Head and Skull Base Features of

Nine Egyptian Mummies: Evaluation

with High-Resolution CT and
Reformation Techniques
Heidi Hoffman 1 OBJECTIVE. CT is an indispensable imaging tool in the evaluation of Egyptian mummies
Patricia A. Hudgins because it can noninvasively generate large amounts of data. We applied current CT imaging and
postprocessing techniques to methodically survey the head and skull base features of nine Egyp-
tian mummies in the hope of providing paleopathologic and radiologic information.
MATERIALS AND METHODS. Nine Egyptian mummies were evaluated on helical
CT using 1-mm axial scans obtained from the skull vertex to the mid cervical spine. System-
atic evaluation of the skull and intracranial contents, paranasal sinuses, craniocervical junc-
American Journal of Roentgenology 2002.178:1367-1376.

tion, orbits, temporal bones including the middle and inner ears, teeth, and superficial soft
tissues was undertaken. Reformatted and volume-rendered images were generated.
RESULTS. CT findings indicated that the intracranial contents of the nine mummies var-
ied tremendously. Destruction of the anterior skull base structures in mummies without in-
tracranial contents suggested a transnasal, transethmoidal approach to excerebration. A large
amount of expensive embalming material within the skull of one mummy suggests that he
may have been a royal pharaoh. A cleft palate deformity was identified in a child mummy.
Temporal bone analysis revealed one case of asymmetric mastoid air cell erosion and dehis-
cence, which is strongly suggestive of prior mastoiditis. Craniocervical junction abnormali-
ties and ossicular chain disruption in several mummies were attributed to postmortem
damage. The orbital structures had intentionally been removed in several mummies. Dental
disease was ubiquitous among the adult specimens.
CONCLUSION. The systematic evaluation of the head and skull base of mummies with CT
can provide insight into the life, disease, death, and postmortem treatment of these ancient Egyptians.

E gyptian mummies are “biologic

Received November 7, 2001; accepted after revision
December 20, 2001.
Presented at the annual meeting of the American Society
of Neuroradiology, Boston, April 2001.
1
Both authors: Department of Radiology, Emory University
Hospital, 1364 Clifton Rd., N.E., Atlanta, GA 30322. Address
correspondence to P. A. Hudgins.
AJR 2002;178:1367–1376
0361–803X/02/1786–1367
© American Roentgen Ray Society
museums” [1] that contain a
wealth of information about the
life and death of an ancient population. Al-
though the cranium and its contents were ac-
corded no specific value by the ancient
Egyptians, the heads of mummies have been a
source of fascination and scientific interest for
many previous investigators. Radiologists, oto-
laryngologists, surgeons, and orthodontists
have published focused studies about various
features of the skull base, sinuses, nasal cavi-
ties, temporal bones, and dentition of ancient
mummies based on radiologic and endoscopic
evaluations [2–8].
CT has become the primary means of
studying these embalmed individuals because
of its ability to noninvasively, thus nonde-
structively, reveal both internal and superfi-
cial structures while providing excellent
spatial and contrast resolution. Current post-
processing algorithms enable the manipula-
tion of CT data so that images can be
generated in multiple planes and in three-di-
mensional formats, further expanding the
abilities and uses of CT. Our goal was to per-
form a comprehensive, systematic review of
multiple components of the face, head, and
skull base of nine Egyptian mummies using
thin-collimation CT imaging and advanced
reconstruction techniques.
We reviewed the integrity and appearance
of the skull and intracranial contents, cranio-
cervical junction, skull base, paranasal sinuses,
temporal bones, middle and inner ears, orbits,
dentition, and superficial soft tissues. To our
knowledge, a broad yet systematic evaluation
of these structures in a collection of mummies
this size has not heretofore been published in
the radiology literature. In this investigation,
we hoped to show that advanced CT can pro-
vide substantial information about the anat-
omy, pathology, and postmortem treatment of
these ancient Egyptians.

