Abstract
The evaluation of any superimposition is a significant issue that is dependent on the consistency of the anatomical link between the location of the soft tissue surfaces relative to the underlying bone.
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3.1 Introduction
The evaluation of any superimposition is a significant issue that is dependent on the consistency of the anatomical link between the location of the soft tissue surfaces relative to the underlying bone (Taylor and Brown 1998).
In order to evaluate this consistency, a full comprehension of the anatomy of the skull and the relationship between the skull and the face are required. In biological organisms, structure and function are closely related. The human head, in terms of function, is related to four of the five senses: stereoscopic vision (eyes), audition (ears), gustation (tongue/mouth), and olfaction (nose), along with the protection of the brain. These functions are responsible for the structure of the head, and therefore the form of the face and the skull will be directly related to the position of the brain, eyes, ears, mouth, and nose.
From an anthropological perspective, the reliability of CFS and an identification based on this technique are evaluated mainly on the basis of the consistency between the anatomical structures of the face and skull.
The forensic expert usually relies on the analysis of anatomical criteria such as the soft tissue thickness, outlines, and positional relationships between the skull and the face. In the scientific literature, there are several studies conducted to assess the quality/degree of matching in CFS as well as to examine the criteria used to conduct this assessment. Before reviewing the different studies, Martin and Saller’s studies (1957) must be considered. They created a treatise in which the fundamental pillars of this discipline were established. They defined an important set of craniometric and somatometric points (Tables 3.1, 3.2, and 3.3) that are crucial for all anthropological studies (Figs. 3.1, 3.2, 3.3, 3.4, 3.5, and 3.6).
A correct evaluation of anatomical consistency between facial and cranial structures is of paramount importance for reliable CFS. Generating accurate data on soft tissue thickness and the positioning of facial structures are important steps to improve current practices in craniofacial identification. At the moment, there is a clear lack of consensus in methodological approaches for CFS. The development of standard protocols is necessary to enhance the credibility of the technique, making it more readily admissible in judicial processes.
3.2 Anthropometrical Relationships
Understanding the relationship between the skull and the facial soft tissue has major relevance for forensic identification. Facial soft tissue thickness, measured as the distance from the skin surface to the most superficial surface of the underlying skeletal tissue at specific landmarks, provides an important criterion for the evaluation of anatomical consistency. This kind of measurement provides general information on the match between the face and the skull, using facial soft tissue thickness as a means to control the outer contour of the face during the superimposition (Codinha and Fialho 2010; Stephan and Simpson 2008).
Due to the scientific value of facial soft tissue thickness in craniofacial identification, numerous studies have been conducted since 1883, with a great variation in measuring techniques, sample size, population ancestry, anatomical landmarks, and variables analyzed (e.g., sex, age, and body composition) (Codinha and Fialho 2010; Stephan and Simpson 2008).
Some of the main modalities for soft tissue thickness acquisition mentioned in the literature include:
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Needle puncture (Codinha and Fialho 2010; Simpson and Henneberg 2002; Domaracki and Stephan 2006; Rhine and Campbell 1980; Suzuki 1948; Birkner 1905; Stadtmuller 1925; Rhine et al. 1982; Galdames et al. 2008; His 1895; von Eggeling 1909)
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Cephaloradiography (George 1987; Leopold 1968; Weinig 1958; Bankowski 1958)
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Computer-assisted tomography (CT) (Phillips and Smuts 1996)
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Cone-beam CT (Bankowski 1958)
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Magnetic resonance imaging (Sahni 2002)
A summary of the most important soft tissue thickness studies and their main characteristics are listed in Table 3.4. None of these methodologies offer a perfect solution, as each technique has advantages and disadvantages. For example, needle puncture methods are inexpensive, but cadaveric material is not wholly representative of living subjects; CT scans are accurate and reproducible but may present gravity effects on the supine face, artifacts, and radiation damage; craniographs are inexpensive and the subject is upright, but the images can suffer from magnification and planar issues; ultrasound can be used on upright living subjects but involves contact and pressure issues. A more extensive list of advantages and disadvantages of the different methodologies used in soft tissue data collection was analyzed in Stephan and Simpson (2008) and in Preedy (2012). The latter is summarized in Tables 3.5 and 3.6.
