International J. of Healthcare and Biomedical Research, Volume: 03, Issue: 03, April 2015, Pages 192-202
Original article: Age estimation from cranial sutures – a Postmortem study
Dr. S. V. Khandare *, Dr. S.S.Bhise **, Dr A. B. Shinde ***
* Asst. Professor, Forensic Medicine Dept. , B.J. medical college, Pune , India ** Asst. Professor, Forensic Medicine Dept.. Grant Govt. medical college, Mumbai. India *** Asst. Professor, Forensic Medicine , Dept. B.J. medical college, Pune , India Corresponding author: Dr S V Khandare
Abstract: Age estimation is an integral part of the biological profile employed by forensic anthropologists in order to assist in achieving an identification of an unknown deceased individual. Its estimation is of paramount importance and requires special attention in cases where bodies are found in decomposed, mutilated state or only fragmentary remains are discovered. After 25 years of age, other scientific methods like tooth microscopy, Gustafson’s method (applicable to dead persons only), study of union of parts of sternum, lipping of joints and closure of cranial sutures are considered for age estimation of the individual. The oldest and most controversial age indicator is cranial suture closure. Cranial sutures generally fuse with increasing age, although there is considerable variability in closure rates and patterns. 11 The present study has been done on post-mortem cases referred to Government hospital, Mumbai which is a tertiary referral centre. It becomes difficult to determine age in middle and older age groups and as Very few studies have been conducted on cranial suture closure of Mumbai region subjects we decided to do study on suture closure by actually viewing the stage of closure of suture of autopsy dead body, to see the actual fusion and its correlation with age and to compare with the documented present studies. Present study reveal that Ectocranial obliteration of the various segments of the three main sutures of the skull is so inconclusive that neither does it help in estimating the age of the deceased nor does it provide any supportive evidence in determining the age of skeletal remain. Age was determined on the basis of endocranial suture fusion. It was found that almost Complete closure of Sagittal suture occurs at the age of 61 to 65 yrs, almost Complete closure of coronal suture occurs at the age of 56 to 60 yrs, almost Complete closure of lambdoid suture occurs at the age of 66 to 70 yrs and almost Complete closure of Temporoparietal suture occurs at the age of 66 to 70 yrs. Keywords: Suture, Sagittal, Coronal, lambdoid, Temporoparietal
Introduction: etc. and even in new born cases when babies get Identification is recognition of an individual by interchanged. 1 Age estimation is an integral part of means of various physical features and biological the biological profile employed by forensic parameters, which are unique to each individual. anthropologists in order to assist in achieving an Question of identification arises in everyday identification of an unknown deceased individual. medicolegal practice both in civil cases like Its estimation is of paramount importance and marriage, inheritance, insurance and disputed sex requires special attention in cases where bodies are etc. and in criminal cases like assault, murder, rape found in decomposed, mutilated state or only
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fragmentary remains are discovered. Age noted that the period of union, for each suture, estimation can be done in several ways by varied across individuals but followed the general macroscopic examination of dental development pattern. 8 Pommerol identified the following and eruption, epiphyseal union of long bones, sequence : 1) individuals under 35 years of age had degeneration of pelvic articular surfaces, sternal rib open cranial sutures; 2) around 40 years, the ends, and cranial sutures, as well as microscopic sagittal suture begins to close; 3) around 50 years, examination of bone in histological analysis. 1 Since the coronal suture begins to close; and 4) by 65 the bone resists putrefaction and destruction by years or more, the temporal suture has finished animals, they can lead to the reliable determination closing. of age, sex, race, stature in decomposed bodies. The research by Todd and Lyon (1924, Cranial sutures are classified as fibrous joints, 1925a, 1925b, 1925c) was the first new attempt to meaning that they lack a synovial cavity and the estimate age using endo and ectocranial suture bones are held together firmly by fibrous closure since Pommerol, Ribbe, Frederic, Parsons connective tissue. The functions of sutures are (1) and Box, with the specific aim to create a precise to prevent separation of the bones when external numerical rating system for cranial closure. 9 In forces are applied (e.g., muscle function or trauma), 1981, Patil T.L. et al studied closure of cranial and (2) to allow some movement to occur between suture of vault of skull in 150 skulls for bones during rapid growth of the cephalic viscera. 