Pre-Hispanic Evidence of Cleft Lip and/or Palate in Mesoamerica

Mesoamerica is a culturally defined geographical area, corresponding to the central and southern parts of modern Mexico and the northern part of Central America. The term refers to the territory on which civilizations with common cultural traits flourished from the second millennium bc, when the first complex societies emerged, until the Spanish conquest in the early 16th century ad (Sprajc, 2010).

The prevalence of CLP has been reported as high in some areas of Mesoamerica; in 2018, Corona et al. reported an overall prevalence in western Mexico as 28 per 10 000 or 1 per 358 live births. In 2015, Matute et al. reported in Guatemala a prevalence of 18.9 per 10 000 for cleft lip and 4.7 per 10 000 for cleft palate, a prevalence higher than that reported in Europe, Asia, and the United States of America. Allam et al. in 2014 reported a prevalence of 2.39 per 1000 for Latin America, the highest, compared with North America, Western Europe, Pacific Asia, and North Africa. The evidence of CLP in pre-Hispanic ceramics could suggest a potential high prevalence of CLP in the Mesoamerican pre-Hispanic population. Furthermore, this archeological evidence may provide for some reasons behind the higher prevalence of cleft lip and/or palate (CLP) in this region.

Although the study of Mesoamerican culture has been quite extensive over the last 2 centuries, there are just a few documents related to the pre-Hispanic archeological representation of CLP in Mesoamerica (Aleman & Martínez, 2017).

During years 2016 and 2017, the authors visited 5 anthropology museums in Mexico, Guatemala, and El Salvador, in search for pre-Hispanic archeological evidence of CLP (the National Anthropology Museum of Mexico, the Anahuacalli Museum in Mexico, the National Anthropology Museum of Guatemala, the Pablo Tesak Museum in El Salvador, and the National Anthropology Museum of El Salvador). The paintings, ceramics and facial bones exhibited were analyzed in search of features compatible with CLP and other craniofacial clefts. High-resolution photographs of all identified pieces were performed and examined independently with permission from all museums.

Sixteen anthropomorphic ceramics were identified with evidence of CLP. Nine were found at the Anahuacalli Museum, 6 at the National Anthropology Museum of Mexico, and 1 at the National Anthropology Museum of El Salvador. Of these ceramics, 15 originate from the shaft tombs, a pre-Hispanic culture in western Mexico (Jalisco, Colima, and Nayarit) (Al-Muheisen & Al-Bashaireh, 2012; Cabrero, 2016). One figurine originated from the Cotzumalguapa, a pre-Hispanic culture that lived in western El Salvador in the classic period (200 ad-900 ad). Of the 16 ceramics, 12 had male characteristics and 3 had female characteristics; 15 were anthropomorphic figurines resembling bilateral cleft lip (Figures 1A and 2A), 9 were incomplete, and 6 were complete clefts. Three items demonstrated evidence of cleft palate. Two of these items showed a representation of complete bilateral clefts (primary palate [premaxilla] anteriorly displaced and separated from the secondary palate [Figure 2B]). Lastly, 1 item represented a complete unilateral CLP but associated with a Tessier 3 facial cleft which has already been described in detail in a previous publication (Aleman & Martinez, 2017).

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Figure 1.

A, Anthropomorphic ceramic with a bilateral cleft lip defect, the figurine has a hat, earrings, a nose ring, body paintings, and is holding an ear of corn in her hands. B, On a lateral view, you can see signs of malnutrition, thin arms, thin legs, marked ribs, and face bones. This ceramic belongs to the classic period. Shaft tombs culture (200 bc-600 ad). Western Mexico (Jalisco, Colima, and Nayarit). This archeological piece belongs to the national anthropology museum of Mexico City.

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Figure 2.

A, Anthropomorphic figurine presenting a bilateral cleft lip, it has a hat, earrings, and arms bracelets. B, Lateral view with evidence of protruding premaxilla, thin arms, and legs. This ceramic belongs to the classic period. Shaft tombs culture (200 bc-600 ad). West Mexico (Jalisco, Colima, and Nayarit). This archeological piece belongs to the Anahuacalli Museum in Mexico City.

Five of the figurines show evidence of malnutrition, of which 3 and 2 were identified as male and females, respectively. Evidence of malnutrition was documented due to the portrayal of protruding ribs and facial bones, and thin arms and legs (Figures 1B and 2B). One figurine displayed pustules all over the skin accompanied by a complete bilateral cleft lip (Figure 3). Lastly, all figurines displayed different types of corporeal decoration, such as paintings, earrings, nose rings, hats, necklaces, bracelets, and loincloths. Fifteen figurines displayed hats, 8 displayed bracelets, 9 displayed nose rings, and 12 earrings. Eight figurines displayed objects in their hands such as an ear of corn, a cocoa pod, and a drum, while 2 figurines displayed drinking from a vessel with a straw. It is difficult to precise the exact number of objects in possession of the institutions where these figurines were found; in 1957 when Diego Rivera died, he left a collection of 59 400 pre-Hispanic objects to Anahuacalli Museum (Rivera, 1965); 2000 are currently exhibited. Bautista Martínez in 2005 reports nearly 10 000 anthropomorphic figurines studied at the National Anthropology Museum of Mexico. Urrutia et al. (2019) report nearly 30 anthropomorphic figurines present at the National Anthropology Museum of El Salvador.

