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Computed tomography of the heads of ancient Egyptian mummies: a systematic review of the medical literature.

Authors:

Abstract

Objective: To summarize the current knowledge on CT scanning of Egyptian mummy heads and faces and provide more valid methodology than that previously available. Material and methods: A systematic review was performed by one observer using two biomedical databases: PubMed and EMBASE. Inclusion and exclusion criteria were applied along with language restrictions. Finally, 2120 articles were found, 359 articles were duplicated among all search equations, 1454 articles were excluded, 307 articles were retained for full review, and 28 articles (31 mummies) were selected for the final study (PRISMA workflow). Results: The data were categorized into the following groups: 1) general information; 2) 1st author affiliation; 3) CT radiological protocol; 4) excerebration pathways; 5) soft tissue preservation; 6) dental status and displaced teeth; 7) packing of the mouth, ears, nose, and eyes, and 8) outer facial appearance. The evidence-based quality of the studies was low because only case reports and small case series were found. Discussion: The embalming art applied to a mummified head and face shows great variability across the whole span of Egyptian civilization. The differences among the various embalming techniques rely on multiple tiny details that are revealed by meticulous analysis of CT scans by a multidisciplinary team of experts. Conclusion: There is a need for more systematization of the CT radiological protocol and the description of Egyptian mumm’y heads and faces to better understand the details of embalming methods.
1
Computed tomography of the heads of ancient 1
Egyptian mummies: a systematic review of the 2
medical literature. 3
4
Authors: 5
Olszewski R DDS, MD, PhD, Prof1,*, 6
Hastir JP BInf2, 7
Tilleux C MS3,4 8
Delvaux L MS, PhD3 9
Danse E MD, PhD, Prof2
10
11
Affiliations: 12
1 Department of oral and maxillofacial surgery, Cliniques universitaires saint Luc, 13
Université catholique de Louvain, Brussels, Belgium 14
2 Department of medical imaging, Cliniques universitaires saint Luc, Université 15
catholique de Louvain, Brussels, Belgium 16
3 Museums of Art and History, Parc du Cinquantenaire 10, Brussels, Belgium 17
4 Université catholique de Louvain, Pl. Blaise Pascal 1, Louvain-la-Neuve, 18
Belgium 19
Corresponding author: Olszewski Raphael, Department of oral and maxillofacial 20
surgery, Cliniques universitaires saint Luc, Université catholique de Louvain, 21
[ N em es i s] T i tr e de l’ art ic le (P UL -En-t êt e p ai re )
2
Av.Hippocrate 10, 1200 Brussels, Belgium phone+3227645718; fax: +3227645876; 22
ORCID iD: orcid.org/0000-0002-2211-7731 23
24
Disclaimer: the views expressed in the submitted article are our own and not an of-25
ficial position of the institution or funder. 26
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[ N em es i s] T i tr e de l’ art ic le (P UL -En-t êt e i mp ai r e)
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Abstract 63
Objective: To summarize the current knowledge on CT scanning of Egyptian 64
mummy heads and faces and provide more valid methodology than that previously 65
available. 66
67
Material and methods: A systematic review was performed by one observer us-68
ing two biomedical databases: PubMed and EMBASE. Inclusion and exclusion cri-69
teria were applied along with language restrictions. Finally, 2120 articles were 70
found, 359 articles were duplicated among all search equations, 1454 articles were 71
excluded, 307 articles were retained for full review, and 28 articles (31 mummies) 72
were selected for the final study (PRISMA workflow). 73
74
Results: The data were categorized into the following groups: 1) general infor-75
mation; 2) 1st author affiliation; 3) CT radiological protocol; 4) excerebration path-76
ways; 5) soft tissue preservation; 6) dental status and displaced teeth; 7) packing of 77
the mouth, ears, nose, and eyes, and 8) outer facial appearance. The evidence-based 78
quality of the studies was low because only case reports and small case series were 79
found. 80
81
Discussion: The embalming art applied to a mummified head and face shows 82
great variability across the whole span of Egyptian civilization. The differences 83
among the various embalming techniques rely on multiple tiny details that are re-84
vealed by meticulous analysis of CT scans by a multidisciplinary team of experts. 85
86
Conclusion: There is a need for more systematization of the CT radiological pro-87
tocol and the description of Egyptian mumm’y heads and faces to better understand 88
the details of embalming methods. 89
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Keywords: Egyptian mummy, embalming, computer tomography, systematic 91
review, head, face 92
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[ N em es i s] T i tr e de l’ art ic le (P UL -En-t êt e p ai re )
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Introduction 101
Studies on ancient Egyptian embalming procedures started in the XVIth century 102
[1]. However, the first attempt to provide an evidence-based approach to categorize 103
and systematize this field of research was first performed by Zweifel et al., in 2009 104
[2]. Zweifel’s systematic review was mainly focused on all types of articles related 105
to egyptian mummification [2]. The selection of articles was based on only one 106
database (PubMed). The strength of systematic review methodology relies on its 107
repeatability over time, which is also one of the main components in scientific 108
methodology. To conduct a valid systematic review, the methodology must be 109
provided in as much detail as possible to ensure the repeatability of the search such 110
as that subsequent attempts obtain the same results as the initial authors. 111
In Zweifel‘s systematic review, the methodological description was missing the 112
PRISMA workflow, which provides the exact numbers of articles found, articles 113
rejected (based on clear inclusion and exclusion criteria) after title and abstract 114
review, articles rejected after full-text review, and articles retained in the final 115
analysis [2]. Additionally, clear inclusion and exclusion criteria were missing [2]. 116
The number of observers who performed the research was not included [2]. The 117
search strategies along with the exact date (day, month, year) of the search were not 118
provided [2]. The MeSH terms were also not provided [2]. All these elements 119
indicate that the Zweifel review cannot be repeated by other authors. On the other 120
hand, computed tomography (CT) scanning is a non-invasive imaging technique 121
used to study ancient Egyptian artificially mummified human bodies. CT has been 122
used for almost forty years [3]. The systematic review by Zweifel is not specifically 123
related to CT scanning of mummies as it presents a general overview of this specific 124
research field [2]. Therefore, we wanted to summarize the current knowledge on CT 125
scanning of Egyptian artificially mummified bodies [4]. We also wanted to provide 126
more valid methodology than that previously available. However, as this field seems 127
too broad to be encapsulated in one global systematic review, we choose to focus on 128
head and face CT scans of ancient Egyptian artificially mummified human remains. 129
Materials and methods 130
This systematic review was performed by one observer using two databases, 131
PubMed (search equations n° 1 to n° 6) and EMBASE (search equation n° 7). The 132
exclusion criteria were as follows: civilizations other than Egyptian, other 133
archaeological periods of time; descriptions of ancient Egyptian mummies without 134
heads; primary investigation technique other than CT (X-rays, MRI, endoscopy); 135
chemistry, biochemistry, microbiology, parasitology, pathology, biomolecular and 136
genetic studies (DNA studies, isotopes); description of a series of mummies without 137
a clear distinction between individuals; no identification of the historical period of 138
time for a given mummy; the description of a male mummy in a female coffin or a 139
female mummy in male coffin; discordance of the date between the coffin and 140
mummy [5]; experimental mummification; animal mummification; natural 141
[ N em es i s] T i tr e de l’ art ic le (P UL -En-t êt e i mp ai r e)
5
mummification; reviews; and languages other than English and French. The 142
inclusion criteria were as follows: description of ancient Egyptian artificial 143
mummification using CT scan, the presence of description of the head, and English 144
and French language. We used no time frame limitation (from 1948 to present). The 145
article types accepted for this review consisted of case reports, case series, and com-146
parative studies if it was possible to determine the individual characteristics for each 147
of the individuals. 148
Search equation 1 (“teeth and ancient Egypt”) was as follows: (("tooth"[MeSH 149
Terms] OR "tooth"[All Fields]) OR ("tooth"[MeSH Terms] OR "tooth"[All Fields] 150
OR "teeth"[All Fields])) OR ("dental health services"[MeSH Terms] OR 151
("dental"[All Fields] AND "health"[All Fields] AND "services"[All Fields]) OR 152
"dental health services"[All Fields] OR "dental"[All Fields])) AND (ancient[All 153
Fields] AND ("egypt"[MeSH Terms] OR "egypt"[All Fields])). The search was 154
performed on 27/10/2016. We found 139 articles; 61 articles were excluded based 155
on the title and abstract, 78 articles were included for a full-text review, and 8 arti-156
cles were included for the final analysis after a full-text review. Articles with no 157
abstract were also included in search equation n° 1. 158
Search equation n° 2 (“teeth and Egyptian mummy”) was as follows: (egyptian[All 159
Fields] AND ("mummies"[MeSH Terms] OR "mummies"[All Fields] OR 160
"mummy"[All Fields]) AND ("tooth"[MeSH Terms] OR "tooth"[All Fields] OR 161
"teeth"[All Fields])) AND hasabstract[text]. The search was performed on 162
13/10/2016, and we found 16 articles. Ten of the articles were excluded as duplicate 163
articles from search equation n°1. We excluded 3 articles based on the title and 164
abstract. Three articles were included for full-text review, and 2 articles were 165
included for the final analysis after a full-text review. 166
Search equation n° 3 (“Egyptian and mummy and dentistry”) was as follows: 167
(egyptian[All Fields] AND ("mummies"[MeSH Terms] OR "mummies"[All Fields] 168
OR "mummy"[All Fields]) AND ("dentistry"[MeSH Terms] OR "dentistry"[All 169
Fields])) OR (egyptian[All Fields] AND ("mummies"[MeSH Terms] OR 170
"mummies"[All Fields] OR "mummy"[All Fields]) AND ("dental health 171
services"[MeSH Terms] OR ("dental"[All Fields] AND "health"[All Fields] AND 172
"services"[All Fields]) OR "dental health services"[All Fields] OR "dental"[All 173
Fields])) AND hasabstract[text]. The search was performed on 13/10/2016. We 174
found 21 articles. There were 13 duplicate articles from previous search equations. 175
Three articles were included for a full review, and finally 2 articles were selected for 176
final study. 177
The search equation 4 (“Egyptian and mummies”) was as follows: Egyptian[All 178
