A note on craniofacial sutural growth

A novel method for assessment of human midpalatal sutures using CBCT-based geometric morphometrics and complexity scores

INTRODUCTION

Management of dentofacial deficiencies requires knowledge about sutural morphology and complexity. The present study assesses midpalatal sutural morphology based on human cone-beam computed tomography (CBCT) using geometric morphometrics (GMM) and complexity scores. The study is the first to apply a sutural complexity score to human CBCT datasets and demonstrates the potential such a score has to improve objectiveness and comparability when analysing the midpalatal suture.

MATERIALS AND METHODS

CBCTs of various age and sex groups were analysed retrospectively (n = 48). For the geometric morphometric analysis, landmark acquisition and generalised Procrustes superimposition were combined with principal component analysis to detect variability in sutural shape patterns. For complexity analysis, a windowed short-time Fourier transform with a power spectrum density (PSD) calculation was applied to resampled superimposed semi-landmarks.

RESULTS

According to the GMM, younger patients exhibited comparable sutural patterns. With increasing age, the shape variation increased among the samples. The principal components did not sufficiently capture complexity patterns, so an additional methodology was applied to assess characteristics such as sutural interdigitation. According to the complexity analysis, the average PSD complexity score was 1.465 (standard deviation = 0.010). Suture complexity increased with patient age (p < 0.0001), but was not influenced by sex (p = 0.588). The intra-class correlation coefficient exceeded 0.9, indicating intra-rater reliability.

CONCLUSION

Our study demonstrated that GMM applied to human CBCTs can reveal shape variations and allow the comparison of sutural morphologies across samples. We demonstrate that complexity scores can be applied to study human sutures captured in CBCTs and complement GMM for a comprehensive sutural analysis.

The Intertwined Evolution and Development of Sutures and Cranial Morphology

Phenotypic variation across mammals is extensive and reflects their ecological diversification into a remarkable range of habitats on every continent and in every ocean. The skull performs many functions to enable each species to thrive within its unique ecological niche, from prey acquisition, feeding, sensory capture (supporting vision and hearing) to brain protection. Diversity of skull function is reflected by its complex and highly variable morphology. Cranial morphology can be quantified using geometric morphometric techniques to offer invaluable insights into evolutionary patterns, ecomorphology, development, taxonomy, and phylogenetics. Therefore, the skull is one of the best suited skeletal elements for developmental and evolutionary analyses. In contrast, less attention is dedicated to the fibrous sutural joints separating the cranial bones. Throughout postnatal craniofacial development, sutures function as sites of bone growth, accommodating expansion of a growing brain. As growth frontiers, cranial sutures are actively responsible for the size and shape of the cranial bones, with overall skull shape being altered by changes to both the level and time period of activity of a given cranial suture. In keeping with this, pathological premature closure of sutures postnatally causes profound misshaping of the skull (craniosynostosis). Beyond this crucial role, sutures also function postnatally to provide locomotive shock absorption, allow joint mobility during feeding, and, in later postnatal stages, suture fusion acts to protect the developed brain. All these sutural functions have a clear impact on overall cranial function, development and morphology, and highlight the importance that patterns of suture development have in shaping the diversity of cranial morphology across taxa. Here we focus on the mammalian cranial system and review the intrinsic relationship between suture development and morphology and cranial shape from an evolutionary developmental biology perspective, with a view to understanding the influence of sutures on evolutionary diversity. Future work integrating suture development into a comparative evolutionary framework will be instrumental to understanding how developmental mechanisms shaping sutures ultimately influence evolutionary diversity.

