title: A new anatomic trait for identifying the mendosal suture in young children: the mendosal-lambdoidal angle.
abstract: OBJECTIVE
  Radiologic diagnosis of skull fractures in young children is difficult due to numerous accessory sutures. This is especially true around the occipital bone because it has more than one ossification center. Normal anatomic variants, such as the mendosal suture, may be misinterpreted as a skull fracture. We investigated the anatomic traits of the mendosal suture in young children.
  
  
  METHODS
  We retrospectively evaluated 52 children, aged between 1 month and 4 years, who had undergone head computed tomography with three-dimensional reconstructions. We evaluated the presence or absence of the mendosal suture. If present, then we measured the length of the suture and the angle between the lambdoidal and mendosal suture lines.
  
  
  RESULTS
  The presence of the mendosal suture was bilateral in 12 children and unilateral in 5 children. The mendosal suture had a mean length of 13.9 ± 3.4 mm on the right side and 11.2 ± 4 mm on the left side. The angle between the mendosal and lambdoidal sutures had a mean value of 54.2° ± 11° for the right side and 53.6° ± 13.9° for the left side. The 95 % confidence interval for the mean value of the angle had a lower and upper bounds of 48° and 60° on the right side and 46° and 61° on the left side, respectively.
  
  
  CONCLUSIONS
  The angle between mendosal and lambdoidal suture lines may help radiologists to identify the mendosal suture.
authors.affiliation: Department of Anatomy, Istanbul Faculty of Medicine, Istanbul University, Millet Caddesi, 34093, Fatih, Istanbul, Turkey. iagurses@gmail.com.
authors.forename: Ilke Ali
authors.initials: IA
authors.lastname: Gurses
authors.affiliation: Department of Radiology, Cerrahpasa Faculty of Medicine, Istanbul University, Kocamustafapasa Caddesi, No: 53, 34098, Fatih, Istanbul, Turkey.
authors.forename: Asim
authors.initials: A
authors.lastname: Esenkaya
authors.affiliation: Department of Anatomy, Istanbul Faculty of Medicine, Istanbul University, Millet Caddesi, 34093, Fatih, Istanbul, Turkey.
authors.forename: Ozcan
authors.initials: O
authors.lastname: Gayretli
authors.affiliation: Department of Anatomy, Istanbul Faculty of Medicine, Istanbul University, Millet Caddesi, 34093, Fatih, Istanbul, Turkey.
authors.forename: Aysin
authors.initials: A
authors.lastname: Kale
authors.affiliation: Department of Anatomy, Istanbul Faculty of Medicine, Istanbul University, Millet Caddesi, 34093, Fatih, Istanbul, Turkey.
authors.forename: Adnan
authors.initials: A
authors.lastname: Ozturk
authors.affiliation: Division of Pediatric Radiology, Department of Radiology and Radiologic Science, Johns Hopkins Hospital, Baltimore, MD, 21202, USA.
authors.forename: Aylin
authors.initials: A
authors.lastname: Tekes
mesh_terms: D063405:Anatomic Variation; D002675:Child, Preschool; D003393:Cranial Sutures / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D007223:Infant; D008297:Male; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed
keywords: 3D head CT; Fracture; Mendosal suture; Occipital bone