Persistent open anterior fontanelle in a healthy 32-month-old boy.

Nova Southeastern University College of Osteopathic Medicine, Ft. Lauderdale, Florida 33328, USA.
The Journal of the American Osteopathic Association 10/2002; 102(9):500-1.
Source: PubMed

ABSTRACT Delayed closure of the anterior fontanelle is often associated with significant disease entities. Range of normal closure of the anterior fontanelle is 4 to 26 months. Increased intracranial pressure, hypothyroidism, and skeletal anomalies are common etiologic factors. History, physical examination, and diagnostic testing rule out most disorders. Once these disorders have been ruled out, it is important for the physician to realize that a persistent open anterior fontanelle beyond the accepted ranges of closure can be a normal outlier.

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    ABSTRACT: We report a child with osteopetrosis, oxycephaly and Chiari type I malformation who presented with raised intracranial pressure. During cranial expansion surgery the patient developed sudden cardiac arrest which we believe was probably related to the Chiari malformation. The case highlights a previously unrecognized association between osteopetrosis, craniosynostosis and a persistently open fontanelle at age 4 years. In addition it supports the existing literature in emphasizing the need for careful preoperative work up, choice of approach and operative technique in children with complex craniosynostosis and Chiari malformation.
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    ABSTRACT: Resumen Objetivo. Describir la anatomía de las fontanelas y actualizar las aplicaciones del conocimiento de las mismas. Métodos. Se utilizaron 7 preparados cadavéricos de cabezas fetales, 2 cráneos secos y 2 huesos frontales, se analizaron 48 fontanelas anteriores de pacientes pediátricos con y sin patología asociada, así como también casos quirúrgicos y neuroecografías. Dichas estructuras fueron sometidas a mediciones y posterior análisis. Resultado. Se evidenció las medidas, estructura y límites de las fontanelas en las cabezas y cráneos fetales, así como la evaluación de pacientes pediátricos y las medidas de las fontanelas en diferentes patologías. Conclusión. Debido a sus características anatómicas, las fontanelas son una verdadera ventana al endocráneo, lo que determina sus múltiples aplicaciones clínico-quirúrgicas.
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