Squamous suture obliteration: frequency and investigation of the associated skull morphology

This study aimed to investigate the frequency of squamous suture (SqS) obliteration, to estimate the involvement of the major calvarial sutures and those surrounding the temporal squama, and to inspect the neuro- and basicranium for deformities. A series of 211 dry skulls of contemporary adult males were macroscopically observed. The skulls with closed SqS were scanned using an industrial µCT system. Digital morphometry of the skulls with obliterated SqS was performed by recording the 3D coordinates of anatomic landmarks and calculation of linear distances, angles and indices. Obliteration of SqS was observed in 3 (1.42%) skulls. One skull showed bilateral SqS obliteration. The other two cases were unilateral, one right-sided and one left-sided. SqS obliteration seems to be co-ordinated with the closure of the parietomastoid suture, partially related to the closure of the occipitomastoid, sphenoparietal and sphenofrontal sutures, and independent from the closure of the sphenosquamosal suture and the major calvarial sutures. No severe disproportions in the skull configuration were observed in the three investigated cases. The major differences in the complimentary hemicrania concern the parietal and occipital parts of the skull vault. Dorsum sellae erosion, an indicator for raised intracranial pressure, was observed in all three cases.

Development and three-dimensional morphology of the zygomaticotemporal suture in primate skulls

Cranial sutures are an essential part of the growing skull, allowing bones to increase in size during growth, with their morphology widely believed to be dictated by the forces and displacements that they experience. The zygomaticotemporal suture in primates is located in the relatively weak zygomatic arch, and externally it appears a very simple connection. However, large forces are almost certainly transmitted across this suture, suggesting that it requires some level of stability while also allowing controlled movements under high loading. Here we examine the 2- and 3-dimensional (3D) morphology of the zygomaticotemporal suture in an ontogenetic series of Macaca fascicularis skulls. High resolution microcomputed tomography data sets were examined, and virtual and physical 3D replicas were created to assess both structure and general stability. The zygomaticotemporal suture is much more complex than its external appearance suggests, with interlocking facets between the adjacent zygomatic and temporal bones. It appears as if some movement is permitted across the suture in younger animals, but as they approach adulthood the complexity of the suture's interlocking bone facets reaches a level where these movements become minimal.

Cranial sutures work collectively to distribute strain throughout the reptile skull

The skull is composed of many bones that come together at sutures. These sutures are important sites of growth, and as growth ceases some become fused while others remain patent. Their mechanical behaviour and how they interact with changing form and loadings to ensure balanced craniofacial development is still poorly understood. Early suture fusion often leads to disfiguring syndromes, thus is it imperative that we understand the function of sutures more clearly. By applying advanced engineering modelling techniques, we reveal for the first time that patent sutures generate a more widely distributed, high level of strain throughout the reptile skull. Without patent sutures, large regions of the skull are only subjected to infrequent low-level strains that could weaken the bone and result in abnormal development. Sutures are therefore not only sites of bone growth, but could also be essential for the modulation of strains necessary for normal growth and development in reptiles.

Histology-based morphology of the neurocentral synchondrosis in Alligator mississippiensis (Archosauria, Crocodylia)

Morphology of the neurocentral synchondroses--thin cartilaginous layers between centra and neural arches--are documented in the extant crocodilian, Alligator mississippiensis (Archosauria, Crocodylia). Examination of dry skeletons demonstrates that neurocentral suture closure occurs in very late postnatal ontogeny (after reaching sexual maturity and/or body size ca. 40% from the upper range). Before sexual maturity (body length (BL) ≥ ca. 1.80 m), completely fused centra and neural arches are restricted to the caudal vertebral series. In contrast, the presacral vertebrae often remain unfused throughout postnatal ontogeny, retaining open sutures in very mature individuals (BL ≥ 2.80 m). These unfused centra and neural arches are structurally supported by the relatively large surface area of the neurocentral junctions, which results from primarily horizontal (mediolateral) increases with strong positive allometry. Cleared and stained specimens show that the cartilaginous neurocentral synchondrosis starts to form after approximately 40 embryonic days. Histological examination of the neurocentral junction in dorsal and anterior caudal vertebrae of six individuals (BL = 0.28-3.12 m) shows : (1) neurocentral fusion is the result of endochondral ossification of the neurocentral synchondrosis, (2) the neurocentral synchondrosis exhibits bipolar organization of three types of cartilaginous cells, and (3) complex neurocentral sutures (i.e., curved, zigzagged, and/or interdigitated boundaries) come from clumping of bone cells of the neural arches and centra into the neurocentral synchondrosis. The last two morphological features can be advantageous for delaying neurocentral fusion, which seems to be unique in crocodilians and possibly their close relatives, including nonavian dinosaurs and other Mesozoic archosaurs.

