better understanding of sutural biology is reached, this will render cranial sutures only marginally useful in age determination. This does not mean, however, that investigations should not be made to elucidate more unbiased methods of sutural morphology quantification.

A fractal analysis of human cranial sutures

OBJECTIVES

Many biological structures are products of repeated iteration functions. As such, they demonstrate characteristic, scale-invariant features. Fractal analysis of these features elucidates the mechanism of their formation. The objectives of this project were to determine whether human cranial sutures demonstrate self-similarity and measure their exponents of similarity (fractal dimensions).

DESIGN

One hundred three documented human skulls from the Terry Collection of the Smithsonian Institution were used. Their sagittal sutures were digitized and the data converted to bitmap images for analysis using box-counting method of fractal software.

RESULTS

The log-log plots of the number of boxes containing the sutural pattern, N(r), and the size of the boxes, r, were all linear, indicating that human sagittal sutures possess scale-invariant features and thus are fractals. The linear portion of these log-log plots has limits because of the finite resolution used for data acquisition. The mean box dimension, D(b), was 1.29289 +/- 0.078457 with a 95% confidence interval of 1.27634 to 1.30944.

CONCLUSIONS

Human sagittal sutures are self-similar and have a fractal dimension of 1.29 by the box-counting method. The significance of these findings includes: sutural morphogenesis can be described as a repeated iteration function, and mathematical models can be constructed to produce self-similar curves with such D(b). This elucidates the mechanism of actual pattern formation. Whatever the mechanisms at the cellular and molecular levels, human sagittal suture follows the equation log N(r) = 1.29 log 1/r, where N(r) is the number of square boxes with sides r that are needed to contain the sutural pattern and r equals the length of the sides of the boxes.

Normal palatal sutures in newborns and fetuses: a critical fact for successful palatal distraction

Distraction osteogenesis (DO) has recently been applied to the palate. Successful posterior lengthening and medial advancement of the palates was continuously reported. Based on these studies, it is obvious that DO will play a major role in the management of problems related to palatal defects in the near future. Although the results are appealing, they may not be applicable for humans due to anatomic differences. All experimental studies used normal palatal sutures of young dogs for size expansion. Therefore, it is necessary to know normal palatal sutures in infants before one can clinically apply this new technique. With consent, palates of fetuses and neonates who died of various causes were examined. Eight fresh cadavers were available for the dissection, with two being skeletonized using the boiling process. There were three fetal deaths in utero (33-41 weeks of gestational age) and five postnatal deaths (aged between 5 hours and 6 months). All specimens were grossly normal in shape and size except for one with a unilateral complete cleft of lip and palate. A midline palatal suture was found in every noncleft specimen, while premaxillary and transverse palatomaxillary sutures were present in every specimen. Laterally, there was no true suture except for the most posterior portion, which was contiguous with the greater palatine foramen. The palatal sutures of third-trimester fetuses and neonates are not different from adult ones. There is no lateral suture that will allow distraction in the medial direction. It is only the posterior hard palate (palatine bones) that can potentially be moved medially and posteriorly by sutural expansion with DO.

Tensile stress induces alpha-adaptin C production in mouse calvariae in an organ culture: possible involvement of endocytosis in mechanical stress-stimulated osteoblast differentiation

We previously demonstrated that tensile stress (TS)-induced osteoblast differentiation eventually led to osteogenesis in an organ culture of mouse calvarial sutures. In the present study, we employed RNA-fingerprinting using an arbitrarily primed polymerase chain reaction (RAP-PCR) to identify alpha-adaptin C, a component of the endocytosis machinery AP2, as a TS-inducible gene. Protein production, as well as the gene expression of alpha-adaptin C, was induced by TS as early as 3 h following the initiation of loading. In situ hybridization and immunohistochemical analysis revealed that the induction of alpha-adaptin C mostly occurred in fibroblastic cells in the sutures, suggesting that it precedes TS-induced osteoblast differentiation. Consistent with this result, TS significantly increased the number of coated pits (CPs) and coated vesicles (CVs) in the undifferentiated fibroblastic cells but not in the osteoblastic cells around calvarial bones. Further, TS-induced osteoblast differentiation was suppressed when endocytosis was inhibited by potassium depletion. These results, taken together, suggest that TS accelerates osteoblast differentiation and osteogenesis, possibly through the induction of the alpha-adaptin C expression and consequent activation of receptor-mediated endocytosis.

