Archaeological and Anthropological Sciences

https://doi.org/10.1007/s12520-019-00890-9

ORIGINAL PAPER

A unified descriptive method for analysing artificial cranial

deformation from a palaeopathological perspective
Mónika Molnár 1 & László Szathmáry 2 & László Szűcs 2 & Róbert Ferenc Széll 1 & István János 3

Received: 15 October 2018 / Accepted: 20 June 2019

# Springer-Verlag GmbH Germany, part of Springer Nature 2019

Abstract
The study’s goal is to propose a unified descriptive method for analysing artificial cranial deformation (ACD) in
order to achieve consistent descriptions as well as to document the modification from a palaeopathological perspec-
tive. A number of examinations have dealt with the fact that ACD can either directly cause or predispose the
formation of pathological and neurological lesions. The bulk of earlier studies only have focused on one or a few
deviations in detail. The basic research aim was to assemble all previously described lesions which could be related
to ACD; in addition, a further deviation undescribed as yet is also noted. Present and ongoing studies enable the
development of a unified approach for the observation and description of ACD. Authors also suggest a data collector
sheet based on previously published morphological alterations. This study makes an attempt to serve as a basis or a
first step towards creating a general, standardized method to detect pathological alterations on ACD skulls and to
distinguish ACD and non-ACD skulls from each other. In this paper, pathological consequences of ACD in ten
individuals excavated from two contemporaneous cemeteries dated to the Hun-Germanic Period (fifth–sixth century
AD) were investigated in an attempt to elucidate pathological lesions caused by ACD and to shed light on the
possible connections between the type or the extent of deformation and the lesions appearing on ACD skulls. X-ray
recordings were used to generate more accurate results, while previously used methods and recommendations were
also applied in accordance with special literature.

Keywords Artificial cranial deformation . Palaeopathology . Unified descriptive method . Hun-Germanic Period

Introduction
* István János
janos.istvan@nye.hu; ijanos82@gmail.com The results of some previous studies have suggested that small
Mónika Molnár and medium extent artificial cranial deformation (ACD) may
molnar.monika@foh.unideb.hu not exert significant effects on population mortality and mor-
László Szathmáry
bidity. Admittedly, if this hypothesis were incorrect, then
szathmary.laszlo@science.unideb.hu ACD practices would not have spread so widely around the
world (Gerszten 1993). A number of previous studies have
László Szűcs
yuzenet@gmail.com also addressed the connections between ACD and the appear-
ance of pathological and neurological lesions or disorders (e.g.
Róbert Ferenc Széll
szell.robert@foh.unideb.hu
blindness, defective hearing, headaches, premature fusion of
the cranial sutures, bone necrosis, endocranial shape changes
1
Faculty of Health, University of Debrecen, Sóstói út 2-4, and premature death) (Allison et al. 1981; Czigány 2008;
Nyíregyháza H-4400, Hungary Dean 1995; Dingwall 1931; Enchev et al. 2010; Gerszten
2
Department of Evolutionary Zoology and Human Biology, 1993; Gerszten and Gerszten 1995; Guillen et al. 2009;
University of Debrecen, Egyetem tér 1, Debrecen H-4032, Hungary Holliday 1993; Józsa and Pap 1992, 2012; Kiszely 2006;
3
Institute of Environmental Science, University of Nyíregyháza, Mendonca de Souza et al. 2008; O’Brien et al. 2013;
Sóstói út 31/B, Nyíregyháza H-4400, Hungary O’Loughlin 1996; Posnansky 1957; White 1996).

Research in this area has only focussed on particular or a
few pathological lesions related to ACD, but hardly provided
general summaries. A number of other works have addressed
the effect of ACD on cranial sutures (Antón et al. 1992; El-
Najjar and Dawson 1977; Moss 1959; O’Loughlin 2004;
Sanchez-Lara et al. 2007; White 1996; Wilczak and Ousley
2009), the cranial base (Antón 1989; Cheverud et al. 1992;
Cottin et al. 2017; McNeil and Newton 1965; Moss 1958;
Oetteking 1924), nonmetric traits (Del Papa and Perez 2007;
Konigsberg et al. 1993; Ossenberg 1970), the temporal region
(McGibbon 1912), the splanchnocranium (Bjork and Bjork
1964; Brown and Mizoguchi 2011; Kohn et al. 1993; Rhode
and Arriaza 2006; Ross and Ubelaker 2009), the mandible
(Cheverud and Midkiff 1992), different metric traits (Boston
et al. 2015; Cocilovo et al. 2010; Perez 2007; Pomeroy et al.
2010) and other brain functions (O’Brien et al. 2013).
A large number of ACD skulls have been discovered on the
American Continent (Chile, Mexico). This wealth of data of-
fers numerous opportunities to observe and to describe the
pathological and neurological deviations of ACD skulls.
Although a much smaller number of finds have been discov-
ered in Eurasia, the European Carpathian Basin is significant-
ly important in this context. Recently, in this area (present-day
Hungary), additional finds have been excavated (Bereczki and
Marcsik 2005; Hajdu and Bernert 2007; Ódor 2011; Straub
2011). In Europe in general and in the Carpathian Basin in
particular, the frequent appearance of ACD is mainly connect-
ed with migrations of Sarmatian, Alan, Gothic, Gepidic and
Hun populations although some cases are thought to originate
from the late Iron Age (Kiszely 2006; Mende 2010). The vast
majority of ACD cases in the Carpathian Basin are known to
date from the Migration Period (fourth–sixth century AD),
and the custom survived within the area of the Avar Empire
until the early seventh century (Hajdu et al. 2009; Kiszely
2006; Mende 2010). The skulls analysed in the present paper
both chronologically and according to type as well as the way
of distortion fit in the course of expansion of the custom of
ACD spreading along a migration line from the east to the
west, from Asia through the Talas Valley into the Caucasus,
across the Volga Region, the Kalmykia Steppe, the Danube
Basin, the Thuringian, Bavarian and Renish territories up to
valley of the Rhone River (Molnár et al. 2014; Nemeskéri
1976; Torres-Rouff and Yablonsky 2005).
In accordance with the discussion presented above, the
main aim of this study was to propose a unified method to
describe ACD, which can then serve as a generally useful
approach and a routine component of similar examinations
to make them more comparable, accurate as well as faster.
Applying the unified descriptive method can enable re-
searchers to analyse pathological lesions more profoundly
(e.g. focusing on neurological aspect). The results received
in this way can also be interpreted as more than mere single
individuals with specific lesions, but as part of a population
Archaeol Anthropol Sci
using statistical analysis (e.g. describing lesions caused by
ACD as a sole or a cumulative appearance) or by comparing
different populations. It is therefore interesting to ask ques-
tions about any direct or indirect (inclination) relationships
between the type or the extent of deformation and the patho-
logical or neurological lesions.
Material and method
We described nine artificially deformed skulls excavated from
two cemeteries (Ároktő Csík-gát and Nyíregyháza M3 36/
c sites) in the northeastern part of Hungary in an earlier study.
The excavated skeletal remains were dated to the Hun-
Germanic Period (fifth–sixth century AD). The crania were
analysed from a physical anthropological point of view: age at
death, sex, type and extent of deformation with each individ-
ual, as well as supposed head-shaping techniques were record-
ed (Molnár et al. 2014). The detailed morphological and
palaeopathological descriptions of these skulls are presented
in the recent study.
An additional ACD skull (referred to as “unmarked skull”,
abbreviated Aunm) was recently discovered from Ároktő
Csík-gát site at the Ottó Herman Museum (the storing place
of the collection) as well. The grave number of this individual
is unfortunately unknown because of some documentation
mistake. The characteristics of this skull, including method
and distortion techniques, are quite similar to other deformed
crania from the same site described in our earlier study. In the
“Descriptions” section of the recent work, the visible anthro-
pological and distortion features of the Aunm skull were
discussed in detail. The morphological sex and age at death
of this individual were determined by following the recom-
mendations of Éry et al. (1963), Nemeskéri et al. (1960),
Acsádi and Nemeskéri (1970) and Sjøvold (1975). The extent
of ACD was calculated and classified using the OGŽ index
developed by Oetteking (1930) and later by Ginzburg and
Žirov (1949). Four types of ACD suggested by Dembo and
Imbelloni (1938) (see also Cocilovo et al. 2010) were also
determined.
All of the ten ACD skulls (Table 1) examined here were
studied using an approach that emphasizes the pathological
aspects of ACD, and morphological and nonmetric traits
were also described. The body height of individuals was
estimated using Sjøvold (1990) regression equations and
was categorized following the Martin and Saller (1957) clas-
sification. The classification of body height was separated to
sex; thus, each individual of these categories became compa-
rable with each other. Dental abrasion was determined using
the six-degree scale of Baume (1964), while clivus steepness
was measured using the method proposed by Józsa and Pap
(2012). Additionally, ten undeformed skulls were analysed
from the same cemeteries, populations and archaeological
Archaeol Anthropol Sci