AJR:178, June 2002 1367


American Journal of Roentgenology 2002.178:1367-1376.
A B
Materials and Methods
Between October 1999 and May 2001, nine in-
tact Egyptian mummies, including two children,
were individually transported from the Michael C.
Carlos Museum on the Emory University campus
to the Department of Radiology for whole-body
CT and radiography. The mummies are thought to
be from various eras on the basis of the accompa-
nying coffins and other Egyptologic evidence (Ta-
1368
Hoffman and Hudgins
Fig. 1.—Male mummy from 21st Dy-
nasty who was older than 18 years at
death. Defects of ethmoidal sinuses
are depicted in multiplanar and three-
dimensional formats.
A, Coronal reformation from CT scan
obtained at level of cribriform plate
shows destruction of ethmoid air cells
and roof of ethmoidal sinuses (arrows)
along path of postmortem excerebra-
tion.
B, Sagittal CT scan shows transnasal
passageway of brain removal (arrow)
in plane that allows better conceptual-
ization of location, length, and appear-
ance of defect.
C, Three-dimensional reformation from
CT scan of defect of ethmoidal sinuses
(arrows) shown in B provides another
compelling perspective of this abnor-
mality.
C
ble 1). The approximate age at death of each
mummy was based on prior bone evaluations.
All mummies were evaluated on a helical CT
scanner (General Electric Medical Systems, Mil-
waukee, WI) with 1-mm axial images from the
skull vertex through the mid cervical spine. The
scanning parameters were 70–100 mA/sec, 120–
140 kVp, and a pitch of 1.0; no gantry tilt was
used. The number of axial images generated per
mummy ranged from 126 to 218.
Each set of images was systematically evaluated in
the axial, coronal, and sagittal planes for integrity of
the skull and skull base (anterior, central, and poste-
rior); the presence or absence of intracranial contents;
the morphology of the paranasal sinuses; and the ap-
pearance and condition of the craniocervical junction,
dentition, orbits, temporal bones, middle and inner
ears, and soft tissues of the face. Detailed multiplanar
and two- and three-dimensional volume-rendered im-
ages of the head and face were methodically gener-
ated on-site at a workstation (Advantage Windows
[version 3.1]; General Electric Medical Systems).
Results
The Skull, Skull Base, and Sinuses
The calvarium was intact in eight of the nine
mummies in the collection. In one of the child
mummies (mummy 5), a complex, sagittally
oriented, partially depressed fracture of the left
parietal skull with resultant diastasis of the
lambdoid sutures was revealed. We could not
determine whether this fracture occurred before
or after death, but no evidence of callous forma-
tion to suggest bone healing was found.
Because the brain held no particular value to
the Egyptians and was a potential source of pu-
trefaction after death, the brain was traditionally
removed from a corpse before embalming and
burial [9–12]. Historical accounts by Herodotus
describe the insertion of a curved metal hook
into the nostril of a corpse and the removal of
the cranial contents via a transnasal, transeth-
moidal approach [11]. Four of the mummies in
our study had skull base abnormalities reflect-
ing this means of excerebration. In these four
specimens, the ethmoidal sinuses were either
partially or completely destroyed (Fig. 1). The
side of traumatic penetration was variable:
right-sided destruction in two mummies from
the 19th Dynasty, left-sided destruction in a
child from the 25th or 26th Dynasty, and bilat-
eral destruction of the ethmoidal sinuses in the
other child from the same era. Although the de-
fects were evident on CT scans obtained in the
traditional axial plane, sagittal and coronal re-
formations were illustrative in further showing
the location and extent of the bony abnormali-
ties. Using volume-rendering algorithms, we
generated three-dimensional images that pro-
vided additional perspectives of these defects.
Axial CT of the skull of the child with the
calvarial fracture showed a bony fragment
that had been displaced into the posterior as-
pect of the skull (Fig. 2A). The morphology
of this fragment was difficult to conceptualize
on images obtained in the axial plane; this
finding was more easily identifiable as a
piece of sphenoid bone on three-dimensional
AJR:178, June 2002
 CT of the Head and Skull Base in Egyptian Mummies