Computed tomographic assisted study of morphological changes in the sutural areas as resulting from obliteration

The authors have studied the morphological differences of sutural areas in human skulls at distinct stages of obliteration. A computed tomography aided with computer algorithm of tonal correction was applied to visualise structural changes in the sutural areas that are correlated with sutural ossification. The results of our study suggest that obliteration of cranial sutures is accompanied by local fluctuations of bony density in sutural areas, gradual unification of structural density towards ectocranium. When the obliteration proceeds, the sutural gap ceases. The laminas and diploic layers of the two opposing bones become a single structure of increased integrity.

Fractal dimensions of the sagittal (interparietal) sutures in humans

Traditional studies of the cranial suture morphology have focused mostly on visual estimation and linear measurements, and thus on evaluating their complexity. This paper presents a new look on cranial sutures as curves, which can be analysed by fractal dimension. This new measure seems to be a much better method of expressing properties of sutural patterns than traditional methods. Our findings suggest that the fractal dimension of non-complicated interparietal sutures slightly exceeds the topological dimension of the line, that is 1.0, whereas the fractal dimension of complicated sutures may reach a value of 1.4 or even more. The difference between the minimum and maximum decimal fraction of the fractal dimension indicates a three-fold increase in complexity in the investigated sutures.

A morphometrical study of the human palatine sutures

The paper presents metrical data on the palatine sutures of a dry skull collection comprising 29 male and 33 female specimens. The length and mutual proportions of the mid-palatal, interpalatine and transverse palatine sutures were considered. These properties led to a conclusion as to the extent to which the palatine process of the maxilla and palatine bones dominate in the formation of the hard palate. We discovered that the palatine process of the maxilla is prevalent and that it constitutes approximately 65% of the hard palate in both sexes. Moreover our findings indicated a significant correlation in the diameters of the palatine sutures that are arranged sagittally.

Morphological variability of pterion in the human skull

The pterion is one of the most interesting bone meeting points in craniofacial osteology and its complex morphology derives from the fact that is the contact point of the facial skeletal elements, skull base and calvarium. Knowledge of its peculiar morphology is mandatory for the pterional approach used in microsurgery and surgery. The Authors studied 506 adult, human skulls where the pterion was accurately reconstructed on polyethylene sheets. They report their data on the morphological analysis and classify the forms. They focussed their attention on the presence of wormian bones at the level of the sphenoparietal suture, on the peculiar existing morphology and reviewed the literature on these classifications. The Authors also evaluated the length of the sphenoparietal suture, the minimum gap between the frontal and temporal, the influence of pteric bones on pterion variability and any correlations between measurements and cranial indexes.

The internal structure of bony tissue of a human metopic suture by Soft X-ray

A complete metopic suture was found in the frontal bone of a 79 years old male cadaver. Compact bone matrices were found in the border region of the metopic suture using a Soft X-ray apparatus. The coronal and sagittal sutures were also complete. The appearance of these complete cranial sutures may be due to continuous bone restructuring and resorption in the border region of sutures during brain development of brachy crany.

Incidence of metopism in the Lebanese population

This study was carried out on 968 skull X-rays to determine the incidence of the metopic suture in the Lebanese population. Complete and incomplete metopism was present in 0.82% and 0.93% of cases, respectively, leading to an overall incidence of 1.75%. In both categories, the incidence was relatively higher in males (1.84%) than in females (1.62%). Persons living in rural areas had a higher incidence of complete and incomplete metopism compared to persons living in urban areas, with ratios of 4:1 and 4:2, respectively. Other findings included an absence of frontal sinuses in all but one skull with complete metopism, accessory ossicles in the majority of cases of complete metopism (7/8), and hydrocephalus in one case. Medical records did not reveal any other associated diseases or abnormalities. Despite the low incidence of metopic suture in the Lebanese population, in X-ray diagnosis of fractures of the frontal bone, metopic suture must not be ruled out.

