Translation. Region: Russian Federation –
Source: Novosibirsk State University –
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Scientists from the Laboratory of Nuclear and Innovative Medicine performed a CT scan of the skull of a woman buried about 2,500 years ago. Faculty of Physics Novosibirsk State University. Analysis of the data obtained from the study revealed that she had suffered a serious head injury during her lifetime, resulting in the destruction of her right temporomandibular joint. She underwent major surgery to restore the function of her lower jaw, which restored her ability to speak and eat. Scientists had not previously encountered such findings or found any references to such surgeries in the scientific literature.
"The use of X-ray computed tomography (CT) has become a key tool in studying the skull of a woman from the Pazyryk burial (approximately 2,500 years ago). Thanks to this technology, we were able to overcome a major obstacle—the mummified soft tissues that obscured the bone structure. The CT scanner allowed us to virtually 'remove' these coverings and create an accurate digital and then physical 3D model of the skull, making it accessible for detailed anthropological analysis," said Vladimir Kanygin, head of the Laboratory of Nuclear and Innovative Medicine at the NSU Faculty of Physics.
A CT scan performed on a Philips MX 16 provided comprehensive data on the condition of the bones. It revealed not only the consequences of severe trauma (a 6-8 mm depression of the right temporal bone) but also subtle details invisible during routine examination. These included: displacement and subluxation of the mandible with ligament rupture, two artificial bone canals in the joint area, drilled during the patient's life, and annular bone compaction around these canals, proving their origin and healing process during life. An attempt to probe the canals revealed remnants of an elastic material (likely tendon or hair), used as a surgical ligature to stabilize the jaw. The CT scan also clearly showed asymmetry in the dental arch and signs of increased stress on the left side, confirming the success of the ancient surgery and the woman's significant survival.
"Thus, the CT scanner acted as a 'time machine,' providing non-destructive access to anatomical structures. It allowed us not only to diagnose the injury but also to reconstruct the results of a complex surgical intervention performed in ancient times, transforming a single find into detailed evidence of the Pazyryk culture's high level of medical knowledge," explained Vladimir Kanygin.
The Verkh-Kaldzhin-2 burial ground on the Ukok Plateau in the Altai Republic was discovered in 1994 by Vyacheslav Molodin, Doctor of Historical Sciences and Academician of the Russian Academy of Sciences. This site belongs to the Pazyryk culture, an archaeological culture of the Scythian-Siberian world during the Iron Age (6th-3rd centuries BC), known for its "frozen" graves, which preserve organic objects and sometimes even the mummies of the deceased.
In this small burial ground, consisting of five small, barely visible mounds, three adjacent stone burial structures were excavated. Two of them were found to be undisturbed and fully met the researchers' expectations. In the shallow graves, in the wooden vaults of ordinary Pazyryk people, all the utensils they brought with them were preserved, consisting of remarkable wooden objects and clothing items made of fabric and fur. And in Mound 3, a well-preserved male mummy was discovered. It is currently housed in the Museum of the Institute of Archaeology and Ethnography of the Siberian Branch of the Russian Academy of Sciences, along with all the other artifacts from these burials. The finds from the Verkh-Kaldzhin-2 burial ground immediately became widely known, and have been the subject of numerous publications both in Russia and abroad. But there remained one burial, located between these two known ones, about which, as it seemed at the time, there was nothing to say, said Natalia Polosmak, Doctor of Historical Sciences, Corresponding Member of the Russian Academy of Sciences, and Chief Researcher at the Institute of Archaeology and Ethnography of the Siberian Branch of the Russian Academy of Sciences.
It was a complete, undisturbed burial of a woman, preserved in a lens of ice. She lay in a perfectly preserved larch frame on a wooden cot, lying on her right side, with her legs tucked under her, in a sleeping position. The burial was unusually absent of any objects, which is likely why it held little interest for the researchers. The only item was a wig, typical of women of the Pazyryk culture, on the woman's head. However, the wig was devoid of any jewelry. It is likely that very little time had passed between her death and her burial, and the woman's body had not yet had time to transform into a mummy (usually, a prepared corpse would mummify during storage, which could last up to six months). What the archaeologists found was simply a decomposing corpse. Only the head of the deceased was partially mummified, with the facial portion remaining. It was preserved and is currently housed at the Institute of Archaeology and Ethnography, Siberian Branch of the Russian Academy of Sciences.
