96 • Oscar Urteaga-Ballon 



Figure 1 . Ceramic representation of a case of cleft palate and lip. Peruvian Mochica 

 culture. Lima, Peru. 



Figure 2. Ceramic representation of a punitive mutilation of nose and lips. Peruvian 

 Mochica culture. Lima, Peru. 



Figure 3. Ceramic representation of a mucocutaneous leishmaniasis. Mochica 

 portrait-head vessel shows an ulcerative lesion of left wall of nose. Peruvian 

 Mochica culture. Lima, Peru. 



Figure 4. Ceramic representation of a case of mucocutaneous leishmaniasis. Sec- 

 ond stage. Necrotic lesions have destroyed both sides of nose and upper lip. Peru- 

 vian Mochica culture. Lima, Peru. 



of mucocutaneous leishmaniasis. A 

 large ulcer has destroyed the left wall of 

 the nose. This is a typical lesion of the 

 disease. Figure 4 corresponds to an ad- 

 vanced stage of the infection. The ne- 

 crotic lesions have destroyed both sides 

 of the nares walls and the infection has 

 also invaded the left side of the upper 

 lip. If you compare the graphic repre- 

 sentations of these four cases you can- 

 not miss the diagnosis. In our time the 

 microscopic finding of the protozoan 

 organism makes the diagnosis defini- 

 tive, but the gross lesion is extremely 

 clear in the endemic zones of this dis- 

 ease. Figure 5 corresponds to the third 

 stage of the leishmaniasis infection. 

 The necrotic lesion has destroyed not 

 only the subcutaneous tissues of the 

 nose, but also completely destroyed the 

 nasal septum, rounding and widening 

 the nasal cavity. The upper lip has also 

 disappeared but there are no lesions in 

 the dental alveolar process. 



The last stage of the disease is 

 characterized by a complete destruction 

 of the nasal cavity with partial resorp- 

 tion of the hard palate bone, which pro- 

 duced a direct opening between the 

 nasal and the oral cavities. Figure 6 

 shows one of these cases. The destruc- 

 tion of the frontal part of the palate bone 

 also produces the loss of the upper in- 

 cisor teeth. 



We have found similar lesions in the 

 skull of some ancient Peruvian mum- 

 mies. Figure 7 corresponds to one of 

 these skulls and shows a complete de- 

 struction of the nasal septum and the 

 resorption of the lateral border lines of 

 the nasal cavity, which appear un- 

 usually round and wide. The bone re- 

 sorption also included the anterior part 

 of the palate bone. Figure 8 corre- 

 sponds to a Mochica ceramic which 

 represents the frontal view of the face of 

 a normal skull. The Peruvian craftsmen 

 have represented the anatomical pro- 

 portion of size and shape of the nasal 

 and oral cavities, including the nasal 

 septal bone. 



Zagreb PulfofHiihitlof;}' Symp. 1988 



