An enquiring journey!

It is now at least 25 years since I have habitually palpated the cranial fontanelles and sutures of the skull, while examining children. The fontanelles after closure are not palpable normally. The sutures are also not normally palpable except for a faint trace of them if one were to palpate over their location intently. 

The palpable Metopic, Lamdoidal, Coronal or Sagtittal sutures in children led me to search for a cause for the premature closure of these sutures in children. About eighty percent of the developmentally challenged children had one or more of these sutures closed prematurely! That needed an explanation. 

It was this which led me to look into the level of vitamin D and to my surprise a similar percent of children had low levels of vitamin D. The others had reduced growth velocity of had size.

Since documenting this with a desire to find an association between low levels of vitamin D and premature closure of cranial sutures, I feel we are nearing a direction for seeking for further clarity. 

Since supplementing with vitamin D, whether these sutures become less prominent is a worthwhile question. As bony union is less likely to have occurred, the fibrous union might get undone over a period of time if we can maintain the vitamin D levels in the serum. This hypothesis needs authentic evidence. I feel inclined to keep it as an active question for enquiry! 

The fact that the X-ray of the skull showed the sutural line even when the sutures were palpable might mean that the bony union had not taken place. So the hypothesis before me is that the palpable sutures might only suggest in most situations, reversible fibrous sutural closure  and not Craniosynostosis. The few 3D CT scan of the skull done made this even more clear. 

I have had some other questions similar to this keeping me inquisitive during my forty years of practicing of Developmental Neurology. More of these questions surfaced in the recent 25 years. 

Every day I go to work, I look forward to exercising my clinical skills and feeling my way through some questions that remain alive in my mind!

M.C.Mathew(text and photo)