Anatomy, Head and Neck, Coronal Suture


Article Author:
William Russell


Article Editor:
Mark Russell


Editors In Chief:
David Wood
Andrew Wilt
Mary Cataletto


Managing Editors:
Avais Raja
Orawan Chaigasame
Carrie Smith
Abdul Waheed
Khalid Alsayouri
Trevor Nezwek
Radia Jamil
Patrick Le
Anoosh Zafar Gondal
Saad Nazir
William Gossman
Hassam Zulfiqar
Hussain Sajjad
Steve Bhimji
Muhammad Hashmi
John Shell
Matthew Varacallo
Heba Mahdy
Ahmad Malik
Sarosh Vaqar
Mark Pellegrini
James Hughes
Beata Beatty
Beenish Sohail
Nazia Sadiq
Hajira Basit
Phillip Hynes


Updated:
2/6/2019 10:28:04 AM

Introduction

Cranial sutures are syndesmosis between the cranial bones. A syndesmosis is a fibrous joint between two bones. The coronal suture is oblique in direction and extends between the frontal and the parietal bones. The term is derived from the Latin word "corona" and from the Ancient Greek word "korone," both translating to “garland” or “crown,” referring to the anatomical location where a crown would be placed. It is one of the four major sutures of the skull alongside the metopic (also known as a frontal suture), sagittal, and lambdoid sutures.

The coronal suture extends cephalad (toward the apex of the skull) and meets the sagittal suture. This point is called the "bregma" and indicates the position of the anterior fontanel.

The coronal suture extends caudal (toward the base of skull) to the pterion. The pterion is the area where four bones, the parietal, frontal bones, the greater wing of the sphenoid bone, and the squamous part of the temporal approach each other. Several minor sutures such as the sphenoparietal suture, sphenosquamous suture, sphenofrontal suture are at the pterion. The pterion is deemed the skull's weakest part.[1]

Structure and Function

The coronal suture is a dense and fibrous association of connection tissue located in between the frontal and parietal bones of the skull. At birth, the sutures decrease in size (molding) and allow the skull to become smaller. In children, the suture enables the skull to expand with the rapidly growing brain. The suture will close and fuse around age 24.

The coronal suture is one of the three sutures whose juncture forms the anterior fontanelle. This fontanelle originates at the intersection of the frontal suture, the coronal suture, and the sagittal suture. This fontanelle is open at birth and generally fuses around 18 to 24 months after birth.

Embryology

The coronal suture is derived from paraxial mesoderm, as is the sclerotome, myotome, syndotome, dermatome, and endothelial cells.

Blood Supply and Lymphatics

Due to the fibrous-like nature of the tissue, the coronal suture lacks significant blood supply, deriving its needs from microvasculature in surrounding tissues. However, the coronal suture protects an important blood supply to other tissues: the middle meningeal artery. While there is minor anatomical variation, the anterior division of the middle meningeal artery crosses the squamous suture as it intersects the coronal suture at the pterion. Trauma to this location is worrisome for an injury to the middle meningeal artery or one of its branches, which can secondarily result in an epidural hematoma.

Muscles

The coronal suture does not serve as a marker for any specific muscle groups; however, it is overlaid laterally by the temporalis muscle and superiorly by the epicranial aponeurotica.

Physiologic Variants

Wormian bones are accessory bones within a suture, most commonly in the posteriorly positioned sutures. They are considered normal variants, but the presence of multiple wormian bones may indicate an underlying pathologic process.

Surgical Considerations

Craniosynostosis is a condition where the sutures prematurely close. When the coronal suture closes prematurely, the condition is known as anterior plagiocephaly. When the lambdoidal suture closes prematurely, the condition is called posterior plagiocephaly. This term arises from the ancient Greek word “plagios,” meaning oblique or slanting. The premature closure of the sutures may occur unilaterally or bilaterally. Premature fusion of one of the coronal sutures may cause the skull to flatten on the affected side. This may lead to deviation of the superior orbital rim on the affected side. Radiographs of the skull may reveal the “harlequin eye deformity.”[2] This description is based on the eyes having exaggerated superior orbital margins. When both sides are prematurely closed, the head will develop a short and widen appearance. Craniosynostosis can cause problems with brain growth and head shape. Specific treatment will be determined by the child’s physician; however, surgery is often the recommended treatment.[3] This premature closure of the coronal or lambdoidal suture must be differentiated from positional plagiocephaly that results from external forces such as laying in one position for too long.[4] This type of plagiocephaly does not possess underlying suture dysfunction.[4]

Clinical Significance

The anterior fontanelle is found at the intersection of the sagittal, coronal, and frontal suture. It is the largest fontanelle of the skull, rhomboid-shaped, and measures approximately 4 cm anterior-posterior and 2.5 cm transverse. The anterior fontanelle closes between 12 and 18 months. The median age of closure is 13.8 months. The anterior fontanelle can provide clinical information, such as a sunken anterior fontanelle indicating dehydration. Bulging anterior fontanelle may indicate increased intracranial pressure or meningitis. Anterior fontanelle closure delay is seen in several conditions, most notably achondroplasia, Down syndrome, and congenital hypothyroidism.

The average age of coronal suture closure is 24 years; however, numerous diseases and factors may cause the dysfunction of a suture. The most common dysfunction is early closure or abnormal closure of a suture or group of sutures of the skull. Premature ossification of the sutures is referred to as craniosynostosis. Several types of craniosynostosis can develop, depending on which suture or combination of sutures have fused.