Enlargement of the temporalis muscle and alterations in the lateral cranial vault

The purpose of this study was to test the hypothesis that increased masticatory muscle accompanied morphologic changes in the temporal bone and squamosal suture. Ten mice deficient for the protein myostatin (Mstn -/-) had significantly increased skeletal muscle mass and were compared with nine controls (Mstn +/+). Variables measured include linear and areal metrics describing temporal size and temporal bone shape as well as the extent of the area of the squamosal suture that overlaps, or bevels, with parietal bones. Mstn-/- mice showed significantly larger temporalis muscles. Their temporal bones showed significantly decreased size as well as decreased beveling of the squamosal suture. These decreases were absolute as well as relative and were not restricted to either vertical or horizontal axes. The increased masticatory musculature of Myostatin-null mice had a shrinking effect on the temporal aspect of the cranium. These results are inconsistent with the interpretation that increased temporalis mass induces morphologic changes in temporal bone that compensate for putative increases in compressive forces transduced at this region. Rather than increase in the area of overlap between two calvarial bones, potential increase in biomechanical loading along the temporal squama led to a smaller bevel which would presumably weaken this joint. It is unclear why this is so. Either compressive forces are not anabolic to suture beveling or they do upregulate growth of the suture bevel, with compression not being the primary loading regime at this suture.

Craniofacial sutures: morphology, growth, and in vivo masticatory strains

The growth and morphology of craniofacial sutures are thought to reflect their functional environment. However, little is known about in vivo sutural mechanics. The present study investigates the strains experienced by the internasal, nasofrontal, and anterior interfrontal sutures during masticatory activity in 4-6-month-old miniature swine (Sus scrofa). Measurements of the bony/fibrous arrangements and growth rates of these sutures were then examined in the context of their mechanical environment. Large tensile strains were measured in the interfrontal suture (1,036 microepsilon +/- 400 SD), whereas the posterior internasal suture was under moderate compression (-440 microepsilon +/- 238) and the nasofrontal suture experienced large compression (-1,583 microepsilon +/- 506). Sutural interdigitation was associated with compressive strain. The collagen fibers of the internasal and interfrontal sutures were clearly arranged to resist compression and tension, respectively, whereas those of the nasofrontal suture could not be readily characterized as either compression or tension resisting. The average linear rate of growth over a 1-week period at the nasofrontal suture (133.8 micrometer, +/- 50.9 S.D) was significantly greater than that of both the internasal and interfrontal sutures (39.2 micrometer +/- 11.4 and 65. 5 micrometer +/- 14.0, respectively). Histological observations suggest that the nasofrontal suture contains chondroid tissue, which may explain the unexpected combination of high compressive loading and rapid growth in this suture.