"This mummified patch of skin on the deceased's skull made anthropological research impossible, but we wanted to learn as much as possible about the woman, and her skull was all we had left. Therefore, the opportunity to study it on a CT scanner was a unique and fortunate opportunity, which I took advantage of," explained Natalia Polosmak.
A computed tomography scan was performed at the Leningrad Institute of Mathematics and Physics (NSU) using a Philips MX 16 CT scanner. It utilized 551 slices (0.75 mm thick, 0.375 mm interslice distance, and a 140 kVp setting—typical for adult patients). Next, Andrey Letyagin, MD, professor, and a top-category physician specializing in radiology, examined the woman's skull and its 3D model.
"We already had successful experience working with the results of a mummy study using magnetic resonance imaging. In 2010, Andrei Yuryevich Letyagin and Andrei Aleksandrovich Savelov, PhD in Physics and Mathematics and a senior researcher in the MRI Technologies Laboratory at the International Tomography Center of the Siberian Branch of the Russian Academy of Sciences, conducted an MRI scan of the mummy of a woman from the Ak-Alakha 3 burial mound, better known as the 'Princess of Ukok.'" Natalia Polosmak said: "This study yielded remarkable results, which, in addition to a number of important observations and discoveries, allowed us to answer the question of the cause of death of this extraordinary woman. Furthermore, this was invaluable experience working with the unusual mummies of the Ukok Plateau, which bear little resemblance to the Egyptian mummies or even other famous mummies of noble Pazyryk people housed in the Hermitage."
The results of the study of the skull of an unknown woman from a seemingly unremarkable Pazyryk burial site were unexpected, but not particularly surprising. From the study of the mummy of a woman from Ak-Alakha 3, as well as the pathology of the Pazyryk people of Ukok, they already knew that people of that time knew how to perform cranial trepanation during life. They did not abandon the sick and injured to their fate, but treated them with available methods and means. The Pazyryk people had a tradition of mummifying bodies, which involved various dissection techniques, from the simplest to quite complex. Therefore, they possessed extensive knowledge of the structure of the human body and its internal organs. Researchers believe that the tradition of mummification contributed to the development of surgery. The Egyptians were among the most outstanding surgeons of antiquity, and the reason for their success lies in the same tradition of mummification, described in detail by Herodotus.
— Surgery is the first branch of medicine necessary to maintain and continue life. In the life that the Pazyryk people led in the extreme conditions of the Altai mountain valleys, it was necessary. The Pazyryk people were a small population, with a low birth rate, short life expectancy, with women having shorter lives, and from what we see, everyone’s life was valued. We know very little about what knowledge our ancestors possessed. If they did not have certain medical knowledge and did not use surgical methods, how would they survive in the extreme conditions of the mountain and high-altitude valleys of Altai? The new study was another important confirmation that the Pazyryk people knew how to perform complex surgical operations to save the lives of their fellow tribesmen. It should be noted that the unique preservation of organic objects in a number of Pazyryk graves, in particular leather coats, vessels, bags and other things, makes it possible to verify what unusual skills these people possessed today. So, those who sewed all this had extremely developed fine motor skills – what a surgeon needs, as a contemporary of the Pazyryk people – the great Herodotus – wrote about – that a surgeon needs to have good control of the ends of his fingers. After all, for example, for strength, the light leather fur coats of the Pazyryk people were stitched in parallel rows with thin tendon threads, and these seams ran at a distance of 4 mm from each other and per 1 cm of seam there could be up to 20 stitches, which they made with a thin needle. The hands of these craftsmen were already ready to perform surgical operations,” said Natalya Polosmak.
While examining X-ray CT scans, Andrei Letyagin noticed that, in addition to all the standard changes typically found in such objects, this artifact showed evidence of severe traumatic impact—clearly during life. It also showed signs of a complex surgical procedure involving a crude replacement of the damaged joint.