2 macroscopic suture closure and observed that The use of cranial sutures for age estimation has sequence of closure is not constant; it proceeds always been a matter of considerable debate and its more quickly in endocranial sutures and reaches to reliability within the parameter has not been higher degree. 10 The study by Vyas P.C showed demonstrated conclusively by various researchers. that closure of sutures although not an appropriate Only handful of studies has been conducted in indictor of age, yet accuracy in age estimation in India and data on heterogeneous population of elderly persons can reasonably achieved if other Mumbai region is virtually non ‐existent. indicators of ageing process are taken into The method of determining age by cranial suture consideration .e.g. ‐graying of hair ,wrinkles, arcus closure has always been more generally used, but senalis , menopause and teeth. 11 because the cranium is frequently the best Sahni and colleagues (2005) investigated age preserved portion of the recovered skeleton. 3 assessment from cranial suture closure in a modern Cranial sutures generally fuse with increasing age, sample of individuals 538 male and 127 female although there is considerable variability in closure adults of known ages from Northwestern India. rates and patterns. 4 The idea that cranial bones fuse Sagittal,coronal, and lambdoid sutures were studied progressively with age has been in existence since at autopsy . Sutures were recorded only as “open” at least the 16th century. 5 Since the 16th century or “closed”. Sahni and coworkers found that this method of age assessment has been studied in obliteration begins earlier in males than in females, various populations with several methods begins earlier on the endocranial surface and that introduced to produce the most accurate results. 4 In commencement and obliteration is so erratic that it more recent decades, many studies discussing the is not useful for estimating age. 12 lack of accuracy and reliability of various methods In an effort to reduce the subjectivity and have been published. 3 6 7 In 1869, F. Pommerol quantify age estimations from cranial suture
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closure , Kirk (2007) utilized laser technology to complete coronal, sagittal suture & temporoparietal measure the amount of light reflected off of a suture. Lambdoid suture was studied in ‐situ. The suture joint. A general trend of decreasing calvarium was cleaned of soft tissues which made measurements with increasing age was the sutures more prominent. Photographs were observed. 11In 2009, Ullhas Shetty carried out study taken in all cases. The obliteration of the sutures on 100 cases brought to mortuary of Maulana Azad was ascertained endocranially as well as College, Delhi, for post-mortem. He concluded that ectocranially. The coronal suture was studied in ectocranial suture cannot be used for age three parts, sagittal suture in four parts, lambdoid estimation. Suture obliteration starts earlier on sutures in three parts and temporoparietal suture in endocranial suture than ectocranial, also suture one part. closure occurred earlier in males. Commencement Scale for closure: Acsadi ‐‐‐Nemeskeri complex and complete obliteration of segment or the entire method suture is so erratic that it is not amenable for 0 = open. There is still little space left between estimating the age. Metopism was observed in 3 % edges of adjoining bones. cases. 11 1 = incipient closure. Clearly visible as a The present study has been done on post-mortem continuous often zigzagging line. cases referred to mortuary of Department of 2 = closure in process. Line thinner, less zigzags, Forensic medicine of GGMC & Sir JJ interrupted by complete hospital,Mumbai which is a tertiary referral centre. Closure Very few studies have been conducted on cranial 3 = advanced closure. Only pits indicate where the suture closure of Mumbai region subjects. suture is located (almost complete closure) Material and Methods: 4 = closed. Even location cannot be recognised. The study was conducted on cases referred for Abbreviations: medico ‐legal post-mortem examination to the S1: Pars bregmatica (i.e first part) of Sagittal suture Mortuary of Department of Forensic medicine of S2: Pars verticis (i.e second part) of Sagittal suture GGMC & Sir JJ hospital, Mumbai which is a S3: Pars obelica(i.e third part) of Sagittal suture tertiary referral centre. Age was confirmed by S4: Pars lambdicia(i.e fourth part) of Sagittal documentary evidences like birth certificate, suture identification cards; ration card, Indoor papers etc. C1: Pars bregmatica(i.e first part) of Coronal Deceased with nutritional deficiency, skeletal suture malformation or deformity, Endocrinal disorders, C2: Pars complicate (i.e second part) of Coronal skeletal,cranial pathology or old healed fracture suture were excluded from study. For Post-mortem Study C3: Pars pterica (i.e third part) of Coronal suture 100 cases of males of age 25 and above were L1: Pars lambdicia(i.e first part) of Lambdoid studied. After reflecting the scalp, coronal, sagittal, suture lambdoid and temporoparietal sutures were studied L2: Pars intermedia (i.e second part) of Lambdoid by applying Acsadi ‐Nemeskeri scale suture ectocranially. 13 For endocranial suture same L3: Pars asterica (i.e third part) of Lambdoid suture scoring system was applied after removing the calvaria by craniotome taking due care to include
