PersistanMetopik Sütürü Olan Yetişkinlerde Kranial Morfometrik Paternler ve Frontal Sinüs Varyasyonları: Bilgisayarlı Tomografi Temelli Analiz

Yıl 2026, Cilt: 48 Sayı: 1, 42 - 53, 15.12.2025

Erdem Özkan , Aybüke Uçgun , Ersin Yavuz , Şehnaz Evrimler

https://doi.org/10.20515/otd.1768335

Öz

Persistan metopik sütür (PMS), metopik sütürün normal gelişimi sırasında füzyone olmadığı anatomik bir varyasyondur. Bu çalışmada, PMS'li yetişkin Türk popülasyonunda, kranial morfometrik paternlerin ve frontal sinüs (FS) morfolojisinin bilgisayarlı tomografi (BT) ile araştırılması amaçlanmıştır. Ocak 2023-2024 arasında kranial BT çekilen PMS'li 165 yetişkin hastayı (83 kadın, 82 erkek; ortalama yaş 56.67±19.78 yıl) analiz ettik. Oksipitofrontal mesafe (OFM), biparietal mesafe (BPM) ve interorbital mesafe (İOM) dahil kranial morfometrik ölçümler elde edildi, sefalik indeks (Sİ) hesaplandı ve FS morfolojisi değerlendirildi. Brakisefalik morfoloji en yaygındı (%40.0), bunu hiperbrakisefalik (%38.8), mezosefalik (%18.8) ve dolikosefalik (%2.4) formlar takip etti. Erkeklerde kadınlara göre OFM, BPM ve İOM anlamlı olarak daha büyük değerler gösterdi (p<0.001), Sİ ise cinsiyetler arası fark göstermedi (p=0.719). Bilateral FS asimetrisi hastaların %40.0'ında tespit edildi. Sağ FS hiperplazisi daha büyük İOM’ler ile anlamlı olarak ilişkiliydi (p=0.009). Bulgularımız PMS'nin ağırlıklı olarak brakisefalik formlar ve artmış FS asimetrisi ile karakterize belirgin kranial morfolojik paternlerle ilişkili olduğunu göstermektedir. Bu çalışmanın bulguları oldukça değerli olmakla birlikte çalışmamız Türk yetişkin kohortuyla sınırlıdır ve diğer etnik veya demografik popülasyonlara genellenemez.

Anahtar Kelimeler

Persistan metopik sütür , bilgisayarlı tomografi , sefalik indeks , frontal sinüs

Cranial Morphometric Patterns and Frontal Sinus Variations in Adults with Persistent Metopic Suture: Computed Tomography Based Analysis

Öz

Persistent metopic suture (PMS) represents an anatomical variation where the metopic suture fails to fuse during normal development. This study aimed to investigate cranial morphometric patterns and frontal sinus (FS) morphology in the adult Turkish population with PMS using computed tomography (CT).We analyzed 165 adult patients (83 women, 82 men; mean age 56.67±19.78 years) with PMS who underwent cranial CT between January 2023-2024. Cranial morphometric measurements including occipitofrontal distance (OFD), biparietal diameter (BPD), and interorbital distance (IOD) were obtained, cephalic index (CI) was calculated, and FS morphology was evaluated. Brachycephalic morphology was most prevalent (40.0%), followed by hyperbrachycephalic (38.8%), mesocephalic (18.8%), and dolichocephalic (2.4%) forms. Males demonstrated significantly larger OFD, BPD and IOD compared to females (p<0.001), while CI showed no sex-related differences (p=0.719). Bilateral FS asymmetry was identified in 40.0% of patients. Right frontal sinus hyperplasia was significantly associated with larger IOD (p=0.009). Our findings reveal that PMS is associated with distinctive cranial morphological patterns characterized by predominantly brachycephalic forms and elevated frontal sinus asymmetry. Although the findings of this study are quite valuable, our study is limited to a Turkish adult cohort and cannot be generalized to other ethnic or demographic populations.

