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Relationships Between the Skull and the Face for Forensic Craniofacial Superimposition

  • Sergio Damas
  • Oscar Cordón
  • Oscar Ibáñez
Open Access
Chapter

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.

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).
Table 3.1

Craniometric points from Martin (1914) study (neurocranium)

Craniometric points: neurocranium

ast

asterion

ft

frontotemporale

ms

mastoideale

au

auriculare

g

glabella

o

opisthion

b

bregma

i

inion

op

opisthocranion

ba

basion

l

lambda

po

porion

eu

euryon

m

metopion

so

supraorbitale

Taken from Martin and Saller (1957)

Table 3.2

Craniometric points from Martin (1914) study (splanchnocranium)

Craniometric points: splanchnocranium

d

dacryon

n

nasion

rhi

rhinion

gn

gnathion

ns

nasospinale

zo

zygoorbitale

go

gonion

or

orbitale

zm

zygomaxillare

ml

mentale

pg

pogonion

zy

zygion

mf

maxillo-frontale

pr

prosthion

 

Taken from Knußmann (1988)

Table 3.3

Somatometric points from Martin (1914) study

al

alare

g

glabellare

ma

mastoidale

pr

prosthion

cdl

condylion laterale

go

gonion

n

nasion

prn

pronasale

ch

cheilion

I

inion

or

orbitale

ps

palpebrale superius

en

endocanthion

labm

labiomentale

os

orbitale superius

sa

superaulare

eu

euryon

li

labrale inferius

pg

pogonion

sba

subaurale

ex

exocanthion

ls

labrale superius

pi

palpebral inferius

sci

superciliare

ft

frontotemporale

m

metopion

po

porion

se

sellion

gn

gnathion

op

opisthocranion

pu

pupilare

sn

subnasale

sto

stomion

t

tragion

tr

trichion

v

vertex

zy

zygion

 

Taken from Knußmann (1988)

Fig. 3.1

Craniometric points in lateral view. Taken from Knußmann (1988)

Fig. 3.2

Craniometric point in vertical view (left) and in occipital view (right). Taken from Knußmann (1988)

Fig. 3.3

Craniometric points in basilar view. Taken from Knußmann (1988)

Fig. 3.4

Craniometric points in frontal view. Taken from Knußmann (1988)

Fig. 3.5

Somatometric points in frontal view

Fig. 3.6

Somatometric points in lateral view

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:

  • 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)

  • Cephaloradiography (George 1987; Leopold 1968; Weinig 1958; Bankowski 1958)

  • Ultrasound imaging (Aulsebrook et al. 1996; Wilkinson 2002)

  • Computer-assisted tomography (CT) (Phillips and Smuts 1996)

  • Cone-beam CT (Bankowski 1958)

  • 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.
Table 3.4

Landmarks used by authors, sample, and methodology

Reference

Date

Number of points

Male

Female

Total

Populationa

Methods

Welcker

1883

7

13

 

13

White (Cadavers)

Tissue puncture by using needle

His

1895

15

24

4

28

White (Cadavers)

Tissue puncture by using needle

Kollmann and Buchly

1898

18

21

4

25

White European (Cadavers)

Tissue puncture by using needle

Fischer

1905

18

2

 

2

Mongoloid (Papuans)

Tissue puncture by using needle

Birkner

1905

18

9

 

6

Mongoloid (Chinese)

Tissue puncture by using needle

Czekanowski

1907

6

64

51

112

White Caucasian (Cadavers)

Tissue puncture by using needle

Von Eggeling

1909

18

3

 

3

Black (Hererons)

Tissue puncture by using needle

Stadtmuller

1923–1925

20

15

3

18

Mongoloid, White

Tissue puncture by using needle

Suzuki

1948

18

7

48

55

Mongoloid (Japanese)

Tissue puncture by using needle

Weinig

1958

10

99

21

120

White Americans (Living)

Craniographs

Bankowski

1958

13

15

9

24

White Europeans (Living)

Craniographs

Berger

1965

14

26

102

128

White Caucasian (Cadavers)

Tissue puncture by using needle

Leopold

1968

13

102

52

154

White Europeans (Cadavers)

Craniographs

Sutton

1969

   

104

White Caucasian (Cadavers)

Tissue puncture by using needle

Rhine and Campbell

1980

21

44

15

59

American Black (Unembalmed cadavers)

Needle and rubber-stopper technique

Farkas

1981

132

   

White (Caucasian North American population)

 

Rhine et al.

1982

21

37

19

56

American White Caucasian (Unembalmed cadavers)

Tissue puncture by using needle

Rhine

1983

21

9

2

11

South-western Indians (Cadavers)

Tissue puncture by using needle

Helmer

1984

34

61

62

123

White European (Living)

Ultrasound

Hodson et al.

