Homo heidelbergensis: the oldest case of odontogenic orbital cellulitis?

Abstract

SummaryHomo heidelbergensis, an extinct species of the genus Homo, is probably the ancestor of Homo sapiens in Africa and the Neanderthals in Europe. In 1992, one the most complete and best preserved ancient hominid skulls ever found was discovered in a Middle Pleistocene cave called the Sima de los Huesos, Atapuerca site (Spain). Skull 5 dates back to 350,000 to 500,000 years ago and represents a nearly complete Homo heidelbergensis cranium. An extensive osteitis on the left maxilla, a worm‐like pattern on the orbital roof and several dental lesions with remodelling and recession of the alveolar crest were described. Computed tomography (CT) images identified a maxillar fracture and determined the timing of the pathological events. These findings suggest that an ongoing serious infection might had been present in this individual at the time of death and that it was very likely the cause of death from a generalized sepsis. The infection would have spread from the dental abscess into the ipsilateral orbit. In a ‘pre‐antibiotic era’, the lack of sinus and orbital drainage might have led to intracranial infection or sepsis. We will discuss the anatomic pathways by which dental infection could spread to the orbit in what seems to be the first documented case of orbital cellulitis.