Home About us Editorial board Search Ahead of print Current issue Archives Submit article Instructions Subscribe Contact us Login 
  • Users Online:160
  • Home
  • Print this page
  • Email this page


 
 Table of Contents  
CASE REPORT
Year : 2014  |  Volume : 2  |  Issue : 1  |  Page : 61-63

A rare case of persistent metopic suture in an elderly individual: Incidental autopsy finding with clinical implications


1 Department of Anatomy, Yenepoya Medical College, Mangalore, Karnataka, India
2 Department of Forensic Medicine and Toxicology, Kasturba Medical College, Mangalore, Karnataka, India
3 Department of Physiology, Yenepoya Medical College, Mangalore, Karnataka, India

Date of Web Publication4-Jun-2014

Correspondence Address:
Aswini R. Dutt
Department of Physiology, Yenepoya Medical College, Yenepoya University, Deralakatte, Mangalore - 575 018, Karnataka
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2321-4848.133817

Rights and Permissions
  Abstract 

Metopic suture is a dense fibrous joint extending from the nasion to the bregma. Normally, closure of this suture takes place between 1-8 years of age. Failure of this closure beyond 8 years leads to persistent metopic suture. A rare case of persistent metopic suture in a 60-year-old male is documented, who committed suicide by alleged consumption of organophosphorous compound at District Govt. Wenlock Hospital, Mangalore, Karnataka, India.
Metopic suture may mimic skull fracture and may mislead an inexperienced forensic expert. Neurosurgeon should also be aware of this anatomical variation while performing frontal craniotomy, as the persistent metopic suture may mimic vertical fracture of the skull. Hence, in this case report, the clinical and medico-legal implications of the persistent metopic sutures have been discussed.

Keywords: Bregma, metopic suture, nasion, persistent frontal suture


How to cite this article:
Vikram S, Padubidri JR, Dutt AR. A rare case of persistent metopic suture in an elderly individual: Incidental autopsy finding with clinical implications. Arch Med Health Sci 2014;2:61-3

How to cite this URL:
Vikram S, Padubidri JR, Dutt AR. A rare case of persistent metopic suture in an elderly individual: Incidental autopsy finding with clinical implications. Arch Med Health Sci [serial online] 2014 [cited 2017 May 29];2:61-3. Available from: http://www.amhsjournal.org/text.asp?2014/2/1/61/133817


  Introduction Top


In the recent years, variations of cranial sutures are commonly studied because of their significance in various fields of medicine and surgery. Metopic suture is a dense connective tissue extending from the nasion to the bregma. The fusion of this metopic suture starts at the anterior fontanelle and terminates at the nasion. [1]

Fusion of suture between the two frontal bones occurs at the age of (1-3) years. [2] But, earlier studies have shown that the age of fusion varies from as early as 1 year to 7 years, the upper limit might extend upto 8 years. [3] Failure to fuse leads to persistent metopic suture above the age of 8 years. [4] Racial variations in the incidence of fusion of metopic sutures and shapes have been observed. [5] Caffey claimed that metopic suture may persist up to the sixth year and even throughout life in about 10% of cases in dry skull studies. [6]


  Case Report Top


Medico-legal autopsy was conducted on the dead body of a 60-year-old male at District Govt. Wenlock Hospital, Mangalore after receiving authorization from the investigating officer.

Autopsy findings

External Examination: Dead body of an elderly male, wheatish in complexion, moderately built and nourished, weighing 65 kg and measuring 163 cm in length. No evidence of external injuries over the body. There was no evidence of head injury.

Routine reflection of the scalp tissue revealed a midline vertical suture extending from nasion to bregma over the frontal bone suggestive of persistent frontal suture.[Dentate suture] [Figure 1],[Figure 2],[Figure 3]. The posterior part of the persistent frontal suture is the pars bregmatica, and this area is included within the anterior fontanelle. The anterior end of the frontal suture fails to meet the suture between the two nasal bones. The coronal and the sagittal sutures were normal in appearance [Figure 1].
Figure 1: Persistent frontal suture

Click here to view
Figure 2: Measurement of Metopic suture

Click here to view
Figure 3: Enlarged view

Click here to view



  Discussion Top


The incidence of the metopism and difference in shapes varies by races. [5] It is also called median frontal suture, usually present between the two superciliary arches. [7] Sometimes, there may be presence of wormian bones. [8] In a recent study conducted in South India, metopism was observed in 3.2% of the skulls, and incomplete metopic suture was present in 26.4% of the 125 adult skulls that were examined. [9] 2.66% of adult Indian skulls have metopic suture. [1]

Various theories have been proposed for the persistence of metopic suture. Active expression of some of the cytokines during cranial fusion can be one of the causes. [10] Another study has mentioned that active resorption of the chondriodal tissue results in metopism. [11] If it does not disappear, it may be called a "metopic suture" or "sutura frontalis persistens." If it is a premature closure, it will cause a keel-shaped deformity of the skull called trigonocephaly.