The soft tissue thickness depth measurements are applied in facial depiction, but if they are used in CFS, changes due to facial expression must also be considered when determining identity. These measurements are usually, but not always, perpendicular to the bony structures, and are most useful if the image shows the soft tissue directly to the point of measurement (Clement and Ranson 1998).
Other factors that must be taken into account when utilizing soft tissue data are growth, weight change, and age-related changes. For this purpose, many authors place emphasis on facial features with minimal soft tissue depth. The middle third of the face (eyes, nose, and teeth) is less influenced by any photographic distortion and could be considered more accurate (Taylor and Brown 1998).
Currently, there is no agreement among practitioners as to the number of landmarks, their name, or their correct position; thus, comparison between the results of several papers is extremely difficult (Panenková 2007). Furthermore, some papers use the vernacular rather than anatomical terminology, that is, “end of nasal” (Phillips and Smuts 1996), “middle of the bony nose” (Helmer 1984), and “angle of mouth” (Aulsebrook et al. 1996; Panenková 2007).
There seems to be one major difference of opinion with regard to the thicknesses of facial tissues (Wilkinson 2002). The results obtained by the needle puncture method in cadavers are relative to the process of dehydration of the soft tissue (10–18 g/day/weight), resulting in considerable variations depending on the different methods used for conservation, alongside the development of rigor mortis, which affects the muscle fibers (Galdames et al. 2008; de Greef et al. 2006).
Various investigators have compared the soft facial tissue thicknesses measured in fresh cadavers with embalmed cadavers. Simpson and Henneberg (2002) reported an increase in soft tissue thickness of all landmarks, due to embalming processes. Galdames et al. (2008) indicated that the embalmed cadavers presented larger thicknesses of tissue in all sites, with the exception of the right exocanthion and right and left gonion points. The most significant differences between fresh and embalmed tissue were observed at the trichion, glabella, nasion, pogonion, superciliary, supraorbital, infraorbital, and gonion points (Galdames et al. 2008; Simpson and Henneberg 2002).
Postmortem data and the use of the different methods of cadaver conservation must be considered when comparing measurements with those obtained from living subjects by means of radiograph, ultrasound, computerized tomography, or nuclear magnetic resonance (Clement and Ranson 1998; Galdames et al. 2008).
3.3 Anatomical Relationships
The face is one of the most individualistic and unique parts of the human body. It is important to establish the most commonly utilized morphological features when carrying out an assessment of face and skull correspondence. There are many standards for the prediction of the soft tissue features from skeletal assessment, and these standards were established through human dissection, palpation, medical imaging modalities, and direct anthropometry of living subjects. The relative limitations of each method when evaluating the reliability of the standards produced should be noted. Human dissection studies offer a unique opportunity to visualize the face and the related skeletal structures, but are limited by the effects of embalming, deformation associated with a cadaver face, and dehydration. Palpation studies employ living faces but are limited by the inability to accurately locate bony landmarks, especially in the areas of the face with the greatest soft tissues. Clinical imaging of living faces enables the visualization of soft and hard tissues simultaneously, but different imaging modalities suffer from gravitational problems (the subject is supine), artifacts (dental flare), bone visibility (MRI), and pressure effects (ultrasound). Direct anthropometry from a living subject is probably the most reliable form of data collection, but although multiple measurements can be collected from the soft tissues, direct measurements of the skull are limited to the teeth.
This report will attempt to highlight the published anatomical standards feature by feature.
3.3.1 General Face Shape
The relationship between the shape of the head and the shape of the cranium is well established. Several classifications of this relationship have been published (Clement and Ranson 1998; Fedosyutkin and Nainys 1993; Balueva et al. 2009), Table 3.7 summarizes the standards.
The relationship between facial measurements and related skull measurements has also been studied (Balueva et al. 2009). Table 3.8 summarizes the standards.
3.3.2 The Eyebrows
Eyebrow pattern standards (Table 3.9) have been developed from a combination of palpation (Balueva et al. 2009) and craniograph studies (Fedosyutkin and Nainys 1993).
3.3.3 The Eyes
A number of studies assessing the relationship between the eyeball and the orbit in relation to prominence and frontal position have been conducted.
