Study of Sexual Dimorphism in the Closure of Sagittal Suture – A Postmortem Study

Background: Performing identity is a prime task in medicolegal and postmortem examinations. Age is the first parameter that has to be determined followed by sex. There are several techniques through which sex can be determined. As well there are different anatomical, physiological and pathological parameters determination of sex. Aim: To determine the sexual dimorphism in the cranial sagittal suture closure macroscopically. Methods: All the cases for this purpose had been selected from those brought for autopsy in the Department of Forensic Medicine and Toxicology, King Edward Medical University Lahore during the year 2016. Results: The statistical analysis revealed early closure in males than in females both ectocranially and endocranially with advancing age in the sagittal suture of cranial vault. The p value was found significant being less than 0.05 thereby establishing the fact that sexual dimorphism in the cranial sagittal suture exists. Conclusion: Conclusively the determination of sex is possible from the pattern of Cranial Sutures closure on autopsy table. Key words: Sex, Sagittal, Suture, Cranial

Do standard surgical techniques lead to satisfying aesthetic results in nonsyndromic sagittal suture synostosis?

OBJECTIVE Surgical correction of synostotic cranial sutures is typically performed early in an affected child’s life. Depending on the severity of the cranial synostoses, different aspects of the surgical treatment may have varying degrees of importance. In this sense, the aesthetic appearance in children with normal neurological development in single-suture synostosis plays an important role in self-perception and social acceptance for both the patients themselves and their caregivers. Therefore, in this study, the authors aimed to evaluate the aesthetic outcome after surgical correction in a cohort of patients with nonsyndromic sagittal suture synostosis. METHODS Between December 2002 and December 2019, a total of 99 patients underwent surgical correction of a synostotic sagittal suture at the Medical University of Vienna. Depending on their age, patients underwent either an extended midline strip craniectomy (EMSC) (< 4 months) or a modified pi procedure (MPP) (≥ 4 months). After the surgical procedure, the outcome was evaluated by the treating neurosurgeon at 1- and 12-month follow-up visits, and after approximately 5 years, before the patient entered elementary school. In addition to that, the patients’ caregivers were asked to evaluate the aesthetic outcome of the surgical procedure after 12 months. These results were then compared to evaluate potential differences in the perception of the surgical outcome. RESULTS After 12 months, the majority of the included patients were evaluated as having a good aesthetic outcome by the treating neurosurgeon (97%) and by their caregivers (89%). These differences did not show statistical significance (p = 0.11). Similarly, no differences in the aesthetic outcome depending on the surgical procedure performed could be found (p = 0.55). At the last follow-up visit, before entering elementary school, all available patients had an excellent or good surgical outcome. Moreover, the majority of caregivers (73%) reported that their child had a normal head shape appearance after surgical correction. CONCLUSIONS The results of this study have suggested that surgical correction of sagittal suture synostosis by simple operative techniques leads to a good aesthetic outcome and a normal head shape appearance in the majority of patients. An analysis of the evaluation of the surgical outcome by either the treating neurosurgeon or the patient caregivers showed comparable results and, thus, early intervention with simple surgical techniques can be recommended.

Cinematic rendering of a burst sagittal suture caused by an occipito-frontal gunshot wound

The computed tomography (CT) scan of a 19-year-old man who died from an occipito-frontal gunshot wound presented an impressive radiating fracture line where the entire sagittal suture burst due to the high intracranial pressure that arose from a near-contact shot from a 9 mm bullet fired from a Glock 17 pistol. Photorealistic depictions of the radiating fracture lines along the cranial bones were created using three-dimensional reconstruction methods, such as the novel cinematic rendering technique that simulates the propagation and interaction of light when it passes through volumetric data. Since the brain had collapsed, depiction of soft tissue was insufficient on CT images. An additional magnetic resonance imaging (MRI) examination was performed, which enabled the diagnostic assessment of cerebral injuries.