Age-related structural changes of the facial skeleton: insights from sutural ossification and CT-based analysis

OBJECTIVE: To provide comprehensive information on the age-related growth of the facial skeleton by analyzing the ossification stages of facial sutures along with the lengths, volume, and density of facial bones. METHODS: A total of 510 healthy subjects, examined for craniofacial trauma and found to have normal CT scans, were grouped into homogeneous, age-matched cohorts ranging from birth to 80 years. High-resolution CT imaging was used to assess the degree of facial sutural closure, sutural patterns, gap width and density, as well as to measure the length, density, and volume of the bones in the facial skeletal complex. RESULTS: Sutural pattern was significantly associated with closure grades 1,2, 3a (p < 0.001), but not specific to suture type (p > 0.05). Closure degree is age-related, occurring at different time points for each suture, and shows a strong inverse correlation with gap width (r = - 0.752) and a positive correlation with gap density (r = 0.465) (p ≤ 0.001). Most sutures close by mid-to-late adulthood or remain partially patent. Despite sex-related differences in linear growth (p < 0.001), bone volumes do not differ (p > 0.05). Positive bone turnover completes by early adulthood, followed by a gradual decline in bone volume and density after age 40. CONCLUSIONS: Age-related progressive closure of facial sutures, along with ongoing bone turnover, contributes to the dynamic, lifelong development of the facial bone complex, which reaches peak volume by early adulthood and then gradually declines.