Several gain-of-function mutant mouse models, mimicking human craniosynostoses, have been generated to study the mechanism of FGFR2 for regulating the suture development.
Shh may increase mesenchymal proliferation via promotion of Msx2, and similarities are present between the Shh, Msx2, and BMP expression during neonatal craniofacial suture development.
TP sutures develop as overlapping sutures, similar to cranial coronal sutures, and expression of Tgf-βs in TP sutures was similar to their distribution in cranial coronal sutures.
In four of six patients, there was documented manipulation of a suture before the development of endophthalmitis.
This unique expression profile may help explain the earlier occurrence of metopic suture fusion during development.
Only adult specimens were used in this study, as defined by the eruption of all permanent teeth (often showing some wear), the complete ossification of the basiosphenoid suture, and the development of the sagittal crest.
There are reports describing gene expression profiles of human cranial sutures in normal development and in abnormal medical conditions such as premature bony suture fusion in craniosynostosis, but limited information about how suture cell functions are regulated and the molecular consequences of genetic mutations on them [ 20, 27, 28].
In four patients, there was documented manipulation of a suture shortly before the development of endophthalmitis, including removal of a loose or exposed suture (two patients), a broken running suture (one patient), or manipulation of a loose running suture (one patient).
The identity of FGFs expressed during early craniofacial morphogenesis and palatal formation have been extensively characterized (Britto et al., 2002; Bachler and Neubüser, 2001; Welsh et al., 2007), but the complement of FGFs expressed in the facial sutures during late embryological development is undefined.
The authors identified loose or degraded sutures in all three cases as the principal source for the development of a suture infection and subsequent endophthalmitis.
Clinical Relevance: Although development of new suture materials has increased their failure strength, further advancements in suture material design should focus on decreasing soft-tissue abrasion properties and increasing strength to suture failure when cycled through bone.
