Lumps, bumps and funny shaped heads

BMPR1A maintains skeletal stem cell properties in craniofacial development and craniosynostosis

Skeletal stem cells from the suture mesenchyme, which are referred to as suture stem cells (SuSCs), exhibit long-term self-renewal, clonal expansion, and multipotency. These SuSCs reside in the suture midline and serve as the skeletal stem cell population responsible for calvarial development, homeostasis, injury repair, and regeneration. The ability of SuSCs to engraft in injury site to replace the damaged skeleton supports their potential use for stem cell-based therapy. Here, we identified BMPR1A as essential for SuSC self-renewal and SuSC-mediated bone formation. SuSC-specific disruption of Bmpr1a in mice caused precocious differentiation, leading to craniosynostosis initiated at the suture midline, which is the stem cell niche. We found that BMPR1A is a cell surface marker of human SuSCs. Using an ex vivo system, we showed that SuSCs maintained stemness properties for an extended period without losing the osteogenic ability. This study advances our knowledge base of congenital deformity and regenerative medicine mediated by skeletal stem cells.

NAI: never actually injured

A female infant presented at 31 days of life following a head injury with concerning features for non-accidental injury. Examination revealed a noticeable depression in the left temporoparietal region with a concave depression of the left parietal bone on CT imaging. After careful consideration of the history and examination findings, along with standard investigations for non-accidental injury, the infant was diagnosed with faulty fetal packing (also known as congenital vault depression). The defect had almost completely resolved by follow-up at 5 months. This case represented a diagnostic conundrum not previously reported in the literature.

Genetic advances in craniosynostosis

Craniosynostosis, the premature ossification of one or more skull sutures, is a clinically and genetically heterogeneous congenital anomaly affecting approximately one in 2,500 live births. In most cases, it occurs as an isolated congenital anomaly, that is, nonsyndromic craniosynostosis (NCS), the genetic, and environmental causes of which remain largely unknown. Recent data suggest that, at least some of the midline NCS cases may be explained by two loci inheritance. In approximately 25-30% of patients, craniosynostosis presents as a feature of a genetic syndrome due to chromosomal defects or mutations in genes within interconnected signaling pathways. The aim of this review is to provide a detailed and comprehensive update on the genetic and environmental factors associated with NCS, integrating the scientific findings achieved during the last decade. Focus on the neurodevelopmental, imaging, and treatment aspects of NCS is also provided.

Bedside ultrasound in the diagnosis of skull fractures in the pediatric emergency department

Bedside ultrasound has become a diagnostic tool that is commonly used in the emergency department. In trained hands, it can be used to diagnose multiple pathologies. In this case series, we describe the utility of ultrasound in diagnosing skull fractures in pediatric patients with scalp hematomas.

Faulty fetal packing

A male infant was born by emergency caesarean section at 34(+4) weeks for failed induction of labour. Shortly after birth a depression about the same size as the baby's fist was noted over the right parietal region. After careful consideration of the perinatal history and examination findings, the baby was diagnosed with faulty fetal packing. At 3-month follow-up, the defect had completely corrected without intervention.

A 150-year conundrum: cranial robusticity and its bearing on the origin of aboriginal australians

The origin of Aboriginal Australians has been a central question of palaeoanthropology since its inception during the 19th Century. Moreover, the idea that Australians could trace their ancestry to a non-modern Pleistocene population such as Homo erectus in Southeast Asia have existed for more than 100 years, being explicitly linked to cranial robusticity. It is argued here that in order to resolve this issue a new program of research should be embraced, one aiming to test the full range of alternative explanations for robust morphology. Recent developments in the morphological sciences, especially relating to the ontogeny of the cranium indicate that character atomisation, an approach underpinning phylogenetic reconstruction, is fraught with difficulties. This leads to the conclusion that phylogenetic-based explanations for robusticity should be reconsidered and a more parsimonious approach to explaining Aboriginal Australian origins taken. One that takes proper account of the complex processes involved in the growth of the human cranium rather than just assuming natural selection to explain every subtle variation seen in past populations. In doing so, the null hypothesis that robusticity might result from phenotypic plasticity alone cannot be rejected, a position at odds with both reticulate and deep-time continuity models of Australian origins.

Subaponeurotic or subgaleal fluid collections in infancy: an unusual but distinct cause of scalp swelling in infancy

Subaponeurotic or subgaleal fluid collection is a rare but important cause of scalp swelling in young infants. Fluid in the subaponeurotic or subgaleal space presents as soft, ill-defined, fluctuant, highly mobile scalp swelling and is not limited by suture lines, which makes it clinically very distinct from other scalp swellings. However, the aetiology of such swelling still remains uncertain but may be related to traumatic labour that manifests after the first few weeks of life. There is no indication for imaging if the condition is diagnosed clinically with confidence. The late subaponeurotic or subgaleal fluid collection resolves spontaneously without any intervention, hence conservative management is the treatment of choice.