Radiologically and Historically Based Estimates of the Demographic large amount of resin, an embalming fluid (Fig.
TABLE 1 3). Two different densities within this hardened
Information for the Nine Mummies Studied
molten mass are clearly depicted, suggesting
Mummy Sex Age at Death (yr) Era Time Period
either that the fluid was poured in two different
1 Female 20–40 21st Dynasty 1085–945 BC installments or that it had layered into sedi-
2 Unknown a 20–35 21st Dynasty 1085–945 BC ments before hardening into a solid mass. A
3 Female >35 21st Dynasty 1085–945 BC small amount of resin was identified in only
4 Unknowna 2 25th or 26th Dynasty 747–525 BC one other mummy: one of the children from the
5 Unknowna 5 25th or 26th Dynasty 747–525 BC 25th or 26th Dynasty.
6 Male >30 Roman period 305 BC–AD 323 The brain was left in situ in the remaining
five mummies, a finding that contradicted tra-
7 Unknown a >18 21st Dynasty 1085–945 BC
ditional accounts of mummification. Although
8 Male >45 19th Dynasty 1320–1200 BC
varying in appearance, the brain typically atro-
9 Unknown a 20–35 21st Dynasty 1085–945 BC
phied and settled in the dependent (posterior)
a
We were unable to definitively determine the sex. Mummies 4, 5, 7, and 9 are thought to be males. portion of the skull (Figs. 4–6). Residual dural
linings were also evident in three of the five
mummies, thus confirming that no attempt
reformations (Fig. 2B). Although invasion Intracranial Contents was made to remove the brain.
and destruction of the ethmoidal sinuses were The brain was absent from the four mum-
apparent, the brain appears to have been re- mies with traumatic anterior skull base defects. Craniocervical Junction
moved more aggressively in this child than in Although the cranial vault was primarily empty The craniocervical junction was abnormal in
American Journal of Roentgenology 2002.178:1367-1376.

the other mummies via a posteriorly oriented, in three of these mummies, approximately half three of the nine mummies studied. The abnor-
transsphenoidal approach. of the cranium of mummy 4 was filled with a malities included rotary subluxation and disloca-

A B

Fig. 2.—Skull of child mummy from 25th or 26th Dynasty who was approximately 5 years old at death. Sex of child could not be definitively determined.
A, Axial CT image shows amorphous bony fragment (straight arrow) in dependent portion of skull. Also note small amount of resin poured within cranium (r) and depressed
fracture of parietal skull (curved arrow), which may have been related to death of this child.
B, Volume-rendered shaded-surface–display CT image better depicts shape of bony fragment (arrow) seen within posterior calvarium. This fragment appeared to repre-
sent portion of sphenoid bone, which was likely displaced during process of brain removal.

AJR:178, June 2002 1369

 Hoffman and Hudgins

tion (Fig. 7). Although the cases of rotary
subluxation were evident on images obtained in
the traditional axial plane, craniocervical dislo-
cation was best illustrated on the reformatted
coronal images.
Temporal Bone and Middle and Inner Ears
The external auditory canals were normal in
all nine mummies. Remarkably, despite up to
3000 years of elapsed time, the fragile middle
ear ossicles were pristinely preserved bilater-
ally in three of the mummies (Fig. 8). The os-
sicular chain was disrupted in six of the nine of
the mummies studied. Abnormalities ranged
from ossicular subluxation and dislocation to
the complete absence of all ossicles. The inner
ear, including the otic capsule and cochlea,
vestibule, and semicircular canals, was normal
in all the specimens.
Mastoid air cells in eight of the nine mum-
mies were well pneumatized and normal in ar-
American Journal of Roentgenology 2002.178:1367-1376.
the adult male mummies were seen (Fig. 9A),
in addition to discontinuity of the adjacent cor-
tical bone at the occipitomastoid confluence.
Dentition
Extraction sockets, fractured teeth, and
periapical radiolucencies were identified in
all seven adult mummies to various degrees.
Dental caries was suggested in only two of
the adult mummies. Mild to moderate erosion
of the cusps of the molars and premolars was
seen in two of the adult male mummies.
These abnormalities were difficult to appreci-
ate on the axial images but were readily ap-
parent on images obtained in the sagittal
plane and on the three-dimensional reforma-
tions (Fig. 10).
The two pediatric specimens had unerupted
teeth, the pattern of which helped establish the
approximate ages at the time of death as 2 and
5 years.
terior midline alveolar process of the maxilla and
did not appear to extend into the posterior palate.
Evident on contiguous axial images and those
reproduced in a three-dimensional format, this
abnormality is believed to represent a mild form
of a cleft palate (Fig. 11). Volume-rendered
shaded-surface–display images suggested that
this child also may have had a cleft lip.
Orbital Structures
The atrophied remains of the extraocular
muscles and optic nerves were identifiable in
six of the nine mummies (Fig. 12). The defini-
tive identification of the globe was more vari-
able, and the lenses were distinctly seen in
only one mummy (Fig. 13).
In one male mummy, the right orbital
structures were absent, and fractures of the
adjacent lamina papyracea were detected.
These findings suggest that the removal of the
orbital contents was intentional. In two other