Age-related morphological changes in squamous and parietomastoid sutures of human cranium

Age-related morphological changes in the inner and outer surfaces of the squamous and parietomastoid sutures were examined in 65 skulls (35 male, 30 female) obtained from Japanese subjects 5-90 years of age at the time of death. Dimensions were measured in both the horizontal and sagittal planes. Wavelength analysis was done by three-dimensional construction. Irregularities were evaluated by calculating fractal dimensions. The outer squamous suture showed no significant age-related changes in size, but wavelength increased because of the development of bony interdigitations with aging. The posterior part of the outer squamous suture showed significant age-related increases in both wavelength (p < 0.01, R(2) = 0.164) and fractal dimension (p < 0.01, R(2) = 0.101) in males. The parietomastoid suture showed significant age-related changes in size (p < 0.05), but not in wavelength or fractal dimension. These distinct morphological changes found on both the inner and outer surfaces of the squamous and parietomastoid sutures suggest that the age-related morphological characteristics of these sutures are affected by extrinsic mechanical forces.

Persistent open anterior fontanelle in a healthy 32-month-old boy

Delayed closure of the anterior fontanelle is often associated with significant disease entities. Range of normal closure of the anterior fontanelle is 4 to 26 months. Increased intracranial pressure, hypothyroidism, and skeletal anomalies are common etiologic factors. History, physical examination, and diagnostic testing rule out most disorders. Once these disorders have been ruled out, it is important for the physician to realize that a persistent open anterior fontanelle beyond the accepted ranges of closure can be a normal outlier.

A geometric approach to cranial sexual dimorphism in the orang-utan

Adult craniofacial morphology is quantified and compared using Euclidean distance matrix analysis (EDMA), a three-dimensional morphometric method for the comparison of forms, which localizes form differences between comparative groups. Results indicate that the number and magnitude of differences between male and female crania are striking. The face, basicranium and neurocranium exhibit the most dimorphism, while the palate shows the least. Significant differences also exist between young adult and fully adult individuals, especially males, supporting the delayed onset of sexual maturity and secondary sex characteristics in males. As one of the many new morphometric techniques available, EDMA was useful for identifying local form difference and provides insights into the understanding of sexual dimorphism in this species beyond that obtained from traditional statistical methods based on linear caliper measurements.

Nervous branch passing through an accessory canal in the sphenozygomatic suture: the temporal branch of the zygomatic nerve

A nervous branch which passes through a small canal in the sphenozygomatic suture is sometimes observed during dissection. To examine the origin, course and distribution of this nervous branch, 42 head halves of 21 Japanese cadavers (11 males, 10 females) and 142 head halves of 71 human dry skulls were used. The branch was observed in seven sides (16.7%); it originated from the communication between the lacrimal nerve and the zygomaticotemporal branch of the zygomatic nerve or from the trunk of the zygomatic nerve. In two head halves (4.8%), the branch pierced the anterior part of the temporalis muscle during its course to the skin of the anterior part of the temple. The small canal in the suture was observed in 31 head halves (21.8%) of the dry skulls. Although this nervous branch is inconstantly observed, it should be called the temporal branch of the zygomatic nerve according to the constant positional relationship to the sphenoid and zygomatic bones. According to its origin, course and distribution, this nervous branch may be considered to be influential in zygomatic and retro-orbital pain due to entrapment and tension from the temporalis muscle and/or the narrow bony canal. The French version of this article is available in the form of electronic supplementary material and can be obtained by using the Springer LINK server located at http://dx.doi.org/10.1007/s00276-002-0027-4.