Fields] AND ("mummies"[MeSH Terms] OR "mummies"[All Fields] OR 179
"mummy"[All Fields]) AND hasabstract[text]. The search was performed on 180
13.10.2016, and 308 articles were found. Eighty-three of the articles without an 181
abstract were excluded, and 90 articles with an abstract were excluded. There were 182
20 duplicate articles from previous search equations. There were 115 articles 183
included for full-text review, and 17 articles were selected for the final analysis. 184
Search equation n° 5 (“mummy and CT scan”) was as follows: "mummies"[MeSH 185
Terms] OR "mummies"[All Fields] OR "mummy"[All Fields]) AND ("tomography, 186
[ N em es i s] T i tr e de l’ art ic le (P UL -En-t êt e p ai re )
6
x-ray computed"[MeSH Terms] OR ("tomography"[All Fields] AND "x-ray"[All 187
Fields] AND "computed"[All Fields]) OR "x-ray computed tomography"[All Fields] 188
OR ("computed"[All Fields] AND "tomography"[All Fields]) OR "computed 189
tomography"[All Fields]) AND ("0001/01/01"[PDAT] : "2017/02/27"[PDAT]). The 190
search was performed on 27/02/2017. There were 190 articles found. Thirty-nine of 191
the articles without an abstract were excluded, and 82 articles with an abstract were 192
excluded. There were 53 duplicate articles from previous search equations. Sixteen 193
articles were included for full-text review, and 1 article was selected for final 194
analysis. 195
The search equation n° 6 (“mummy and human”) was as follows: 196
("mummies"[MeSH Terms] OR "mummies"[All Fields] OR "mummy"[All Fields]) 197
AND "humans"[MeSH Terms]. The search was performed on 16/11/2016. We 198
found 1170 articles. In total, 433 articles without an abstract were excluded, and 532 199
articles with an abstract were excluded. There were 144 duplicate articles from 200
previous search equations. Finally, 61 articles were included for a full-text review. 201
All 61 of the articles were excluded, and no articles were selected for the final 202
analysis. 203
The search equation n° 7 was performed on 28/10/2016 with the EMBASE database. 204
The term 'paleopathology'/exp provided 2818 articles. The term 'computer assisted 205
tomography'/exp provided 740,292 articles. The association of the terms 206
'paleopathology'/exp AND 'computer assisted tomography/exp’ provided 276 207
articles. There were 119 articles that were duplicates of those identified from the 208
PubMed database. A total of 126 articles were excluded based on the title and 209
abstract. There were 31 articles included for a full-text review. The 31 articles were 210
then excluded after a full-text review, and no articles were selected for the final 211
analysis. 212
Finally, 2120 articles were found, 359 articles were duplicated among all search 213
equations, 1454 articles were excluded, 307 articles were retained for a full-text 214
review, and 28 articles were selected for the final analysis. We added a PRISMA 215
flow diagram to better represent our findings (Figure 1). 216
Moreover, we proposed a simple score to compare the quality assessment of the 217
reported CT data for each article selected for the review. The items receiving a score 218
were as follows: tube intensity (kVp), tube current (mAs), slice thickness in mm, 219
pitch, detector collimation, and reconstruction increment. If the item was described 220
and cited it received one point, and if the item was missing it received no points. A 221
score could vary from 0 (the minimum) to 6 (the maximum) for each CT-scanned 222
mummy. 223
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[ N em es i s] T i tr e de l’ art ic le (P UL -En-t êt e i mp ai r e)
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231
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Fig . 1 PRIS M A 2009 F low D i agram . 233
234
235
236
237
238
239
240
241
242
243
244
245
246
247
248
249
250
251
252
253
254
255
256
257
258
259
260
261
262
263
264
265
266
267
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Records identified through
Pubmed database searching
(n = 1844)
Records identified through
Embase database searching
(n = 276)
Records after duplicates removed
(n = 359)
Identification
Records excluded
(n = 1454)
Full-text articles as-
sessed for eligibility
(n = 307)
Full-text articles exclud-
ed, with reasons
(n = 279)
Studies included in qual-
itative synthesis
(n = 28)
Studies included in
quantitative synthesis
(meta-analysis)
(n = 28)
Screening
Eligibility
Included
[ N em es i s] T i tr e de l’ art ic le (P UL -En-t êt e p ai re )
8
Results 269
General information 270
271
The main information about the mummies is described in Table 1. There are 31 272
descriptions of CT findings related to individual artificial mummification of the 273
head from ancient Egypt. Three cases were described by two different authors at 274
different times: 1) Djedmaatesankh was described by Harwood-Nash in 1979 [3] 275
and by Melcher in 1997 [6], 2) Tjentmutengebtiu described by Baldock in 1994 [7] 276
and Hughes in 2005 [8], and 3) Se-Ankh (named so by the Memphis State Museum 277
Director of Egyptology) was described by Singarella in 1986 [9], and Babin in 1990 278
[10]. We have not eliminated the duplicate reports to be able to study the differences 279
in analyses performed by different scientific teams and authors. 280
There were 6 case series with 2 mummies and 19 case reports with one mummy 281
description. The group consisted of 28 adults, 2 children and 1 adolescent. There 282
were 15 males, 13 females, and 3 mummies of unknown sex. The supposed age was 283
provided for 21 mummies and was undetermined or unknown in 10 individuals. The 284
minimum age was 4 years, the maximum age was 60 years, and the average age was 285
38.88 years. The oldest described mummies in this study were from the Middle 286
Kingdom (2040 BC), and the most recent were from the Roman period (110 AD). 287
There were 3 mummies belonging to the Middle Kingdom, 3 mummies from the 288
XVII Dynasty, 2 mummies from the XVIII Dynasty, 1 mummy from the End of the 289
New Empire and the beginning of the 3rd intermediary period, 9 mummies from the 290
XX-XXII Dynasty, 2 mummies from the XXV-XXVI Dynasties, 8 mummies from 291
the Ptolemaic period, and 3 mummies from the Roman period. Mummies were 292
found in museums in the following countries: 8 in the United States, 5 in Canada, 4 293
in the United Kingdom, 1 in Australia, 4 in Italy, 4 in Switzerland, 3 in Germany, 1 294
in Lithuania, and 1 in Vatican City. 295
296
Table 1. Information on selected studies. 297
Historical
period
Study
Mummy name
Museum, Coun-
try,
Inventory
number (Inv)
Adult/
child
Sex
Age
(years)
c. 2040-
1674 BC
(Middle
Kingdom)
Yardley,
1997 [11]
ROM1
NI
Royal Ontario
Museum, Toronto,
Canada
Adult
M
NI
c. 2040-
1674 BC
(Middle
Kingdom)
Yardley,
1997 [11]
ROM2
NI
Royal Ontario
Museum, Toronto,
Canada
Adult
M
NI
c. 2000 BC
(Middle
Kingdom)
Gupta,
2008 [12]
Djehutynakht (local
governor of Middle
Egyptian province)
Museum of Fine
Arts, Boston, USA
Inv. 21.11767
Adult
M
NI
c.1570-1520
Manley,
Qurna woman
National Muse-
Adult
F
20?
[ N em es i s] T i tr e de l’ art ic le (P UL -En-t êt e i mp ai r e)
9
BC, (New
Kingdom,
XVII dyn)
2002 [13]
ums of Scotland,
UK
Inv. A.1909.527
c.1570-1520
BC (XVII
dyn)
Marquez,
2015 [14]
VL/1248
American
Museum of
Natural History,
USA
Adult
NI
NI
c.1570-1520
BC (XVII
dyn)
Marquez,
2015 [14]
VL/1232
American
Museum of
Natural History,
USA
Adult
NI
NI
c.1479-1424
BC (XVIII
dyn)
Wade,
2012 [15]
Theban female
Redpath Museum
of McGill
University,
Canada
Inv. RM2717
Adult
F
30-50
(40)
c.1479-1424
BC
(XVIII dyn)
Bianucci,
2016 [16]
Nebiri (“Chief of
stables”)
Fondazione
Museo delle
Antichità Egizie,
Torino, Italy
Inv. S.5109 RCGE
17504
Adult
M
45-60
(52.5)
c.1150-795
BC
(End New
Empire-3rd
intermediary
period)
Lindsay,
2015 [17]
No name
Center for
Evolutionary
Medicine, Institute
of Anatomy,
University of
Zurich,
Switzerland
Adult
F
30-40
(35)
c.1069-945
BC
(XXI dyn)
Brier, 2015
[18] (male)
Ankhefenmut, priest
of the temple of the
goddess Mut, and
temple sculptor
Albany Institute of
History and Art,
USA
Inv. 1909.18.1b
Adult
M
50-55
(52.5)
c.1069-747
BC
(XXI XXII
dyn)
Hill, 1993
[19]
Bakt-en-Hor-Nekht
Hancock
Museum,
Newcastle-upon-
Tyne, UK,
Inv. Aregypt605
Adult
F
29
c.1069-747
BC (XXI-
XXII dyn)
Gerloni,
2009 [20]
(M2)
(Coffin Pa-sen-en-
Hor), incense bear-
er in the Amon tem-
ple
Civic museum of
history and art,
Trieste, Italy,
Inv. Cat.4.4
Adult
M
Middle-
aged
c. 1000 BC
(XXI dyn)
Wanek,
2011 [21]
NI
Musée d’Orbe,
Switzerland
Adult
NI
NI
c. 1000-800
BC (XXI
XXII dyn)
Seiler,
2015 [22]
0492
Musée cantonal
d’archéologie et
d’histoire,
Lausanne,
Switzerland
Adult
M
NI
[ N em es i s] T i tr e de l’ art ic le (P UL -En-t êt e p ai re )
10
c.945-747
BC (XXII
dyn)
Harwood-
Nash,
1979 [3]
Djedmaatesankh
(lady and musician
of the House of
Amun, Thebes)
Royal Ontario
Museum, Toronto,
Canada,
Inv. 910.10
ROM2004_1039_
9
Adult
F
NI
c.900 BC
(XXII dyn)
Melcher,
1997 [6]
Djedmaatesankh
(lady musician,
Temple of Amun
Re, Karnak)
Royal Ontario
Museum, Toronto,
Canada,
Inv. 910.10
ROM2004_1039_
9
Adult
F
Mature
female
c.945-747
BC
(XXII dyn)
Baldock,
1994 [7]
Tjentmutengebtiu
British Museum,
London, UK,
Inv. EA22939
Adult
F
19-23
(21)
c.770 BC
(XXII dyn)
Hughes,
2005 [8]
Tjentmutengebtiu,
priestess of temple
in Karnak
British Museum,
London, UK, Inv.
Inv. EA22939
Adult
F
25-40
(32.5)
c.945-747
BC (XXI-
XXIV dyn)
Cesarani,
2004 [23]
Harwa (artisan)
Egyptian Museum
Torino, Italy,
Inv. S. 5226/2
CGT 13011
Adult
M
45
c. 800-700
BC (XXII
dyn)
Seiler,
2015 [22]
D242
Musée d’art et
d’histoire,
Genève,
Switzerland
Adult
F
NI
c.746-525
BC
(XXV-XXVI
dyn)
Sigmund,
2002 [24]
Pa-es-tjau-em-aui-
nu
Rheinische
Landesmuseum,
Trier, Germany,
Inv. GIIC536
Adult
F
25?
c.600 BC
(XXVI dyn)
Thekkaniyil
, 2000 [25]
Lady Udja
Field Museum of
natural History,
Chicago, USA,
Inv. 30001
Adult
M
30-40
(35)
Ptolemaic
period
Singarella,
1986 [9]
No name
Private collection,
Memphis, USA
Adult
F
30?
Ptolemaic
period (323-
30 BC)
Babin,
1990 [10]
Se-Ankh
Memphis State
University,
Egyptology
collection,
Memphis, USA
Adult
F
30-40
(35)
Ptolemaic
period
c.305-150
BC
Babin,
1990 [10]
Irtw-Irw
Memphis State
University,
Egyptology
collection,
Memphis, USA,
Inv. 1985.3.1
Adult
M
60
Ptolemaic
Chan,
Akhmim
Academy of
Ado-
F
16?
[ N em es i s] T i tr e de l’ art ic le (P UL -En-t êt e i mp ai r e)
11
period
2008 [26]
Natural Sciences,
Philadelphia,
USA, Inv. ANSP
1903.1a
lescent
Ptolemaic
period
Gerloni,
2009 [20]
(M3)
NI
Civic museum of
history and art,
Trieste, Italy
Adult
M
NI
Ptolemaic
period
Pelo, 2012
[27]
Fayoum female
Vatican Museum,
Vatican
Adult
F
30
Ptolemaic
period
Wade,
2012 [15]
Ptolemaic female
Redpath Museum
of McGill
University,
Canada, Inv.
RM2720
Adult
F
18-24
(21)
Ptolemaic
period (323-
30 BC)
Davey,
2013 [28]
Horus
Nicholson
Museum, Sidney,
Australia, Inv.
NMR.26.1
Child
M
5-7 (6)
Ptolemaic
period
Zesch,
2016 [29]
AS18
Senckenberg
Museum of
Natural History,
Germany
Child
M
4 to 5
years-
old
(4.5)
100 BC-100
AD
Nickol,
1995 [30]
Mummy with the
gilded cartonnage
mask
Leipzig
Ethnological
Museum,
Germany, Inv.
MfVL 1965/33
Adult
F
25-30
(27.5)
Roman
period (c.80-
110 AD)
MacLeod,
2000 [31]
NI
National Museum
of Scotland,
Edinburgh, UK,
Inv. A.1911.210.1
Adult
M
Young
adult
Roman
period (30
BC-395 AD
Piombino-
Mascali,
2016 [32]
Hori, priest of
Amun-Ra?
