engleski

Additional Consideration of a Rare “History Case” of Mastoid Trepanning from Northern Croatia: “Issues” with Diagnosing “Increased” Opacities in the Air Cell System of the Trepanned Mastoid and Concomitant Temporal Pyramid Scored from Initial Screening by Plain Film Radiography

In a prior study, we reported on bone and CT evidence of an antemortal mastoid trepanning in a deceased from the 11th century AD cemetery Zvonimirovo (Northern Croatia). So far unique “history case” of infratentorial trepanation, appeared in combination with supratentorial fracture indicative of a onetime trauma whose therapeutic treating was eventually hypothesized as a possible reason for performing such surgery – due to lack of CT evidence of otopathology. This paper aims to discuss, additionally, “issues” with diagnosing “increased” opacities in the air cell system of the trepanned mastoid and concomitant temporal pyramid scored from initial screening by plain film radiography. Although CT scans in a prior study confirmed normal air cell appearance in both mastoids and pyramids, the sediment matrix imaged as seemingly “increased” radiographic opacities (“dense“ greyish X-ray shadows), in the air cell system of the trepanned mastoid and concomitant pyramid (base) – where should have been air opacity (imaged black), tended to be suggestive of possibly “reduced” pneumatic spaces. Such pseudo imaging might have accounted for even puzzler case given that it was the very localization of the artificial hole which initially suggested the surgery made for reasons other than treating the supratentorial trauma, i.e. the possible otopathology. In conclusion, evidently, plain film radiography appears to be less diagnostic in the management of hollow structures of crania from bioarchaeology – in this paper focused on the air cell system initially susceptive of the possible presence of otopathology. In spite of thorough cleaning, the sediment residue in certain skull hollows in some cases, apparently, might tend to mimic the possible true bone pathology. Hence, paleoradiological managing of the complex surgeries from the past – such as the present “history case”, requires the use of more diagnostic CT already reported in a prior study, or a combination of radiography with CT.

trepanation; mastoid; temporal pyramid; pneumatic cell system; plain film radiography; sediment; “increased” opacities; medieval Zvonimirovo; Croatia

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