period as a control (Table 1). The number of individuals was

M3 36/c

M3 36/c
short

Female
Female
145.39

23–40
40–80
very low in both deformed and undeformed groups; however,
92.63
N220

N415
415
220
representatives of both sexes appear with both deformed (six

–
females, four males) and control (six females, four males)

156.47 medium
groups.
On the evidence of previously described pathological le-
M3 36/c

M3 36/c
Female

40–80
35–55
sions known from the special literature so far and on the basis

tall
88.67

N262

Male
N61

262
61

of the conclusions of this study, the authors propose a unified

–
descriptive method to document the features likely caused by

157.63 medium
163.46 medium
ACD as part of a unified palaeopathological approach. The
authors are aware of the small number of individuals in the
M3 36/c

M3 36/c
samples; however, it is rather rare in Europe that skeletal finds
short

Female
41–50
37–46

tall
90.85

Male
N50

N60
60 with ACD skulls are dug up—as we have referred to it in the
50

“Introduction” section. That is why we find it an extraordinary

opportunity to examine ten ACD crania coming from two

169.94 very
medium

nearby cemeteries recently and make an attempt to outline a

M3 36/c

M3 36/c

Female
Female
153.24
30–60

23–40

tall
84.56

unified descriptive method on the basis of the analysis of these

N49

N57
57
49

particular skulls. Our suggested ACD descriptive method

helps to standardize later examinations performed on de-
158.06 medium

formed skulls and to develop comparable data. In our descrip-

159.25 short

tive method (presented in a collector sheet), particular data

M3 36/c

M3 36/c

Female
40–80

23–40

tall
82.35

regarding skulls can be collected and represented in different

Male
N42

N45
45
42

ways: by the naked eye, via X-ray or computed tomography

(CT) recordings. We applied our new descriptive approach to
169.88 medium

complete the form (collector sheet) for all ten crania we ex-
176.57 tall

amined, but the present paper provides only one (for cranium
M3 36/c

M3 36/c
40–80

52–61

tall
88.30

A168) as an example (Table 2). Our X-ray data were collected

Male
Male
N40

N41
40

41

with the kind cooperation of the Department of Forensic

Medicine, University of Debrecen (Figs. 1, 2, 3, and 4).
Csík-gát

Csík-gát

medium
Unmarked

Female
Female
Ároktő

Ároktő

154.00
Anmd

23–40

40–80
96.79

A249
249

Descriptions
–

Morphological and nonmetric traits as well as anatomical and

Csík-gát

Csík-gát

pathological alterations of ACD skulls are described below,

Female
Ároktő

Ároktő
101.30

15–17

30–60
A168

A170

Male

assigning site names, grave numbers, sex and age at death.

170
168

–
–

The general anthropological and ACD features of the skulls

as well as suggested body heights are presented in Table 1.
160.00 medium
Árokt Csík-gát

Árokt Csík-gát

Description of ACD features of nine skulls (degree, type, way

and device of deformation) was described previously (Molnár
short
A166/a

Female
105.60

21–25

et al. 2014), that is why in the recent study, these general

166/a

A165

23-X

Male
General data of the examined skulls

165

features only for the unmarked skull (Aunm) are detailed.

–
Ároktő Csík-gát

Ároktő Csík-gát

Body height (cm) 158.00 medium

Body height (cm) 169.00 medium

Cranium A166
Female
21–25

37–46

Ároktő Csík-gát, no. 166 (male cranium, age at death

tall
tall
A166

Male

A44
166

44

21–25 years)
–
Grave number

Grave number
Deformed skulls

and category
and category

This cranium is poorly preserved and quite fragmentary. The

Age at death

Age at death
Control skulls
OGŽ index

neurocranium could be analysed in detail, but the

(years)

(years)