1985

20

  

50

American Caucasians

Ultrasound

Dumont

1986

9

93

101

194

Caucasian

X-Ray

George

1987

10

17

37

54

Whites American (Living)

Lateral craniographs

Nanda and Meng

1990

4

17

23

40

Caucasian

X-Ray

Aulsebrook et al.

1996

55

 

55

Zulu (Living) Negroids

Lateral, oblique cephalometry ultrasound

Phillips and Smuts

1996

21

16

16

32

Mixed raced South Africans (Living)

Computerized tomography

Manhein and Listi

2000

19

  

712

American

Ultrasound

El-Mehallawi and Soliman

2001

17

120

84

204

Egyptian (Living)

Ultrasound

El-Mehallawi and Soliman

2001

17

120

84

204

Egyptian

Ultrasound

Sahni

2002

19

30

30

60

Indians (Living)

MRI scans

Simpson and Henneberg

2002

20

17

23

40

Australian

Tissue puncture by using needle

Wilkinson

2002

21

99

101

200

British Juveniles

Ultrasonic echo-location

Williamson and Nawrocki

2002

15

77

147

224

African American

X-Ray

Utsuno and Kageyama

2005

12

0

112

112

Japanese

X-Ray

De Greef et al.

2006

52

510

457

967

White Caucasian (Living)

Ultrasound

Domaracki and Stephan

2006

13

19

14

33

Australian

Tissue puncture by using needle

Vander Pluym et al.

2007

5

5

10

American (multiple ancestries)

MRI

Panenková

2007

14

80

80

160

Slovak

CT Scan

Galdames et al.

2008

14

30

 

30

Cadavers

Tissue puncture by using needle

Sahni et al.

2008

29

173

127

300

Indian

MRI

Inada et al.

2009

 

40

40

80

Mongoloid (Japanese) (Living)

Cephalograms

Codinha and Fialho

2010

20

103

48

151

Portuguese

Tissue puncture by using needle

Menezes et al.

2009

50

531

357

888

 

Electronic digitizer

Tedeschi-Oliveira et al.

2009

11

26

14

40

Brazilian

Tissue puncture by using needle

Cavanagh and Steyn

2011

28

0

154

154

South African

CT Scan

Saxena et al.

2012

7

19

21

40

Indian

CT Scan

Hwang et al.

2012

31

50

50

100

Korean

CT Scan

aPopulation as described by the authors

Table 3.5

Comparison of the commonly used measuring techniques for calculating soft-tissue depth

Method of measurement

Advantage

Disadvantage

Needle puncture

Low cost.

Operating characteristics well defined. Measurements can be made in Frankfort. Horizontal plane.

Invasive.

Most information from cadavers, soft tissue may not accurately reflect living tissue.

Compression of soft tissue inevitable during measurement.

No visualization of the skeletal surface.

Plain film radiography

Standard cephalograms widely used in dentistry and medicine.

Films generally taken in Frankfort horizontal plane. Relatively inexpensive.

No compression of tissue while taking measurement.

Exposure to ionizing radiation, patient selection may bias results.

Only useful where surface landmark and bony landmark are parallel to the film plate.

Metallic implants (braces and fillings) may interfere with measurements. Magnification issues.

Computerized tomography

Widely used in medicine and dentistry.

Images are digital and easy to manipulate (e.g., absorption characteristic of soft and hard tissue relatively easy to distinguish).

Accuracy of surface landmark placement relative to bony landmark can be verified.

Paired landmarks easily measured.

Known accuracy and reproducibility.

Expensive.

Requires exposure to ionizing radiation, patient selection may introduce bias.

Patient motion artifact (voluntary or involuntary) may interfere with measurements.

Radio-opaque objects (e.g., filling, braces) may distort images and measurements.

Images are not in Frankfort horizontal plane.

Gravity effects on soft tissue due to supine position.

Translation to 3D shape may involve manual intervention.

Magnetic Resonance Imaging

No exposure to ionizing radiation, ethically acceptable to image subjects for tissue depth estimation.

Can be repeated on same subjects to obtain longitudinal data.

No soft-tissue compression during measurement

Images are digital and easy to manipulate (e.g. absorption characteristics of soft and hard tissue relatively easy to distinguish).

Accuracy of surface landmark placement relative to bony landmark can be verified.

Paired landmarks easily measured.

Very expensive.

Images generally not acquired in Frankfort horizontal plane.

Requires exposure to high-intensity magnetic field, subjects with metallic exposure not eligible.

Subject motion artifact distorts images.

May not visualize bone well.

Gravity effects due to supine position.

Translation to 3D shape may involve manual intervention.

Ultrasound

No exposure to ionizing radiation; can be used repeatedly in the same subject.

Portable, can be used in the field.

Measurements made in Frankfort horizontal plane.

Probe must touch skin surface, tissue compression possible with inexperienced operator.

Operating characteristics of portable equipment differ according to manufacturer and must be defined before use.