Anahtar Kelimeler

Persistent metopic suture , computed tomography , cephalic index , frontal sinus

Kaynakça

• 1. 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):527-32.
• 2. 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(5):1211-8.
• 3. Murlimanju BV, Prabhu LV, Pai MM, Goveas AA, Dhananjaya KV, Somesh MS. Median frontal sutures - incidence, morphology and their surgical, radiological importance. Turk Neurosurg. 2011;21(4):489-93.
• 4. Glass RB, Fernbach SK, Norton KI, Choi PS, Naidich TP. The infant skull: a vault of information. Radiographics. 2004;24(2):507-22.
• 5. Roa I, Moraga JI, Cantin M. Metopism: morphologic basis clinical implications and case report. International Journal of Morphology. 2011;29(3):992-9.
• 6. Vinchon M. The metopic suture: Natural history. Neurochirurgie. 2019;65(5):239-45.
• 7. Sharma S, Krishna H, Dixit SG, Ghatak S. Metopism and Its Clinical Relevance: A Persistent Suture. Annals of African Medicine. 2025;24(1):19-21.
• 8. Castilho S, Oda Y, Santana G. Metopism in adult skulls from Southern Brazil. Int J Morphol. 2006;24(1):61-6.
• 9. Sol Md, Binvignat O, Bolini PDA, Prates JC. Metopismo no individuo brasileiro. Rev Paul Med. 1989:105-7.
• 10. Çakur B, Sumbullu MA, Durna NB. Aplasia and agenesis of the frontal sinus in Turkish individuals: a retrospective study using dental volumetric tomography. Int J Med Sci. 2011;8(3):278-82.
• 11. Torgersen J. The developmental genetics and evolutionary meaning of the metopic suture. American Journal of Physical Anthropology. 1951;9(2):193-207.
• 12. Allanson JE, Cunniff C, Hoyme HE, McGaughran J, Muenke M, Neri G. Elements of morphology: standard terminology for the head and face. American Journal of Medical Genetics Part A. 2009;149(1):6-28.
• 13. Hess L. The metopic suture and the metopic syndrome. Human Biology. 1945;17(2):107.
• 14. Waitzman AA, Posnick JC, Armstrong DC, Pron GE. Craniofacial skeletal measurements based on computed tomography: Part II. Normal values and growth trends. The Cleft Palate-Craniofacial Journal. 1992;29(2):118-28.
• 15. Mafee MF, Pruzansky S, Corrales MM, Phatak MG, Valvassori GE, Dobben GD, et al. CT in the evaluation of the orbit and the bony interorbital distance. AJNR Am J Neuroradiol. 1986;7(2):265-9.
• 16. Kolar JC, Salter EM. Craniofacial anthropometry: practical measurement of the head and face for clinical, surgical, and research use. (No Title). 1997.
• 17. Botwe BO, Boadu JNA, Kyei KA, John D, Thompson. Radiological determination of the cranial index of present-day Ghanaians. Forensic Sci Res. 2022;7(2):138-41.
• 18. Likus W, Bajor G, Gruszczyńska K, Baron J, Markowski J, Machnikowska-Sokołowska M, et al. Cephalic index in the first three years of life: study of children with normal brain development based on computed tomography. ScientificWorldJournal. 2014;2014:502836.
• 19. Sharma S, Krishna H, Dixit SG, Ghatak S. Metopism and Its Clinical Relevance: A Persistent Suture. Annals of African Medicine. 2025;24(1).
• 20. Guerram A, Le Minor JM, Renger S, Bierry G. Brief communication: The size of the human frontal sinuses in adults presenting complete persistence of the metopic suture. American journal of physical anthropology. 2014;154(4):621-7.
• 21. Öğüt E, Güzelad Ö, Yıldırım FB. Anatomical and morphometric evaluation of the Cranial Index and its relevance to clinical syndromes. Meandros Medical And Dental Journal. 2023;24(1):46-51.