viscerocranium is missing. The shape of this cranium is spher-

Table 1

oid in norma verticalis; in medio-sagittal plane, the frontal

Site

Site

Sex
Sex

bone is straight, but the occipital bone is typically


curvoccipital. An X-ray image of this skull shows that the
trabecular system has become denser in the frontal and in
the occipital bone near the asterion. Smaller wall thickness
of these bones can be observed in the above-mentioned areas.
Impressions of arachnoid granulations and gyri are pro-
nounced on the inner surface of the frontal bone, while deep
grooves for blood vessels are present on the left parietal bone.
As the frontal bone is fragmentary, thus the frontal sinus is
hardly observable. That is why it cannot be stated with cer-
tainty that the frontal sinus was heavily deformed.
Cranium A166/a
Ároktő Csík-gát, no. 166/a (female cranium, age at death
21–25 years)
This skull is fragmentary and poorly preserved but the
neurocranium is clearly examinable. The shape of this crani-
um is ovoid in norma verticalis; in medio-sagittal plane, the
frontal bone is straight while the occipital is planoccipital. The
interorbital interval is wider than the normal state. The wall
thickness in these areas has become narrower and the trabec-
ular system of the spongy bone has become denser possibly
due to artificial deformation. Endocranial grooves for blood
vessels are observable on the inner surface of the cranium;
these are normal in shape and depth. Impressions of gyri are
slightly deepened while arachnoid granulations are dilated and
pronounced. These are seen on the inner surface of the frontal
and the parietal bones under the supposed location of the
bandage used for deformation.
Cranium A168
Ároktő Csík-gát, no. 168 (female cranium, age at death
15–17 years) (Fig. 1, Table 2)
This female skull is relatively undamaged and clearly exam-
inable although the mandible cannot be analysed. The shape
of the cranium is sphenoid in norma verticalis and house-like
in norma occipitalis. The frontal is straight in medio-sagittal
plane and the occipital is tapered, a condition referred to as
bathrokran. The orbits are not shallow but extremely high,
which is referred to as hyperhypsikonch. The interorbital in-
terval is moderately wide. Cribra orbitalia are seen on both
sides. The optic foramens of this skull are normal shaped;
porotic hyperostoses are present on the anterior surface of
the maxilla, and the dental arch of this element is parabolic
in shape. The palatinum is also shallow but cambered and
concave in shape, and no torus maxillaris and torus palatinus
are present. The depth of the fossa canina is moderate, and the
alveolar prognathism is expressed. The nasal cavity is ex-
tremely narrow, a condition referred to as hyperlepthorrhin.
One component of the sutura nasofrontalis is crooked because
Archaeol Anthropol Sci
the nasals are developed asymmetrically that is the left ele-
ment is smaller. The septum nasi of this skull are also consid-
erably deviated to the left; the shape of the lower margin of the
anterior nasal aperture is anthropin and the female cranium
shows concave nasal profile type. As this individual was
young at death, dental abrasion in this case remains in phase
1. Considering X-ray images, the upper third molar has not
erupted on the right side, its position is abnormal, and its axis
has considerably turned towards the posterior direction. The
upper canines and upper first premolars were probably lost
postmortem on both sides, and no caries can be seen. The
shape of the external acoustic pore is slightly narrow on either
side, and the left mastoid process has developed so that it is
larger than its right counterpart even though neither is sclerot-
ic. The right petrous part of the temporal bone is deformed and
is a little smaller than the left one, and it turned towards the
vertical axis of the cranial base. The wall thickness of the
frontal bone has become thinner and the trabecular system
on these areas has become denser probably because of defor-
mation. A metopic suture on the frontal bone and wormian
bones on the lambdoid suture are present on the external sur-
face of the cranium; in endocranial view, grooves for blood
vessels are deep and pronounced on the parietal bones.
Arachnoid granulations are also present here, but their devel-
opmental state can be estimated as normal. Platybasia (steep-
ness of the clivus 129.5°) were not detected, but the clivus is
moderately flat (45.5°). The foramen magnum is also elongat-
ed in an anterio-posterior direction in this specimen; the ca-
rotid canal has become narrower and the condyloid fossa has
disappeared on both temporal bones. Interestingly, the occip-
ital condyles have been pressed into the occipital bone, prob-
ably due to the head-shaping process. X-ray images show that
these cavities were normal in shape with the exception of the
left maxillary one, which has developed in an extraordinary
fashion and exhibits moderate deformation.
Cranium Anmd
Ároktő Csík-gát, unmarked grave (female cranium, age
at death 23–40 years)
This cranium is relatively undamaged, and the mandible could
be analysed. The head was considerably deformed with one
50-mm-wide, circular bandage (the type of circular erect),
which probably ran 20 mm above the squamosal suture on
the parietal bones as well as above the frontal tubers on the
frontal bone. Due to the using of the bandage, a tuber called
tuberculum prebregmaticum has evolved on the skullcap. It is
very possible that another bandage was used during the defor-
mation, which left a shallow groove right behind the bregma
region on the calvaria as well as on the occipital bone running
on the squamosal suture. For the deformation, usage of a rigid
tool on the frontal bone could also be supposed. According to
Archaeol Anthropol Sci
the OGŽ index (96.79), medium deformation (macrocranic)
could be suggested for the cranium.
The shape of this cranium is ovoid in norma verticalis and
house-like in norma occipitalis. In the medio-sagittal plane,
the frontal bone is moderately backward, and the occipital is
depressed, planoccipital. The orbits are round in their shape
and not shallow. The interorbital interval is wider than the
normal state. The extents of the optic foramens are normal.
The shape of the lower margin of the apertura piriformis is
anthropin. The fossa canina is moderately deep on both sides.
In lateral view, the nose profile is concave. The maxillary
dental arch is parabolic in its shape. Palate is high, but torus
maxillaris and torus palatinus cannot be observed. The alveo-
lar prognathism is expressed. The shape of the mandibular
fossa is normal on both temporal bones but the deformation
of the caput articularis is apparent on both sides. Arthrosis in
the temporomandibular joint cannot be detected. In accor-
dance with the individual’s age at death, the dental abrasio
was assessed to phase 2. Caries is not present, but plaque is
found on the upper incisives. The shape of the external acous-
tic pore is deformed, especially on the left temporal bone. The
petrous parts of the temporal bones have mildly turned to-
wards the posterior direction. On the frontal bone, sutura
metopica can be observed, while, on the occipital bone,
wormian and lambda bones can be found. The line of the
sagittal suture has developed in an asymmetric way: it curves
to the left around in 10°. In an endocranial view, the grooves
for the blood vessels have become deep and the expression of
gyri is slightly deepened on the frontal and parietal bones.
Arachnoid granulation is not present in this specimen. The
foramen magnum has moderately elongated in anterior-
posterior direction.
Cranium N40
Nyíregyháza M3 36/c no. 40 (male cranium, age at death
40–80 years) (Fig. 2)
The cranium represents a relatively undamaged state and its
mandible could also be examined. The shape of the cranium is
sphenoid in norma verticalis and house-like in norma
occipitalis. In medio-sagittal plane, the frontal bone is ex-
tremely backward, and the occipital bone is depressed,
planoccipital. The orbita does not seem to be shallow or an-
gled in shape. The interorbital interval is narrower than its
normal state. The shape of the optic foramens is normal. The
form of the lower margin of the apertura piriformis is
anthropin. The cranium shows concave nasal profile in norma
temporalis. Torus maxillaris and palatinus cannot be observed
and the maxillary dental arch is parabolic in its shape. Canine
fossa is relatively shallow on both sides. The teeth are flaw-
less, caries is not observable, and the dental abrasion can be
estimated to phase 2. Arthrosis in the temporomandibular joint
is not present. The shape of the external acoustic meatus is
slightly narrow on either side. The mastoid process is missing
on the left temporal bone, but based on its residual part, this
may have a pneumatic internal system. The petrous part of
either temporal bone has turned towards the vertical axis.
The latter is more apparent on the right side of the cranium.
No extra bone pieces can be found on the external surface of
the skull. On the basis of the X-ray images reported here, the
frontal and the parietal bones are characterized by smaller wall
thickness and rather denser internal trabecular system under
the supposed places of the bandage used for the deformation.
Porotic hyperostosis in quite an initial stadium can also be
observed at the glabella on the frontal bone. The grooves for
blood vessels can be well examined, and their status is con-
sidered as normal. Gyri cannot be observed but arachnoid
granulations with great expression are found. Skull base angle
is 109°, so no platybasia occurs. The clivus is considered high-
pitched (85.3°). The frontal sinus is extremely distorted and
the left sphenoidal sinus is moderately distorted, while the
shape of the maxillary sinus is normal on either side.
Cranium N42
Nyíregyháza M3 36/c, no. 42 (male cranium, age at death
40–80 years)
A fragmentary cranium with a preserved mandible can be
analysed in this case. The left side of the frontal and occipital
as well as the left parietal bone is missing. The shape of the
skull is considered as sphenoid in norma verticalis and house-
like in norma occipitalis. In the medio-sagittal plane, the fron-
tal bone is widely backward, and the occipital bone is cam-
bered, curvoccipital. The orbits are slightly shallow, and the
interorbital space is regarded as normal. The shape of the
lower margin of the apertura piriformis is anthropin and the
female cranium represents a concave nasal profile type. The
palatinum is cambered and torus palatinus can also be found
on it. The depth of the fossa canina is shallow. Slight alveolar
prognathism is estimated. The size of the mandibular fossa
and the caput mandibulae are normal. Dental abrasion could
be assessed to phase 3. Arthrosis on the temporomandibular
joint is not observable. Signs of inflammation are found on the
mandible and the maxillas: the affected dens are the following:
the lower second and third molars, the upper third molars on
both sides. Caries was detected on the lower first molar on the
left side and on the lower second molar on the right side. The
shape of the external acoustic pore has become narrow and
slightly deformed on the right-hand side. The left one cannot
be examined. The left mastoid process is missing, and the
right one does not show extraordinary appearance. The right
petrous part of the temporal bone has slightly turned towards
posterior direction of the cranial base, the left one is missing.
No extra bone pieces can be found on the external surface of