The premaxilla in Neandertal and early modern children: ontogeny and morphology

This comparative study of maxillae in Neandertals, Qafzeh, and extant children examines two specific traits: the premaxillary suture (sutura incisiva) and the interincisive sinuses, proposing a new hypothesis about some features of the Neandertal mid-face. Morphologic study of the premaxillary suture at its different borders (i.e. the nasal aspect of the frontal process, nasal and palatal aspects of the palatal process of the maxilla) indicates a persistence of the suture among very young Neandertal children in comparison to the condition in extant ones. This suggests a longer independence of some parts of the premaxilla in Neandertals. To further examine this possibility, CT scans of two Neandertal children were analyzed: Roc de Marsal, estimated to be about 3 years, and Engis 2, estimated to be about 5-6 years. The results are quite different between the fossils. In the older, the premaxillary suture is represented only by a deep groove. In the younger it extends deep to the surface of the nasal process reaching the Parinaud's canal. Synostosis of the premaxillary suture was found to occur later in Neandertal children than in modern ones. Moreover, we observed the existence of two interincisive sinuses in the fossil children, whereas this is rare in modern children (present on only 2% of our sample of 0-6 year-old infants, n = 247). Persistence of an open premaxillary suture represents the potential for an extended period of growth of the Neandertal mid-face. Although no trace of the premaxillary suture remains in adult Neandertals, Neandertals present many features classically considered as consequences of this persistence. The two interincisive sinuses could be a consequence of the labio-lingual diameter of the incisors. The results presented here can be further investigated by additional studies on the cranial sutural system and by precise morphologic observations and CT scans of the mid-face of a larger sample of fossil children.

Sutural biology and the correlates of craniosynostosis

The purpose of this paper is to provide a new perspective on craniosynostosis by correlating what is known about sutural biology with the events of craniosynostosis per se. A number of key points emerge from this analysis: 1) Sutural initiation may take place by overlapping, which results in beveled sutures, or by end-to-end approximation, which produces nonbeveled, end-to-end sutures. All end-to-end sutures occur in the midline (e.g., sagittal and metopic) probably because embryonic biomechanical forces on either side of the initiating suture tend to be equal in magnitude. A correlate appears to be that only synostosed sutures of the midline have pronounced bony ridging. 2) Long-term histologic observations of the sutural life cycle call into question the number of layers within sutures. The structure varies not only in different sutures, but also within the same suture over time. 3) Few, if any, of the many elegant experimental research studies in the field of sutural biology have increased our understanding of craniosynostosis per se. An understanding of the pathogenesis of craniosynostosis requires a genetic animal model with primary craniosynostosis and molecular techniques to understand the gene defect. This may allow insight into pathogenetic mechanisms involved in primary craniosynostosis. It may prove to be quite heterogeneous at the basic level. 4) The relationship between suture closure, cessation of growth, and functional demands across sutures poses questions about various biological relationships. Two conclusions are provocative. First, cessation of growth does not necessarily, or always lead to fusion of sutures. Second, although patent sutures aid in the growth process, some growth can take place after suture closure. 5) In an affected suture, craniosynostosis usually begins at a single point and then spreads along the suture. This has been shown by serial sectioning and calls into question results of studies in which the affected sutures are only histologically sampled. 6) Craniosynostosis is etiologically and pathogenetically heterogeneous. Known human causes are reviewed. Is craniosynostosis simply normal suture closure commencing too early?(ABSTRACT TRUNCATED AT 400 WORDS)

In vivo strain in cranial sutures: the zygomatic arch

Although cranial sutures presumably play a role in absorbing and/or transmitting loads applied to the skull, loading patterns on facial sutures are poorly understood. The zygomatic arch provides a comparatively isolated mechanical part of the skull containing a single suture, the zygomatico-squamosal. In pigs the zygomatico-squamosal suture has a short vertical segment located within the postorbital process and a longer horizontal segment which extends posteriorly. In anesthetized pigs single-element high-elongation strain gages were bonded over both segments of the suture. Strain was recorded during stimulation of the masseter muscles and while the lightly anesthetized animals masticated food pellets. The predominant strain patterns differed in the two segments of the suture. During mastication compressive strains predominated in the vertical segment, but tensile strains predominated in the horizontal segment. The same patterns were also produced by stimulation of the ipsilateral masseter muscle. Contraction of the contralateral masseter reversed the strain pattern, but strain levels were low and during mastication such reversals occurred only transiently. The two segments of the suture have contrasting morphologies. The vertical segment has broad, interdigitating contacts with fibers arranged in a compression-resisting orientation. The horizontal segment has a simple tongue and groove structure with fibers arranged to resist tension. Thus, the structure of the suture reflects the predominant strain pattern.

