The Sociopolitical History and Physiological Underpinnings of Skull Deformation

Amit Ayer, B.S.; Alexander Campbell, M.Phil.; Geoffrey Appelboom, M.D.; Brian Y. Hwang, B.A.; Michael McDowell, B.S.; Matthew Piazza, B.A.; Neil A. Feldstein, M.D.; Richard C. E. Anderson, M.D.


Neurosurg Focus. 2010;29(6):e1 

In This Article

Artificial Cranial Deformation by Region

The earliest evidence of the practice of ACD comes from remains of the Mousterian people from Shanidar in Iraq and dates from the Middle Paleolithic period (approximately 300,000–30,000 years ago).[30] The practice in ancient Peru and Egypt shall be addressed here, because evidence from the latter society greatly differs from that of the former in terms of frequency. Anthropologists studying the 2 societies, nonetheless, have accounted for the practice in similar ways.

Ancient Peru

The first evidence of an artificially deformed skull in Peru was found near Uricocha, dated to the period between 6000 and 7000 BCE, suggesting that the ancient Peruvians introduced the practice on the continent.[7,26] A collection of 500 Peruvian skulls in Paris only contains 60 free of deformation (Figs. 1 and 2).[5] In some cases, dig sites yielded human remains with 90% of the skulls deformed.[3,5,26] Head shape appears to have demarcated membership within a group in a large, complex society, whereas in smaller societies, head shape demarcated social group differences. There is a "complex" archaeological record in the region according to Dingwall,[5] which Imbelloni[13] divided into 7 distinct regions according to, among other things, the method used. Intentional deformation was accomplished either by compression of the front and back of the head with boards and pads, tightly bandaging the head and progressively adjusting the bandages, or by restraining the child against a cradleboard.[26]

Figure 1.

Lateral view of ancient Peruvian skull. Courtesy of the Université Libre de Bruxelles (Bruxelles, Belgium).

Figure 2.

Posterior view of ancient Peruvian skull. Courtesy of the Université Libre de Bruxelles.

Anthropologists have explained ACD as a method of defining membership of social or ethnic groups. Tommaseo and Drusini[29] argued that the practice could enforce a hierarchy or signify membership in a warrior class. Social distinctions, however, could also give the individual political power. In ancient Peru it has been suggested that as the ruling class became comfortable in power, they permitted some noble families to shape the skulls of their children, imitating the distinct features of the ruler's skull.[5,8,26] While this may have entrenched the ruler's power, permitting an individual to show such allegiance would require the individual to take on a political role. Conversely, this privilege could have resulted in a proliferation of claims to rule the society. With more nobles eliciting the cranial characteristics of the ruler, the populace would no longer be able to differentiate between ruler and noble based upon that criterion.

Ancient Egypt

Although there is little archaeological evidence of ACD in Egypt before 600 CE, notable exceptions exist from the reign of Akhenaten (1375–1358 BCE) in the 18th dynasty. Studies of the morphology of Akhenaten's skull suggest that an acromegalic or macrocephalic disease may have deformed it.[3,5] Akhenaten's queen, Nefertiti, is notably portrayed in busts and reliefs with apparent anterior plagiocephaly, although her mummy has not been discovered to verify this trait. The mummy of another of Akhenaten's consorts and the mother of Tutankhamen, the so-called "Younger Lady" mummy, also possesses a cranial deformity.[11] Finally, the mummy of Tutankhamen, Akhenaten's apparent successor, was discovered at the start of the 20th century with a deformed cranium (Fig. 3).[5] Although no current study addresses the methods that might have been used, the skulls elicit deformations characteristic of frontooccipital deformation.

Figure 3.

Artistic reproduction of Tutankhamen's head shape based on a CT of his skull.

Akhenaten ushered in a great religious, political, and artistic upheaval: the Amarna revolution. Government was centralized as the pharaoh dissolved local cults and turned Egypt into a monotheism worshipping Aten. Stylistic changes in depictions of the royal family were so drastic that it is believed they could only have occurred at the suggestion of the pharaoh.[1] In particular, the cranial shape of the royal family and officials was distorted.[3,5]

Dingwall's[5] claim that no physical evidence exists from the period surrounding Akhenaten's reign appears to be disproven by the skulls of the "Younger Lady" and Tutankhamen. Yet the artistic evidence should not be discredited. Depictions of members of the royal family, such as Nefertiti, may have deliberately been distorted so that they became linked to Akhenaten's growing power. Further research into the causes of Tutankhamen's deformed cranium may reveal that Akhenaten decided to physically deform his heir's head to legitimize his claim to the throne. The importance of distorting head shape, artistically or physically, may have been politically significant for Akhenaten.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.