the skull. The wall thickness of the frontal and the parietal
bones has become narrower and the trabecular system of the
spongy bone is denser on the areas where the bandages are
supposed to have been. On the internal surface of the cranium,
grooves for blood vessels and gyri are slightly deeper, but
Pacchioni granulations are not deviated from the normal state.
Skull base angle is not measurable nor can the sella turcica be
examined. Steepness of the clivus is not measurable, but its
fragmentary refers to a steeply dipping shape. In the cases of
cavities, anatomical disorders cannot be established.
Cranium N49
Nyíregyháza M3 36/c, no. 49 (female cranium, age at death
30–60 years)
The cranium with its mandible is relatively undamaged and
well examinable. The shape of the skull is pentagonid in
norma verticalis and house-like in norma occipitalis. The fron-
tal is definitely backward and the occipital is cambered, called
curvoccipital. The shape of the orbits seems to be transitory
and their depths do not considerably differ from the normal
state. The optic foramens also show regular form (round). The
interorbital interval is normal. The lower margin of the
apertura piriformis represents anthropin type appearance and
a concave nasal profile type can be observed in lateral view.
The septum nasi deviates to the right in a smaller degree. The
maxillary dental arch is parabolic in shape; torus maxillaris
and torus palatinus are not found. The caninal fossae are rel-
atively deep and moderate alveolar prognathism can be no-
ticed in lateral view. The size of the mandibular fossa and the
caput articularis are normal on the right side (the left condylar
process of mandible is fragmentary). Arthrosis in the tempo-
romandibular joint cannot be detected. Dental abrasion can be
estimated to phase 3. The third molar has not erupted from the
mandible on the right. Caries can be detected on the upper first
premolar, the lower second premolar and first molar on the
right as well as on the lower second molar on the left. The
shape of the external acoustic meatus is normal on either side.
No anomaly can be observed on the mastoid processes and
petrous parts of the temporal bones on either side. Wormian
bones on the lambdoid suture are apparent. According to the
X-ray recordings, the trabecular system of the frontal bone has
become denser and the bone-wall thickness has become thin-
ner under the hypothetical location of the bandage used for
deformation. On the endocranial surface of the cranium, the
grooves for the blood vessels are normal. Contrarily, gyri are
absent and impressions of arachnoid granulations are not de-
viated from the normal state. The degree of platybasia cannot
be measured. The shape of the foramen magnum is described
to be normal. The extent of the frontal sinus is normal and the
clivus cannot be examined.
Archaeol Anthropol Sci
Cranium N50 cranium
Nyíregyháza M3 36/c no. 50 (male cranium, age at death
37–46 years) (Fig. 3)
A complete male cranium with an undamaged mandible has
been evaluated. The shape of the skull is rhomboid in norma
verticalis and house-like in norma occipitalis. The frontal is
robustly backward and plane, the occipital is depressed,
planoccipital. The orbits are angled and normal in depth.
The interorbital interval is normal in its extent. The shape of
the optic foramens is regular. The lower margin of the apertura
piriformis is anthropin and this male skull shows a concave
nasal profile type. The maxillary dental arch is parabolic, and
the palatinum is shallow and cambered. Alveolar prognathism
can be detected, but its extent is only moderate. No torus
maxillaris, torus palatinus and torus mandibluaris can be ob-
served. The depth of caninal fossae is moderate. The mandib-
ular fossae are slightly dilated in both sides, but the mandib-
ular condyles are not deformed nor can arthrosis be detected.
Dental abrasion could be estimated to phase 2. The teeth are in
good condition and no caries are present. The shape of the
external acoustic pores is oval and slightly narrow on either
side. The right mastoid process has slightly cambered towards
the anterior direction, but its internal structure is not sclerotic.
The left one is missing. The petrous parts of the temporal
bones are deformed and turned towards the posterior direction
of the cranial base. No additional sutural bones and metopic
suture can be observed on the external surface of the cranium.
Under the hypothetical location of the bandage used during
modification, the internal bone structure (the trabecular sys-
tem) of the frontal bone has become denser and the wall thick-
ness of this bone has become thinner. Before the coronal su-
ture at the tuberculum prebregmaticum of the frontal bone, the
spongy substance is thicker. The grooves for blood vessels
could be well noticed but their expressions are normal.
Although gyri are absent, deep impressions of arachnoid gran-
ulations are found pronounced next to the sagittal suture at the
bregma region. Platybasia (base of skull angle 125.5°) cannot
be detected and the steepness of the clivus is also normal
(73.0°). The shape of the foramen magnum is supposed to
be normal. Minor deformations can be observed in the devel-
opment of the frontal and sphenoidal cavities.
Cranium N61
Nyíregyháza M3 36/c no. 61 (female cranium, age at death
35–55 years)
The cranium is extremely fragmentary. Only small parts are
available from the maxillary bones and the mandible. The
shape of the cranium is ovoid in norma verticalis and house-
like in norma occipitalis. From lateral view, the frontal is
Archaeol Anthropol Sci
moderately backward and the occipital is cambered,
curvoccipital. The orbits are assumed to be round in shape;
the interorbital interval and the foramen opticum cannot be
analysed. No torus palatinus or torus maxillaris is present.
The depth of the fossa canina is moderate and does not show
extraordinary structure. Alveolar prognathism is extensive.
The size of the mandibular fossae is normal on both sides of
the temporal bones. The caput articularis is missing on either
side. No arthrosis in the temporomandibular joint can be de-
tected. The dental abrasion is assumed to phase 2. Caries can
be detected on the maxillary second molar on the right-hand
side, on the mandibular first and third molars on the left-hand
side as well as on the second molar on the right. The external
acoustic pores are normal in shape on both sides. The mastoid
processes are quite fragmentary, and based on the remaining
parts, they can be assumed to have pneumatic internal struc-
ture. No additional sutural bones in the lambdoid suture and
metopic suture are present. The petrous part of the temporal
bone is fragmentary on either temporal bone. The wall thick-
ness of the frontal and parietal bones is thinner under the
hypothetical locations of the bandages. Grooves for blood
vessels can be well noticed but their expression is assessed
as normal. Gyri are not present and only small impressions of
arachnoid granulations can be detected. Base of skull angle
was not measurable. The foramen magnum is fragmentary in a
small degree but can be described to be normal and round in
its shape. Clivus is not measurable. The only examinable cav-
ity is the frontal sinus, which is undeformed in its shape.
Cranium N220
Nyíregyháza M3 36/c, no. 220 (female cranium, age at death
40–80 years) (Fig. 4)
The cranium is slightly fragmentary but the mandible is un-
damaged. The shape of the cranium is not examinable in either
view. In lateral view, the frontal is extremely backward, and
the occipital region is planoccipital. The shape of the orbits is
angled and normal in depth. The interorbital interval is slightly
wider than the normal state. The foramen opticum seems to be
normal. The shape of the lower margin of the aptertura
piriformis is anthropin and the skull has a straight nasal pro-
file. The shape of the maxillary dental arch is parabolic. Torus
palatinus is present, but no torus maxillaris can be detected.
The caninal fossae are moderate in depth and the left one is
deeper than the right one. On the maxillary bones, alveolar
prognathism can be found to a moderate extent. The mandib-
ular fossa is not distended on either side and the mandibular
condyles are also normal in their shape. No arthrosis can be
observed in the temporomandibular joint. The dental abrasion
can be estimated to phase 5. Caries are present on the upper
first premolar and second molar on the left-hand side and on
the upper first premolar on the right-hand side. The upper first
molar is lost because of inflammation presumably. The shape
of external acoustic pore is extremely narrow on the left unlike
the right side. The two mastoid processes have leaned towards
the frontal bone. The petrous parts of the temporal bones have
mildly turned towards the vertical axis. No additional bone
pieces and no sutura metopica can be detected on the cranium.
Seeing the X-ray recordings, the trabecular system of the fron-
tal bone has become denser and the bone-wall thickness thin-
ner under the possible location of the bandage applied for
modification. On the endocranial surface of the skull, the
grooves for blood vessels and gyri are definitely deep. Due
to the fragmentation of the calvaria, arachnoid granulation is
not observable. No platybasia (base of skull angle 130°) oc-
curred. The shape of the foramen magnum is slightly elongat-
ed. Steepness of the clivus is moderately flat (56°). The shape
of the sella turcica is “boat shaped”, flat. Minor deformations
can be found in the cases of both sphenoidal and frontal si-
nuses according to the X-ray recordings.
Results
Some morphological features are highlighted according to an-
atomical regions in the general descriptions of ACD skulls.
Only those features of anatomical deviations are shown that
can possibly be connected to ACD. In the group of the control
sample, the same features in the same regions were also ex-
amined and are compared with the ACD crania. Nevertheless,
deviations known from special literature but not found in our
material examined presently are also discussed. In each of the
following paragraphs, firstly, the previously described literary
references of deviations caused by ACD are discussed, then
possible pathophysiological symptoms are added, lastly, the
results of ACD skulls and controls are described.
Orbital region There are references in special literature about
the effect of distortion on the orbital region: the orbit may be
shallower, the foramen opticum may be smaller and deformed
and the interorbital interval may be increased (Czigány 2008;
J ó z sa a n d P a p 2 0 1 2 , 2 0 14 ; S a n d y e t a l . 2 0 18 ) ;
pathophysiologically, it may result in possibly failing in vision
or even blindness (Dingwall 1931; Kiszely 2006; O’Brien
et al. 2013). With our present ACD skulls, we could not find
any example for deformation of foramen opticum and only
one skull (N42) showed a slightly shallower orbita (N42).
The increase of interorbital interval could be described in four
heavily distorted skulls (A166/a, A168, Aunm, N220); how-
ever, it can be found in four control skulls as well (A165, N41,
N57, N60). Slightly narrower interorbital interval in the cases
of N40 and 262 (control) was detected. In many cases, either
among deformed or control skulls, this region was not observ-
able because of fragmentary character of crania (A166, N61
on the one side and A44, A249, N45, N415 on the other side).