Mechanical properties of cranial sutures

Many bones in mammalian skulls are linked together by cranial sutures, connective tissue joints that are morphologically variable and show different levels of interdigitation among and within species. The goal of this investigation was to determine whether sections of skull with cranial sutures have different mechanical properties than adjacent sections without sutures, and if these properties are enhanced with increased interdigitation. To test these hypotheses, bending strength and impact energy absorption were measured for samples of goat (Capra hircus) cranial bone without sutures and with sutures of different degrees of interdigitation. Bending strength was measured under both dynamic (9.7 mm displacement s-1) and relatively static (0.8 mm s-1) conditions, and at either speed, increased sutural interdigitation provided increased strength during three-point bending. However, except for very highly interdigitated sutures loaded slowly, sutures were not as strong in bending as bone. In contrast, sutures absorbed from 16% to 100% more energy per unit volume during impact loading than did bone. This five-fold increase in energy absorption by the sutures was significantly correlated with increased sutural interdigitation.

Thickness of the lateral surface of the temporal bone in children

The placement of implantable auditory prostheses in children has raised questions concerning the thickness of the temporal bone in the region of implantation. The purpose of this study is to describe the thickness at specific sites of the lateral surface of the temporal bone in children of different ages. One hundred twenty-five intact temporal bones from 83 children of known sex, race, and age between birth and 20 years were measured. Thickness was measured with a specially designed micrometer at specific locations from a fixed reference point by use of a surface projected grid for site identification. Thickness was plotted against age on scattergraphs for each site, and regression analysis revealed a bimodal linear relationship. Sites medial to the temporalis muscle were the thinnest; sites associated with the posteroinferior insertion of the temporalis muscle, along the supramastoid crest, were the thickest. However, wide interindividual variability was the rule.

Sutures and forces: a review

This review gives a description of the biologic significance of craniofacial sutures with respect to growth and to growth corrections. Sutural growth and its regulation are discussed briefly. Morphogenesis of sutures, sutural morphology, both microscopic and macroscopic, the structure and function of the sutural periosteum and secondary cartilages, and the biochemical composition of sutures are described. Furthermore, in vivo and in vitro experiments, including transplantation experiments, are discussed. The relationship between extrinsic mechanical forces and the resulting tissue responses in sutures is given special attention. The present article describes the state of our knowledge on the interaction between sutures and forces, and indicates problems that need to be investigated.

Lambdoid synostosis. Part 1. The lambdoid suture: normal development and pathology of "synostosis"

The microscopic development of the normal lambdoid suture was studied in autopsy specimens from 19 normal subjects ranging in age from 20 weeks' gestation to 60 years. The cellular activity at the suture varied considerably with age; however, maximal activity was seen in specimens approximately 3 months of age. There were several unusual features, including a high incidence of cartilaginous differentiation and the presence of intrasutural Wormian bones. Forty-one specimens from 37 patients with isolated lambdoid synostosis were also studied pathologically. Only three cases showed bone union across the suture, which appears to be a result of closure rather than fusion as in other synostoses. The remainder of the cases showed varying degrees of increased cellular proliferation at the suture line, resulting in exaggerated and prolonged sutural activity. Morphologically, this produced increased interdigitation and fibrous adhesion between the suture margins.