chitecture bilaterally. Asymmetric sclerosis, A thin, corticated bony defect was revealed in mummies, the orbital structures were also ab-
erosion, and dehiscence of the lateral right the paramedian hard palate of one of the child sent and embalming debris was present in the
mastoid air cells and sigmoid plate in one of mummies. The defect primarily involved the an- empty bony orbits.

Fig. 3.—Cranial contents of male mummy from 19th Dynasty, potentially a pharaoh, Fig. 4.—Intracranial contents of female mummy from 21st Dynasty. When left intact,
who was more than 45 years old at death. Axial CT image of skull shows replace- brain (large arrow) typically atrophied and fell within dependent portion of skull.
ment of brain tissue with resin (embalming fluid), which fills approximately 50% of Meningeal linings (small arrow) can also be identified, evidence that no attempt was
skull. Two different densities are clearly present within this molten resin mass, sug- made to remove intracranial contents.
gesting fluid was poured in two different installments or, alternatively, layered into
precipitates before drying. Small amount of resin (arrowhead) is also present in
right maxillary sinus. Also note near-complete absence of ethmoid air cells, reflect-
ing transethmoidal approach for excerebration.

1370 AJR:178, June 2002

 CT of the Head and Skull Base in Egyptian Mummies
American Journal of Roentgenology 2002.178:1367-1376.
Fig. 5.—Intracranial contents of female mummy from 21st Dynasty (different specimen
from Figure 4) who was between 20 and 40 years old at death. Sagittal CT image re-
veals atrophied brain (straight arrow) within dependent posterior cranium. Note
linen (curved arrow) within oropharynx; linen was likely placed postmortem to help
restore facial contours to corpse.
Fig. 7.—Craniocervical junction of male mummy from 21st Dynasty who was ap-
proximately 20–35 years old at death. Coronal reformation from CT scan shows sub-
luxation and dislocation at C1–C2 and C2–C3 levels, which were suspected on axial
acquisitions but could be confirmed on high-resolution reformations. This injury
likely occurred postmortem.
AJR:178, June 2002
Fig. 6.—Intracranial contents of male mummy from 21st Dynasty who was more than 30
years old at death. Axial CT image reveals markedly atrophied, heterogeneous brain
(large arrow) within dependent skull. Small arrow denotes meningeal linings, evidence
that no attempt was made to remove intracranial contents.
Fig. 8.—Temporal bone of male mummy from 21st Dynasty who was approximately 20–
35 years old at death. Note normal middle and inner ear structures, including malleolar
head and body, short process of incus (arrow), and lateral semicircular canal
(arrowhead). Only three of nine mummies had such well-preserved temporal bones.
1371
 Hoffman and Hudgins

Fig. 9.—Mastoid air cells of male

mummy, possible pharaoh from 19th
Dynasty, who was more than 45
years old at death.
A, Axial CT image of right temporal
bone shows demineralization of mas-
toid septations as well as focal dehis-
cence of mastoid bone and sigmoid
plate (thick arrows). Opacification
within air cells likely results from in-
tracranial embalming fluid. This pat-
tern of dehiscence likely represents
premorbid bone erosion, possibly from
mastoiditis. Note defect at occipito-
mastoid confluence (thin arrow). We
speculate this defect may reflect site
of treatment attempt.
B, Axial CT image of contralateral
(left) mastoid and sigmoid plate re-
veals intact bony architecture.