Maxillary and mandibular regions In the maxillary and man-
dibular region, ACD may cause alveolar prognathy according
to previous descriptions (Czigány 2008; Józsa and Pap 1992).
All of our examined ACD skulls where it was observable at all
had alveolar prognathy in expressed (A168, Aunm, N61,
N40) or in moderate scale (N220, N50, N49, N42). Among
control skulls coming from the M3 36/c site, only moderate
alveolar prognathy (N41, N45) was observable. This region of
ACD crania A166, A166/a and A44, A249, N415 skulls were
not examinable because of their fragmentary character.
There are literary sources about double bandaging tech-
nique that was also applied for deformation in historic times:
in these cases, the teeth might have had more extensive dental
abrasion, caries or inflammation. Furthermore, in the tempo-
romandibular joint, significant deformation, arthrosis and di-
latation of mandibular fossa as well as deformation of caput
articularis were described (Czigány 2008; Józsa 2011; Józsa
and Pap 1992; Pap 1985). The main reason of all these devi-
ations is the obstacle of mandibular movements.
Unfortunately, the teeth and the mandibles of two skulls with
double bandaging technique were not excavated (A166,
A166/a). Deformed caput articularis on both sides of the me-
dium deformed Aunm skull could be observed. These have
possibly appeared due to application of two bandages used for
the modification. The mandibular fossa of medium deformed
N50 skull was slightly wider, though the caput articularis is
not deformed. We did not find any signs of arthrosis and the
teeth are in relatively good state regarding the age at death. In
four ACD cases (N42, N49, N61 and N220), caries was
found, and it was also detected among control in the N41,
N45, N60 and N262 skulls. In two cases, signs of dental in-
flammation in both sides of N42 and in only one location of
N220 were found. No signs of dental inflammation were
found among the control sample.
Temporal region Several papers reported that ACD may cause
narrower, deformed external auditory pore and auditory
canal and may cause smaller, deformed auditory ossicles in
the temporal region (Czigány 2008; Józsa 2012; Józsa and Pap
1992, 2012, 2014; Kiszely 2006). All of these may predispose
to chronic middle ear inflammation—which can be concluded
from the sclerotic internal system of the mastoid process—and
this inflammation may cause hearing loss or even deafness
(Czigány 2008; Dingwall 1931; Józsa and Pap 1992;
Kiszely 2006; McGibbon 1912; O’Brien et al. 2013). In the
present study, we could not examine the auditory canal or the
auditory ossicles. Examining the external auditory pores of the
distorted skulls, we could find that the changes were promi-
nent as only two cases assessed as normal (N49, N61). All
other modified crania have narrower or deformed external
auditory pores in a smaller or greater degree (A168, Aunm,
N220, N50, N42, N40). Similar alterations were not found
among control crania. Mastoidal process deviated towards
Archaeol Anthropol Sci
the anterior direction in two medium deformed cases of
ACD (N220, N50), but no signs (of sclerotic feature) of chron-
ic middle ear inflammation were found. We would like to
underline the fact that the deformation type of both of these
skulls could be classified as tabular oblique. The processus
mastoideus is slightly elongated in skull A168 and nor among
control skulls. We found in five cases (A168, Aunm, N220,
N50, N40) that the petrous parts of the temporal bones have
slightly deformed and mildly turned towards the vertical axis
as a previously undescribed alteration. The petrous parts
assessed as normal-shaped just in two slightly deformed skulls
(N49, N42). The other cases are hardly observable because of
their fragmentary feature. We did not observe any signs of
deformations of the petrous part among control crania. The
temporal region is missing in some cases (A166, A166/a, N61
and A44, A249, N45).
Cranial sutures It is needed to lay emphasis on the effect of
distortion on the appearance of cranial sutures. According to
some authors, premature suture fusion (synostosis) and a
greater number of sutural bones (Józsa and Pap 2012;
Mende 2010; O’Loughlin 2004; White 1996) may occur due
artificial deformation. As regards sutures, we only focused on
metopic suture, lambdoid and wormian bones, because only
these appeared in our examined skulls. All of these three epi-
genetic traits were observable on each ACD skulls (like on the
heavily deformed A168 and the medium deformed (Aunm)
skulls). Only one epigenetic trait was observable on the slight-
ly deformed cranium with wormian bones (N49). There was
difference between the control skulls of the two sites: none of
the above-mentioned nonmetric traits could be observed on
the control skulls of Ároktő Csík-gát site, whereas, metopic
suture (N57), lambdoid bone (N45) and wormian bones (N41,
N45, N60, N262) have appeared on several control skulls of
M3/36C site. Any signs of premature suture fusion
(synostosis) were not detected on the examined skulls of
ACD and controls.
Cranial bones The structure of cranial wall could alter and
become thinner due to the impression caused by the bandage
or other instruments used for distortion. It did not preclude the
possibility of infections under the unsuitable applied bandage
(Dingwall 1931; Kiszely 2006). We have described thinner
bone-wall thickness (total bone thickness: internal and
external compact bone and spongy bone) and denser inner
trabecular structure (spongy bone only) of frontal bone
than its normal state in three cases (A168, N49, N50).
These are similar to the parietal in four cases (A166,
A166/a, N42, N61) and to the occipital bone in one case
(N40). The appearances of trabecular internal system are
denser under the bandage in nearly each case (A166,
A166/a, A168, N220, N61, N50, N42, N40). The control