A radioautographic study of the effect of age on the protein-synthetic and bone-deposition activity in interparietal sutures of male white mice

Groups of male white mice were killed at 4, 5, 6, 7, 8, 9 and 10 weeks of age 2 h after intraperitoneal injection with [3H]-proline. Radioautographic analysis of sections of the interparietal suture demonstrated significantly greater protein-synthetic activity in the para-osseous zones relative to the middle zone (p less than 0.01) and a plateau of lower protein-synthetic activity by 7-8 weeks of age (p less than 0.05). Groups of mice were selected at 4, 6, 8 and 10 weeks of age. Each mouse was injected intraperitoneally with [3H]-proline three times at one-week intervals. Sutural growth rate was determined from incremental lines revealed by radioautographs prepared from serial paraffin sections of the interparietal suture and demonstrated a stabilization of growth by 8 weeks of age. This, together with the grain counting data, suggested that a mouse of 7-8 weeks would provide a suitable model for experimental studies in sutural remodelling response without masking effects by normal growth.

Experimental investigations into the clinical significance of bone growth at viscerocranial sutures

The development of a viscerocranial suture under physiological conditions was investigated in a total of 37 pigs and the effects of various traumas on expected sutural bone growth were observed. Different operations were carried out on one side only in the vicinity of the zygomaticotemporal suture in 18-25 day old piglets. The animals were sacrificed six months after the operation. The skulls of some of the animals were macerated and subjected to macroscopic and radiological investigation. Both zygomatic arches were removed from each of the remaining animals and used for the production of undecalcified microtome and ground sections. Intravital fluorochrome labelling was used to determine the asymmetric growth at this suture; this is interpreted as being the formation of new bone following passive expansion of the sutural region. After injury or transplantation of the periosteum and after the healing of a narrow bone defect or fracture we observed either a continuous suture from the outset or the formation of a new fissure after osseous regeneration. Similar findings were also made after the transplantation of compact rib fragments into a sutural defect without subsequent bridging of the defect. Only after the transplantation of autologous pieces of cancellous rib into an osseous defect in the sutural region was sutural ossification, accompanied by distinct deformation of the skull observed. As a clinical consequence of this it may be presumed that trauma or operation in the region of a suture has a considerable effect on the growth of the visceral cranium only if it results in premature synostosis.

Skull growth after coronal suturectomy, periostectomy, and dural transection

Using radiocephalometric procedures, the authors examined the separate effects of suturectomy, periostectomy, and dural transection on the growing skull in young rabbits. When the coronal suture was surgically removed during normal growth, The freed frontal and parietal bones separated at a significantly accelerated rate. No accelerated separation was found when only the overlying periosteum and aponeurosis were transected. Furthermore, no additional separation was observed when the dura mater and falx cerebri were transected following suturectomy. Analysis of growth at the adjacent frontonasal and anterior lambdoid sutures suggested that the accelerated separation of bones after suturectomy was compensated for by reduced growth at these adjacent sutures. The result of these compensatory actions was that the total length of the skull remained unchanged. This study not only supports earlier observations that sutures grow in response to extrinsic separative forces but, significantly, that the suture tissue itself, rather than the dura or pericranium, acts as a restraint during normal translatory growth.

Craniosynostosis in vitamin D-resistant rickets. A mouse model

Craniosynostosis and associated craniofacial deformities, such as frontal bossing, often occur as symptoms of vitamin D-resistant rickets in children. Similar skull deformities develop in mice with X-linked dominant hypophosphatemia, the most common form of vitamin D-resistant rickets. These mice have a short, wide, high neurocranium, which suggested an inhibition of coronal suture growth. To study this question, we compared histologically the postnatal development of the coronal sutures in normal and hypophosphatemic mice between 1 and 13 weeks of age. Premature fusion of the coronal suture occurred in hypophosphatemic mice by 4 weeks of age. The proportion of the suture obliterated by bone varied among individual animals, but craniosynostosis was present in all animals studied at 4 weeks and older. Fusion of the coronal suture did not occur through 13 weeks of age in any of the normal mice studied. The x-linked hypophosphatemic mouse is an animal model that can be used to study the role of vitamin D-resistant rickets in the development of craniosynostosis, to relate craniosynostosis to the development of associated skull deformities, and to test new treatment procedures.