Prominence studies utilizing MRI (Wilkinson and Mautner 2003) exophthalmometry (Stephan 2002), and palpation (Fedosyutkin and Nainys 1993; Balueva et al. 2009) all present results indicating a general agreement between current published standards (see Table 3.10).
Studies on the position of the eyeball in the orbit from a frontal view seem to report different results depending on the method of assessment. Dissection studies (Whitnall 1921; Stephan and Davidson 2008; Stephan et al. 2003) suggest that the eyeball sits slightly superior (1–2 mm) and lateral to the centre in the orbit, but palpation studies (Balueva and Veselovskaya 2004) suggest that the eyeball sits 2 mm closer to the medial wall than the lateral wall; other dissection studies (Krogman and İşcan 1986) suggest the eyeball sits centrally in the orbit.
The positions of the inner (endocanthus) and outer (exocanthus) corners of the eye have been studied in detail, but there is no clear agreement between standards. There is a general agreement concerning the malar (or Whitnall’s) tubercle in relation to the outer canthus. Human dissection has shown that the tendons that fix the eyelids to the orbit are inserted at this tubercle (Whitnall 1921). Although it has been established that the outer canthus is located at the same height as the malar tubercle, there is no consensus as to the distance of the outer canthus from the orbital wall. The distance has been published as 1 mm (Sills 2004), 3–5 mm (Balueva et al. 2009; Angel 1978; Krogman and İşcan 1986; Stephan 2009), 5–7 mm (Wolff 1976; Rosenstein et al. 2000), 8–10 mm (Couly et al. 1976), and 13 mm ( Anastassov and van Damme 1996). Where the malar tubercle is absent, the outer canthus can be positioned 8–11 mm below the line of the frontozygomatic suture (Stewart 1983; Krogman and İşcan 1986; Wolff 1976).
There is an agreement that the medial canthus is positioned approximately 2–5 mm lateral to the anterior lacrimal crest (Yoshino and Seta 1989; Angel 1978; Sills 2004; Krogman and İşcan 1986; Stephan 2009), but where exactly on the anterior lacrimal crest this measurement is taken from is unclear. Different studies suggest the top (Balueva and Veselovskaya 2004), middle (Angel 1978), and base (Fedosyutkin and Nainys 1993) as the measurement point, while other studies suggest that the point can be found 4–5 mm (Angel 1978) or 10 mm (Stewart 1983) below the dacryon. Table 3.11 presents the standards related to dissection and anthropometrical studies (Whitnall 1921; Merkel 1886).
The eyelid pattern has been studied using palpation and anthropometry studies (comparison of skulls with ante-mortem images) (Balueva et al. 2009; Rynn et al. 2012). These standards are presented in Table 3.12.
3.3.4 The Nose
The nose is the most studied feature on the face; studies on the relationship between the configuration of the nasal tissue and the bones surrounding the nasal aperture are abundant (Gerasimov 1955; Macho 1986; McClintock Robinson et al. 1986; George 1993; Schultz 2005; Tandler 1909; Virchow 1912; Glanville 1969; Prokopec and Ubelaker 2002; Stephan et al. 2003). Studies conducted by Gerasimov (1955) show that the soft nose is wider than the bony aperture, as a narrower soft nose would have no supporting structure. Furthermore, he suggested that the bony nasal aperture at its widest point is three-fifths of the overall width of the soft nose. This assertion has been confirmed by a CT study on living subjects of various ethnic groups (Rynn 2006).