A B
American Journal of Roentgenology 2002.178:1367-1376.

A B

Fig. 10.—Dental images of male mummy from 21st Dynasty who was approximately 20–35 years old at death.
A, Sagittal CT image obtained through left mandible shows concavity of cusps of preserved mandibular teeth. These changes are thought to result from sand and grit in diet.
B, Volume-rendered shaded-surface–display image again shows cusp erosions (arrow).

1372 AJR:178, June 2002

 CT of the Head and Skull Base in Egyptian Mummies

Facial Soft Tissues
Study of superficial soft-tissue features
with both standard and three-dimensional im-
aging methods revealed complete or partial
American Journal of Roentgenology 2002.178:1367-1376.
destruction of the bony and cartilaginous intracranial contents. A wad of resin-soaked
structures of the nose in four mummies. In linen was placed over the left side of a child’s
three of these mummies, this damage was likely nose after the cartilaginous structures had been
related to traumatic transnasal removal of the destroyed (Fig. 14). The three-dimensional

A B

Fig. 11.—Probable midface congenital deformity, cleft palate, in child mummy from 25th or 26th Dynasty who was approximately 5 years old at death. Sex of mummy could
not be definitively determined.
A, Axial CT image shows bony cleft (straight arrow) in midline. Also note right nasal pledget (curved arrow), either linen or resin, that was placed to restore natural facial
contours in this child mummy.
B, Shaded-surface–display reformation shows cleft.

Fig. 12.—Orbital structures in female mummy from 21st Dynasty who was approximately Fig. 13.—Orbital structures in male mummy from Roman period who was more than 30
20–40 years old at death. Axial CT image shows atrophied and degenerated orbital con- years old at death. Axial CT image shows collapsed globes and lenses (arrow).
tents including extraocular muscles, fascia, and other orbital structures (arrows).

AJR:178, June 2002 1373

 Hoffman and Hudgins

reconstruction of one mummy showed a de-
formity of the nose (Fig. 15); this finding re-
flects the underlying nasal and maxillary
sinus fractures depicted on the axial images.
This image also nicely shows that the orbits
in this woman are sunken, apparently having
been removed.
Three-dimensional reconstructions of an-
other mummy also revealed a deformity of the
pinna of the right ear (Fig. 16), a detail that
was difficult to appreciate on images obtained
in the standard axial plane.
Volume-rendered images were remarkably
similar to the true appearance of the mummies.
Other Findings and Normal Variants
Careful study of the head and skull base fea-
tures of the nine mummies resulted in the detec-
tion of normal variants and other incidental
findings. Linen packing was identified in the
oropharynx or hypopharynx of three mummies
American Journal of Roentgenology 2002.178:1367-1376.
Discussion
The systematic review of the skull and its
associated structures of nine Egyptian mum-
mies yielded information of historical and sci-
entific interest. There was evidence of
intentional excerebration in four mummies. As
alluded to in ancient historical accounts and more
recent scientific investigations [4, 6, 13–17], a
transnasal, transethmoidal approach into the
cranium was typically used. In this collection
of mummies, it is unclear whether there was a
preferential side, or nostril, through which the
Egyptians approached the skull base. The
mummies from the 19th Dynasty and 21st Dy-
nasty had right-sided defects; one child from
the 25th or 26th Dynasty had left-sided bony
destruction, whereas the other child from the
same era had bilateral defects. Interestingly,
the child with bilateral defects had a wad of
resin-soaked linen over the left nostril, raising
the possibility that this site was the site of trau-
expensive aromatic embalming fluid derived
from trees that was used in the mummification
process during several dynasties. The contrast
resolution inherent to CT enabled the identifica-
tion and characterization of two different densi-
ties of the embalming fluid, a detail that was not
evident on the radiographs of the skull. This
finding suggests that the resin either was poured
into the cranium in two different installments or,
alternatively, was composed of different sedi-
ments that precipitated before drying into a mol-
ten mass. A growing body of evidence in the
Egyptology literature and radiology literature
supports the hypothesis that this particular male
mummy lived during the 19th Dynasty of the
New Kingdom and is of royal lineage, perhaps
the lost body of Ramesses I, the first ruler of the
19th Dynasty. The large amount of expensive
embalming fluid found in the skull and else-
where in the body of this individual corresponds
with known New Kingdom mummification