• 22. Çağlayan F, Güller H, Öncü E, Kuzey N, Dalcı H. The Frequency of Occipital Spurs in Relation to the Cephalic Index: An Anatomorphometric Cone Beam CT Study. Nigerian Journal of Clinical Practice. 2024;27(5):647-53.
• 23. Torres-Restrepo AM, Quintero-Monsalve AM, Giraldo-Mira JF, Rueda ZV, Vélez-Trujillo N, Botero-Mariaca P. Agreement between cranial and facial classification through clinical observation and anthropometric measurement among envigado school children. BMC Oral Health. 2014;14(1):50.
• 24. Emekli E. Sex Determination Using Frontal Sinus Diameters on Direct Radiography. Cureus. 2023 Oct 22;15(10):e47476.
• 25. Kaya, S., Harmandaoğlu, O., Öztürk, O., Seçgin, Y., Şenol, D., & Önbaş, Ö. (2025). Sex estimation based on frontal sinus computed tomography images using machine learning and artificial neural networks. Australian Journal of Forensic Sciences, 1-14.
• 26. Atalay B, Eser MB. The Relation Between the Metopic Suture Persistence and Frontal Sinus Volume and Olfactory Fossa Depth: A Reliability Study with Semiautomatic Volume Measurement. Medeni Med J. 2021;36(4):287-93.
• 27. Nikolova S, Toneva D. Frontal sinus dimensions in the presence of persistent metopic suture. et anthropologica. 2019;26:90.
• 28. Bilgin S, Kantarcı UH, Duymus M, Yildirim CH, Ercakmak B, Orman G, et al. Association between frontal sinus development and persistent metopic suture. Folia Morphol (Warsz). 2013;72(4):306-10.
• 29. Grabcika A, Kazoka D, Vetra J, Pilmane M. Craniofacial Measurements and Indices Trends in Latvian Children Aged 1-15. Children (Basel). 2024;11(9).
• 30. Beals KL, Smith CL, Dodd SM, Angel JL, Armstrong E, Blumenberg B, et al. Brain size, cranial morphology, climate, and time machines [and comments and reply]. Current Anthropology. 1984;25(3):301-30.
• 31. Noback ML, Harvati K, Spoor F. Climate‐related variation of the human nasal cavity. American journal of physical anthropology. 2011;145(4):599-614.
• 32. Techataweewan N, Hefner JT, Freas L, Surachotmongkhon N, Benchawattananon R, Tayles N. Metric sexual dimorphism of the skull in Thailand. Forensic Science International: Reports. 2021;4:100236.
• 33. Del Bove A, Menéndez L, Manzi G, Moggi-Cecchi J, Lorenzo C, Profico A. Mapping sexual dimorphism signal in the human cranium. Scientific reports. 2023;13(1):16847.
• 34. Kumar NV, Vijayashanmugam U, Gugapriya T, Nalinakumari S. A roentgen-anatomic study of association between persistant inter-frontal Suture with varied presence of frontal sinus. Indian Journal of Clinical Anatomy and Physiology. 2016;3(4):510.
• 35. Bilgin S, Kantarcı U, Duymus M, Yildirim C, Ercakmak B, Orman G, et al. Association between frontal sinus development and persistent metopic suture. Folia Morphologica. 2013;72(4):306-10.
• 36. Murlimanju B, Prabhu Lv, Goveas Aa, Dhananjaya K, Somesh M. Median frontal sutures–incidence, morphology and their surgical, radiological importance. Turkish Neurosurgery. 2011;21(4).
• 37. Aksu F, Cirpan S, Mas NG, Karabekir S, Magden AO. Anatomic features of metopic suture in adult dry skulls. J Craniofac Surg. 2014;25(3):1044-6.
• 38. da Silva Ido N, Fernandes KJ, Ramalho AJ, Bispo RF, Rodrigues CF, Aragão JA. Occurrence of metopism in dry crania of adult brazilians. ISRN Anat. 2013;2013:158341.
• 39. Nikolova S, Toneva D, Tasheva-Terzieva E, Lazarov N. Cranial morphology in metopism: A comparative geometric morphometric study. Annals of Anatomy - Anatomischer Anzeiger. 2022;243:151951.