Medvedeva N.А.1,2, Serova N.S.1


1 - I.M. Sechenov First Moscow State Medical University (Sechenov University).

2 - Bureau of Forensic Medicine of the Department of Health of the City of Moscow. Moscow, Russia.


urpose. To determine the possibilities of radiological diagnostics of accessory, non-permanent bones of the skull. To demonstrate the role of unreliable assessment of skull bones in victims of traumatic brain injury on investigative and judicial decisions.

Materials and methods. The study included medical data and electronic archives in DICOM formats of radiology methods of 37 victims who underwent a forensic medical examination procedure for traumatic brain injury at the state budgetary healthcare institution of Moscow "Bureau of Forensic Medical Examination of the Moscow Department of Health”. All patients underwent computed tomography and X-ray of the skull bones.

Results. CT and X-ray of the skull were performed in 37 victims with a clinical diagnosis of traumatic brain injury (TBI), fractures of the arch and base of the skull. According to the primary documentation, in 6 people (n=6; 16%), a variant of anatomical and physiological development of the skull bones in the form of accessory, non-permanent skull bones was suspected.  As a result of the revision of X-ray examinations during the forensic medical examination, the diagnosis of a fracture of the arch and/or base of the skull was not confirmed in 31 victims (n=31; 84%), however, the accessory bones of the skull were revealed. In cases in which bone-traumatic injuries were not confirmed radiologically, the degree of harm to health did not correspond to serious, and therefore, a criminal measure of responsibility could not be implemented.

Discussion. Incorrect interpretation of the accessory, island bones of the skull in victims of traumatic brain injury leads to criminal liability for those involved. Differential radiological criteria for fractures of the calvarium and accessory, unstable bones of the skull are presented. Accessory, intercalary bones are variants of anatomical development, and indicate the absence of traumatic brain injury. Considering the difficulties of conducting a forensic medical examination of living persons, at the moment only radiological diagnostic methods make it possible to exclude fractures of the cranial vault and to detail the intercalary bones.

Conclusion. The results of our work demonstrate the possibilities of CT scan of the skull bones in the differential diagnosis of fractures of the arch and inset bones. To date, the only lifetime method of differential diagnosis of fractures and accessory bones is CT with three-dimensional reconstruction. For a reliable assessment and differential diagnosis between accessory bones and true fractures, a CT scan of the skull with mandatory three-dimensional reconstruction is necessary.


Keywords: accessory bones, non-permanent bones, forensic medical examination, skull bones, traumatic brain injury, abnormalities of skull development, traumatic brain injury, forensic medical examination of living persons.


Corresponding author: Medvedeva N.А., e-mail: Этот e-mail адрес защищен от спам-ботов, для его просмотра у Вас должен быть включен Javascript


For citation: Medvedeva N.А., Serova N.S. Radiological diagnostics of cranial accessory bones and their role in the forensic medical examination of living persons. REJR 2024; 14(1):16-25. DOI: 10.21569/2222-7415-2024-14-1-16-25.

Received:        05.02.24 Accepted:       15.03.24