Gerasimov (1955) also suggested that the nasal base angle (the angle between the upper lip and the columella) is determined by the direction of the nasal spine. In his study, he stated that the axis of the nasal spine serves as a base for the soft nose and the determination of the nasal spine direction follows the point of the spine, as if it were an arrowhead. He also suggested that the end of the soft nose could be predicted as the point where a line following the projection of the last part of the nasal bones (at the rhinion) crosses a line following the direction of the nasal spine, and he confirmed these standards with a blind study of 50 cadaver heads. This standard has been widely debated in the literature; Ullrich, a former student of Gerasimov, claimed that Gerasimov did not follow the direction of the nasal spine, but rather the general direction of the floor of the anterior part of the nasal aperture (maxillary bone) laterally adjacent to the anterior nasal spine and vomer bone (Ullrich and Stephan 2011). However, this is disputed by the academic group who worked for many years alongside Gerasimov and Lebedinskaya, and continue their work at the Russian Academy of Sciences in Moscow (Balueva et al. 2009; Rynn et al. 2012) and they confirm that the nasal spine was indeed the feature used by Gerasimov to determine the nasal base angle. Rynn and Wilkinson (2006) tested six different methods of nose prominence prediction (Gerasimov 1955; Prokopec and Ubelaker 2002; Macho 1986; Stephan et al. 2003; George 1987; Krogman and İşcan 1986) in order to understand which method was the most accurate. This study found that the Gerasimov (1955) method performed with the most accuracy, while the Krogman and İşcan (1986) method performed poorly.
Rynn (2006) produced guidelines for nasal shape prediction, utilizing three cranial measurements that can be used to predict six soft nose measurements. These guidelines were tested in a blind study showing a high level of accuracy (Rynn et al. 2010).
Gerasimov (1955) also suggested that the height of the upper border of the alae is in line with the crista conchalis and the profile of the nose is a nonscaled mirror of the nasal aperture in profile. These standards have been confirmed using CT data of living subjects (Rynn 2006); this study additionally confirmed previous papers’ suggestions that deviation of the nasal tip from the midline is associated with opposing nasal septum deviation (Selzter 1944; Gray 1965) and that nasal tip bifurcation is associated with a bifid nasal spine (Weaver and Bellinger 1946).
A recent dissection study suggested that the shape of the nasal aperture when viewed from posterior–anterior aspect is mirrored in the shape of the nasal tip (Davy-Jow et al. 2012). Standards for nose shape prediction are given in Table 3.13.
3.3.5 The Mouth
There are some anatomical standards relating to mouth shape, which have been confirmed in different populations and by a variety of methods of study (Stephan et al. 2003; Balueva et al. 2009; Stephan and Murphy 2008; Angel 1978; Krogman and İşcan 1986). These are presented in Table 3.14.
Scientific literature from orthodontic and anatomical disciplines suggests that the form of the mouth is related to the occlusion of the teeth (Roos 1977; Rudee 1964; Koch et al. 1979; Waldman 1982; Holdaway 1983; Denis and Speidel 1987; Talass et al. 1987), the dental pattern (Subtelny 1959), and the facial profile (Gerasimov 1955). These are presented in Table 3.14.
3.3.6 The Cheeks
Studies demonstrating the relationship between the zygomatic bones, the canine fossa, and the soft cheeks are presented in Table 3.15 (Fedosyutkin and Nainys 1993; Balueva et al. 2009).
3.3.7 The Ear
Although there have been some studies relating ear morphology to skeletal structure, this facial feature is understudied. Gerasimov (1955) considered the angle of ear to be parallel to the jaw line and stated that when the mastoid processes are directed downward (in the Frankfort Horizontal Plane), the earlobe will be attached (adherent to the soft tissue of the cheek), whereas, where the mastoid processes point forward, the ear lobe will be free. However, recent dissection studies disagree as to the reliability of these standards; Renwick (2012) confirmed that adherent ear lobes relate to downward pointing mastoid processes, while studies using CT data showed no relationship between these features (Guyomarc’h and Stephan 2012). The confirmed standards are presented in Table 3.16.
3.3.8 The Chin
There are some standards relating the mental region of the mandible to chin shape (Balueva et al. 2009). These are presented in Table 3.17.
The facial proportions are an important element to understanding facial geometry. The aim of the facial proportion assessment is to establish the variation from the ideal dimensions of the human form. This, combined with anthropometric norms, gives information about facial features as a symmetrical and balanced pattern, based on statistical means taking into account variations in age, sex, and ancestry. In this way, George (1993) described facial proportions based on the studies of Farkas and Munro (1987), Powell and Humphreys (1984).
