The two main paleopathological conditions of the recovered skeleton are the osteoblastoma and plagiocephaly. Even though these conditions are common today, paleopathological research has documented few cases. Although osteoblastoma and osteoid osteoma may have similar characteristics, the findings support osteoblastoma as a diagnosis. According to Atesok et al. (2011), osteoid osteoma accounts for 12% of all benign tumors, while osteoblastoma accounts for 3%. Males are twice as likely as females to develop osteoid osteoma and osteoblastoma. The diameter of an osteoid osteoma is usually less than 2 cm. The diameter of osteoblasoma, on the other hand, is greater than 2 cm. The lower extremity, spine, upper extremity, hands, feet, and pelvis are all usually affected by osteoid osteoma, while osteobalstoma primarily affects the vertebral column’s posterior elements, long bones, hands, and feet. Osteoid osteoma affects people between the ages of 5 and 25, while osteoblastoma affects people between the ages of 10 and 25 (De andrea and Hongendoorn 2010). The presence of a localized tumor, its size and location, the individual’s age and sex, and the X-ray examination all point to an osteoblastoma. Personal communication with Zimmerman (7/3/2018) further supports this conclusion. The osteoblastoma is a painful disease that makes this individual rely more on his left leg while walking. This suggestion is supported by the massive osteoarthritis observed in the left articular surface only, which worsen with strenuous daily activities (Alrousan and Abu Dalou 2013; Estebaranz et al. 2018; Martinez et al. 2019; Abu Dalou et al. 2017), as well as by the observed asymmetry of the sacrum, with the right side being higher than the left one (Fig. 6).
The cranium revealed the presence of a posterior, occipital plagiocephaly (partial premature fusion of the right lambdoid suture). The cranium is a parallelogram in shape with occipital bossing on the contralateral side. The ipsilateral ear is situated anterior and superior to the contralateral ones, with bulging of the mastoid process on the ipsilateral side. There is also asymmetry at the base of the cranium, and asymmetry of the occipital condyles and foramen magnum (Fig. 4).
The differential diagnosis between occipital synostotic plagiocephly and occipital positional plagiocephaly is difficult, and many researchers consider them as lambdoid craniosyntosis (Hinton et al. 1984; Muakkassa et al. 1984; Goodrich and Argamaso1996; Gracia et al. 2010). However, the percentage of lambdoid or posterior plagiocephaly is about 1–3% of all types of craniosyntoses, with more frequent positional posterior plagiocephaly (Gracia et al. 2010). The morphological characters that support the occipital positional plagiocephaly are parallelogram of the cranium in vertex view, bossing of the occipital on the left side, flattening of the right parietooccipital area, asymmetry of the position of the external acoustic meatus, and asymmetry of the external cranium base, with asymmetry of the foramen magnum and the occipital condyles. In addition, the X-ray image also reveals an asymmetry of the internal cranium base with a marked asymmetry of the posterior cranial fossa (Fig. 5).
The premature sutural synostosis results in deformities of the cranium, endocranially and exocranially. Positional plagiocephaly is the most common form of plagiocephaly, it results from asymmetrical cranial growth without synostosis, not associated with restriction of head growth or increased intracranial pressure (Lance and Governale 2015). The risk factors or the etiology of positional plagiocephaly are associated with prolonged traditional back sleeping position, premature birth, muscular torticollis, and intrauterine constraints due to many reasons, including multiple gestation or oligohydramonion (Pospíšilová and Procházková 2006; Lance and Governale 2015). It is proven that the cause of positional plagiocephly is due to traditional or cultural factors in ancient human populations that resulted in prolonged back sleeping positions and suckling of the infants on one side of the prieto-occipital region during the development of the skull (Pospíšilová and Procházková 2006). This may be the cause of the skull deformity of the individual under study.
The skeleton suffered from several modifications over the person’s lifetime. Degenerative changes in the articular surface of the joints subjected to mechanical stress are a common example. Compression fracture of the vertebrae is a mechanical stress fracture, which is correlated to activity patterns and may occur as a result of repeated carrying of heavy loads (Robert and Manchester 2013). This fracture has been reported among agriculturalists (Agnew et al. 2015). This is also supported by the archaeological documentation of the Iron Age period that indicates the main subsistence economy was agriculture (Kafafi 2018). The ribs of the studied individual are normal; this allows us to exclude tuberculosis from our consideration. Osteoarthritis with osteophytosis was noticed among vertebrae (Fig. 8). (Alrousan and Abu dalou 2013; Estebaranz et al. 2008; 2018). Both of the acetabulums, the trochlea of both humerii, and the trochlear notch of the right ulna showed extensive osteoarthritis.
Porotic hyperostosis and cribra orbitalia have been described as circumscribed areas of porosity or pitting of cranium and eye orbits, respectively (Walker 2009). This lesion is related to expanded blood forming marrow due to various types of anemia and an increase in the production of red blood cells (Larsen 1995). Cribra orbitalia and porotic hyperostosis are associated with many diseases etiologies, such as iron deficiency anemia, rickets, and infections (Estabaran et al. 2008; Martinez et al. 2019). Cribra orbitalia was observed in the eye orbits of the skeleton under the study (Fig. 9). This may indicate that this individual suffered from anemia, likely due to reduced quality of their food intake. Cribra orbiltalia is well known in agricultural populations.
Dental remains are the most preserved human remains in any archaeological site. It is known that the ancient populations used their teeth not only for food processing but also as a tool in their daily life activities. Mastication of food results in both types of wear macroscopic (dental wear) or microscopic (microwear) (Alrousan 2009; 2011; 2016; Alrousan and Perez-Perez 2008; 2012; Alrousan et al. 2009; 2013; 2019). Both types of wear and the percent of dentine exposure are strongly correlated with the subsistence economy of ancient populations. The teeth of the studied individual displays heavy occlusal wear of an oblique form (Fig, 4A). This type of wear is associated with agricultural economy, while the flat form of wear is associated with hunting and gathering (Alrousan and Abu Dalou 2013: Alrousan 2009; 2016; Alrousan et al. 2019). The results of this study suggest that the individual in this case study endured strenuous daily life activities that were exacerbated by the abnormal body physique.