(Fig. 5). This material was probably strategically
placed to restore the lifelike contours to the face
and soft tissues of the neck. A small resin-coated
pledget was present in the right nostril of one of
the child mummies (Fig. 11A).
Other normal variants included a large pneu-
matized frontal sinus, concha bullosa, several
cases of nasal septal deviation, and one high-
riding jugular bulb.
matic entry. Irrespective of the side of the de-
fect, all defects could be identified on images
obtained in the axial plane; however, these de-
fects were best conceptualized on images ob-
tained in the sagittal plane and as part of a
three-dimensional image.
A finding of particular interest was the pres-
ence of a large amount of resin within the skull
of one of the adult male mummies. Resin was an
techniques and further supports this theory.
In four of five mummies from the 21st Dy-
nasty, the brain was left intact. Although this
practice may indicate that the deceased were
of a lower social status, this trend suggests that
mummification techniques were simplified
during this time period, because evidence of
brain removal has more typically been found
in mummies from earlier periods.

Fig. 14.—Facial features of child mummy from 25th or 26th Dynasty who was ap-
proximately 2 years old at death. Sex of infant could not be determined. Volume-ren-
dered surface–display reformation shows wad of linen (arrowhead) over left nares.
This detail was better appreciated on three-dimensional images, which can provide
Egyptologists with additional information about mummification techniques.
Fig. 15.—Facial features of female mummy from 21st Dynasty who was more than 35
years old at death. Volume-rendered shaded-surface–display image eerily displays
sunken orbits, abnormal facial contours, and fractured teeth that closely replicate this
female mummy’s true appearance. Reformations are complementary to direct axial ac-
quisitions and reveal detail that could only be imagined otherwise.

