Metopism and persistence of wormian bone in advanced age. A case report
Keywords:
Skull; Cranial Fractures; Suture; Tomography.Abstract
Introduction: metopism is a rare condition characterized by the persistence of the complete metopic suture in advanced age. The wormian bone is an uncommon bone that appears between two cranial sutures; both are not usually associated with any pathology, so they do not pose a health problem. Objective: To present the case of an elderly man with metopism and persistent wormian bone. Case presentation: We report a 55-year-old patient presenting with headache associated with elevated blood pressure, dizziness, gait instability, dysarthric speech, and diplopia for the past 5 days. A physical examination revealed palpebral ptosis. A computed tomography scan revealed no imaging abnormalities, but the presence of a wormian bone and a persistent metopic suture unrelated to the patient's symptoms was detected. The patient was referred to the neurology department, where he was diagnosed with metabolic neuropathy and directed toward treatment with vitamin therapy and metabolic control. Currently, only the palpebral ptosis persists. Conclusion: In this case, correctly differentiating the sutures, both the metopic and the wormian bone, from fractures was decisive in the diagnosis, which rebound the importance of understanding their differences for an accurate diagnosis.
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1. Sharma S, Krishna H, Dixit SG, Ghatak S. Metopism and Its Clinical Relevance: A Persistent Suture. Ann Afr Med[Internet]. 2025 [citado 04 Sep 2025];24(1):19–21. Disponible en: https://journals.lww.com/aoam/fulltext/2025/01000/metopism_and_its_clinical_relevance__a_persistent.4.aspx
2. Fajardo Quesada AJ, Brizuela Fernández Y. Metopismo y persistencia de hueso wormiano en edades avanzadas. Reporte de un caso [Internet]. En: V Jornada Científica Provincial en Imagenología. Holguín: Hospital Clínico Quirúrgico ¨Lucía Iñiguez Landín¨. Capítulo de la Sociedad Cubana de Imagenología. Universidad de Ciencias Médicas de Holguín. Consejo Provincial de Sociedades Científicas; 2022 [citado 04 Sep 2025]. Disponible en: https://imagenologiaholguin2022.sld.cu/index.php/imagenologiaholguin/2022/paper/viewPaper/131
3. Kundlikrao Tale A, Bhopalwala Ali F, Kundilkrao Tale S, Gupta J, Shravanrao Fupare S. A Morphological Cross-Sectional Study of Metopic Suture in Human Adult Cadaveric Skulls. J Evid Based Med Healthc [Internet]. 2021 [citado 04 Sep 2025];8(8):405-9. Disponible en: https://www.jebmh.com/articles/a-morphological-crosssectional-study-ofmetopic-suture-in-human-adult-cadaveric-skulls.pdf.pdf
4. López Lima LL, Mora de Oliveira R, Silva Santos AH, Gomes Freires ME, Monteiro Simião J, Carvalho Neto AJ, et al. Incidência do metopismo em crânios secos de adultos da coleção osteológica da Faculdade de Medicina da FAP-Araripina (PE). Stud Health Sci [Internet]. 2023 [citado 04 Sep 2025];4(2):443-53. Disponible en: https://ojs.studiespublicacoes.com.br/ojs/index.php/shs/article/view/1104/967
5. Aslıer NGY, Zeybek G, Karabay N, Keskinoğlu P, Kiray A, Sütay S, et al. The Relationships Between Craniofacial Structure and Frontal Sinus Morphology: Evaluation With Conventional Anthropometry and CT-Based Volumetry. Ear Nose Throat J [Internet]. 2020 [citado 04 Sep 2025];99(10):637-47. Disponible en: https://journals.sagepub.com/doi/epub/10.1177/0145561319876927
6. Barbosa da Luz de Santana M, Diniz de Carvalho MV, Buarque Rodrigues NG, Araújo Pereira E, Nogueira da Fonte Cornélio AM, Porto Petraki GG, et al. Persistência da sutura metópica em crânios secos adultos do Nordeste brasileiro: análise antropológica forense. Rev. cir. traumatol. buco-maxilo-fac [Internet]. 2023 [citado 04 Sep 2025];23(1):6-11. Disponible en: hhttps://www.revistacirurgiabmf.com/2023/01/Artigos/02ArtOriginalPersistenciadasuturametopicaemcranios.pdf
7. Grine FE, Greening VA, Hernandez E, Billings BK, Mngomezulu V, Mongle CS. Metopism in adult South Africans and its relationship to frontal sinus size. Anat Rec [Internet]. 2024 [citado 04 Sep 2025];307(6):2018-35. Disponible en: https://anatomypubs.onlinelibrary.wiley.com/doi/epdf/10.1002/ar.25350
8. Mamani Rodríguez CE, Soler Murillo CA, De Sampaio Ricardo ME, Arias Suárez F, Paredes Jarro MA, Valdez Carlomagno PR. Hallazgo incidental de hueso interparietal wormiano en un caso de fractura múltiple de cráneo. Rev. Investig. Dep. Cienc. Salud [Internet]. 2022 [citado 04 Sep 2025]:1(1):18-23. Disponible en: https://repositoriocyt.unlam.edu.ar/bitstream/123456789/1247/1/ReDSal%201-1-3.pdf
9. Shrestha A, Khan GA. Morphometric Study on Wormian Bone of Dry Adult Skull of Nepalese Population. Kathmandu Univ Med J [Internet]. 2023 [citado 04 Sep 2025];21(4):371-5. Disponible en: http://www.kumj.com.np/issue/84/372-375.pdf
10. Natsis K, Piagkou M, Lazaridis N, Anastasopoulos N, Nousios G, Piagkos G, et al. Incidence, number and topography of Wormian bones in Greek adult dry skulls. Folia Morphol (Warsz) [Internet]. 2019 [citado 04 Sep 2025];78(2):359-70. Disponible en: https://journals.viamedica.pl/folia_morphologica/article/view/FM.a2018.0078/45249
11. Sabu R, I'Ons B, Mangham DC. Skull fractures or accessory sutures: A case report. J Forensic Leg Med [Internet]. 2025 [citado 04 Sep 2025];111:102835-44. Disponible en: https://www.sciencedirect.com/science/article/abs/pii/S1752928X25000368
12. Newcombe N, Richter S, Whitehouse DP, Bloom BM, Lecky F. Fluid biomarkers and neuroimaging in mild traumatic brain injury: current uses and potential future directions for clinical use in emergency medicine. Emergency Medicine Jornal [Internet]. 2023 [citado 04 Sep 2025];40(9):214-25. Disponible en: https://emj.bmj.com/content/40/9/671
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Copyright (c) 2025 Pedro Miguel Alonso Batista; Annier Jesús Fajardo Quesada; Yudier Brizuela Fernández
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