3.4 Examination Criteria for Craniofacial Superimposition
Assessment of the quality of the matching and anatomical consistency between the face and skeletal structures for CFS has been carried out following a number of different criteria. These include the works of Helmer (1987), Helmer et al. (1989), Powell and Humphreys (1984), Chai et al. (1989), Austin-Smith and Maples (1994), Yoshino et al. (1995), Yoshino (2012), Lan (1995), Jayaprakash et al. (2001), Ricci et al. (2006), Ishii et al. (2011), and Gordon and Steyn (2012). These criteria are presented in detail below.
3.4.1 Helmer (1984, 2012)
This method of assessment includes the use of several soft tissue thickness markers, attached to the skull along a vertical central line. Helmer employed average German soft tissue data (Helmer 1984) collected by ultrasound. These cephalometric landmarks (nasion, rhinion, gonion, gnathion) are then matched to the profile on the ante-mortem photograph. The alignment of these landmarks indicates a positive identification. Variations on this methodology have been employed. Bajnóczky and Királyfalvi (1995) suggested a digital method to mark the superimposed ante-mortem photograph and skull image. The coordinate values of these points were then recorded and expressed as pixel units. Birngruber et al. (2010) glued 53 markers to the skull to mark the tissue depth at each anthropological landmark (Helmer 1984). The skull and the ante-mortem photograph were then superimposed in order to assess whether or not the tissue markers matched with the contours of the face.
3.4.2 Chai et al. (2010)
This method is based on a study of 224 Chinese subjects (100 males and 124 females) aged between 18 and 55 years, from X-ray images. The protocol relies on the analysis of positional relationships between homologous facial and skull landmarks, the thickness of soft tissue at specific points, and the fit of facial outlines with the cranial structures. Fifty-two indices were established as a standard for CFS and identification (Table 3.18).
3.4.3 Austin-Smith and Maples (1994)
Two sets of 12 criteria are employed in this method to analyze skull-face consistency using lateral and frontal view photographs. Relevant soft tissue thickness data is also utilized along with the anatomical criteria. The authors suggest that with anterior dentition, skull/photograph superimposition is reliable when two or more photographs are used in the identification. The following features were used for a consistent fit between skull and face:
Lateral View
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1.
The vault of the skull and the head height must be similar.
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2.
The glabellar outline of both the bone and the soft tissue must have a similar slope, although the line of the face does not always follow the line of the skull exactly. There may be slight differences in soft tissue thicknesses that do not relate to nuances in the contour of the bone.
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3.
The lateral angle of the eye lies within the bony lateral wall of the orbit.
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4.
The glabella, nasal bridge, and nasal bone area is perhaps the most distinctive. The prominence of the glabella and the depth of the nasal bridge are closely approximated by the soft tissue covering this area. The nasal bones fall within the structure of the nose and the imaginary continued line, composed of the lateral nasal cartilages in life, will conform to the shape of the nose except in cases of noticeable deformity.
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5.
The outline of the frontal process of the zygomatic bones can normally be seen in the flesh of the face. The skeletal process can be aligned with the process seen in the face.
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6.
The outline of the zygomatic arch can be seen and aligned in those individuals with minimal soft tissue thickness.
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7.
The anterior nasal spine lies posterior to the base of the nose near the most posterior portion of the lateral septal cartilage.
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8.
The porion aligns posterior to the tragus and inferior to the crus of the helix.
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9.
The prosthion lies posterior to the anterior edge of the upper lip.
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10.
The pogonion lies posterior to the indentation observable in the chin where the orbicularis oris muscle crosses the mentalis muscle.
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11.
The mental protuberance of the mandible lies posterior to the point of the chin. The shape of the bone (pointed or rounded) corresponds to the shape of the chin.
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12.
The occipital curve lies within the outline of the back of the head. This area is usually covered with hair and the exact location may be difficult to judge.
Frontal View
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1.
The length of the skull from bregma to menton fits within the face. Bregma is usually covered with hair.
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2.
The width of the cranium fills the forehead area of the face.
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3.
The temporal line can sometimes be distinguished on the photograph. If so, the line of the skull corresponds to the line seen on the face.
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4.
The eyebrow generally follows the upper edge of the orbit over the medial two-thirds. At the lateral superior one-third of the orbit, the eyebrow continues horizontally as the orbital rim begins to curve inferiorly.
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5.
The orbits completely encase the eyes including the medial and lateral folds. The point of attachment of the medial and lateral palpebral ligaments can usually be found on the skull. These areas align with the folds of the eye.