crania have not been examined in this respect. However,
Archaeol Anthropol Sci
any signs of infection and possible osteoporosis were
observed.
Endocranium Several studies suggested that there was a nota-
ble connection between ACD and increased intracranial pres-
sure. The symptoms may include headache, mental retarda-
tion, problems of vision and hearing or even sudden death
(Czigány 2008; Józsa 2011, 2012; Józsa and Pap 1992,
2012, 2014; O’Brien et al. 2013). The signs of increased in-
tracranial pressure endure endocranially, and in quite a few
cases, we could observe the following: deepened grooves for
blood vessels, gyri of brain and dilated arachnoid
granulation. Deepened grooves for blood vessels were found
in only one case (N60) of control crania. Impressions of gyri
of brain and arachnoid granulation were assessed as normal.
In contrast, five of the ACD crania (A166, A168, Aunm,
N220, N42) had signs of deepened grooves for blood vessels.
Five individuals (A166, A166/a, Aunm, N220, N42) have
medium or high degree of deepened and expressed impres-
sions of gyri of brain and four individuals (A166, A166/a,
N50, N40) had dilated and expressed arachnoid granulation
on the endocranial surface of crania.
Józsa and Pap (2012) suggested that there might be a con-
nection between ACD and shorter body height. As a possible
explanation, it can be mentioned that the growth hormone
production decreased (because of deformation of the sella
turcica), enhanced by the increased intracranial pressure
caused by ACD. In the control individuals of M3 36/c site,
the calculated body heights (calculated by using long bone
measurements) mainly vary between the very tall and the
tall-medium (N57, N41, N45, N60) height categories
(Table 1). In two cases (N262, N415), the height could not
be assessed. On the other hand, in the group of ACD sample,
four individuals’ height (N42, N220, N49, N50) fell into the
short, the short-medium and the medium body height catego-
ry. Body height of only two individuals could be calculated
falling in the tall (N40) and the tall-medium (N61) categories
respectively. It is noteworthy that there were deeper and pro-
nounced impressions of gyri and blood vessels of brain in two
individuals (N220, N42) where calculated body height was
short. Among the individuals in the Ároktő Csík-gát site, we
could only calculate a few data for body height, so we did not
make a comparison for those.
Cranial base Many researchers (Antón 1989; Cheverud et al.
1992; Czigány 2008; Józsa and Pap 1992, 2012; McNeil and
Newton 1965; Oetteking 1924) reported about the possible
connection between ACD and malformation of the cranial
base: platybasia, shape of the foramen magnum and sella
turcica, steepness of the clivus. Platybasia and the alteration
of the foramen magnum may predispose to sudden death. If
the steepness of the clivus is flat, it may cause susceptibility to
headache and increased pressure to the brain stem (Czigány
2008; Józsa and Pap 1992). As a result of ACD, the shape of
the sella turcica might become flatter (parabolic or “boat-
shaped”) and it might affect hormone production of hypoph-
ysis. In this way, it might cause a short stature because of the
possible hypofunction of the hypophysis, especially in the
case of the reduced production of growth hormone. The dor-
sum sellae might become more porotic or even disappear as
an effect of ACD (Józsa and Pap 2012). Some researchers
reported about disproportion between cranial fossae (cubic
capacity of anterior cranial fossa is smaller while that of the
posterior cranial fossa is greater) appearing due to ACD and
these changes might affect certain brain functions (Czigány
2008; Józsa and Pap 2014). We do not have a possibility to
examine the dorsum sellae and the cubic capacities of cranial
fossae. Furthermore, we could not examine platybasia, sella
turcica, steepness of the clivus of control and Aunm skulls.
Platybasia was not found in any of our examined skulls. The
foramen magnum was moderately elongated in anterior-
posterior direction in a heavily deformed (A168) and two
medium deformed (Aunm, N220) skulls, but no signs of such
deviations were found among control crania. We could exam-
ine the shape of the sella turcica in four ACD cases. One of
them is flat, “boat-shaped” in a medium deformed skull
(N220) (Fig. 4). The steepness of the clivus was assessed as
moderately flat in two deformed skulls (A168, N220), but the
clivus was steep in only one slightly deformed skull (N40).
Nevertheless, we could not examine the steepness of the
clivus and the shape of the sella turcica in five cases of ACD
skulls (A166, A166/a, N42, N49, N61).
Paranasal sinuses Certain connection between ACD and the
developmental anomalies or complete lack of paranasal
sinuses has been published in special literature. Sometimes
these can induce diseases of upper respiratory system or even
untimely death (Czigány 2008; Józsa 2011, 2012; Józsa and
Pap 1992, 2014). Among our ACD crania, we observed ves-
tigial sinuses, malformations of frontal and sphenoidal sinuses
on skulls N220, N50, N40 and abnormal alteration of the
shape of sinus maxillaris on A168 skull (Figs. 1, 2, 3, and
4). Paranasal sinuses could not be examined in control and
the Aunm skulls.
Other deviations and specialities We have described the fol-
lowing additional alterations appearing on the ACD skulls
but, as a matter of fact, missing on undeformed crania: porotic
hyperostosis in three cases; high curved plate; torus palatinus;
leaning nasal septum and tuberculum prebregmaticum in 2-2
cases each third molar in abnormal position; tartar on teeth;
smaller and deformed nasal bone, missing condyloid fossa;
occipital condyle pressed into the squama occipitale; asym-
metrical sagittal suture and narrower carotid canal in 1-1
cases. Torus palatinus and torus mandibularis were found in
1-1 cases among controls.

