A radiographic study of porotic hyperostosis

Abstract

Skull lesions known as porotic hyperostosis have been of interest to researchers since the mid-19th century. The etiology of porotic hyperostosis has long been a matter for speculation yet there has never been complete acceptance or substantiation of any one of the many theories proposed. Today the most widely accepted theory suggests that anemias of either acquired or genetic origin are responsible for porotic hyperostosis. The present study tests this hypothesis using criteria which were chosen after the examination of clinical radiographs of patients with various types of anemia. These criteria are: the presence of "hair-on-end" trabeculation, outer table thinning, texture changes, diploic thickening, orbital roof thickening, orbital rim changes, and the underdevelopment of frontal sinuses. A comparison of these criteria from the clinical X-rays with X-rays of skulls with porotic hyperostosis provides a more rigorous, repeatable, and standardized method upon which to base a diagnosis. This approach enables radiography to provide the necessary link between the clinical and anthropological with which to investigate the origin of porotic hyperostosis.

Late Pleistocene age and archaeological context for the hominin calvaria from GvJm-22 (Lukenya Hill, Kenya)

“…2C). Although located in a small area of the calvaria and associated with no other criteria (e.g., absence of cribra orbitalia, presence of frontal sinus), this thickening, together with the external porosity, could be related to healed expression of light porotic hyperostosis (53). The alternate hypothesis for the localized porotic cranial changes on the right side of the frontal bone is that they are related to periosteal reactions resulting from trauma infection (54).…”

Prevalence and etiology of acquired anemia in Medieval York, England

“…This suggests that high iron-demand reproductive functions helped to make iron-deficiency anemia a chronic condition in many women's lives irrespective of their status affiliation. Cribra orbitalia and porotic hyperostosis were often remarked upon in early paleopathological inquiries, but it was not until the mid-1980s that these dry bone lesions were linked to the modern clinical expressions of anemia (Stuart-Macadam, 1985, 1987a. Clinical radiographic manifestations that correlated with archaeological findings included hair-on-end trabeculations, outer table thinning, textural changes, orbital roof thickening, orbital rim changes, and underdevelopment of the frontal sinuses.…”

“…Like most scientific knowledge, our understanding of this paleopathological feature is being refined through much-needed critique and reexamination. However, the wholesale abandonment of this indicator is unwarranted, as the distribution of anemia based on an assessment of cribra orbitalia in past populations does correlate well with radiographic findings, distributions of anemia in nonindustrialized contexts, and paleopathological expectations based on clinical and ethnographic comparisons (Danforth, 1999;Kent, 1986;Kent and Lee, 1992;Kent and Dunn, 1996;Kent et al, 1994;Stuart-Macadam, 1985, 1987a. Apart from diagnostic issues, the assertion that cribra orbitalia forms only in childhood and should only be studied in children (Stuart-Macadam, 1985) is also problematic, based on the insufficient amount of clinical evidence used to support this claim and on the complex physical appearance and distribution of these lesions among adult segments of skeletal populations.…”

Craniosynostosis in the Middle Pleistocene human Cranium 14 from the Sima de los Huesos, Atapuerca, Spain

“…The right orbit is severely affected, showing extensive pitting on the roof. Both anemia and rickets are claimed to be metabolic causes associated with the presence of cribra orbitalia (42,43). Since rickets and anemia have been related to some cases of craniosynostosis (34,44,45), we cannot exclude these metabolic diseases as the possible trigger factor of the premature suture fusion.…”