1374 AJR:178, June 2002

 CT of the Head and Skull Base in Egyptian Mummies
Fig. 16.—Soft-tissue facial struc-
tures in male mummy, possible 19th
Dynasty royalty, who was more than
45 years old at death. Volume-ren-
dered shaded-surface–display ref-
ormation shows absence of large
portion of superior cartilaginous
pinna.
American Journal of Roentgenology 2002.178:1367-1376.
Egyptologists and the general population
alike are interested in the afflictions and possible
causes of death of these ancient people. Al-
though speculative, our findings identify a po-
tential contributor to or cause of death in two of
the nine mummies studied. A complex, partially
depressed skull fracture in a child mummy raises
the possibility of a traumatic antemortem head
injury. The absence of callous formation, indi-
cating there was not enough time for bone heal-
ing to occur, suggests the relative acuity of the
trauma. The location and appearance of this
skull fracture are not likely to have been related
to brain removal, because brain removal is ac-
counted for by traditional skull base and sinus
fractures. Furthermore, it is less likely that this
fracture resulted from postmortem mishandling
because only one other fracture (of the distal fe-
mur) was identified in this specimen, whereas
mummies that are indiscriminately handled typi-
cally have innumerable fractures throughout the
entire bony skeleton. These fractures usually re-
flected previous attempts by vandals to steal or
unwrap mummies in the hopes of finding jewels,
which were often wrapped beneath the linens.
This same child had a piece of the sphenoid
bone displaced into the posterior skull. Three-di-
mensional reformations of this bony piece were
helpful in establishing its shape and identity.
The other, and potentially more noteworthy,
finding that may be related to morbidity, if not
mortality, was the discovery of evidence of
mastoid disease in the potential male pharaoh.
The asymmetric sclerosis, erosion, and dehis-
cence of the mastoid air cells in this adult male
strongly suggest prior inflammatory mastoid
disease—that is, mastoiditis. This condition has
AJR:178, June 2002
been previously described, most notably by
Brothwell and Sandison [18] who in 1967 re-
ported seven cases of mastoiditis in Egyptian
remains. The apparent bony destruction in the
mummy in our collection suggests a process
that was chronic and recurrent. The reason for
Ramesses I’s brief 2-year reign and presumed
hasty demise is a mystery. If this mummy is in
fact the royal pharaoh, one might speculate
that almost 3000 years ago an episode of acute
untreated mastoiditis could potentially be a
source of intracranial or widespread infection
and subsequent death. Of additional interest is
the discontinuity of the cortical bone posterior
to the mastoid abnormality at the occipitomas-
toid confluence; this finding raises the possi-
bility that interventional efforts were attempted
to facilitate healing of the condition.
Examination of the temporal bone and mid-
dle ear revealed either disruption or the absence
of the ossicular chain in six mummies. Similar
findings were reported by Yardley and Rutka [4]
using CT scans and direct otoscopic examina-
tions. Given the absence of associated temporal
bone abnormalities in all but one of these mum-
mies (the one with possible mastoiditis), we
have also concluded that these fragile ossicles
were disrupted in the postmortem state and are
not indicative of antemortem pathology.
To our knowledge, the craniocervical junc-
tion of mummies has not been studied. Evi-
dence of either dislocation or rotary subluxation
of the craniocervical junction in three mummies
was found. Because these mummies also had
innumerable other fractures, these abnormalities
are also thought to reflect postmortem mishan-
dling. Although rotary subluxation of the cra-
niocervical junction was evident on standard
axial images, reformatted images in the coronal
plane better showed dislocation of the cranio-
cervical junction.
The utility of advanced CT imaging and
postprocessing techniques was further high-
lighted by the application of volume-rendering
algorithms in the evaluation of soft tissues.
Contour abnormalities of the face that were
difficult to appreciate on images obtained in
the axial plane were readily apparent on three-
dimensional images.
Several authors have dedicated book chapters
and journal articles solely to the study of ancient
Egyptian teeth [2, 3, 5, 19]. The mummies in
our collection, like those studied before them,
overwhelmingly suffered from varying degrees
of dental and periodontal disease. Ancient
Egyptians suffered greatly from antemortem
tooth loss [19], as evidenced in our study by a
large number of empty sockets. These findings
may have resulted partly from periodontal dis-
ease, which was also present in most of the
adult mummies in this study. Evidence of gen-
eralized tooth cusp attrition was present in two
mummies. Apparently widespread in ancient
Egypt, tooth cusp attrition has been attributed to
the large amount of coarse, erosive grit and sand
in the diet of most Egyptians. The easy identifi-
cation of these abnormalities on sagittal and
three-dimensional images again highlights the
importance and utility of multiplanar, multidi-
mensional CT.
Evaluation of the teeth revealed the presence
of a mild form of cleft palate in one of the child
mummies. To the best of our knowledge, this
abnormality has rarely been reported in the
Egyptology literature. Although the defect is
confined to the alveolar ridge and is seemingly
mild, this child may have experienced eating
and speech difficulties and an increased predis-
position to infection.
The orbital structures were primarily intact,
albeit atrophied, in six of the mummies in this
collection. The meningeal sheath of the optic
nerve could be identified to varying degrees, as
could the atrophied extraocular muscles and
their fascial sheaths. The unilateral absence of
orbital structures in one mummy, who also had
ipsilateral lamina papyracea fractures, strongly
suggested intentional and traumatic removal of
the orbital contents. Only three of the five mum-
mies thought to be from the same dynasty had
intact orbital structures; this finding suggests
that mummification techniques varied during
the same era, possibly reflecting the different
social or financial status of the deceased. The
globes were difficult to identify, and the lenses
1375

