Table 2.

Location of macroscopic cranial and postcranial osseous lesions attributed to infantile scurvy described in the primary paleopathological literature^{12,35–41,46,47,52}.

Skeletal features
Diagnostic strength	Lesion location	Lesion type and distribution	Anatomical connection: musculature (new features only)	Anatomical connection: vasculature (new features only)
Diagnostic	Cranial
	Sphenoid bone: greater wings (lateral and cerebral surfaces)	Bilateral and symmetrical abnormal porosity < 1 mm in diameter penetrating cortical bone and/or SPNBF
	Sphenoid bone: lesser wings	Bilateral and symmetrical abnormal porosity < 1 mm in diameter penetrating cortical bone and/or SPNBF
	Sphenoid bone: body	SPNBF
	Sphenoid bone: pterygoid fossae/plates	Bilateral and symmetrical Abnormal porosity < 1 mm in diameter penetrating cortical bone and/or SPNBF
	Sphenoid bone: foramen rotundum (cerebral surface of the greater wings)	Bilateral and symmetrical SPNBF
	Sphenoid bone: foramen ovale (cerebral surface of the greater wings)	Bilateral and symmetrical SPNBF	Temporalis muscle (indirect) with masticatory function; Tensor veli palatini muscle (external) with deglutition function	Accessory meningeal artery and sphenoid emissary vein
	Sphenoid bone: foramen spinosum (cerebral surface of the greater wings)	Bilateral and symmetrical SPNBF	Tensor veli palatini muscle (external and indirect) with deglutition function	Middle meningeal artery and vein
	Occipital bone: external surface of partes laterales and pars basilaris	Bilateral and symmetrical SPNBF (except for pars basilaris)	Rectus capitis lateralis and rectus capitis posterior major muscles (partes laterales of the occipital bone); rectus capitis anterior and longus capitis muscles (pars basilaris of the occipital bone)—Postural muscles for flexion, rotation, extension of the head	Vertebral artery, occipital artery, ascending cervical artery, inferior thyroid artery
	Temporal bones: lateral surface of the squama	Bilateral and symmetrical abnormal porosity < 1 mm in diameter penetrating cortical bone and/or SPNBF
	Zygomatic bones (posteromedial, and lateral surface)	Bilateral and symmetrical abnormal porosity < 1 mm in diameter penetrating cortical bone and /or SPNBF
	Zygomatic bones (orbital surface)	Bilateral and symmetrical abnormal porosity < 1 mm in diameter penetrating cortical bone and /or SPNBF	Extraocular muscles for internal eye movements	Lacrimal artery, ophthalmic artery, and infraorbital artery
	Maxilla: anterior surface/infraorbital foramina and posterior surface	Bilateral and symmetrical abnormal porosity < 1 mm in diameter penetrating cortical bone and/or SPNBF
	Maxilla and palatine processes: hard palate surface	Abnormal porosity < 1 mm in diameter penetrating cortical bone extending markedly into the posterior portion of the palate with spiculated bone
	Mandible: medial surface of the ramus/coronoid process	Bilateral and symmetrical abnormal porosity < 1 mm in diameter penetrating cortical bone and/or SPNBF
	Mandible mylohyoid line	Bilateral and symmetrical SPNBF
	Mandible: superior and inferior mental spines	Bilateral and symmetrical SPNBF	Genioglossus muscle (superior spine); Geniohyoid muscle (inferior spine) for tong movements and deglutition	Lingual artery
	Post-cranial
	Scapula: supraspinous fossa and infraspinatus fossa	Bilateral and symmetrical abnormal porosity < 1 mm in diameter penetrating cortical bone and/or SPNBF
	Scapula: axillary margins	Bilateral and symmetrical abnormal porosity < 1 mm in diameter penetrating cortical bone and/or SPNBF	Teres major and subscapularis muscles (rotator cuff complex)	Subscapular artery branches of the axillary artery
	Ilium: gluteal and medial surface	Bilateral and symmetrical abnormal porosity < 1 mm in diameter penetrating cortical bone and/or SPNBF; vascular impressions
Highly consistent/typical	Cranial
	Ectocranial surface of cranial vault (frontal bone, parietals and occipital bone)	Bilateral (except for frontal bone) abnormal porosity < 1 mm in diameter penetrating cortical with asymmetrical localized SPNBF§ (especially in correspondence of the bosses) and ABVI; no thickening of the diploe
	Frontal bone (orbital roof)	Bilateral abnormal porosity < 1 mm in diameter penetrating cortical bone and asymmetrical localized SPNBF§§ (i.e., residual haematoma); vascular impressions; no thickening of the diploe
	Post-cranial
	Ribs: costochondral joints	Flaring
	Post cranial skeleton: metaphyseal of long bones	Abnormal porosity < 1 mm in diameter penetrating cortical bone extending beyond 10 mm from the plate
	Long bones: diaphysis	Bilateral and symmetrical ossified haematomas
Consistent with	Cranial
	Endocranial surface	PADM; ABVI
	Post-cranial
	Ribs: shaft	SPNBF
	Long bones: diaphysis	Bilateral and symmetrical SPNBF
	Long bones: metaphyseal enlargement
Radiographic features
	White line of Fränkel
	Scurvy line (or Trümmerfeld zone)
	Pelkan spur
	Corner sign of Park
	Long bones groundglass osteopenia
	Postcranial skeleton: diaphysis long bones (upper and lower limbs)	Bilateral and symmetrical pathological SPNBF (> 2 mm in thickness)
	Metaphyseal enlargment

Details on lesion type and distribution are provided. Further macroscopic skeletal features with details about vasculature and musculature connection and derived from the present study are in italics. Proposed diagnostic strength was established according to the modified Istanbul protocol⁴⁸. Radiological findings of the long bones evaluated in clinical practice are also included^{21,24,32–34,49,50}.

SPNBF, subperiosteal new bone formation.

ABVI, abnormal blood vessel impressions^120,121.

PADM, periosteal apposition of the dura madre¹²¹.

^§The connective tissue is the pericranium.

^§§The connective tissue is the periorbita.