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Figure 3.

Male anthropomorphic figurine with a bilateral cleft lip. It exhibits pustules over the skin. It has a nose ring and bracelets in both arms and earrings. This ceramic belongs to the classic period. Shaft tombs culture (200 bc-600 ad). Western Mexico (Jalisco, Colima, and Nayarit). This archaeological piece belongs to the national anthropology museum of Mexico City.

The ceramics described in this paper all belong to the classic period (200 ad-900 ad) of Mesoamerica. During this period, great cities and complex government institutions emerged. In addition, there was a growing sophistication in the arts, crafts, architecture, religion, and astronomical knowledge. These centuries represent the apogee of Mesoamerican civilization (Fowler, 1995). Urbanization led the classic period to develop civic and ceremonial centers that were carefully planned and oriented. In these centers, specialized crafts were developed. The development of the arts and specialized crafts grew from the growth of a theocratic civilization that dominated the classic period in this region. The religion was polytheistic, dominated by the Gods of rain (Tlaloc) and thunder (Chac). Other important deities were the fire god and the goddess of fertility. In concordance with the theocratic regimen during the classic period, most of the ceramic that was found was related to religion (Galdamez, 2008).

Interestingly, all figurines studied by the authors were adorned with either hats, necklaces, bracelets, earrings, nose rings, or body paintings. Body adornments were a distinct characteristic of those members of the elite in pre-Hispanic Mesoamerica. Adornments were given, especially those related to perforation of the skin (ie, earrings, nose rings, tattoos, scarification), during special religious ceremonies, nose rings were usually associated with governors and deities. In fact, some pre-Hispanic gods had nose rings within their distinctive attributes (Vela, 2010). Similarly, to the observations made by Marius-Nunez and Wasiak (2015), it is theorized that the figures described in this document show evidence that they played a sacred role in Mesoamerican society. In pre-Hispanic culture, individuals with congenital malformations were considered to be divinely chosen for a life of priesthood as they believed to be uniquely anointed to have these physical features.

Mesoamerican pre-Hispanic cultures believed that facial clefts in children appeared secondary to solar or lunar eclipses, which were events that affected these 2 important deities. Mesoamericans believed that the sun was the source for life on earth—the origin of light and heat. Another important deity was the moon; also known as the fertility goddess, the moon was the light in the night, the protector of water, the energy for fecundity and fertility, and the protector of birth. An accidental disappearance of light secondary to eclipses was considered dangerous. A solar or lunar eclipse represented that the moon had bitten the sun or vice versa. Moreover, during an eclipse, Mesoamericans believed that the stars’ powers were diminished, thus bringing tragic consequences to the population. Pregnant women were at risk during an eclipse event. Lunar eclipses were thought to place pregnant women at risk of bearing children with facial clefts; therefore, all pregnant women were encouraged to not witness these events. Interestingly, the Chortis Mayan still to this day call infants with clefts as “bitten by the moon,” metaphorically describing that the powers of the moon were deleteriously affected by the sun (Najera, 1995). Additionally, other communities in the region continue to explain the presence of facial clefts as related to lunar activity.Castro (1995), through testimonies collected during 5 years, documented the common belief in the population of Ocuituco, Morelos, Mexico, that CLP might appear as a consequence of the exposure of a pregnant woman either to a solar eclipse or to the full moon’s light. Lastly, another common belief was that the moon had a special substance that contained a rabbit inside. The rabbit could take possession of the baby during the eclipse, and these babies would be born with a CLP, resembling a rabbit (Lopez & Perez, 2012).

There are few descriptions in the literature of archeological findings related to the evidence of CLP. In 1920, George Dorrance described an Egyptian mummy dating 2000 years bc as having a CLP. A terracotta statue in a museum in Corinth, dating from the years 700 bc to 300 bc, has also been described as having a CLP (Bhattacharya et al., 2009). In 2015, Marius-Nunez and Wasiak reported the findings of 3 stirrup spout vessels with midline clefts resembling the Tessier 0 cleft, combined with clefts that went into the lower lip and chin resembling a Tessier 30 cleft, these vessels belonged to the pre-Hispanic Moche culture in northern Peru (200 bc-600 ad) (Marius-Nunez & Wasiak, 2015). In 2017, Pachajoa and Rodriguez found that CLP was common in the Tumaco-La Tolita, a pre-Hispanic culture that inhabited the borders of present-day Colombia and Ecuador, they documented 4 ceramics that demonstrated cleft lip (Rodriguez & Pachajoa, 2017). The anthropomorphic figurines described in this document contribute to the previously documented historical evidence of CLP.