In the “Results” section, we attempted to focus only on the
facts. Our sample is not suitable to get a generally valid connec-
tion between ACD and certain deviations or draw conclusions
because the number of cases is too small and some of them are
fragmentary. However, it is worthy to describe and does not seem
useless to put emphasis on describing some noteworthy lesions
found on ACD crania. Expressed alveolar prognathy was found
as a possible result of ACD on the deformed skulls in many
cases. Some deviations in the temporal region were also ob-
served: narrowed, deformed external acoustic pore on one or
both temporal bones in many cases. It is notable that the mastoid
process leaned towards the anterior direction in skulls with
tabular-oblique deformation type. We would like to underline
that the petrous part of the temporal bone leaned towards poste-
rior direction of the cranial base in five cases and their shape is
slightly deformed. Several papers reported that accessory bones
might appear in force in the cranial sutures as a result of ACD. In
accordance, a frequent appearance of suture bones in deformed
crania of Ároktő Csík-gát site was found, while additional bone
pieces were missing in the control skulls of Ároktő Csík-gát site.
The wall thickness of cranial bones decreased on those areas
where devices applied for modification pressed the bones and
the trabecular system of spongy bone became denser on the same
areas. These features were indicated mainly on the frontal bone
and on parietal bones in some cases. During the examination of
endocranium, markers for increased intracranial pressure could
be found: five of ten distorted skulls had deepened and pro-
nounced grooves for blood vessels, five skulls had deepened
and expressed impressions of gyri of brain and four skulls have
dilated and well observable Pacchioni granulation. It deserves
attention that two individuals—whose calculated body height
was short—have deepened and pronounced blood vessels fis-
sures and impressions of gyri of brain as well. We also detected
the effect of ACD on cranial base. Slightly elongated (in anterior-
posterior direction) foramen magnum was indicated on the me-
dium and heavily deformed skulls. The sella turcica is boat-
shaped and relatively flat in one case and it is possibly in con-
nection with ACD. Deviations of paranasal sinuses (vestigial
frontal sinus, sphenoidal sinus, maxillary sinus), which are also
known from the literature and caused by ACD, were found in
four cases.
Discussion
In the present study, the morphological effects of ACD were
analysed in detail, emphasizing the possible pathological conse-
quences of the custom. Previous researchers shed light on path-
ological lesions or disorders in relation to this practice and noted
a number of predisposition or direct clinical and neurological
symptoms due to ACD. The lesions described in previous rele-
vant papers, most of which were only concerned with a single or
a few pathological deviations in detail, were collected and
Archaeol Anthropol Sci
reviewed. There are just a few overall analyses in this subject
matter (Boston 2012; Józsa and Pap 1992, 2012; Vyslozil and
Slavicek 2001). The authors of the present paper think it would
be important that all the observed morphological lesions of ACD
crania should be described precisely by anthropologists follow-
ing the same, standard method. This could largely help to draw
proper conclusions concerning the pathological alterations and
the possible neurological symptoms occurring as a consequence
of ACD. That is why the authors intend to point out the necessity
of a unified descriptive method for the analysis of artificially
deformed skulls as a standard procedure, which can be an effec-
tive tool for researchers to get comparable data as well as com-
mon and generally valid results concerning the pathological al-
terations caused by ACD.
With this end in view, the authors have created a data col-
lector sheet (Table 2) which is easy to survey, clear and well
arranged. All of the examined areas (anatomical parts) of
ACD skulls are put and indicated in a relatively short, sum-
marizing tabular form, a single sheet of paper, which can be
easily filled in and effectively analysed at the same time
(Table 2). Primary data, such as name of site, grave number,
sex, age at death, OGŽ index and type of deformation, can be
found in the heading, at the top of the form. Many of the
anatomical areas and regions indicated in the sheet can be
examined simply by the naked eye or using a loupe or a mi-
croscope. Some hidden lesions can only be examined by ap-
plying X-ray and CT recordings if the skull is intact. The form
should be filled in by mainly using numbers (− 3, − 2, 0, 1, 2,
3, 4). “0” means that the particular anatomical part is missing
or not examinable. “1” means the normal type (with no devi-
ation) of the area, accordingly, “2” means minor difference
and “3” means great difference from the normal state of the
given anatomical part of the skull. The examined cranial re-
gions and the probable pathological disorders (in parentheses)
due to artificial deformation procedure are indicated (Czigány
2008; Józsa 2011, 2012; Józsa and Pap 1992, 2012, 2014;
Kiszely 2006; Mende 2010; O’Brien et al. 2013;
O’Loughlin 2004; Pap 1985; White 1996). Sometimes the
direction, the way of the lesions is the opposite as expected
(compared with the previously mentioned results of the ade-
quate literature). In these cases, a minus sign as a prefix: (“−
2” “− 3”) is applied to present the direction of the alteration. If
the particular region cannot be examined, “0” should be used
as a description. If there is atresia of the examined area, “4”
should be used. If the given anatomical part is not examined,
“−” sign (a minus sign) should be used in the proper block of
the form. Using the correctly filled form, it is easy to
recognize which anatomical parts show deviations and
lesions on an artificially deformed cranium. This proce-
dure helps to accomplish analyse and discover what con-
nections between the pathological lesions of ACD skulls
and the sex, age at death, type and extent of deformation.
The best way to get a clear view of the usability of this
Archaeol Anthropol Sci
Table 2 An example (A168
cranium) using the unified
descriptive method of ACD
form is to test it in real examinations. We filled in these
forms for all our deformed skulls and we demonstrate one
in detail (for skull A168) as an example (Table 2). To sum
Site: Ároktő Csík-gát – not examined
Grave number: 168 0 cannot be examined
Sex: female 1 normal, or no deviation
Age at death: 15–17 2 minor differences from normal type (direction)
OGŽ index: 101.30 3 great differences from normal type (direction)
Type of deformation: circular erect 4 atresia, not developed
Others: one bandage was used − 2 contrary minor differences from normal type
(opposite direction)
− 3 contrary great differences from normal type
(opposite direction)
Examined area R L Examined area R L
Orbital region Cranial base
Orbita (shallow) 1 1 Platybasia (pronounced) 1
Foramen opticum (small, deformed) 1 1 Foramen magnum (elongated) 2
Interorbital interval (increased) 2 Steepness of the clivus (flat) 2
Maxillary and mandibular region Shape of sella tucica (flat) 1
Alveolar prognathy (expressed) 3 Dorsum sellae (porous) –
Caput articularis (deformed) 0 0 Paranasal sinuses
Fossa mandibularis (dilated) 0 0 Sinus frontalis (vestigial) 1
Temporomandibular joint (arthrosis) 0 0 Sinus sphenoidalis (vestigial) – 1
Abrasio compared with age at death 1 Sinus maxillaris (vestigial) 1 2
(extensive)
Caries (3, or more teeth) 1 Other deviations, specialities
Teeth-related inflammation (extensive) 1 Fossa condyloidea disappeared 3 3
Temporal region Condylus occipitalis pressed into the 3 3
squama occipitale
Porus meatus acusticus ext. (narrow, 2 2 Smaller nasal bone 1 3
deformed)
Auditory canal (narrow, deformed) – – Septum nasale leans to the left 3
Auditory ossicles (deformed) – – Third molar in abnormal position 3 1
Auditory ossicles (smaller) – – Poroticus hyperostosis on the maxilla 2
Processus mastoideus (elongation) 2 1 Cribra orbita 2 2
Processus mastoideus (deviate) 1 1 Canalis caroticus narrower 2 2
Processus mastoideus (sclerotic) 1 1
Os petrosa (lean to vertical axis of skulls) 2 1
Cranial suture
Accessory bones (appear) 3
Premature suture fusion (synostosis) 1
Cranial bones
Osteoporosis (extensive, where?) 1
Bone thickness (decreased, where?) Frontal
Trabeculae of spongy bone (denser) 2
Endocranium
Gyri (deepened and pronounced) 0
Grooves for blood vessels (deepened and 3
pronounced)
Arachnoid Pacchioni’s granulation (dilated 1
and pronounced)
up and to get an easier overview, the results (lesions of
examined areas) of the ACD and control skulls are shown
with the exact number of cases in Table 3. This table was
 Archaeol Anthropol Sci