"The study utilized the maximum capabilities of this equipment. Typically, such modes are used only in the rarest of medical cases, as the X-ray load on the object being examined is quite high. But in this case, the object being examined was not a living patient, but an archaeological artifact. As a result, we obtained images of the highest quality, which proved crucial in this situation. Upon examining them, we immediately noticed evidence of intervention typical of burial preparation among the Pazyryk people: part of the brain and the dura mater had been removed. Further results were obtained that we had not previously encountered in the scientific literature. It is possible that we have discovered evidence of such a surgical procedure for the first time," explained Andrey Letyagin.
During the initial examination of the skull images, traumatic changes were discovered in the area of the right temporomandibular joint. A subluxation with displacement and severe ligament damage were clearly visible. The cause of these changes was also determined: a traumatic deformation of the skull with a depression of the bones of the right temporal region by approximately 6–8 mm. The mandible remained intact, but the right temporomandibular joint was destroyed, the head of the jaw was displaced under the skin, and the lateral ligament was torn. After such a severe injury, the woman was unable to eat or speak, and without qualified surgical care, seemingly unavailable at the time, she would have died soon after. However, further examination revealed that the woman had survived—the teeth on the damaged side were well preserved, but on the left, "healthy" side, the molars on the lower jaw were severely damaged, as if they had been subjected to prolonged, intense chewing stress. The crowns were worn down and chipped, there were inflammatory changes around the roots, and the eighth tooth had been affected by complicated caries and had completely lost its crown. The bone tissue around the roots was sparse, indicating a prolonged inflammatory process. Scientists needed to determine how the woman could chew with such a severe injury, and for so long that the crowns were worn down. They found the answer through a more detailed study of the CT images.
We noticed changes in the right temporomandibular joint that were clearly non-traumatic and not age-related, but rather human-induced, most likely by a doctor. These were two thin canals, 1.53 mm in diameter, drilled into the bone. They were quite long—one about half a centimeter, and the other somewhat longer, almost 8 millimeters. Interestingly, they converged at a right angle. One canal was drilled through the head of the mandible, and the second through the zygomatic process of the temporal bone. In the area of the right temporomandibular joint, they converged at a right angle when the jaw was closed. Most likely, the patient kept her mouth open during the surgery. These canals were likely drilled in two stages—horizontally and vertically. CT images clearly showed that the bone had been drilled very smoothly, and bone tissue had grown around the holes. The half-millimeter-thick annular bone compaction we discovered indicates that these canals were formed during life. Some elastic material—most likely horsehair or animal tendon—was found within them. This primitive prosthetic held the articular surfaces together and allowed the patient to move her jaw. The joint functioned, but she still couldn't chew food on the injured side due to severe pain," said Andrey Letyagin.
It is impossible to determine the circumstances under which such a serious injury occurred. Scientists speculate that the woman could have sustained such a powerful blow from a fall from a horse while galloping or from a height. It is also unknown how long she survived after the operation—perhaps several months or years. The injury left her skull distorted, depressed on the right side, which undoubtedly affected her appearance. However, she retained the ability to speak and eat throughout this time.
It was determined that the woman whose skull was CT-scanned at the Novosibirsk State University Laboratory of Archaeology and Mathematics was approximately 25-30 years old at the time of her death. By that time, most of her life had already been lived. Her burial is considered a so-called ordinary burial of the Pazyryk culture; however, contemporaries constructed a larch frame for her, constructed from massive half-logs, and she rested on a wooden cot.
"On treeless Ukok, such wood was valuable. The absence of artifacts makes the burial unusual, which, of course, has its explanation, but for now we can only speculate. The operation performed indicates that her life was valued and even such a risky method was used to prolong it. We don't know what her personal value to society consisted of. Every Pazyryk resident possessed certain essential, and perhaps even unique, qualities and talents, such as wood carving, sewing, felt and leather appliqué, tattooing, healing, storytelling, and much else we don't know. In this society, everyone was valued in life simply for their existence, and honored after death," said Natalia Polosmak.
Material prepared by: Elena Panfilo, NSU press service
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