Other Issues

Trauma to the coronal suture may present in a variety of manners, from lateral blows to the head to falls and superior impacts. Trauma to the region of the coronal suture and pterion is of great concern as both displaced cranial fractures and non-displaced fractures may result in an injury to the middle meningeal artery or one of its branches. [5][6][7]

The anterior division of the middle meningeal arch crosses or runs parallel to the coronal suture rising above the pterion. Trauma to this location is concerning for a life-threatening epidural hematoma, a bleed located between the dura mater (outer membrane covering the brain) and the inner table of the skull. An epidural hematoma may present with a “lucid interval,” during which the patient may display minimal symptoms. Diagnosis is typically made with a head CT or brain MRI. Imaging will most often reveal a convex hematoma along the inner table of the skull. The convex shape of the epidural hematoma is formed by the pressure required to strip the dura mater from the inner table of the skull. This type of hematoma often requires neurosurgical consultation and intervention due to the arterial etiology.


Interested in Participating?

We are looking for contributors to author, edit, and peer review our vast library of review articles and multiple choice questions. In as little as 2-3 hours you can make a significant contribution to your specialty. In return for a small amount of your time, you will receive free access to all content and you will be published as an author or editor in eBooks, apps, online CME/CE activities, and an online Learning Management System for students, teachers, and program directors that allows access to review materials in over 500 specialties.

Improve Content - Become an Author or Editor

This is an academic project designed to provide inexpensive peer-reviewed Apps, eBooks, and very soon an online CME/CE system to help students identify weaknesses and improve knowledge. We would like you to consider being an author or editor. Please click here to learn more. Thank you for you for your interest, the StatPearls Publishing Editorial Team.

Anatomy, Head and Neck, Coronal Suture - Questions

Take a quiz of the questions on this article.

Take Quiz
Which bones are separated by the coronal suture?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
The point of junction of the sagittal and coronal sutures is called the:



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
The junction between which of the following pairs of bones forms the coronal suture?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
The anterior fontanelle is the intersection of which of the following sutures?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
What are wormian bones?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
Why is trauma to the area of the coronal suture and pterion of great clinical concern?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
Which of the following is false concerning plagiocephaly?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up

Anatomy, Head and Neck, Coronal Suture - References

References

Anderson BW,Al Kharazi KA, Anatomy, Head, Bones, Skull null. 2018 Jan     [PubMed]
Ballardini E,Sisti M,Basaglia N,Benedetto M,Baldan A,Borgna-Pignatti C,Garani G, Prevalence and characteristics of positional plagiocephaly in healthy full-term infants at 8-12 weeks of life. European journal of pediatrics. 2018 Jul 20     [PubMed]
Runyan CM,Xu W,Alperovich M,Massie JP,Paek G,Cohen BA,Staffenberg DA,Flores RL,Taylor JA, Minor Suture Fusion in Syndromic Craniosynostosis. Plastic and reconstructive surgery. 2017 Sep     [PubMed]
Schweitzer T,Kunz F,Meyer-Marcotty P,Müller-Richter UD,Böhm H,Wirth C,Ernestus RI,Linz C, Diagnostic features of prematurely fused cranial sutures on plain skull X-rays. Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery. 2015 Nov     [PubMed]
Bennett KG,Hespe GE,Vercler CJ,Buchman SR, Short- and Long-Term Outcomes by Procedure Type for Nonsagittal Single-Suture Craniosynostosis. The Journal of craniofacial surgery. 2019 Jan 10;     [PubMed]
Hassanpour SE,Abbasnezhad M,Alizadeh Otaghvar H,Tizmaghz A, Surgical Correction of Unicoronal Craniosynostosis with Frontal Bone Symmetrization and Staggered Osteotomies. Plastic surgery international. 2018;     [PubMed]
Yang T, Traumatic nondisplaced coronal suture fracture causing delayed intracranial hemorrhage in a pediatric patient. Journal of neurosurgery. Pediatrics. 2017 Jul;     [PubMed]

Disclaimer

The intent of StatPearls is to provide practice questions and explanations to assist you in identifying and resolving knowledge deficits. These questions and explanations are not intended to be a source of the knowledge base of all of medicine, nor is it intended to be a board or certification review of Pediatric. The authors or editors do not warrant the information is complete or accurate. The reader is encouraged to verify each answer and explanation in several references. All drug indications and dosages should be verified before administration.

StatPearls offers the most comprehensive database of free multiple-choice questions with explanations and short review chapters ever developed. This system helps physicians, medical students, dentists, nurses, pharmacists, and allied health professionals identify education deficits and learn new concepts. StatPearls is not a board or certification review system for Pediatric, it is a learning system that you can use to help improve your knowledge base of medicine for life-long learning. StatPearls will help you identify your weaknesses so that when you are ready to study for a board or certification exam in Pediatric, you will already be prepared.

Our content is updated continuously through a multi-step peer review process that will help you be prepared and review for a thorough knowledge of Pediatric. When it is time for the Pediatric board and certification exam, you will already be ready. Besides online study quizzes, we also publish our peer-reviewed content in eBooks and mobile Apps. We also offer inexpensive CME/CE, so our content can be used to attain education credits while you study Pediatric.