National Museum
of Lithuania,
Vilnus, Lithuania,
Inv. IM6283
Adult
M
Young
NI: No information in the article 298
299
Principal authors affiliation 300
301
Authors affiliations are described in Table 2. The main affiliations and expertise 302
of the authors were as follows: 1) radiology (18/28, 64.2%), 2) Egyptology museum 303
(17/28, 60.7%), 3) anthropology (7/28, 25%), 4) dentistry (7/28, 25%), 5) ear-nose-304
throat (3/28, 10.7%), and 6) other type of affiliation (12/28, 42.8%). 305
Multidisciplinary teams including members with radiology, Egyptology, and 306
dentistry expertise were rare (3/28, 10.7%). 307
308
309
[ N em es i s] T i tr e de l’ art ic le (P UL -En-t êt e p ai re )
12
Table 2. Principal author’s affiliations. 310
Study
Radiology
Museum
(Egyptolo-
gy)
Physical an-
thropology
(forensic)
Dentistry
Ear-
nose-
throat
Other
Harwood-
Nash, 1979
[3]
YES
Singarella,
1986 [9]
Education de-
velopment
Babin, 1990
[10]
YES
YES
Hill, 1993 [19]
YES
YES
Baldock, 1994
[7]
YES
YES
YES
Neurosurgery
Nickol, 1995
[30]
YES
YES
Medical history
Melcher, 1997
[6]
YES
YES
Pediatrics
Yardley,
1997 [11]
YES
MacLeod,
2000 [31]
YES
YES
YES (oral
medicine,
orthodontics)
Thekkaniyil,
2000 [25]
YES (ortho-
dontics)
Sigmund,
2002 [24]
YES
YES
Manley, 2002
[13]
YES
Medical artist
Cesarani,
2004 [23]
YES
YES
YES
Hughes, 2005
[8]
YES
Physical and
chemical sci-
ence,
computer centre
Chan, 2008
[26]
YES
YES
Gupta, 2008
[12]
YES
YES
neurosurgery
Gerloni, 2009
[20]
YES
YES
YES
Wanek, 2011
[21]
Evolutionary
medicine,
computer vision
lab
Wade, 2012
[15]
YES
YES
YES
Pelo, 2012
[27]
YES
YES
YES (maxil-
lofacial sur-
[ N em es i s] T i tr e de l’ art ic le (P UL -En-t êt e i mp ai r e)
13
gery,
orthodontics)
Davey, 2013
[28]
YES
YES
Lindsay, 2015
[17]
YES
Art applied to
medicine,
evolutionary
medicine
Marquez,
2015 [14]
YES
YES
YES
Brier, 2015
(male) [18]
YES
Seiler, 2015
[22]
Evolutionary
medicine
Bianucci,
2016 [16]
YES
YES
YES
Microbiology
and infectiology
Zesch, 2016
[29]
YES
YES
Biomechanics
Piombino-
Mascali, 2016
[32]
YES
YES
YES
311
Computer tomography radiological protocol 312
313
The radiological protocols provided for each mummy are described in Table 3. 314
The maximum score for the quality of the reported CT radiological protocol was 315
reached in only 1 case (in the most recent study). Two cases obtained a score of 5, 2 316
cases obtained a score of 4, 10 cases obtained a score of 3, 5 cases obtained a score 317
of 2, 8 cases obtained a score of 1 (only slice thickness was provided), and 6 studies 318
obtained a score of 0. The kVp was provided for 20 mummies, mAs for 17 319
mummies, slice thickness for 26 mummies, pitch for 3 mummies, detector 320
collimation for 1 mummy (in the most recent study), and reconstruction increment 321
for 5 mummies. The three items most frequently provided together were kvp, mAs, 322
and slice thickness (15 mummies). 323
324
325
Table 3. Computed tomography radiological protocols. 326
Study
CT type
Score (0-
6) (Index
of quality
of report-
ing of CT
protocol)
Tube
volt-
age
(kVp)
Tube
cur-
rent
(mAs
)
Slice
thickness
(mm)
Pitch
(mm/se
c)
Detector
collima-
tion
Reconstruc-
tion incre-
ment (mm)
Harwood-
Nash, 1979
[3]
Ohio
Nuclear
Delta 50
1
NI
NI
12
NI
NI
NI
[ N em es i s] T i tr e de l’ art ic le (P UL -En-t êt e p ai re )
14
Singarella
1986 [9]
CAT scan
0
NI
NI
NI
NI
NI
NI
Babin 1990
(Se-Anh)
[10]
Siemens
DR3
1
NI
NI
4 mm skull,
2 mm tem-
poral bone
NI
NI
NI
Babin 1990
(Iret-Irew)
[10]
Siemens
DR3
1
NI
NI
4 mm skull,
2 mm tem-
poral bone
NI
NI
NI
Hill 1993
[19]
CT
1
NI
NI
5mm
NI
NI
NI
Baldock
1994 [7]
Somatom
DRH,
Siemens
1
NI
NI
2 mm skull,
1 mm teeth
NI
NI
NI
Nickol 1995
[30]
Somaton
plus,
Siemens
2
120
125
NI
NI
NI
NI
Yardley
1997 (ROM
I) [11]
CT
1
NI
NI
1.5 mm
NI
NI
NI
Yardley
1997 (ROM
II) [11]
CT
1
NI
NI
1.5mm
NI
NI
NI
Melcher
1997 [6]
9800
Quick
scanner,
GE
3
120
170
3mm with
3mm spa-
cing
NI
NI
NI
Macleod
2000 [31]
Somatom
plus, Sie-
mens
5
120
210
3
3
NI
1
Thekkaniyil
2000 [25]
CT
0
NI
NI
NI
NI
NI
NI
Manley
2002 [13]
CT
0
NI
NI
NI
NI
NI
NI
Sigmund
2002 [24]
Somatom
Plus 4A,
Siemens
0
NI
NI
NI
NI
NI
NI
Cesarani
2004 [23]
LightSpee
d QX/i,
GE
Healthcar
e
5
120
140
1.25
7.5
NI
0.7
Hughes
2005 [8]
DRH So-
maton,
Siemens
3
125
210
2
NI
NI
NI
Chan 2008
[26]
Lightspee
d 16, GE
3
140
275
0.625
NI
NI
NI
Gupta 2008
[12]
Sensa-
tion-64,
Siemens
2
120
50
NI
NI
NI
NI
[ N em es i s] T i tr e de l’ art ic le (P UL -En-t êt e i mp ai r e)
15
Gerloni
2009 (M2)
[20]
Aquilion
16,
Toshiba
3
120
300
0.5
NI
NI
NI
Gerloni
2009 (M3)
[20]
Aquilion
16,
Toshiba
3
120
300
0.5
NI
NI
NI
Wanek
2011 [21]
Somatom
definition
dual
source,
CT_SOM5
SPI DU-
AL,
Siemens
4
140
and
100
27
and
120
0.6
NI
NI
0.4
Wade 2012
(2717) [15]
Aquilion
one,
Toshiba
2
120
NI
0.5
NI
NI
NI
Wade 2012
(2720) [15]
Aquilion
one,
Toshiba
2
80
and
135
NI
0.5
NI
NI
NI
Pelo 2012
[27]
Brillance
CT 64-
channel,
Phillips
4
120
150
1
NI
NI
0.5
Davey,
2013 [28]
Aquilon
64,
Toshiba
3
120
150
0.5
NI
NI
NI
Seiler 2015
(0492) [22]
NI
0
NI
NI
NI
NI
NI
NI
Seiler 2015
(D242) [22]
NI
0
NI
NI
NI
NI
NI
NI
Lindsay
2015 [17]
NI
3
100
49
0.2
NI
NI
NI
Marquez
2015
VL1248
[14]
High
speed Ad-
vantage
CT, GE
3
120
250
1
NI
NI
NI
Marquez
2015
VL1232
[14]
High
speed Ad-
vantage
CT, GE
3
120
250
1
NI
NI
NI
Brier 2015
(male) [18]
Light
speed 16-
slice CT,
GE
2
120
NI
0.6
NI
NI
NI
Piombino-
Mascali
2016 [32]
Brillance
16-slice,
Phillips
3
120
215
1
NI
NI
NI
Bianucci
MDCT
1
NI
NI
0.4
NI
NI
NI
[ N em es i s] T i tr e de l’ art ic le (P UL -En-t êt e p ai re )
16
2016 [16]
Brillance
16,
Phillips
Zesch 2016
[29]
Dual
energy
6
140/8
0
80/11
0
0.6
0.55
2x32x0.6
0.3
NI : No information in the article 327
328
Excerebration pathways 329
330
Different types of excerebration pathways are presented in Table 4. Nasal bone 331
fractures were present in 15 mummies, they were absent in 5 mummies, and no 332
information was provided in 11 mummies. The nasal septum deviates to the side 333
opposite the excerebration pathway. Ethmoid bone fractures were present in 19 334
cases, with no fractures in 5 cases and no information provided in 7 cases. Most 335
ethmoid bone fractures were on the left side (6/19, 31.5%), or were bilateral (5/19, 336
26.3%). A right ethmoid bone fracture was described in few cases (2/19, 10.5%). 337
However, there were also some cases with no side indication (7/19, 36.8%). The 338
sphenoid bone was fractured in 4 cases, with no fracture in 11 cases, and no 339
information provided for 16 cases. Sphenoid fractures are always associated with 340
ethmoid fractures and represent a posterior extension of the ethmoidal excerebration 341
pathway. Perforation of the thin walls of the orbit (medial wall, roof) was described 342
in 3 cases. The fractures of orbital walls were present on the same side as the 343
ethmoid bone fracture. 344
345
Table 4. Brain excerebration pathways. 346
Historical
period
Study
Sex M/F
Nasal
bone
fracture
Ethmoid
bone
fracture
Sphenoid
bone frac-
ture
Other fractures
2040-1674
BC (Middle
Kingdom)
Yardley 1997
(ROM I) [11]
M
YES
YES, bi-
lateral
NO
NO
2040-1674
BC (Middle
Kingdom)
Yardley 1997
(ROM II) [11]
M
YES
YES, bi-
lateral
NO
NO
2000 BC
(Middle
Kingdom)
Gupta 2008
[12]
M
YES sep-
tum
YES, left
NO
occipital foramen left ,
bilateral coronoid
process-mandible,
zygomatic bone-
bilateral, anterior wall
maxillary sinus-
bilateral, left styloid
process excised
c.1570-1520
BC (XVII
dyn)
Manley 2002
[13]
F
NI
NI
NI
NI
c.1570-1520
BC (XVII
Marquez
2015
NI
YES
YES, bi-
lateral
NO
NO
[ N em es i s] T i tr e de l’ art ic le (P UL -En-t êt e i mp ai r e)
17
dyn)
(VL1248)
[14]
c.1570-1520
BC (XVII
dyn)
Marquez
2015
(VL1232)
[14]
NI
YES
YES
NI
NI
c.1479-1424
BC (XVIII
dyn)
Wade 2012
[15]
F
NO
NO
NO
NO
c.1479-1424
BC
(XVIII dyn)
Bianucci
2016 [16]
M
NO
NO
NO
NO
c.1150-795
BC
(End New
Empire-3rd
intermediary
period)
Lindsay
2015 [17]
F
YES, left
YES, left
YES, left
Medial wall of left or-
bit, parietal bone right
(1 hole) and left (1
hole)
c.1069-945
BC
(XXI dyn)
Brier 2015
[18]
M
YES
YES, bi-
lateral
NI
NI
c.1069-747
BC
(XXI XXII
dyn)
Hill 1993 [19]
F
YES
NI
NI
Upper orbit, right
c.1069-747
BC (XXI-
XXII dyn)
Gerloni 2009
(M2) [20]
M
NI
YES
YES
NI
c. 1000 BC
(XXI dyn)
Wanek 2011
[21]
NI
NI
YES, left
NI
NI
c. 1000-800
BC (XXI
XXII dyn)
Seiler 2015
(0492) [22]
M
NI
NI
NI
NI
c.945-747
BC (XXII
dyn)
Harwood-
Nash 1979
[3]
F
NI
YES, left
NI
NI
c.900 BC
(XXII dyn)
Melcher
1997 [6]
F
NI
NI
NI
NI
c.945-747
BC
(XXII dyn)
Baldock
1994 [7]
F
YES
YES
NI
NI
c.770 BC
(XXII dyn)
Hughes
2005 [8]
F
NI
NI
NI
NI
c.945-747
BC (XXI-
XXIV dyn)
Cesarani
2004 [23]
M
NI
YES
NI
NI
c. 800-700
BC (XXII
Seiler 2015
(D242) [22]
F
NI
NI
NI
Parietal bone, right
[ N em es i s] T i tr e de l’ art ic le (P UL -En-t êt e p ai re )
18
dyn)
c.746-525
BC
(XXV-XXVI
dyn)
Sigmund
2002 [24]
F
NO
NO