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Discussion: A correct estimation of age in elderly people is essential in legal, medical, social and administrative matters i.e. to fixing of age for regularization of employment, superannuation, pension settlements, and senior citizen benefits, 1 Retierments. According to J.B.Mukherjee ‘0’ stage of fusion in second part of Lambdoid estimation of age from suture closure of skull can suture (FM/223/12, 30yrs Male) be given in a range of 5-10 yrs in age of 30-60 yrs, Results: the range may even be more in higher age groups. 1 As endocranial suture fusion is stable, Also according to Reddy estimation of age from speedy,uniform and complete, it was taken into suture closure of skull can be given only in a range consideration for age estimation. Sagittal suture of decades. 14 In our study range has been given in starts fusing in between 25-30 yrs and almost range of 5yrs. Complete closure of Sagittal suture occurs at the The worker who has studied the autopsy specimen age of 61 to 65 yrs. Coronal suture starts fusing in for study of process of ossification and suture between 25-30 yrs and almost Complete closure of fusion like Krogman(1978), Rentoul & Smith coronal suture occurs at the age of 56 to 60 yrs. (1973) , T L Patil (1981) & Robert Shapiro (1960), Lambdoid suture starts fusing in between 25-30 yrs has concluded that the study of ectocranial fusion is and almost Complete closure of lambdoid suture less significant than endocranial fusion because occurs at the age of 66 to 70 yrs. suture along the outer table are more or less serrated while at inner table they are comparatively straight, whereas the process is speedy and more uniform and complete in the endocranial surface. 9 15 10 16 From the present study (Tables A1-A4) it is clearly evident that endocranial union is a far better parameter for age determination than is the ‘3’ stage of fusion in first part of coronal suture. ecotocranial union as also has been established by (FM/639/11, 64yrs Male) Todd & Lyon (1924 & 1925), Dwight.
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Table A1: Sagittal Suture
S1 S2 S3 S4
Ectocranially 61-65 61-65 61-65 46-50 (Age group in yrs) Endocranially 61-65 46-50 41-45 26-30 (Age group in yrs)
In our present study we found that the sagittal reported by Ulhas shetty (2006) ( sagittal suture suture, endocranially, starts fusing at the end of 26 closure at the age of 60-69 years) while it is in yrs and completion is perfected at the age of 61 ‐65 contrast to the observation reported by Pommerol yrs in Ist part of sagittal suture, 46-50 yrs in IInd (1869), and Topinard (1885), who indicated part of sagittal suture, 41-45 yrs in IIIrd part of endocranial commencement of sagittal suture at a sagittal suture and 26-30 yrs in IVth part of sagittal much later age at about 40 years. These latter suture. (Table A1) This observation conforms with that workers have reported on very few specimens so it reported by Todd & Lyon (1924) and with that can’t be considered as authentic. 8, 11
‘2’ stage of fusion in second part of sagittal suture (FM/69/12, 39 yrs Male)
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Table A2: Coronal suture
C1 C2 C3
Ectocranially 61-65 >70 >70 (Age group in yrs) Endocranially 56-60 51-55 36-40 (Age group in yrs)
In our present study we found that endocranial (2000) reported endocranial closure between 46-50 fusion of coronal suture was observed as early as for males & 56-60 for females . Table A5 As per 25 ‐30 years and completion by the age of 56- Schmidt & Modi complete closure occurs in 60years in Ist part of coronal suture, 51-55yrs in between 40-60 yrs while as per krishan vij lower IInd part of coronal suture & 36-40yrs in IIIrd part half closes first in between 40-50 yrs followed by of coronal suture. (Table A2) Workers like Pommerol upper half which closes in between 50-60yrs. TableA5, (1869), Topinard (1885), Ribbe (1885) reported 17, 18 According to Ramachandran lower half closes closure between 40 ‐50 years. 11 Their study does not first in between 40-60 yrs followed by upper half 19 indicate whether it was ectocranial or endocranial which closes in between 50-60yrs. or it was commencement or termination. Moondra
‘3’ stage of fusion in Ist part of coronal suture & ‘4’ stage of fusion in Ist part of Saggital suture (FM/242/11, 54yrs Male)
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Table A3: Lambdoid suture
L1 L2 L3