Fig. 1 Lateral and anterior-posterior X-ray recording and photo of A168

Fig. 2 Lateral and anterior-posterior X-ray recording and photo of N40

Fig. 3 Lateral and anterior-posterior X-ray recording and photo of N50

Fig. 4 Lateral and anterior-posterior X-ray recording and photo of N220

Archaeol Anthropol Sci

Table 3 Summing up the lesions of examined areas with the number of cases of the deformed (D) and control (C) skulls, based on the markings of the
unified descriptive method

Examined area Extent of deviation

D—deformed skulls; C—control skulls

– 0 1 2 3 4 −2 −3

D C D C D C D C D C D C D C D C

Orbital region
Orbita (shallow) 3 4 6 6 1
Foramen opticum (small, deformed) 4 5 6 5
Interorbital interval (increased) 2 4 3 1 3 4 1 1 1
Maxillary and mandibular region
Alveolar prognathy (expressed) 2 3 5 4 2 4
Caput articularis (deformed) 4 4 5 6 1
Fossa mandibularis (dilated) 3 4 6 6 1
Temporomandibular joint (arthrosis) 4 4 6 6
Abrasio compared with age at death (extensive) 2 2 8 8
Caries (3, or more teeth) 2 3 4 3 1 2 3 2
Teeth-related inflammation (extensive) 2 3 6 7 1 1
Temporal region
Porus meatus acusticus ext. (narrow, deformed) 2 2 2 8 4 2
Auditory canal (narrow, deformed) 8 8 2 2
Auditory ossicles (deformed) 8 8 2 2
Auditory ossicles (smaller) 8 8 2 2
Processus mastoideus (elongation) 3 4 6 6 1
Processus mastoideus (deviate) 3 4 5 6 1 1
Processus mastoideus (sclerotic) 2 4 8 6
Os petrosa (lean to vertical axis of skulls) 3 3 2 7 2 3
Cranial suture
Accessory bones (appear) 1 2 6 3 1 4 2 1
Premature suture fusion (synostosis) 2 10 8
Cranial bones
Osteoporosis (extensive) 10 10
Bone thickness (decreased) 10 2 3 5
Trabeculae of spongy bone (denser) 1 10 1 7 1
Endocranium
Gyri (deepened and pronounced) 1 5 9 3 2
Grooves for blood vessels (deepened and pronounced) 1 5 8 1 4 1
Arachnoid Pacchioni’s granulation (dilated and pronounced) 1 1 5 9 4
Cranial base
Platybasia (pronounced) 1 10 5 4
Foramen magnum (elongated) 3 5 4 5 3
Steepness of the clivus (flat) 1 7 5 3 1 2 1
Shape of sella tucica (flat) 1 7 5 3 3 1
Dorsum sellae (porous) 7 7 3 3
Paranasal sinuses
Sinus frontalis (vestigial) 1 7 2 3 4 2 1
Sinus sphenoidalis (vestigial) 1 7 5 3 1 3
Sinus maxillaris (vestigial) 2 7 3 3 4 1
Other deviations, specialities 3 8 5 2 2

prepared by using the markings of the unified descriptive
method presented here.
Conclusions
Consistent with previous results, most of the pathological le-
sions or serious disorders reported were found on the de-
formed skulls. Alveolar prognathy, narrow porus meatus
acusticus externus, deviation of processus mastoideus, defor-
mation and leaning of os petrosa towards the vertical axis of
the skull, appearance of higher numbers of accessory bones
(only in skulls of Ároktő Csík-gát site), signs of increased
intracranial pressure, elongation of foramen magnum and ves-
tigial paranasal sinuses were recorded on ACD crania in sev-
eral cases. These lesions could possibly be the result of the
ACD. In some cases, the pathological leaning of os petrosa
towards vertical axis of the skull was found as a lesion previ-
ously undescribed in the relevant literature. Thus, the authors
think this lesion is worth putting in the form of unified de-
scriptive method as an examined area. There are not many
pieces of information about the deformation of temporal re-
gion as a result of ACD in special literature. The authors
suggest that this region would need deeper examinations.
We need to lay special emphasis on skull N220, where we
can find not only the signs of increased intracranial deviations
(deepened, pronounced gyrus of brain and blood vessel fis-
sure, dilated, pronounced Pacchioni granulation) but also the
deformation of the sella turcica. The shorter calculated body
height (145.39 cm) of this individual may have been caused
by decreased growth hormone (GH) secretion as a result of
heightened intracranial pressure on pituitary gland. The devi-
ation of processus mastoideus must have had anterior connec-
tion with the tabular-oblique type of deformation, especially.
Further deviations and specialities of the examined areas can
be found in our form connected with ACD, where additional
pathological disorders were also indicated. Of course, they
need more investigations to shed more light on in future.
Our earlier supposition (Molnár et al. 2014)—since no in-
dividuals from either site (Ároktő Csík-gát and Nyíregyháza
M3 36/c) suffered from considerable pathological disorders
and possible neurological symptoms—did not change essen-
tially after the detailed morphological and radiological analy-
ses. It would be worthwhile for researchers to examine and
document all the ACD skulls by using the same or a very
similar method so that these skulls should become known in
a standard way in future. Thus, based on extensive data of
numerous ACD crania, more precise observations could be
made, better-grounded valid conclusions could be drawn and
our knowledge about this interesting custom and its possible
pathological consequences would become by far wider and
deeper than now. That is why we propose the use of a unified
descriptive method—and our method has been tested by
Archaeol Anthropol Sci
describing ten ACD skulls. In order to get an even more ap-
plicable procedure, it is important to improve this method
relying on our experience. It would be also useful to get more
objectivity by increasing the number of individuals in the
samples examined or using more metrical data and lessen
the territory of subjectivity for example, also to find the way
how to get clearer distinction between normal and pathologi-
cal forms. This could serve as a good research tool for anthro-
pologists to get a clearer distinction between normal and path-
ological forms of anatomical regions of ACD crania. Thus, the
present study could mean the first step in a long way which
may eventually lead after lot of research work to accurate,
general and well-standardized analysis of ACD skulls.
At the same time, it might be useful to re-examine all the
ACD skulls deriving from certain geographical territories (e.g.
the whole of Carpathian Basin) using a unified method (e.g.
the present method) to get a clearer view of this topic, regard-
ing the origin, types, roles and ethnic relations of the artificial
cranial deformation. Summing up, the authors intend to sug-
gest all other researchers dealing with this subject of a possible
unified descriptive method to collect the pathological devia-
tions, lesions of ACD skulls.
Acknowledgements We are very grateful to Gareth Dyke (University of
Debrecen, Hungary & Babeş-Bolyai University, Romania) for the lan-
guage correction of this article. We would also like to thank all our col-
leagues who have helped the completion of this work.
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