Sutures and Fontanelles: Widened Sutures as a Symptom of Defective Ossification


Sutures and Fontanelles: Widened Sutures as a Symptom of Defective Ossification

In this instance, no signs of increased ICP are present. Usually, the suture has sharp edges without prominent interdigitations. Suture widening is often associated with numerous wormian bones and a persistent fontanelle.

Rare causes of widened sutures include the following:

  • Pseudotumor cerebri, brain edema of unknown cause, post-traumatic with headache and papilledema: normal US, CT, and magnetic resonance imaging (MRI) findings

  • Superior sagittal sinus (SSS) thrombosis: diagnosed by US (Doppler), CT, or MRI

  • Vitamin A toxicity or deficiency

  • Hyperparathyroidism

  • Long-term use of steroid medication

  • Long-term prostaglandin E1 therapy

  • Lead poisoning.

Table 4.2 Widening of the sutures as a symptom of defective ossification



Florid rickets

Indistinct suture margins, generally obscured osseous structures.

Hypothyroidism, untreated

Delayed closure of fontanelles, often numerous wormian bones.

Osteogenesis imperfecta

Numerous wormian bones are generally present; thinned calvarial bones.

Cleidocranial dysostosis

Fig. 4.2, p. 294

Persistent, large anterior fontanelle, numerous wormian bones.


Widely patent fontanelles, widened sutures.

Long-term prostaglandin E1 therapy

Widely patent fontanelles.


Persistent anterior fontanelle, wormian bones, and osteosclerosis.

Menke syndrome (kinky hair syndrome)

Numerous wormian bones, microcephaly.


Extremely rare condition of premature aging.

Zellweger syndrome

Fig. 4.3a, b, p. 294

Fig. 4.4a, b, p. 295

Facial manifestations, wide sutures, hypotonia, developmental delay, hepatomegaly, peripheral retinal pigmentation.

Hallermann-Streiff syndrome (oculomandibulo-dyscephaly)

Delayed closure of fontanelles. Syndrome is characterized by birdlike face, micropthalmia, cataracts, micrognathia, beaked nose, abnormal dentition, hypotrichosis, cutaneous atrophy, and proportional small stature.

Fig. 4.2 Cleidocranial dysostosis in 4-year-old boy. Note the persistent open anterior fontanelle.
Fig. 4.3a, b Epilepsy in a 2-day-old infant. Note the large open anterior fontanelle and facial manifestations that are suspected to be part of Zellweger syndrome.
Fig. 4.4a, b Subependymal heterotopia as part of Zellweger syndrome on T1- and T2-weighted brain images of the same patient as Fig. 4.3 .

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Jul 12, 2020 | Posted by in PEDIATRIC IMAGING | Comments Off on Sutures and Fontanelles: Widened Sutures as a Symptom of Defective Ossification
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