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The superior view of the cranium shows the frontal and paired parietal bones.
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The cranium (skull) is the skeletal structure of the head that supports the face and protects the brain. It is subdivided into the facial bones and the brain case, or cranial vault. The facial bones underlie the facial structures, form the nasal cavity, enclose the eyeballs, and support the teeth of the upper and lower jaws.
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Wormian bones: expanded differential diagnosis and implications for abnormal head shape in infancy.

Noah E Alter1, James L Rogers2, Marcelina Puc3

  • 1Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.

Child'S Nervous System : Chns : Official Journal of the International Society for Pediatric Neurosurgery
|January 3, 2026
PubMed
Summary

Wormian bones (WB), or accessory ossicles, are uncommon in children but can indicate underlying skeletal conditions. Their presence, particularly multiple bones, warrants consideration in diagnosing abnormal head shape.

Keywords:
Abnormal Head ShapeBrachycephalyCranial morphologyCraniosynostosisWormian bones

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Area of Science:

  • Pediatric Radiology
  • Developmental Biology
  • Craniomaxillofacial Surgery

Background:

  • Wormian bones (WB) are accessory ossicles found within cranial sutures.
  • While often asymptomatic, numerous WB can be associated with genetic and developmental disorders.
  • Understanding WB prevalence and associations is crucial for pediatric diagnostics.

Purpose of the Study:

  • To determine the prevalence and anatomical distribution of WB in pediatric patients.
  • To investigate clinical associations, such as genetic disorders and abnormal head shape, with WB presence.
  • To evaluate the diagnostic significance of WB in pediatric cranial CT imaging.

Main Methods:

  • Retrospective review of cranial CT scans from pediatric patients (0-18 years).
  • Radiological confirmation of WB and collection of demographic and clinical data.
  • Analysis of WB prevalence, location, number, and associated conditions, including cephalic index.

Main Results:

  • Wormian bones were identified in 0.57% of 13,519 pediatric patients, increasing to 2.1% in a 5-year clinic cohort.
  • The lambdoid suture was the most frequent site for WB.
  • Multiple WB (≥2) were common (67.5%), and 16.8% of affected patients had associated skeletal or craniofacial conditions, notably craniosynostosis.

Conclusions:

  • Wormian bones are found in a small percentage of pediatric patients, with higher prevalence in specialized clinics.
  • WB can co-exist with conditions like craniosynostosis and osteogenesis imperfecta.
  • Clinicians should consider WB in the differential diagnosis of abnormal head shape in infants, especially in subspecialty settings.