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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
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,
1
Pommerol
identified
the
following
examination of bone in histological analysis. 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
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.
preserved portion of the recovered skeleton.
4
rates and patterns. 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”
5
at least the 16th century. 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
begins earlier on the endocranial surface and that
populations
with
several
methods
4
introduced to produce the most accurate results. 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
have been published.
3 6 7
In 1869, F. Pommerol
In an effort to reduce the subjectivity and
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
was
the sutures more prominent. Photographs were
observed. In 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
College, Delhi, for post-mortem. He concluded that
ectocranially. The coronal suture was studied in
ectocranial suture cannot
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.
with
increasing
age
11
cases.
be used for
11
ascertained
endocranially
as
well
as
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
interrupted by complete
medicine
of
GGMC
&
Sir
JJ
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
suture
certificate,
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
scale
suture
same
L3: Pars asterica (i.e third part) of Lambdoid suture
applying
ectocranially.
13
Acsadi‐Nemeskeri
For
endocranial
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,
Retierments.1
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
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
suture along the outer table are more or less
at
the
suture
age
fusion
of
66
is
to
70
yrs.
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.
(FM/639/11, 64yrs Male)
ecotocranial union as also has been established by
Todd & Lyon (1924 & 1925), Dwight.
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Table A1:
Sagittal Suture
Ectocranially
S1
S2
S3
S4
61-65
61-65
61-65
46-50
61-65
46-50
41-45
26-30
(Age group in
yrs)
Endocranially
(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
reported by Todd & Lyon (1924) and with that
workers have reported on very few specimens so it
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
Ectocranially
C1
C2
C3
61-65
>70
>70
56-60
51-55
36-40
(Age group in yrs)
Endocranially
(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
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
closure between 40‐50 years.11 Their study does not
first in between 40-60 yrs followed by upper half
indicate whether it was ectocranial or endocranial
which closes in between 50-60yrs.19
A5
As per
According to Ramachandran lower half closes
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
Ectocranially
L1
L2
L3
51-55
61-65
61-65
41-45
51-55
66-70
(Age group in yrs)
Endocranially
(Age group in yrs)
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
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.11 The other workers have
lambdoid suture,(Table
not reported on lambdoid suture
In our
present
Study
A3)
which corroborates with
.
Table
A5
According to
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. .
A4)
(Table
age of 80 yrs. 1
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
no
1
2
Temporo
parietal
Todd and Lyon(1924)
Ribbe’s (1885)
20‐29
26‐50
26‐31
20‐32
23‐25
23‐31
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
Ant 1/3:40-50
half:40-50
Mid 1/3:50-60
Upper half:50-
80
60
6
Parikh(1990)(35)
30‐50
40‐60
50‐70
7
Apurba Nandy (1995)(33)
25‐45
25‐45
27‐50
8
Robert Shapiro and Janzen
22‐35
24‐38
26‐42
50‐55
45‐60
60
50-55
50‐60
60
>70
(1960)
10
11
Vyas P. C. (34)
Moondra A.
ECTO
K.(32)
ENDO
12
Krishan Vij
M
46‐50
46‐50
56‐60
F
46-50
56‐60
56-60
M
51‐55
51‐55
Above 60
F
40‐60
56‐60
Above 60
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
ENDO
>70
Lapsed union
>70
60‐69
40‐49
40 49
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
similar to studies done by other authors
referred for Post-mortem in government hospital.
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)
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.
Based on endocranial suture fusion,
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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