Variation in large ectocranial lesions from pre-Columbian Kuelap, Peru

This paper analyses a diverse collection of previously undescribed cranial lesions observed from 42 individuals from the pre-Columbian site of Kuelap, eastern montane, Peru. I describe the presence of cranial lesions, their location on the vault location, shape, and size of affected area, and evidence of remodeling. Seventeen percent of the total cranial sample demonstrates similar superficial cranial lesions including males (25/117, 21.4%) and females (14/74, 18.9%), and adolescents (3/27, 11%). Most lesions are narrow ovals or long and leaf-shaped, with depression of the external cranial vault. While some are well-healed and smooth-surfaced, others are more irregular with variable degrees of remodeling. The highest frequency is on the superior and posterior aspects of the vault, usually along the sagittal plane. Differential diagnoses are considered but no single pathology is clear for all cases. There are some common features consistent with active and healing osteitis and a few are directly associated with trepanation. General patterning suggests intentional treatment, perhaps even possible cauterization of scalp injuries or healed infections. These large cranial "scars" have not been observed at coastal Peruvian sites and may reflect specific regional conditions related to highland environmental factors, local medical treatments of cranial injuries, or population specific malformations.