Ectocranially 51-55 61-65 61-65 (Age group in yrs) Endocranially 41-45 51-55 66-70 (Age group in yrs)
In our present Study Lambdoid suture occurs in between 50-70 yrs. 17 20 As per Moondra endocranially, starts fusing at the age of 25 ‐30 yrs endocranial closure occurs above 60 yrs both for in the present context which shows that it is a year male and females . Table A5 According to earlier than that reported by Todd and Lyon (1924), J.B.Mukherjee lambdoid suture closes at the age while completion in our study is 66-70yrs in Ist group of 45-55yrs. 1 part of lambdoid suture, 56-60yrs in IInd part of According to P.C. Vyas lambdoid suture closes at lambdoid suture & 41-45yrs in IIIrd part of the age group of 60yrs. 11The other workers have lambdoid suture,(Table A3) which corroborates with not reported on lambdoid suture Modi & parikh according to whom complete cloure
‘1’ stage of fusion in First part of Lambdoid suture (FM/28/12, 51yrs Male)
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Table A4: Temporoparietal suture
Ectocranialy >70 (Age group in yrs) Endocranially 66-70 (Age group in yrs)
In our present study we have found that suture closes at and after 70 yrs which positively Temporoparietal suture, endocranially, starts fusing corroborates with our present study. 21 As per at the end of 56 ‐60 years and almost complete Reddy (2010) Temporoparietal suture closes at the closure is perfected at the age of 66-70 years. .(Table age of 80 yrs. 1 A4) As per Apurba Nandy (1995) Temporoparietal
‘1’ stage of fusion in Ectocranial part of Temporoparietal suture (FM/660/11,46yrs Male)
Todd and Lyon, Hrdlicka’s and Reddy have shown Some workers including Singer & Mckern and that skull sutures closed earlier on the endocranial Stewart have stated unequivocally that suture surface than the ectocranial. 8 22 14 In our present closure is unreliable as a guide to the age of a study we also found that endocranial surface skull. 6 11 Present studies reveal that obliteration of closure occurs earlier than the ectocranial except in the various segments of the three main sutures of few sutures like third part of lambdoid suture the skull is so inconclusive that neither does it help endocrinally. However in these sutures sample size in estimating the age of the deceased nor does it was very small to draw conclusion. provide any supportive evidence in determining the age of skeletal remain.
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Table A5: Sr Author/Worker Sagittal Coronal lambdoid Temporo no parietal
1 Todd and Lyon(1924) 20 ‐29 26 ‐50 26 ‐31 20 ‐32 23 ‐25 23 ‐31 2 Ribbe’s (1885) Closure 21 ‐50 years frequent between 44 ‐45 years Ectocranially sagittal closes first then lambdoid, coronal suture
3 Schmidt (1988) Closure between 25 ‐40 and completed 40 ‐60 years
4 Modi’s(1988) 30 ‐50 40 ‐60 50 ‐70 5 Reddy(2010)(2) Post 1/3:30-40 Lower 45 80 Ant 1/3:40-50 half:40-50 Mid 1/3:50-60 Upper half:50- 60 6 Parikh(1990)(35) 30 ‐50 40 ‐60 50 ‐70
7 Apurba Nandy (1995)(33) 25 ‐45 25 ‐45 27 ‐50 >70 8 Robert Shapiro and Janzen 22 ‐35 24 ‐38 26 ‐42 (1960)
10 Vyas P. C. (34) 50 ‐55 45 ‐60 60 50-55 50 ‐60 60 11 Moondra A. ECTO M 46 ‐50 46 ‐50 56 ‐60
K.(32) F 46-50 56 ‐60 56-60
ENDO M 51 ‐55 51 ‐55 Above 60
F 40 ‐60 56 ‐60 Above 60
12 Krishan Vij Post 1/3: Lower 55 30-40 half:40-50 Ant 1/3:40-50 Upper half : Mid 1/3 : 50-60 50-60 13 J.B Mukherji 35-40 40-45 45-55 14 R.K Gorea _ 45-50 45-50
15 Ramachandran (2003) _ Lower _ half:40-60 Upper half:50-
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60
16 Rajesh verma _ M : 42-52 _ F: 42-56 17 Ullhas shetty (2007) ECTO >70 Lapsed union >70
60 ‐69 40 ‐49 40 49 ENDO
Conclusion: Almost complete Lambdoid suture closure Present study done on 100 cases of post-mortem to occurs first in L1 then L2 and finally L3. know actual status of suture closure which were 3) Our present study findings are almost referred for Post-mortem in government hospital. similar to studies done by other authors 1) In present study sutures were studied in like Modi,Parikh, Moondra, Mukherjee, P different stages of sutures i.e. 0, 1, 2, 3 & C vyas , Krishan vij etc. This can be 4 based on advancement of sutures. For considered as reference study for people comparison of results of present study less of Mumbai region for determination of data of previous studies was available. age. 2) In present study suture are divided into 4) Suture obliteration occurs earlier on subparts i.e. sagittal suture in four parts, endocranial surface. Coronal & Lambdoid suture into three 5) Based on endocranial suture fusion, parts each to determine age. Almost Coronal suture was first to close followed by complete Sagittal suture closure occurs Sagittal suture, first in S4 then S3, S2 and finally S1. lambdoid suture sequentially. Almost complete coronal suture closure 6) Present study was done on small sample occurs first in C3 then C2 and finally C1. size. So if done on large sample more correct conclusions can be given.
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