Finding of Hyperostosis Frontalis Interna During the Autopsy Procedure: Forensic Issues

Hyperostosis frontalis interna is a common phenomenon, which may have been overrated in its significance in the past, and may, currently be underrated in its significance. We present three cases of hyperostosis frontalis interna found during medicolegal autopsies and discuss their forensic considerations. The patients were all middle‐aged women with metabolic and endocrine manifestations and psychiatric ailments; thickening of the inner table of the frontal bone of the skull was found during each autopsy. We describe the relationship between hyperostosis frontalis interna, metabolic manifestations, and neuropsychiatric symptoms as part of Morgagni‐Stewart‐Morel syndrome. There is still considerable disagreement in the scientific community as to whether this syndrome is a clinical entity. Nonetheless, awareness of Morgagni‐Stewart‐Morel syndrome can be of help in understanding the circumstances surrounding death. In some other cases, hyperostosis frontalis interna could be used by forensic pathologists as criteria for sexing and aging a skeleton.     

A comprehensive regression tree to estimate body weight from the skeleton

The purpose of this research is to estimate actual body weight (in particular obesity) from the human skeleton. Known individuals (total n=187) were studied from the Bass Collection from the University of Tennessee, Knoxville. This research combines bone density, cross-sectional geometry of the femur and skeletal pathologies. Bone mineral density was calculated for the proximal femur. Three-dimensional bone surface models were created from computed tomographic scans. Cross-sectional geometry of the femur was calculated at five locations along the diaphysis. The pathologies analyzed were heel spurs, diffuse idiopathic skeletal hyperostosis (DISH), and tibial osteoarthritis. The best regression tree model included only four variables. The first split to estimate body weight was the minimum moment of inertia (I(y) ) at the distal femur, the second was midshaft width, then anteroposterior thickness at the proximal slice and the final split was the degree of DISH (SD 17.1-31.0 kg). The ability to estimate body weight from the skeleton is one more useful tool for the osteologist.     

Hyperostosis frontalis interna as an age-related phenomenon – Differences between males and females and possible use in identification

Hyperostosis frontalis interna (HFI) is a condition manifested by thickening of the inner surface of the frontal bone and it could be useful when dealing with the identification of human remains in various anthropological and forensic investigations. We compared the macroscopic appearance and morphologic (metric) features of the skulls in cases with and without HFI, in both sexes, and wanted to establish whether age determined occurrence of HFI. To achieve this aim, we performed prospective autopsy study, covering ten-year period (2007–2016). Study group consisted of southeast Europe Caucasian subjects, with determined age and sex. The severity of HFI was classified by two forensic pathologists independently, according to the four types (A–D) proposed by Hershkovitz et al. Thicknesses of the frontal and temporal bones, as well as the longitudinal and frontal diameters of the skulls were measured. The sample consisted of 35 males and 112 females with HFI, and 55 males and 202 females without HFI (404 individuals in total). Type B was the most common type of HFI among males (45%) and type C among females (41%). HFI type D was almost four times more common in females than in males (OR?=?3.73). Frontal and temporal bones were thicker in all subjects who have HFI. Thickness of the skull was not age-dependent, in the entire sample, or in subjects with HFI, or in the control group (in all the cases Spearman's Rho was <0.3). Age seemed to be a predicting factor for HFI occurrence only in females. Females younger than 55?years have similar risk for HFI occurrence as males. An unidentified skull with the general markers of old age and severe form HFI is most probably from a female decedent.