(great
occipital
foramen)
NO
NO
c.600 BC
(XXVI dyn)
Thekkaniyil,
2000 [25]
M
YES
NI
NI
NI
Ptolemaic
period
Singarella
1986 [9]
F
NI
NI
NI
NI
Ptolemaic
period (323-
30 BC)
Babin 1990
(Se-Anht)
[10]
F
NI
YES, left
NI
NO
Ptolemaic
period
c.305-150
BC
Babin 1990
(Irtw-Irw) [10]
M
YES,
septum
deviated
to left
YES, bi-
lateral
NI
NO
Ptolemaic
period
Chan, 2008
[26]
F
NI
YES,
right
YES, right
NI
Ptolemaic
period
Gerloni,
2009 (M3)
[20]
M
NI
YES
NI
NI
Ptolemaic
period
Pelo, 2012
[27]
F
NI
NI
NI
NI
Ptolemaic
period
Wade, 2012
[15]
F
YES
YES,
right
YES, right
NO
Ptolemaic
period (323-
30 BC)
Davey, 2013
[28]
M
YES,
septum
deviated
to the
right
YES, left
NO
NO
Ptolemaic
period
Zesch, 2016
[29]
M
NO
NO
NO
NO
100 BC-100
AD
Nickol, 1995
[30]
F
YES
YES
NI
NI
Roman
period (c.80-
110 AD)
MacLeod,
2000 [31]
M
NO
NO
(great
occipital
foramen)
NO
NO
Roman
period (30
BC-395 AD
Piombino-
Mascali,
2016 [32]
M
YES,
right
NI
NO
Frontal roof of right
orbit
NI : No information in the article 347
348
When looking at the historical period, and the type of excerebration pathway (Table 349
4), ethmoid left and ethmoid bilateral pathways are the oldest pathways described in 350
this study (from the Middle Kingdom) [11, 12]. 351
[ N em es i s] T i tr e de l’ art ic le (P UL -En-t êt e i mp ai r e)
19
The ethmoid with sphenoid extension pathway, and the ethmoid and orbit extension 352
pathway appeared in this study at the end of New Empire and beginning of the 3rd 353
intermediary period [17]. The right ethmoid bone pathway appears in this study in 354
the Ptolemaic period [26]. We also found 2 cases of excerebration through the great 355
occipital foramen from the XXV-XXVI Dynasty [24]. 356
Table 5 provides information about the relationship between sex and skull fractures 357
associated with excerebration pathways. The small sample in this study did not 358
allow us to perform any statistical analyses. However, sphenoid extension pathways 359
are more common in female mummies. 360
361
Table 5. Relationship between sex and excerebration pathways. 362
Fracture
Nasal bone
Ethmoid bone
Sphenoid bone
Male/Female
8/5
9/7
1/3
363
Table 6 provides information about excerebration and brain content. Full 364
excerebration was described in 19 cases. It appeared in this study in mummies from 365
the Middle Kingdom [11]. Partial excerebration was present in 4 cases (from the 366
XVII Dynasty). No excerebration was found in 3 cases (from the XVIII Dynasty), 367
and no information was provided in 5 cases. 368
369
Table 6. Excerebration and brain content. 370
Historical
period
Study
Gender
M/F
Excerebration
Foreign
objects
in skull
Brain
Dura
mater
Dura
cervical
2040-1674
BC (Middle
Kingdom)
Yardley 1997
(ROM I) [11]
M
YES
NI
NO
NI
NI
2040-1674
BC (Middle
Kingdom)
Yardley 1997
(ROM II) [11]
M
YES
NI
NO
NI
NI
2000 BC
(Middle
Kingdom)
Gupta 2008
[12]
M
YES
NO
NO
NO
NO
c.1570-1520
BC (XVII
dyn)
Manley 2002
[13]
F
NI
NI
NI
NI
NI
c.1570-1520
BC (XVII
dyn)
Marquez
2015
(VL1248)
[14]
NI
YES
YES, re-
sin (occi-
pital)
YES, frag-
ments
YES
YES
c.1570-1520
BC (XVII
dyn)
Marquez
2015
(VL1232)
[14]
NI
YES
NI
NI
NI
NI
c.1479-1424
BC (XVIII
dyn)
Wade 2012
[15]
F
NO
NO
YES
YES
YES
[ N em es i s] T i tr e de l’ art ic le (P UL -En-t êt e p ai re )
20
c.1479-1424
BC
(XVIII dyn)
Bianucci
2016 [16]
M
NO
NO
YES
YES
NI
c.1150-795
BC
(End New
Empire-3rd
intermediary
period)
Lindsay
2015 [17]
F
YES
YES, re-
sin (occi-
pital)
NO
NO
NO
c.1069-945
BC
(XXI dyn)
Brier 2015
[18]
M
YES
YES, res-
in (occipi-
tal, parie-
tal right)
NO
NI
NI
c.1069-747
BC
(XXI XXII
dyn)
Hill 1993 [19]
F
YES
NI
NI
NI
NI
c.1069-747
BC (XXI-
XXII dyn)
Gerloni 2009
(M2) [20]
M
YES
YES, re-
sin-
soaked
linen
ban-
dages
NO
NI
NI
c. 1000 BC
(XXI dyn)
Wanek 2011
[21]
NI
YES
YES, res-
in (occipi-
tal)
NO
NO
NO
c. 1000-800
BC (XXI
XXII dyn)
Seiler 2015
(0492) [22]
M
NI
NI
NI
NI
NI
c.945-747
BC (XXII
dyn)
Harwood-
Nash 1979
[3]
F
YES
NO
NO menin-
geal linings
YES
NI
c.900 BC
(XXII dyn)
Melcher
1997 [6]
F
NI
NI
NI
NI
NI
c.945-747
BC
(XXII dyn)
Baldock
1994 [7]
F
YES
YES, lin-
en
NO
NI
NI
c.770 BC
(XXII dyn)
Hughes
2005 [8]
F
YES
NI
NO
YES
NI
c.945-747
BC (XXI-
XXIV dyn)
Cesarani
2004 [23]
M
YES
NI
NO
YES
NI
c. 800-700
BC (XXII
dyn)
Seiler 2015
(D242) [22]
F
YES
YES, res-
in (parie-
tal, occip-
ital,
occipital
path
NO
NI
NI
[ N em es i s] T i tr e de l’ art ic le (P UL -En-t êt e i mp ai r e)
21
flow), 2
teeth
c.746-525
BC
(XXV-XXVI
dyn)
Sigmund
2002 [24]
F
YES
YES, res-
in (occipi-
tal)
NO
NO
NO
c.600 BC
(XXVI dyn)
Thekkaniyil,
2000 [25]
M
YES
YES,
embalm-
ing
residu
(occipital)
YES, frag-
ments
NI
NI
Ptolemaic
period
Singarella
1986 [9]
F
YES
NI
NI
NI
NI
Ptolemaic
period (323-
30 BC)
Babin 1990
(Se-Anht)
[10]
F
YES
YES, res-
in (occipi-
tal),Insec
ts larvae
(endo-
scope)
NO
NO
NO
Ptolemaic
period
c.305-150
BC
Babin 1990
(Irtw-Irw) [10]
M
YES
YES, res-
in (occipi-
tal), left
frontal
sinus,
right
maxillary
sinus, fo-
ramen
magnum,
Insects
larvae
(endo-
scope)
NO
NO
NI
Ptolemaic
period
Chan, 2008
[26]
F
YES
YES, res-
in
NO
NI
NI
Ptolemaic
period
Gerloni,
2009 (M3)
[20]
M
YES
NI
YES, brain
fragments,
meningeal
linings
YES
NI
Ptolemaic
period
Pelo, 2012
[27]
F
NI
NI
NI
NI
NOI
Ptolemaic
period
Wade, 2012
[15]
F
YES
YES, res-
in (occipi-
tal, 3
path
flows)
Resin in
right
ethmoid
NO
NO
YES
[ N em es i s] T i tr e de l’ art ic le (P UL -En-t êt e p ai re )
22
sinus, in
left maxil-
lary si-
nus, 5
bone
frag-
ments (3
in resin,
2 in cer-
vical ar-
ea), 3
frag-
ments of
wood
Ptolemaic
period (323-
30 BC)
Davey, 2013
[28]
M
YES
NO
NO
NO
YES
Ptolemaic
period
Zesch, 2016
[29]
M
NO
NO
YES
YES
YES
100 BC-100
AD
Nickol, 1995
[30]
F
YES
YES, lin-
en
NO
NI
NOI
Roman
period (c.80-
110 AD)
MacLeod,
2000 [31]
M
YES
YES,
embalm-
ing resi-
due (up-
per
cervical
spine)
NO
NO
YES
Roman
period (30
BC-395 AD
Piombino-
Mascali,
2016 [32]
M
YES
NO
NO
NO
NI
371
The skull was empty in 7 cases. Resin was found in the skull in 10 cases (from the 372
XVII Dynasty), resin and linen bandages in 1 case (from XXI-XXII Dynasty), linen 373
in 2 cases (from the XXII Dynasty), embalming material in 2 cases (from the XXVI 374
Dynasty), and no information was provided for 9 cases. 375
Resin was present in the occipital area in 9 cases (from the XVII Dynasty), in the 376
occipital and parietal areas in 2 cases (from the XXI Dynasty), and outside of the 377
brain in the maxillary sinus in 2 cases (from the Ptolemaic period). There were also 378
two exceptional cases (from one study) from the Ptolemaic period with the presence 379
of larval insects inside the skull [10]. There seems to be no relationship between sex 380
and brain content in this study sample. 381
382
Soft tissue preservation 383
384
Table 7 provides information regarding the preservation of soft facial tissues. The 385
ears were present in 15 cases, and no information was provided for 16 cases. Three 386
[ N em es i s] T i tr e de l’ art ic le (P UL -En-t êt e i mp ai r e)
23
mummy descriptions gave no information about the preservation of any type of soft 387
tissue of the face and skull. The eye globes were present in 15 cases (all historical 388
periods). There were 2 cases of one missing eye (from the Middle Kingdom). There 389
were 17 cases with no description of the eye globe preservation state. Both eye 390
globes were missing in two cases (XXI Dynasty). Eye muscles were preserved in 10 391
cases, with no information provided in 20 cases. In one case all the orbit content was 392
absent including eye globes, eye muscles and the optic nerves [20]. Optic nerves 393
were present in 8 cases, they were absent in 2 cases, and no information was 394
provided for 21 cases. The tongue was present in 12 cases (all historical periods), 395
and no information was provided for 19 cases. 396
397
Table 7. Preservation of facial soft tissues. 398
Historical
period
Study
Sex M/F
Ears
Eye
globe
Eye
muscles
Optic
nerve
Tongue
2040-1674 BC
(Middle
Kingdom)
Yardley
1997 (ROM
I) [11]
M
NOI
YES,
left
NOI
NOI
NOI
2040-1674 BC
(Middle
Kingdom)
Yardley
1997 (ROM
II) [11]
M
NOI
YES,
left
NOI
NOI
NOI
2000 BC
(Middle
Kingdom)
Gupta 2008
[12]
M
NOI
NOI
NOI
NOI
NOI
c.1570-1520
BC (XVII dyn)
Manley 2002
[13]
F
NOI
NOI
NOI
NOI
NOI
c.1570-1520
BC (XVII dyn)
Marquez
2015
(VL1248)
[14]
NI
YES
NOI
NOI
NOI
YES
c.1570-1520
BC (XVII dyn)
Marquez
2015
(VL1232)
[14]
NI
YES
NOI
NOI
NOI
NOI
c.1479-1424
BC (XVIII dyn)
Wade 2012
(RM2717)
[15]
F
NOI
NOI
NOI
NOI
NOI
c.1479-1424
BC
(XVIII dyn)
Bianucci
2016 [16]
M
YES
YES
NOI
NOI
NOI
c.1150-795
BC
(End New
Empire-3rd in-
termediary pe-
riod)
Lindsay
2015 [17]
F
YES
YES
YES
NOI
YES
c.1069-945
BC
(XXI dyn)
Brier 2015
(male) [18]
M
NOI
YES
YES
YES
YES
[ N em es i s] T i tr e de l’ art ic le (P UL -En-t êt e p ai re )
24
c.1069-747
BC
(XXI XXII
dyn)
Hill 1993 [19]
F
NOI
NOI
NOI
NOI
NOI
c.1069-747