Medico-legal and surgical importance

Persistent metopic suture may mimic vertical fissure fracture of skull, which leads to wrong interpretation by an inexperienced medical officers performing medico-legal autopsies or interpreting skull X-rays. Persistent metopic suture can be diagnosed by x-ray of the skull AP view. To avoid wrong diagnosis in emergency conditions, 2D and 3D CT scans are strongly recommended. Multiplanar reformat of CT scans also give valuable information about shape, [12] extent, and closuring status of metopic suture. [13] Hence, the neurosurgeons should be aware of this anatomical variation while performing frontal craniotomy. The autopsy surgeons should be updated with anatomical entity of persistent frontal suture while differentiating it from midline fissure fracture of the skull.

 
  References Top

1.Weinzweig J, Kirschner RE, Farley A, Reiss P, Hunter J, Whitaker LA, et al. Metopic synostosis: Defining the temporal sequence of normal suture fusion and differentiating it from synostosis on the basis of computed tomography images. Plast Reconstr Surg 2003;112:1211-8.  Back to cited text no. 1
    
2.Keith A. Human Embryology and Morphology. 6 th ed. London: Edward Arnold; 1948.  Back to cited text no. 2
    
3.Collins P. Gray's Anatomy. 38 th ed. London: Churchil Livingstone; 1995. p. 354.  Back to cited text no. 3
    
4.Mathijissen IM, Vaadrager JM, Can der Meulen JC, Pieterman H, Zonneveld FW, Dreiborg S, et al. The role of bone centers in the pathogenesis of craniosynostosis: An embryologic approach using CT measurements in an isolated craniosynostosis and Apert and Crouzon syndromes. Plast Reconstr Surg 1996;98:17-26.  Back to cited text no. 4
    
5.Ajmani ML, Mittal RK, Jain SP. Incidence of the metopic suture in adult Nigerian skulls. J Anat 1983;137:177-83.  Back to cited text no. 5
    
6.Caffey J. Pediatric X-ray diagnosis. 7 th ed, Vol. 1. London: Medical Publication Inc; 1978. p. 10-25.  Back to cited text no. 6
    
7.Basmijian J, Slonecker, Charles E. Grants methods of Anatomy-A clinical problem solving approach. 11 th ed. New Delhi, India: B.J. Waverly Pvt. Ltd; 1997. p. 449-51.  Back to cited text no. 7
    
8.Frazer. Anatomy of human skeleton. In: Breathnach AS, editor. 6 th ed. London: J.A. Churchill Limited; 1965. p. 182-5.  Back to cited text no. 8
    
9.Hussain Saheb S, Mavishettar GF, Thomas ST, Prasanna LC. Incidence of metopic suture in adult south Indian skulls. J Biomed Sci Res 2010;2:223-6.  Back to cited text no. 9
    
10.Longaker, MT. Role of TGF-beta signaling in the regulation of programmed cranial suture fusion. J Craniofac Surg 2001;12:389-90.  Back to cited text no. 10
    
11.Levine J, Bradley J, Roth D, McCarthy J, Longaker M. Studies in cranial suture biology: Regional dura mater determines overlying suture biology. Plast Reconstr Surg 1998;101:1441-7.  Back to cited text no. 11
    
12.Longaker MT. Role of TGF-beta signaling in the regulation of programmed cranial suture fusion. J Craniofac Surg 2001;12:389-90.  Back to cited text no. 12
    
13.Vu HL, Panchal J, Parker E, Levine N, Francel P. The timing of physiologic closure of the metopic suture: A review of 159 patients using reconstructed 3D CT scans of the craniofacial region. J Craniofac Surg 2001;12:527-32.  Back to cited text no. 13
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

Top
 
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
Abstract
Introduction
Case Report
Discussion
References
Article Figures

 Article Access Statistics
    Viewed4775    
    Printed34    
    Emailed0    
    PDF Downloaded176    
    Comments [Add]    

Recommend this journal


[TAG2]
[TAG3]
[TAG4]