A morphometric evaluation of anterior fontanel and cranial sutures in infants using computed tomography

Yıl 2022, Cilt: 39 Sayı: 2, 321 - 326, 18.03.2022

Hadi Sasani Sinan Tüfekci Ayşen Haksayar

Öz

Background: To retrospectively analyze anterior fontanel (AF) and the morphometric findings of cranial sutures in infants under two years of age who underwent cranial computed tomography (CT).

Material and Methods: A total of 227 cases, who had cranial CT examination, were studied retrospectively. Forty-five patients were excluded. The study was conducted with 182 patients who had adeqaute imaging with optimum quality. The diameter and area of AF and cranial sutures of the patients were measured using three-dimensional CT reformat and axial CT images.

Results: Male patients made up 53.8% of the total patients and the median age was 6 months. Normocephaly in 86.3%, plagiocephaly in 10.4%, scaphocephaly in 2.7% and trigonocephaly in 0.5% of the cases were present. The median AF transverse diameter was 29.75 mm, the median anteriorposterior diameter was 27.25 mm, and the median fontanel area was 400 mm2. AF was closed in 30.4% in 13-18 months old patiets and 85.7% in 19-24 months old patients. Metopic suture was closed 10% in the first 3 months of age / their lives, 74.3% in 7-9 months of age, and 100% in 19-24 months of age. There was a significant negative correlation between head circumference and suture diameters in infants with open and normosephalic AF, in the CT examination (p <0.05. R = - 0.106 -0.271).

Conclusion: In this study, it was observed that 14.3% of AF did not close radiologically in 19-24 months in the Turkish population living in the Europe - Balkan region. This suggests that AF closes in some patients after the age of two.