BC (XXI-XXII
dyn)
Gerloni 2009
(M2) [20]
M
NOI
NO
NO
NO
NOI
c. 1000 BC
(XXI dyn)
Wanek 2011
[21]
NI
NOI
YES
YES
NOI
YES
c. 1000-800
BC (XXI
XXII dyn)
Seiler 2015
(0492) [22]
M
YES
NOI
NOI
NOI
YES
c.945-747 BC
(XXII dyn)
Harwood-
Nash, 1979
[3]
F
NOI
YES
YES
YES
NOI
c.900 BC
(XXII dyn)
Melcher
1997 [6]
F
NOI
NOI
NOI
NOI
NOI
c.945-747 BC
(XXII dyn)
Baldock
1994 [7]
F
YES
NO
NO
NO
NOI
c.770 BC
(XXII dyn)
Hughes
2005 [8]
F
YES
YES
YES
NOI
NOI
c.945-747 BC
(XXI-XXIV
dyn)
Cesarani
2004 [23]
M
YES
NOI
NOI
NOI
NOI
c. 800-700 BC
(XXII dyn)
Seiler 2015
(D242) [22]
F
YES
NOI
NOI
NOI
YES
c.746-525 BC
(XXV-XXVI
dyn)
Sigmund
2002 [24]
F
YES
YES
YES
YES
YES
c.600 BC
(XXVI dyn)
Thekkaniyil
2000 [25]
M
NOI
NOI
NOI
NOI
NOI
Ptolemaic
period
Singarella
1986 [9]
F
NOI
NOI
NOI
NOI
NOI
Ptolemaic
period (323-
30 BC)
Babin 1990
(Se-Anht)
[10]
F
YES
YES
YES
YES
NOI
Ptolemaic
period c.305-
150 BC
Babin 1990
(Irt-Irw) [10]
M
YES (protu-
berant position
of ears due to
linen wrap-
ping)
YES
YES
YES
NOI
Ptolemaic
period
Chan 2008
[26]
F
NOI
NOI
NOI
NOI
NOI
Ptolemaic
period
Gerloni 2009
(M3) [20]
M
NOI
NOI
NOI
NOI
NOI
Ptolemaic
period
Pelo 2012
[27]
F
NOI
NOI
NOI
NOI
NOI
Ptolemaic
period
Wade 2012
(RM2720)
F
NOI
YES
NOI
NOI
NOI
[ N em es i s] T i tr e de l’ art ic le (P UL -En-t êt e i mp ai r e)
25
[15]
Ptolemaic
period (323-
30 BC)
Davey, 2013
[28]
M
YES
NOI
NOI
NOI
YES
Ptolemaic
period
Zesch 2016
[29]
M
YES
YES
YES
YES
YES
100 BC-100
AD
Nickol 1995
[30]
F
NOI
NOI
NOI
NOI
YES
Roman period
(c.80-110 AD)
MacLeod
2000 [31]
M
YES
YES
YES
YES
YES
Roman period
(30 BC-395
AD
Piombino-
Mascali
2016 [32]
M
YES
YES
NOI
YES
YES
NOI: not interpretable from article and/or from CT image presented in the article 399
400
Information about brain excerebration is provided in Table 4. We also wanted to 401
know how often the excerebration was associated with the removal of the dura mater 402
and/or the dura cervical (Table 6). The dura mater was present in 8 cases, it was 403
absent in 10 cases, and no information was given in 13 cases. The combination of an 404
absent brain with the dura mater present appeared in 3 cases (from the XXII 405
Dynasty). The combination of the absent brain with the dura mater absent was 406
observed in 10 cases (all historical periods). The dura cervical was present in 6 407
cases, it was absent in 5 cases, and no information was provided in 20 cases. The 408
combination of absent brain, absent dura mater, and absent dura cervical was present 409
in 5 cases (all historical periods). The combination of absent brain, absent dura 410
mater, and present dura cervical appeared in 3 cases (from the Ptolemaic period). 411
We could not find any correlation between sex and facial soft tissue preservation 412
due to incomplete data in the selected articles. 413
414
Dental status 415
416
Table 8 provides information about the different types of CT examinations used to 417
study the dental status of Egyptian mummies. The teeth were evaluated with 418
different CT scanning modalities, such as two-dimensional (2D) CT slices (8 cases), 419
2D multiplanar reconstructions (MR) mimicking dental panoramic imaging (4 420
cases), three-dimensional (3D) skull reconstructions (13 cases), and 2D and 3D 421
approaches (6 cases). A combination of techniques with 2D, 3D, and 2D MR was 422
used in two cases. No information on the CT modality used was provided for one 423
case. The visualization and interpretation of the dental status was possible in 21 424
cases, especially when the multiplanar reconstruction of dental arches was provided. 425
The visualization and interpretation of the dental status was impossible in 10 cases 426
because of a field of view excluding the teeth or low-quality 3D CT reconstruction 427
of the dental arches. In those cases, only 2D and/or 3D imaging was provided. 428
429
430
431
[ N em es i s] T i tr e de l’ art ic le (P UL -En-t êt e p ai re )
26
Table 8. Teeth visualization using CT scans. 432
Historical
period
Study
Head CT
modality
Teeth visualized on CT
images in the article
2040-1674
BC (Middle
Kingdom)
Yardley
1997, (ROM
I) [11]
2D
NO
2040-1674
BC (Middle
Kingdom)
Yardley
1997, (ROM
II) [11]
2D
NO
2000 BC
(Middle
Kingdom)
Gupta 2008
[12]
2D, 3D
YES
c.1570-
1520 BC
(XVII dyn)
Manley
2002 [13]
3D
YES
c.1570-
1520 BC
(XVII dyn)
Marquez
2015
(VL1248)
[14]
2D, 3D
NO
c.1570-
1520 BC
(XVII dyn)
Marquez
2015
(VL1232)
[14]
2D
NO
c.1479-
1424 BC
(XVIII dyn)
Wade 2012
(RM2717)
[15]
3D
NO
c.1479-
1424 BC
(XVIII dyn)
Bianucci
2016 [16]
2D, MR
YES
c.1150-795
BC
(End New
Empire-3rd
intermedi-
ary period)
Lindsay
2015 [17]
2D, 3D
YES
c.1069-945
BC
(XXI dyn)
Brier 2015
(male) [18]
2D
NO
c.1069-747
BC
(XXI XXII
dyn)
Hill 1993
[19]
3D (low
quality)
YES
c.1069-747
BC (XXI-
XXII dyn)
Gerloni
2009 (M2)
[20]
2D, MR
YES
c. 1000 BC
(XXI dyn)
Wanek 2011
[21]
3D
YES
c. 1000-
800 BC
Seiler 2016
(0492) [22]
2D, MR
YES
[ N em es i s] T i tr e de l’ art ic le (P UL -En-t êt e i mp ai r e)
27
(XXI XXII
dyn)
c.945-747
BC (XXII
dyn)
Harwood-
Nash, 1979
[3]
2D
NI
c.900 BC
(XXII dyn)
Melcher
1997 [6]
3D, 2D MR
low quality
YES
c.945-747
BC
(XXII dyn)
Baldock
1994 [7]
3D
NI
c.770 BC
(XXII dyn)
Hughes
2005 [8]
2D, 3D
NO
c.945-747
BC (XXI-
XXIV dyn)
Cesarani
2004 [23]
3D
YES
c. 800-700
BC (XXII
dyn)
Seiler 2015
(D242) [22]
2D, MR
YES
c.746-525
BC
(XXV-XXVI
dyn)
Sigmund
2002 [24]
3D
YES
c.600 BC
(XXVI dyn)
Thekkaniyil
2000 [25]
3D, 2D MR
low quality
YES
Ptolemaic
period
Singarella
1986 [9]
NI
NO
Ptolemaic
period
(323-30
BC)
Babin 1990
(Se-Anht)
[10]
2D
NO
Ptolemaic
period
c.305-150
BC
Babin 1990
(Iret-Irew)
[10]
2D
NO
Ptolemaic
period
Chan 2008
[26]
2D
YES
Ptolemaic
period
Gerloni
2009 (M3)
[20]
3D
YES
Ptolemaic
period
Pelo 2012
[27]
3D
YES
Ptolemaic
period
Wade 2012
(RM2720)
[15]
3D
NO
Ptolemaic
period
(323-30
BC)
Davey, 2013
[28]
2D, 3D
YES
[ N em es i s] T i tr e de l’ art ic le (P UL -En-t êt e p ai re )
28
Ptolemaic
period
Zesch 2016
[29]
3D teeth
reconstruc-
tion
YES
100 BC-
100 AD
Nickol 1995
[30]
2D, 3D
YES
Roman
period
(c.80-110
AD)
Macleod
2000 [31]
3D
YES
Roman
period (30
BC-395 AD
Piombino-
Mascali
2016 [32]
3D
YES
NI: no information in the article 433
MR: multiplanar reconstruction 434
435
Table 9 provides information about the dental status of the mummies. The dentition 436
type was definitive in 29 mummies, mixed in one mummy, and lacteal in another 437
mummy. All 32 teeth were present in 10 cases. Missing teeth were observed in 11 438
cases, and no information was provided for 10 cases. Missing teeth were not related 439
to any specific period in history. The teeth were missing in 8 cases on the maxilla 440
and in 10 cases on the mandible. Most of the missing teeth were molars (10 cases), 441
premolars (4 cases), incisors (4 cases), and canines (2 cases). Fractured teeth were 442
present in 5 cases (from the end of the New Empire-to the beginning of the 3rd in-443
termediary period), they were absent in 17 cases, and no information was provided 444
for 9 cases. Fractured teeth were only found on the maxilla and were mostly incisors 445
(4 cases out of 5). Tooth wear was present in this study in 18 cases (all historical 446
periods), it was absent in 5 cases, and no information was provided in 8 cases. No 447
tooth wear and a full dentition were present in this study in 3 cases from the 448
Ptolemaic and Roman times. Periapical lesions represented by an empty space 449
around the apex of a tooth root were present in this study in 10 cases (from the 450
XVIII Dynasty), they were absent in 7 cases, and no information was provided in 14 451
cases. Caries were present in this study in 7 cases (from the XVII Dynasty), they 452
were absent in 9 cases, and no information was available in 15 cases. 453
454
Table 9. Dental status of the mummies. 455
Historical
period
Study
Sex M/F
Dentition
type (L-
lacteal, M-
mixt, D-
definitive)
Teeth
missing
Teeth
fractured
Wear
Periapi
cal le-
sion
(IDF
tooth
num-
ber)
Caries
2040-1674
BC (Middle
Kingdom)
Yardley 1997,
(ROM I) [11]
M
D
NI
NI
YES
NI
NI
2040-1674
BC (Middle
Yardley 1997,
(ROM II) [11]
M
D
NI
NI
YES
NI
NI
[ N em es i s] T i tr e de l’ art ic le (P UL -En-t êt e i mp ai r e)
29
Kingdom)
2000 BC
(Middle
Kingdom)
Gupta 2008
[12]
M
D
48, 18,
17, 16,
26, 27,
28
NO
YES
NO
NI
c.1570-
1520 BC
(XVII dyn)
Manley 2002
[13]
F
D
NI
NI
NO
NI
YES
c.1570-
1520 BC
(XVII dyn)
Marquez 2015
(VL1248) [14]
NI
D
NO
NO
NI
NI
NI
c.1570-
1520 BC
(XVII dyn)
Marquez 2015
(VL1232) [14]
NI
D
27, 38,
47
NO
NI
NI
NI
c.1479-
1424 BC
(XVIII dyn)
Wade 2012
(RM2717) [15]
F
D
12 to 18,
23 to 28,
45 to 48,
34 to 38
NO
YES
21, 22,
31, 32,
33, 42,
43, 44
YES,
43
c.1479-
1424 BC
(XVIII dyn)
Bianucci 2016
[16]
M
D
18, 23,
27, 28
NO
YES
11, 12,
13, 14,
15, 21,
22, 24,
31, 46
NO
c.1150-795
BC
(End New
Empire-3rd
intermedi-
ary period)
Lindsay 2015
[17]