were distinctly identified in only one well-pre-
served male mummy, which suggests that these
structures were probably vulnerable to the harsh
effects of the embalming process.
Our CT findings indicate that despite a dif-
ference of 3000 years and different cultures the
general anatomy and morphology of the skull
and skull base have not changed significantly
over the last 3000 years. Normal variants seen
on present-day head CT scans—including large
pneumatized sinuses, concha bullosa, deviation
of the nasal septum, or a high-riding jugular
bulb—were all seen among this collection of
ancient people.
In conclusion, CT is a highly effective,
nondestructive method of studying the head
and skull base of Egyptian mummies. Exqui-
site anatomic details can be revealed while
leaving the specimen intact. A standard thin-
collimation helical technique produced images
of good resolution and quality. These images
American Journal of Roentgenology 2002.178:1367-1376.
can be further manipulated and reviewed in
coronal, sagittal, and three-dimensional for-
mats to generate images in the most informa-
tive and illustrative plane for viewing. Using
these imaging techniques for the methodic
evaluation of the skull and skull base of nine
Egyptian mummies yielded information of
historical, paleopathologic, and general inter-
est, including evidence of congenital defects,
antemortem disease, causes of death, and gen-
1376
Hoffman and Hudgins
eralized variance in mummification tech-
niques. This study affirms that radiology—in
this case, advanced CT imaging and postpro-
cessing techniques—is an indispensable tool
in the multidisciplinary investigation of Egyp-
tian mummies.
References
1. Harris JE, Weeks KR. X-raying the pharaohs.
New York: Charles Scribner’s Sons, 1973:21
2. Leek F. Observations on the dental pathology
seen in ancient Egyptian skulls. J Egypt Archael
1966;52:59–64
3. Nickol T, Germer R, Lieberenz S, Schmidt F,
Wilke W. An examination of the dental state of an
Egyptian mummy by means of computer tomog-
raphy: a contribution to ‘dentistry in ancient
Egypt.’ Bull Hist Dent 1995;43:105–112
4. Yardley M, Rutka J. Rescued from the sands of time:
interesting otologic and rhinologic findings in two
ancient Egyptian mummies from the Royal Ontario
Museum. J Otolaryngol 1997;26:379–383
5. Melcher AH, Holowka S, Pharaoh M, Lewin PK.
Non-invasive computed tomography and three-
dimensional reconstruction of the dentition of a
2,800-year-old Egyptian mummy exhibiting ex-
tensive dental disease. Am J Phys Anthro 1997;
103:329–340
6. Gaafar H, Abdel-Monem MH, Elsheikh S. Nasal en-
doscopy and CT study of Pharaonic and Roman
mummies. Acta Otolaryngol 1999;119:257–260
7. Thekkaniyil JK, Bishara S, James M. Dental and
skeletal findings on an ancient Egyptian mummy.
Am J Orthod Dentofacial Orthop 2000;117:10–14
8. Motamed M, Alusi G, Campos J, East C. ENT as-
pects of the mummification of the head in ancient
Egypt: an imaging study. Rev Laryngol Otol Rhi-
nol 1998;119:337–339
9. Harris JE, Wente EF. An X-ray atlas of the royal
mummies. Chicago: University of Chicago Press,
1980:5, 11–15, 19, 168–169
10. Andrews C. Egyptian mummies. Cambridge,
MA: Harvard University Press, 1990:16
11. Dunand F, Lichtenberg R. Mummies: a voyage
through eternity. New York: Abrams, 1994:31–32
12. Brier B. Egyptian mummies: unraveling the se-
crets of an ancient art. New York: William Mor-
row, 1994:60–62
13. Herodotus of Halicarnassus. The histories: book
II. New York: Penguin, 1972
14. Vahey T, Brown D. Comely Wenuhotep: computed
tomography of an Egyptian mummy. J Comput As-
sist Tomogr 1984;8:992–997
15. Marx M, D’Auria SH. CT examination of eleven
Egyptian mummies. RadioGraphics 1986;6:
321–330
16. Baldock C, Hughes SW, Whittaker DK, et al. 3-D
reconstruction of an ancient Egyptian mummy
using X-ray computer tomography. J Roy Soc
Med 1994;87:806–808
17. Pickering RB, Conces DJ, Braunstein EM, Yurco
F. Three-dimensional computed tomography of
the mummy Wenuhotep. Am J Phys Anthro
1990;83:49–55
18. Brothwell D, Sandison AT. Diseases in antiquity.
Springfield, IL: Charles C. Thomas, 1967:464–473
19. Harris JE, Wente EF. Dental disease in the royal
mummies. In: Harris JE, Wente EF, eds. An X-ray
atlas of the royal mummies. Chicago: University
of Chicago Press, 1980:328–345
AJR:178, June 2002