Anahtar Kelimeler

Cranial fontanel, Infant, Computed tomography

Destekleyen Kurum

Tekirdağ Namık Kemal University, Faculty of Medicine

Proje Numarası

Ethics Committee Approval number: 2020.261.12.06

Kaynakça

• 1. Adeyemo AA, Omotade OO. Variation in fontanelle size with gestational age. Early Hum Dev. 1999; 54(3): 207-214.
• 2. Agrawal D, Steinbok P, Cochrane DD. Pseudoclosure of anterior fontanelle by wormian bone in isolated sagittal craniosynostosis. Pediatr Neurosurg. 2006; 42(3): 135-137.
• 3. Aisenson MR. Closing of the anterior fontanelle. Pediatrics. 1950; 6(2): 223-226.
• 4. Amiel-Tison C, Gosselin J, Infante-Rivard C. Head growth and cranial assessment at neurological examination in infancy. Dev Med Child Neurol. 2002; 44(9): 643-648.
• 5. Caffey J. Pediatric x-ray diagnosis. 7th ed. London, England: Year Book Medical Publishers; 1978, p.10–25.
• 6. D'Antoni AV, Donaldson OI, Schmidt C, Macchi V, De Caro R, Oskouian RJ, et al. A comprehensive review of the anterior fontanelle: embryology, anatomy, and clinical considerations. Childs Nerv Syst. 2017; 33(6): 909-914.
• 7. De Gaetano HM, De Gaetano JS. Persistent open anterior fontanelle in a healthy 32-month-old boy. J Am Osteopath Assoc. 2002; 102(9): 500-501.
• 8. Duc G, Largo RH. Anterior fontanel: size and closure in term and preterm infants. Pediatrics 1986; 78(5): 904-908.
• 9. Elder CJ, Bishop NJ. Rickets. Lancet. 2014; 383(9929): 1665-1676.
• 10. Esmaeili M, Esmaeili M, Ghane Sharbaf F, Bokharaie S. Fontanel Size from Birth to 24 Months of Age in Iranian Children. Iran J Child Neurol. 2015; 9(4): 15-23.
• 11. Faix RG. Fontanelle size in black and white term newborn infants. J Pediatr. 1982; 100(2): 304-306.
• 12. Franklin D, Cardini A, Flavel A, Kuliukas A. Estimation of sex from cranial measurements in a Western Australian population. Forensic Sci Int. 2013; 229(1-3): 158.e1-8.
• 13. G/meskel T, Kinfu Y, Worku B. The size of anterior fontanel in neonates and infants in Addis Ababa. Ethiop Med J. 2008; 46(1): 47-53.
• 14. Kiesler J, Ricer R. The abnormal fontanel. Am Fam Physician. 2003; 67(12): 2547-2552.
• 15. Kirkpatrick J, Bowie S, Mirjalili SA. Closure of the anterior and posterior fontanelle in the New Zealand population: A computed tomography study. J Paediatr Child Health. 2019; 55(5): 588-593.
• 16. Lyall H, Ogston SA, Paterson CR. Anterior fontanelle size in Scottish infants. Scott Med J. 1991; 36(1): 20-22.
• 17. Malas MA, Sulak O. Measurements of anterior fontanelle during the fetal period. J Obstet Gynaecol. 2000; 20(6): 601-605.
• 18. Mathur S, Kumar R, Mathur GP, Singh VK, Gupta V, Tripathi VN. Anterior fontanel size. Indian Pediatr. 1994; 31(2): 161-4.
• 19. Mir NA, Weislaw R. Anterior fontanelle size in Arab children: standards for appropriately grown full term neonates. Ann Trop Paediatr. 1988; 8(3): 184-186.
• 20. Mitchell LA, Kitley CA, Armitage TL, Krasnokutsky MV, Rooks VJ. Normal sagittal and coronal suture widths by using CT imaging. AJNR Am J Neuroradiol. 2011; 32(10): 1801-1805.
• 21. Moffett EA, Aldridge K. Size of the anterior fontanelle: three-dimensional measurement of a key trait in human evolution. Anat Rec (Hoboken). 2014; 297(2): 234-239.
• 22. Murai M, Lau HK, Pereira BP, Pho RW. A cadaver study on volume and surface area of the fingertip. J Hand Surg Am. 1997; 22(5): 935-941.
• 23. Nakahara K, Utsuki S, Shimizu S, Iida H, Miyasaka Y, Takagi H, et al. Age dependence of fusion of primary occipital sutures: a radiographic study. Childs Nerv Syst. 2006; 22(11): 1457-1459.
• 24. Noble J, Flavel A, Franklin D. Quantification of the timing of anterior fontanelle closure in a Western Australian population. Aust. J. Forensic Sci. 2017; 49(2): 142–153.
• 25. Omotade OO, Kayode CM, Adeyemo AA. Anterior fontanelle size in Nigerian children. Ann Trop Paediatr. 1995; 15(1): 89-91.
• 26. Peters RM, Hackeman E, Goldreich D. Diminutive digits discern delicate details: fingertip size and the sex difference in tactile spatial acuity. J Neurosci. 2009; 29(50): 15756-15761.
• 27. Pindrik J, Ye X, Ji BG, Pendleton C, Ahn ES. Anterior fontanelle closure and size in full-term children based on head computed tomography. Clin Pediatr (Phila). 2014; 53(12): 1149-1157.
• 28. Popich GA, Smith DW. Fontanels: range of normal size. J Pediatr 1972; 80(5): 749-752.
• 29. Rosset A, Spadola L, Ratib O. OsiriX: an open-source software for navigating in multidimensional DICOM images. J Digit Imaging. 2004; 17(3): 205-216.
• 30. Scheuer L, Black S. Developmental juvenile osteology. 2nd ed. Bath: Elsevier Academic Press; 2000.
• 31. Seah SA, Griffin MJ. Thermotactile thresholds at the fingertip: effect of contact area and contact location. Somatosens Mot Res. 2010; 27(3): 82-92.
• 32. Tunnessen WW, Roberts KB. Signs and symptoms in pediatrics. 3rd ed. Philadelphia, PA: Lippincott Williams & Wilkins; 1999.
• 33. Vijay Kumar AG, Agarwal SS, Bastia BK, Shivaramu MG, Honnungar RS. Fusion of Skull Vault Sutures in Relation to Age-A Cross Sectional Postmortem Study Done in 3rd, 4th & 5th Decades of Life. J Forensic Res 2012; 3(10):173.
• 34. Vu HL, Panchal J, Parker EE, Levine NS, 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(6): 527-532.
• 35. Woods RH, Johnson D. Absence of the anterior fontanelle due to a fontanellar bone. J Craniofac Surg. 2010; 21(2): 448-449.
• 36. Wu T, Li HQ. [Changes of anterior fontanel size in children aged 0 - 2 years]. Zhonghua Er Ke Za Zhi. 2012; 50(7): 493-497. Chinese.