F
D
NO
11, 21
YES
NI
NI
c.1069-945
BC
(XXI dyn)
Brier 2015
(male) [18]
M
D
NO
NO
NI
NO
NO
c.1069-747
BC
(XXI XXII
dyn)
Hill 1993 [19]
F
D
NI
NI
NI
NI
NI
c.1069-747
BC (XXI-
XXII dyn)
Gerloni 2009
(M2) [20]
M
D
NO
NO
YES
11, 15,
25
YES,
15, 16
c. 1000 BC
(XXI dyn)
Wanek 2011
[21]
NI
D
NI
NI
NI
NI
NI
c. 1000-
800 BC
(XXI XXII
dyn)
Seiler 2016
(0492) [22]
M
D
41, 42,
46, 47,
31, 35,
36
NI
YES
NI
NI
c.945-747
BC (XXII
dyn)
Harwood-
Nash, 1979
[3]
F
D
NI
NI
NI
NI
NI
[ N em es i s] T i tr e de l’ art ic le (P UL -En-t êt e p ai re )
30
c.900 BC
(XXII dyn)
Melcher 1997
[6]
F
D
18, 37,
38
24
YES
11, 12,
14, 15,
16, 21,
22, 23,
24, 25,
26, 34,
35, 36,
45, 46,
47, 48
NI
c.945-747
BC
(XXII dyn)
Baldock 1994
[7]
F
D
NI
NI
YES
NI
NI
c.770 BC
(XXII dyn)
Hughes 2005
[8]
F
D
NI
NI
YES
NI
NI
c.945-747
BC (XXI-
XXIV dyn)
Cesarani
2004 [23]
M
D
NI
NI
YES
NI
NI
c. 800-700
BC (XXII
dyn)
Seiler 2015
(D242) [22]
F
D
14, 15,
31, 32,
42, 44,
45
11, 21, 22
YES
NI
YES
c.746-525
BC
(XXV-XXVI
dyn)
Sigmund 2002
[24]
F
D
NO
NO
YES
24, 25
NI
c.600 BC
(XXVI dyn)
Thekkaniyil
2000 [25]
M
D
46
NO
NI
NI
NI
Ptolemaic
period
Singarella
1986 [9]
F
D
NI
NI
YES
NI
YES
Ptolemaic
period
(323-30
BC)
Babin 1990
(Se-Anht) [10]
F
D
YES
NO
YES
YES
NO
Ptolemaic
period
c.305-150
BC
Babin 1990
(Iret-Irew) [10]
M
D
YES
NO
YES
YES,
multiple
YES,
multiple
Ptolemaic
period
Chan 2008
[26]
F
D
28, 37,
38, 47
NO
NO
NO
NO
Ptolemaic
period
Gerloni 2009
(M3) [20]
M
D
All mis-
sing ex-
cept 46
NO
NI
NO
YES,
46
Ptolemaic
period
Pelo 2012 [27]
F
D
NO
NO
YES
31, 41
NO
Ptolemaic
period
Wade 2012
(RM2720) [15]
F
D
NO
NO
NO
NO
NO
Ptolemaic
period
(323-30
Davey, 2013
[28]
M
M
NI
NI
NI
NI
NI
[ N em es i s] T i tr e de l’ art ic le (P UL -En-t êt e i mp ai r e)
31
BC)
Ptolemaic
period
Zesch 2016
[29]
M
L
NO
NO
NO
NO
NO
100 BC-
100 AD
Nickol 1995
[30]
F
D
NO
12
YES
12
NO
Roman pe-
riod (c.80-
110 AD)
Macleod 2000
[31]
M
D
NO
NO
NO
NO
NO
Roman pe-
riod (30
BC-395 AD
Piombino-
Mascali 2016
[32]
M
D
18, 28,
41, 45,
46, 48,
36, 38
11, 12, 21,
22, 23
YES
11, 14,
16, 24,
25, 26
NO
NI: no information provided by the article 456
457
Table 10 presents the relationship between sex and the dental status of the 458
mummies. There seems to not be any sex-based differences in missing teeth, 459
periapical lesions, caries, or teeth wear. Only fractured teeth seem more common in 460
female mummies. 461
462
Table 10. Relationship between sex and the dental status of the mummies. 463
Missing
teeth
Fractured
teeth
Wear
Periapical
lesions
Caries
Male/Female
7/5
1/4
9/9
4/6
3/4
464
Tooth displacements 465
466
Table 11 presents different types of tooth displacements inside and around the skull 467
and face. A displacement is defined as a tooth present outside the maxilla and/or the 468
mandible. Teeth were displaced in 5 cases, they were not displaced in 15 cases, and 469
no information was provided in 11 cases. Teeth were found to be displaced in the 470
oral and neck area in 5 cases (from the XVIII Dynasty), in the skull in 1 case [22], 471
and in another area (larynx) in 1 case. There seems to not to be a relationship 472
between sex and the displacement of teeth outside of the maxillae. 473
474
Table 11. Anatomical regions of tooth displacements. 475
Historical
period
Study
Sex M/F
Displaced
in
oral/neck
areas
Displaced
in skull
Displaced
in other
areas
2040-1674
BC (Middle
Kingdom)
Yardley 1997
(ROM I) [11]
M
NI
NI
NI
2040-1674
BC (Middle
Kingdom)
Yardley 1997,
ROM II [11]
M
NI
NI
NI
2000 BC
(Middle
Gupta 2008
[12]
M
NO
NO
NO
[ N em es i s] T i tr e de l’ art ic le (P UL -En-t êt e p ai re )
32
Kingdom)
XVII
Dynasty
Manley 2002
[13]
F
NI
NI
NI
XVII
Dynasty
Marquez
2015
(VL1248) [14]
NI
NO
NO
NO
XVII
Dynasty
Marquez
2015
(VL1232) [14]
NI
NI
NI
NI
XVIII
Dynasty
Wade 2012
(RM2717)
[15]
F
41, 46
NO
NO
XVIII
Dynasty
(1479-1424
BC)
Bianucci 2016
[16]
M
NO
NO
NO
XX-XXII
Dynasty
(1150-795
BC)
Lindsay 2015
[17]
F
YES
(fragments
in oropha-
rynx)
NO
NO
XXI
Dynasty
(1085-950
BC)
Brier 2015
(male) [18]
M
NO
NO
NO
XXI
Dynasty
(1070-945)
Hill 1993 [19]
F
NI
NI
NI
XXI
Dynasty
Gerloni 2009
(M2) [20]
M
NO
NO
NO
1000 BC
Wanek 2011
[21]
NI
NI
NI
NI
1000-800
BC
Seiler 2015
(0492) [22]
M
41, 31, 35,
one molar
NI
NI
XXII
Dynasty
(945-715
BC)
Harwood-
Nash, 1979
[3]
F
NI
NI
NI
XXII
Dynasty
(900 BC)
Melcher 1997
[6]
F
NO
NO
NO
XXII Dyn-
asty (945-
715 BC)
Baldock 1994
[7]
F
NI
NI
NI
XXII
Dynasty
(770 BC)
Hughes 2005
[8]
F
NI
NI
NI
XXII-XXIII
Dynasty
(945-715
Cesarani
2004 [23]
M
NI
NI
NI
[ N em es i s] T i tr e de l’ art ic le (P UL -En-t êt e i mp ai r e)
33
BC)
800-700
BC
Seiler 2015
(D242) [22]
F
YES (mul-
tiple)
YES (2
teeth)
YES (la-
rynx)
XXV-XXVI
Dynasty
(700-650
BC)
Sigmund
2002 [24]
F
NO
NO
NO
500 BC
Thekkaniyil
2000 [25]
M
NO
NO
NO
334-304
BC
Singarella
1986 [9]
F
NI
NI
NI
Ptolemaic
period
(323-30
BC)
Babin 1990
(Se-Anht) [10]
F
NI
NI
NI
Ptolemaic
period
(323-30
BC)
Babin 1990
(Irt-Irw) [10]
M
NI
NI
NI
305-200
BC
Chan 2008
[26]
F
NO
NO
NO
Greek-
Roman
period
Gerloni 2009
(M3) [20]
M
4 teeth in
oropharynx
NO
NO
200 BC
Pelo 2012
[27]
F
NO
NO
NO
Ptolemaic
or Roman
period
Wade 2012
(RM2720)
[15]
F
NO (32
twisted at
90° and
displaced
lingually
behind 31
and 33)
NO
NO
Ptolemaic
period
(323-30
BC)
Davey 2013
[28]
M
NI
NI
NI
378-235
BC
Zesch 2016
[29]
M
NO
NO
NO
100 BC-
100 AD
Nickol 1995
[30]
F
NO
NO
NO
80-110 AD
Macleod 2000
[31]
M
NO
NO
NO
30 BC-395
AD
Piombino-
Mascali 2016
[32]
M
NO
NO
NO
NI: no information in article 476
477
478
[ N em es i s] T i tr e de l’ art ic le (P UL -En-t êt e p ai re )
34
Packing of the mouth, ears, nose, and eyes 479
480
Table 12 provides information about packing inside the mouth, ears, nose, and eyes. 481
An open mouth was present in 13 cases (from the XVIII Dynasty). The mouth was 482
closed in 9 cases (all historical periods), and no information was given for 9 cases. 483
Packing of the mouth was present in 7 cases (from the XVIII Dynasty), no packing 484
of the mouth was observed in 9 cases (from the XVIII Dynasty), and no information 485
was provided in 15 cases (all historical periods). In 2 cases from the Roman period, 486
a coin was placed inside the mouth. An open mouth with no packing was present in 487
4 cases (from the XVIII Dynasty). An open mouth together with packing was 488
present in 4 cases (from the XVIII Dynasty). A closed mouth without packing was 489
present in 3 cases (from the XXI Dynasty). A closed mouth with packing and a coin 490
in the mouth was present in 1 case (Roman period). Packing in the mouth consisted 491
of resin, resin soaked linen, mud, natron or myrrh. There were also bandages or 492
plugs placed between the anterior teeth in 2 cases. 493
494
Table 12. Packing of the mouth, ears, and orbits. 495
Historical
period
Study
Sex M/F
Mouth
opened
Packing
of the
mouth
External
Ear
Middle Ear
Foreign
objects in
orbit
2040-1674
BC (Middle
Kingdom)
Yardley
1997 ROM I
[11]
M
NI
NI
NI
Displace-
ment of
ossicular
chain
NI
2040-1674
BC (Middle
Kingdom)
Yardley
1997 ROM II
[11]
M
NO
NI
Embalming
material
absence of
ossicular
chain
NI
2000 BC
(Middle
Kingdom)
Gupta 2008
[12]
M
NO
NI
NI
NI
NO
c.1570-1520
BC (XVII
dyn)
Manley 2002
[13]
F
NI
NI
Gold ear-
rings
NI
NI
c.1570-1520
BC (XVII
dyn)
Marquez
2015
(VL1248)
[14]
NI
NI
NI
NI
NI
NI
c.1570-1520
BC (XVII
dyn)
Marquez
2015
(VL1232)
[14]
NI
NI
NI
NI
NI
NI
c.1479-1424
BC (XVIII
dyn)
Wade 2012
(RM2717)
[15]
F
NI
YES
(natron
or myrrh)
NI
NI
NO
c.1479-1424
BC
(XVIII dyn)
Bianucci
2016 [16]
M
YES
NO
NI
NI
NI
[ N em es i s] T i tr e de l’ art ic le (P UL -En-t êt e i mp ai r e)
35
c.1150-795
BC
(End New
Empire-3rd
intermediary
period)
Lindsay
2015 [17]
F
YES
NO (resin
in phar-
ynx)
NI
NI
NO
c.1069-945
BC
(XXI dyn)
Brier 2015
[18]
M
YES
NI
NI
NI
NI
c.1069-747
BC
(XXI XXII
dyn)
Hill 1993 [19]
F
YES
NI
NI
NI
NI
c.1069-747
BC (XXI-
XXII dyn)
Gerloni 2009
(M2) [20]
M
YES
YES
(bandag-
es be-
tween
anterior
teeth)
NI
NI
YES, (false
eyes : 2
oval radio-
paque
plates)
c. 1000 BC
(XXI dyn)
Wanek 2011
[21]
NI
NO
NO
NI
NI
NO
c. 1000-800
BC (XXI
XXII dyn)
Seiler 2015
(0492) [22]
M
NI
NO
NI
NI
NI
c.945-747
BC (XXII
dyn)
Harwood-
Nash, 1979
[3]
F
NI
NI
NI
NI
False eye
(left), eye
globes
packed
c.900 BC
(XXII dyn)
Melcher
1997 [6]
F
YES
NO
NI
NI
NI
c.945-747
BC
(XXII dyn)
Baldock
1994 [7]
F
YES
NI
NI
NI
False eyes
(glass)
c.770 BC
(XXII dyn)
Hughes
2005 [8]
F
YES
YES
(plug be-
tween
front
teeth)
NI
NI
YES (false
eyes: 2
plates)
c.945-747
BC (XXI-
XXIV dyn)
Cesarani
2004 [23]
M
NO
NI
NI
NI
NI
c. 800-700
BC (XXII
dyn)
Seiler 2016
(D242) [22]
F
NO
NI
NI
NI
NO
c.746-525
BC
(XXV-XXVI
dyn)
Sigmund
2002 [24]
F
NO
NI
NI
Intact in-
ternal ear
structure
Packing
(Eye bulbs
filled with
substance-
600 HU)
[ N em es i s] T i tr e de l’ art ic le (P UL -En-t êt e p ai re )
36
c.600 BC
(XXVI dyn)
Thekkaniyil
2000 [25]
M
YES
NO
NI
NI
False
eyes:
plates (2?)