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6.
The lacrimal groove can sometimes be distinguished on the photograph. If so, the groove observable on the bone aligns with the groove seen on the face.
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7.
The breadth of the nasal bridge on the cranium and surrounding soft tissue is similar. In the skull, the bridge extends from one orbital opening to the other. In the face, the bridge spreads between the medial palpebral ligament attachments.
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8.
The external auditory meatus opening lies medial to the tragus of the ear. The best way to judge this area is to place a projecting marker in the ear canal. On superimposition, the marker will appear to exit the ear behind the tragus.
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9.
The width and length of the nasal aperture falls inside the borders of the nose.
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10.
The anterior nasal spine lies superior to the inferior border of the medial crus of the nose. With advanced age, the crus of the nose begins to sag and the anterior nasal spine is located more superiorly.
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11.
The oblique line of the mandible (between the buccinator and the masseter muscles) is sometimes visible in the face. The line of the mandible corresponds to the line of the face.
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12.
The curve of the mandible is similar to that of the facial jaw. At no point does the bone appear to project from the flesh. Rounded, pointed, or notched chins will be evident in the mandible.
3.4.4 Yoshino et al. (1995, 2012)
This method evaluates the anatomical consistency between skull and face by means of video superimposition. The anatomical relationships and soft tissue thickness data is based on Ogawa’s data (Ogawa 1960). The exact thicknesses of soft tissue at the anthropometrical points of the skull are measured on the superimposed transparent films by using a sliding caliper. Eighteen assessment criteria are used for the evaluation of the anatomical consistency between the face and the skull. The criteria used are divided into three types: outlines, soft-tissue thickness, and positional relationships (Tables 3.19, 3.20, and 3.21). The authors suggest a positive identification can be achieved if 13 or more criteria demonstrate concordance between the skull and the face.
3.4.5 Lan (1995)
This method is based on a study of 3123 subjects from 15 nationalities (1554 males and 1569 females), with one front view and one profile photograph of each subject. The method includes anthropometry from photographs and X-rays. A total of 69 indices are established for identification (Table 3.22). The authors noted that some indices showed significant differences between different nationalities: the distance between the vertical line of ectocanthion and gonion; the distance between gonions; and the thickness of the soft tissue at the trichion, opisthocranion, and sellion.
3.4.6 Jayaprakash et al. (2001)
This is a craniofacial morpho-analytical approach, based on the shape correlation between the skull and face photograph. This approach relies on previous work developed by Lan (1995), İşcan (1993), Farkas (1981), and George (1987, 1993) and special attention is placed on the nasal region. The facial and skull traits and attributes, and the measurements employed for this study are detailed in Tables 3.23, 3.24, and 3.25.
3.4.7 Ricci et al. (2006)
The authors presented an algorithm for identification using CFS. Fourteen subjects and their matching facial photographs and skull radiographs were selected. The algorithm calculated the distance of each transferred cross (anatomical points) and the corresponding average. Their results indicate that the smaller the mean value, the greater the index of similarity between the face and the skull. A total of 196 cross-comparisons were carried out. The following tables present the anatomical points that were located and marked with a cross on each facial image (Tables 3.26 and 3.27).
3.4.8 Ishii et al. (2011)
This method was based on a study of three subjects, a young man (23 years old), a man with an edentulous upper jaw (36 years old), and a woman (40 years old), using 3D CT data for CFS. Miyasaka (1987), Suzuki (1948), and Ichikawa (1975) studies were used for the morphological assessment technique (Table 3.28).
3.4.9 Gordon et al. (2006)
The authors studied three methods: basic morphological matching (Austin-Smith and Maples 1994), landmark matching, and a combination of both approaches. The bony and soft tissue landmarks used were based on Martin and Saller (1957) and Farkas (1981). They proposed three different sets of landmarks for orientation and evaluation purposes for CFS (see Table 3.29).
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Damas, S., Cordón, O., Ibáñez, O. (2020). Relationships Between the Skull and the Face for Forensic Craniofacial Superimposition. In: Handbook on Craniofacial Superimposition. Springer, Cham. https://doi.org/10.1007/978-3-319-11137-7_3
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