Ptolemaic
period
Singarella
1986 [9]
F
NI
NI
NI
NI
NI
Ptolemaic
period (323-
30 BC)
Babin 1990
(Se-Anht)
[10]
F
NI
NI
Embalming
material
NI
Linen
strips (in
front of the
globes)
Ptolemaic
period
c.305-150
BC
Babin 1990
(Irt-Irw) [10]
M
NI
NI
NO
NI
Linen
strips (in
front of the
globe)
Ptolemaic
period
Chan 2008
[26]
F
NI
YES
(resin)
NI
NI
NI
Ptolemaic
period
Gerloni 2009
(M3) [20]
M
YES
NI
NI
NI
NI
Ptolemaic
period
Pelo 2012
[27]
F
YES
NI
NI
NI
NI
Ptolemaic
period
Wade 2012
(RM2720)
[15]
F
YES
YES, res-
in-
soaked
linen,
posterior-
ly mud?
NI
NI
NO
Ptolemaic
period (323-
30 BC)
Davey, 2013
[28]
M
NO
NO
NI
Intact ossi-
cles in
middle
ears
False eyes
Ptolemaic
period
Zesch 2016
[29]
M
NO
NO
Embalming
material in
external
auditory
canal
(2079 HU)
NI
NO
100 BC-100
AD
Nickol 1995
[30]
F
YES
YES +
metallic
coin-like
object
NI
NI
Linen
Roman pe-
riod (c.80-
110 AD)
MacLeod
2000 [31]
M
NO
Metallic
oval plate
over
tongue
NI
NI
NI
Roman pe-
riod (30 BC-
395 AD
Piombino-
Mascali
2016 [32]
M
YES
NO
NI
NI
packing
NI: no information in the article 496
497
498
[ N em es i s] T i tr e de l’ art ic le (P UL -En-t êt e i mp ai r e)
37
Embalming material was found in the outer ear in 3 cases (from the Middle 499
Kingdom), there was no embalming material in one case, earrings were present in 500
one case, and no information about the outer ear was given in 26 cases. Middle ear 501
content was described in 4 cases with intact ossicles (2 cases), displaced ossicles (1 502
case), and absent ossicles (1 case). Displaced and absent ossicles were found in 503
mummies from the Middle Kingdom. Intact ossicles were found in this study in 504
mummies from the XXV Dynasty and the Ptolemaic period. 505
Foreign objects in the orbits were found in 10 cases (from the XXI Dynasty). There 506
were no objects in the eyes in 7 cases, and no information was provided about 507
foreign objects in the eyes in 14 cases. False eyes were found in 4 cases (from the 508
XXI Dynasty), eye packing in 2 cases (from the XXII Dynasty), false eye and 509
packing in one case, and linen in 3 cases (from the Ptolemaic period). 510
Table 13 provides with information about the relationship between mouth opening, 511
packing, and sex. It seems that mouth opening may be more common among 512
females, however, this study sample is too small to provide any strong evidence. 513
514
Table 13. Relationship between mouth opening, packing, and sex. 515
Male/Female
Open (YES)
Closed (NO)
Packed (YES)
1/3
1/0
Not packed (NO)
3/2
2/0
516
Outer facial appearance 517
518
Table 14 provides information about the outer facial appearance. There were 12 519
cases of mummies with additional elements present outside of the face. There was 520
no information for 18 mummies, and there was one case with no additional element 521
on the face. 522
Nasal plugs were present in 5 cases (from the Middle Kingdom) with a ratio of 4 523
males to 1 female. Facial masks were present in 3 cases (from the Ptolemaic period). 524
A rosette applique placed on the temple was present on a female mummy from the 525
Ptolemaic period. There were also two cases of the presence of metallic elements in 526
wrappings around the head and one case of an undermined type of foreign object 527
close to the nostrils. 528
529
Table 14. Outer facial appearance. 530
Historical
period
Study
Sex M/F
Supplementary ou-
ter appearance
Hair/other
2040-1674
BC (Middle
Kingdom)
Yardley
1997 ROM I
[11]
M
Nasal plug, right
NI
2040-1674
BC (Middle
Kingdom)
Yardley
1997 ROM II
[11]
M
Nasal plug, right
NI
2000 BC
(Middle
Kingdom)
Gupta 2008
[12]
M
Element inferior to
right anterior nasal
opening, on skin, in
Eyebrows
drown on
linen
[ N em es i s] T i tr e de l’ art ic le (P UL -En-t êt e p ai re )
38
linen
c.1570-1520
BC (XVII
dyn)
Manley 2002
[13]
F
NI
NI
c.1570-1520
BC (XVII
dyn)
Marquez
2015
(VL1248)
[14]
NI
NI
NI
c.1570-1520
BC (XVII
dyn)
Marquez
2015
(VL1232)
[14]
NI
NI
NI
c.1479-1424
BC (XVIII
dyn)
Wade 2012
(RM2717)
[15]
F
Metallic element
Short,
straight
white hair
c.1479-1424
BC
(XVIII dyn)
Bianucci
2016 [16]
M
NI
NI
c.1150-795
BC
(End New
Empire-3rd
intermediary
period)
Lindsay
2015 [17]
F
NO
NI
c.1069-945
BC
(XXI dyn)
Brier 2015
[18]
M
NI
NI
c.1069-747
BC
(XXI XXII
dyn)
Hill 1993 [19]
F
NI
NI
c.1069-747
BC (XXI-
XXII dyn)
Gerloni 2009
(M2) [20]
M
NI
NI
c. 1000 BC
(XXI dyn)
Wanek 2011
[21]
NI
NI
NI
c. 1000-800
BC (XXI
XXII dyn)
Seiler 2015
(0492) [22]
M
NI
NI
c.945-747
BC (XXII
dyn)
Harwood-
Nash, 1979
[3]
F
NI
NI
c.900 BC
(XXII dyn)
Melcher
1997 [6]
F
NI
NI
c.945-747
BC
(XXII dyn)
Baldock
1994 [7]
F
NI
NI
c.770 BC
Hughes
F
NI
NI
[ N em es i s] T i tr e de l’ art ic le (P UL -En-t êt e i mp ai r e)
39
(XXII dyn)
2005 [8]
c.945-747
BC (XXI-
XXIV dyn)
Cesarani
2004 [23]
M
NI
NI
c. 800-700
BC (XXII
dyn)
Seiler 2015
(D242) [22]
F
NI
NI
c.746-525
BC
(XXV-XXVI
dyn)
Sigmund
2002 [24]
F
NI
Present
c.600 BC
(XXVI dyn)
Thekkaniyil
2000 [25]
M
NI
NI
Ptolemaic
period
Singarella
1986 [9]
F
Rosette (on the left
temple)
Short, razor-
cropped
brown hair
Ptolemaic
period (323-
30 BC)
Babin 1990
(Se-Anht)
[10]
F
Rosette applique (on
the right temple)
Close-
cropped
Ptolemaic
period
c.305-150
BC
Babin 1990
(Irt-Irw) [10]
M
Nasal plugs (1 right
side, 2 left side)
NI
Ptolemaic
period
Chan 2008
[26]
F
Nasal plugs
NI
Ptolemaic
period
Gerloni 2009
(M3) [20]
M
NI
NI
Ptolemaic
period
Pelo 2012
[27]
F
NI
NI
Ptolemaic
period
Wade 2012
(RM2720)
[15]
F
Facial mask (gilded)
over the face, Wadjet
eye on the forehead
of the mask
Tutulus (chi-
gnon) at the
vertex of the
head
Ptolemaic
period (323-
30 BC)
Davey, 2013
[28]
M
Facial mask
NI
Ptolemaic
period
Zesch 2016
[29]
M
Facial mask
(hyperdense) be-
tween the face and
outer bandage
NI
100 BC-100
AD
Nickol 1995
[30]
F
NI
NI
Roman
period (c.80-
110 AD)
MacLeod
2000 [31]
M
Metallic elements in
wrappings around
head, portrait panel
NI
Roman
period (30
BC-395 AD
Piombino-
Mascali
2016 [32]
M
Nasal plug (right),
Resin soaked linen
over the face
NI
531
[ N em es i s] T i tr e de l’ art ic le (P UL -En-t êt e p ai re )
40
The presence and the type of hair dressing was described in only 4 cases (only in 532
female mummies), false eyebrows were painted on linen in one case, and no 533
information was provided in 26 other cases. 534
Table 15 provides three different combinations of the presence of ethmoid fracture 535
together with nasal plugs. The mummies from the Middle Kingdom presented with 536
bilateral ethmoid fracture and a nasal plug on the right side [11]. The mummies from 537
the Ptolemaic period presented with the following combinations: 1) bilateral 538
ethmoid fracture and bilateral plug [10], and 2) right ethmoid fracture and nasal plug 539
on the right side [26]. 540
541
Table 15. Nasal plugs and excerebration pathways. 542
Historical
period
Study
Sex M/F
Nasal plug
Nasal
bone
frac-
ture
Ethmoid
bone
fracture
Sphenoid
bone frac-
ture
2040-1674
BC (Middle
Kingdom)
Yardley
1997 ROM I
[11]
M
Nasal plug, right
YES
YES, bi-
lateral
NO
2040-1674
BC (Middle
Kingdom)
Yardley
1997 ROM II
[11]
M
Nasal plug, right
YES
YES, bi-
lateral
NO
Ptolemaic
period
c.305-150
BC
Babin 1990
(Irt-Irw) [10]
M
Nasal plugs (1 on
right side, 2 on left
side)
YES,
septum
deviat-
ed to
left
YES, bi-
lateral
NI
Ptolemaic
period
Chan 2008
[26]
F
Nasal plugs, right
NI
YES,
right
YES, right
Roman
period (30
BC-395 AD
Piombino-
Mascali
2016 [32]
M
Nasal plug, right
YES,
right
NI
NO
543
Duplicate studies 544
545
Among three duplicated cases (Djedmaatesankh, Tjentmutengebtiu, and Se-Ankh), 546
there existed multiple discordances between the descriptions of the same mummy by 547
different teams. First, there were differences in deciphering the name of the mummy 548
itself and its titles, along with different approximations of the mummy’s age (Table 549
1). The professional backgrounds and team compositions were different, which may 550
explain the differences in analysis and in description of the mummies (Table 2). 551
Studies were performed with different types of CT scans and using different radio-552
logical protocols which may have led to different conclusions (Table 3). The de-553
scriptive analysis of the mummy was often incomplete, and further studies have not 554
added any new information on the same mummy (Tables 4, 6). Teeth 555
visualization was also performed with different types of CT modalities which may 556
have influenced the description and analysis of the dental status (Tables 8, 9, 11). 557
[ N em es i s] T i tr e de l’ art ic le (P UL -En-t êt e i mp ai r e)
41
There were contradictory findings about the presence or absence of eye globes and 558
eye muscles in the Tjentmutengebtiu mummy (Table 7), caries in the Se-Ankh 559
mummy (Table 9), and the positioning of the rosette applique on the right/left side 560
of the temple of the Se-Ankh mummy (Table 14). 561
562
Quality of the articles included in the systematic review 563
564
The evidence-based quality of the selected articles was low because the selected 565
articles were only case reports and small case series. The EMBASE database did not 566
add any article to our analysis. 567
Discussion 568
Computed tomography applied to Egyptian mummy heads has been used for al-569
most forty years [3]. However, there exists a great diversity of radiological protocol 570
modalities, types of image treatment procedures, and anatomical descriptions related 571
to the quality of the provided images. Moreover, there exists no consensus among 572
specialists regarding a standard CT description of an Egyptian mummy head and 573
face [4]. This lack of a consensus explains why complete information on the diverse 574
elements that should represent a full mummy description is not provided [33]. 575
Therefore, only the application of a systematic categorization of data can provide us 576
with new information on embalming techniques. 577
578
General information on selected cases 579
580
Regarding the study summarized in Table 1, there was an over-representation of 581
mummies belonging to the XXI-XXII Dynasties and Ptolemaic period, which is in 582
accordance with a systematic review by Zweifel et al. [2]. Additionally, the 583
proportion of mummies with an estimated age to those with an unknown age in our 584
study (2/3 to 1/3) was the same as in the Zweifel study [2]. There was an 585
over-representation of author affiliations and museum collections from Anglo-Saxon 586
countries, which was also reported by Zweifel et al. [2]. 587
588
Author affiliations 589
590
One may think that when the main purpose of the study is related to CT imaging, 591
Egyptology and head and face anatomy and related disorders, the authors should 592
represent these three domains of expertise. However, the presence of a 593
multidisciplinary team formed by a radiologist, an Egyptologist, and a maxillofacial 594
surgeon (dentist) occurred in only 10% of the articles. Moreover, the 35% of the 595
articles lacked the expertise of a radiologist, and 40% lacked the expertise of an 596
Egyptologist. The fact that 41% of affiliations were outside radiology, Egyptology, 597
dentistry, or even anthropology may render questionable the scientific quality of 598
[ N em es i s] T i tr e de l’ art ic le (P UL -En-t êt e p ai re )
42
such articles. There were also only 3 articles with an author with an ear-nose-throat 599
affiliation, and this fact is reported in Table 12, with 24/31 cases missing 600
information about ear embalming. 601
602
Computed tomography radiological protocol 603
604
Multiple devices and radiological protocols have been developed and used to scan 605
Egyptian mummies since 1979 [3]. Therefore, a direct comparison between studies 606
is not possible. However, the majority of cases present with a low-quality score 607
between 0 and 3. Moreover, 6 studies had a score of 0, meaning that no radiological 608
CT protocol was described in the article even if CT images of the mummy were 609
presented and commented on. It is an example of a more general problem with peer-610
reviews of this type of interdisciplinary article. One of the main advantages of CT 611
scanning is the Hounsfield unit scale, which allows one to compare and quantify 612
different structures with close density. Hounsfield units were not used at all except 613
in 2 cases to recognize an embalming substance in the middle ear [29] and a packing 614
substance in the eye globe [24] (Table 12). 615
616
Excerebration pathways 617
618
Trans-nasal and trans-ethmoidal excerebrations were more frequent on the left side 619
than on the right side, which is in accordance with the previous literature [34, 35]. 620
This review showed that there exist various excerebration pathways, and brain 621
embalming treatments in mummies that do not belong to the pharaoh’s family or to 622
the closely related aristocracy. This finding is in accord with the Wade et al.; review 623
[36] and in contrary to the hypothesis that experimentation with excerebration was 624
restricted to the king and queen’s family, as stated by Herodotus and explained in 625
Saleem’s study [34]. The evolution of the excerebration pathway from trans-626
ethmoidal to trans-sphenoidal was proposed by Fanous et al. [35], and it is in 627
accordance with our findings. We also hypothesize that the alternative excerebration 628
pathways reported in some cases in this review were deliberate and did not result 629
from accidental perforations during the passage of the instrument through the left 630
nostril. For example, the passage through the nostril, ethmoid and the thin walls of 631
the orbit, which are the medial wall, and the roof of the orbit, were performed 632
precisely behind the frontal process of the maxillary bone, which is a thick bone, on 633
the same side. The experimentation with this type of road may be performed first on 634
dry skulls. The choice of excerebration pathway may be related to technical 635
problems encountered by the embalmers [34] or to anatomical variations of the ante-636
rior cranial fossa, such as thickening of the cribriform plate, or enlargement of the 637
base of the crista galli process, or pneumatisation of the orbital roof, and the crista 638
galli. We also found that, contradictory to the findings of Saleem et al. [34], linen 639
was placed inside the skull without any additional entrance other than the nostrils 640
such as the parietal bone holes in the skull of King Merenptah, to help with the 641
[ N em es i s] T i tr e de l’ art ic le (P UL -En-t êt e i mp ai r e)
43
procedure [34]. Saleem also reported but did not explain the presence of a resin-like 642
substance on the walls of ethmoid cells in the skull of queen Tiye [34]. We found 643
this type of resin present in the sinuses of the face in 2 cases belonging to the 644
Ptolemaic period. 645
The presence of two layers of resin in the parietal and occipital area results from the 646
manipulation of the head during the introduction of the resin to the skull. This 647
technique was described as being used for Tutankhamun’s skull [34]. We found 2 648
similar cases in a non-royal family from the XXI and XXII Dynasties. 649
650
Soft tissue preservation of facial tissues 651
652
The presence and persistence of intraorbital soft tissue structures in an Egyptian 653
mummy was already reported by Sandison in 1957 using rehydration and 654
histological methods [37]. However, the skull and face soft tissue description based 655
on CT scanning has suffered from poor reporting by the authors. Diverse 656
combinations have been described regarding the presence and the absence of the 657
brain, the dura mater, and the dura cervical. They may be related to the technique, to 658
the historical period, to substances used and to the time spent inside the skull 659
removing the brain (by instruments and/or liquid substance dissolving the brain 660
and/or the dura). 661
662
Dental status of the mummies 663
664
We found 3 cases described with full dentition, with no wear, and with no dental 665
pathology among the 31 cases, and 28 cases with dental problems (90.32% of cases 666
had dental problems), which contrasts sharply with Zweifel’s findings (18%) [2]. 667
This difference in findings can be explained by differences in the methodology used, 668
such as the exclusion and inclusion criteria, the MeSH terms used, the differences in 669
search equations, the different dental disease items checked, and our small sample of 670
mummies compared with Zweifel’s sample [2]. The best option for teeth 671
visualization and for the description of dental disorders seems to be a CT pseudo-672
panoramic multiplanar reconstruction showing all dental arches. However, in 673
clinical application this type of reconstructed image cannot be used for the diagnosis 674
of caries, as the gold standard is intraoral apical radiography. Only major crown 675
defects can be evaluated. Therefore, caries may be underestimated when only CT 676
scans are used to evaluate the mummy’s dental health. Fractured teeth appeared only 677
on the maxilla in the incisor area. This fact might be correlated with modern 678
hypotheses [22] about the significance of the opening of the mouth ceremony, which 679
appears to not only be an abstract religious act. Periapical lesions (cysts, granuloma, 680
osteitis) and caries were present in mummies from the XVIII Dynasty. However, as 681
the sample of mummies was small, we cannot conclude that a major modification in 682
diet occurred during the XVIII Dynasty. Displacement of the teeth inside and 683
outside the mouth is not exceptional and seems to be a deliberate method used by 684
the embalmers, as the body should contain all its organs when it is reborn. 685
686
[ N em es i s] T i tr e de l’ art ic le (P UL -En-t êt e p ai re )
44
Packing inside the mouth, ears, nose, eyes, and the outer ap-687
pearance of the head and face 688
689
Different combinations were described concerning the mouth opening or closing 690
together with its packing. These combinations may also be related to more practical 691
aspects of the ceremony of the opening of the mouth [22]. Ear embalming is almost 692
unknown and has been omitted from the articles dealing with descriptions of 693
Egyptian mummy heads using CT imaging. It is also related to the fact that ear-694
nose-throat specialists are rarely invited to provide their expertise in this field of 695
research. Eye packing and foreign objects in the eye are described in mummies from 696
the XXI-XXII Dynasty [38]. However, there was no information about eye 697
replacement in 45% of the articles describing mummy heads using CT imaging. 698
Saleem et al., [34] provided some information about variations in nasal embalming. 699
We propose that the variability of nasal embalming is linked with the excerebration 700
pathway. Combinations may vary depending on the historical period. However, a 701
much larger sample is needed to validate this approach. The shape and type of hair, 702
which is available from 3D CT skull reconstructions, was also underestimated by the 703
majority of authors as added-value information. 704
705
Limitations of the study 706
707
The main limitation of our study is the use of medical databases to research articles 708
for an interdisciplinary review. We may have failed to find useful information in 709
journals focused on archaeology and Egyptology that are not listed in the PubMed or 710
EMBASE databases, even if CT scanning is strongly related to the medical field. 711
We also found only 31 eligible cases, and a more definitive conclusion on the 712
historical period of time connected to the appearance of any new method in the 713
embalming process cannot be drawn. The limited number of included studies did not 714
allow us to draw a more definitive conclusion on the relationships between sex and 715
the different elements of descriptive analysis provided in this article. We were also 716
not able to check the chronological age and the sex of each mummy and we only 717
used the description provided in the selected articles. Moreover, because of the small 718
sample of selected mummies, we were not able to link our findings with historical 719
events in the history of Egyptian civilization, such as proofs of modification of diet 720
by the appearance of more caries and periapical lesions, related to a specific period 721
in history. 722
723
Conclusions 724
725
Finally, there is a need for more systematization of the radiological protocol and 726
the description of Egyptian mummy heads. The tables we presented along with this 727
study may serve as a possible example or template to provide a detailed description 728
of a given individual and of the embalming technique used in a specific region of the 729
[ N em es i s] T i tr e de l’ art ic le (P UL -En-t êt e i mp ai r e)
45
body. Moreover, open access to the CT images of mummies should be granted at 730
least for researchers to be able to obtain complete information missing from 731
manuscripts such as the IMPACT project about radiological mummy database 732
(http://impactdb.uwo.ca/IMPACTdb/Index.html) [39]. A multidisciplinary team is 733
mandatory to provide as much verified and as detailed information as possible for 734
any given mummified person. 735
736
Acknowledgements: none 737
Funding sources statement: this study does not received any funding 738
Competing interests: Prof R. Olszewski is Editor-in-Chief of Nemesis. The 739
other authors have no conflict of interest. 740
Ethical approval: There was no need for ethical committee approval for this 741
study 742
Informed consent: There was no need for informed consent for this study 743
Authors contribution: 744
Author
Contributor role
Olszewski R
Conceptualisation, Data curation,
Investigation, Methodology, Resources,
Validation, Writing original draft
preparation, Supervision, Writing review
and editing
Hastir JP
Validation, Writing review and editing
Tilleux C
Validation, Writing review and editing
Delvaux L
Writing review and editing
Danse E
Writing review and editing
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