Difficult to scan parallel to skeletal surface and this can make visualization of the surface more challenging.

Taken from Taylor and Brown (1998)

Table 3.6

Systematic bias of soft-tissue measurement according to method of measurements

Measurement technique

Landmarks at which tissue depths are consistently higher than with other techniques

Landmarks at which tissue depths are consistently lower than with other techniques

Measurements technique that most closely correlates

Needle puncture

Plain radiology

All midline landmarks

Lateral landmarks: gonion and zygion

CT scan

All midline landmarks

All midline points

MRI

MRI scan

All midline points

CT

Ultrasound

Supra M2, infra M2, gonion, mid-infraorbital, anterior masseter border

Needle puncture (except for supra M2)

Taken from Preedy (2012)

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.
Table 3.7

Shape relationships of head and cranium

Morphological and facial traits

Correspondence with facial structures

The general head shape

Shape of face

Transverse arc of the cranium

Rounded

Semisphere

Square

Pentagonoid

Oval

Oval

Triangular

Rectangular

 

The shape of the temporal lines provides information about the forehead width

Shape of the face

Mandible

Oval

If the gonial angle is over 125° and the coronoid process is high, the lowest part of the head is likely to be narrow

Triangular

If the gonial angle is over 125° and the coronoid process is high, the lowest part of the head is likely to be narrow

Rounded

If the gonial angle is less than 125°, then the face shape is likely to be wide

Rectangular

If the gonial angle is less than 125°, then the face shape is likely to be wide

General face shape

Rounded

Parietal part gently curved in frontal view; occiput rounded in lateral view

Dome shaped

Parietal part protruding; occiput flattened in lateral view

Egg shaped

Parietal part gently curved in frontal view; occiput protruding

Keel shaped

Parietal part narrow, laterally compressed and “sharpened” in frontal view; gently curved or protruding in lateral view; occiput rounded, flattened, or protruding

Flattened

Parietal part flattened in frontal view, flattened in lateral view; occiput rounded or protruding in lateral view

Saddle shape

Parietal part gently curved or flattened, saddle shaped in lateral view; occiput rounded, flattened, or protruding in lateral view

Face in frontal view

Rounded

As in cranial contour; malar bones prominent; general contour rounded

Oval

As in cranial contour; facial outline smooth; general contour elliptical

Triangular

As in cranial contour; frontal part wide, mandible narrow; general contour triangular

Square

As in cranial contour; transverse dimensions large; general contour square

Rectangular

As in cranial contour; frontal and mandibular widths roughly equal; face high, outline angular; general contour rectangular

Diamond-shaped

As in cranial contour; frontal and mandibular breadth small, face broad and high; general contour diamond shaped

Vertical facial profile

Sharp

Nasal saddle high; malar bones not prominent

Flattened

Nasal saddle low; malar bones prominent

Frontal curvature in profile

Flat

Frontal outline nearly straight

Convex

Frontal outline convex arc

Concave

Both glabella and frontal tubers developed, creating the impression of concavity in the middle part

Wavy

Glabella developed, well-expressed flexure between it and the upper part of the frontal bone

Frontal angle in profile

Vertical

Perpendicular to Frankfort horizontal plane tangent to glabella nearly vertical

Inclined backward

Perpendicular to Frankfort horizontal plane tangent to glabella inclined backward

Inclined forward

Perpendicular to Frankfort horizontal plane tangent to glabella inclined forward

Brow ridges

Medium

Brow ridges markedly prominent, but without a depression between them

Large

Brow ridges markedly prominent and separated by depression

Small

Brow ridges barely distinguishable

Brow ridges

Medium

Moderately prominent from side view

Large

Markedly prominent from side view

Small

Barely distinguishable from side view

Length of brow ridges

Large

Extend beyond midpoint of supraorbital margin

Small

Do not reach midpoint of supraorbital margin

The relationship between facial measurements and related skull measurements has also been studied (Balueva et al. 2009). Table 3.8 summarizes the standards.
Table 3.8

Related face and skull measurements

Relative facial breadth

Medium

(Bizygomatic (45) + 10 mm)/(supraorbitale to gnathion (47b) + 6 mm) = 1.10 ± 0.04

Large

(Bizygomatic (45) +10 mm)/(supraorbitale to gnathion (47b) + 6 mm) > 1.14

Small

(Bizygomatic (45) + 10 mm)/(supraorbitale to gnathion (47b) + 6 mm) < 1.06

Frontal height

Medium

(Trichion to supraorbitale)/(supraorbitale to gnathion (47b) + 6 mm) = 0.45 ± 0.03

Large

(Trichion to supraorbitale)/(supraorbitale to gnathion (47b) + 6 mm) > 0.48

Small

(Trichion to supraorbitale)/(supraorbitale to gnathion (47b) + 6 mm) < 0.42

Frontal breadth

Medium

(Bicoronal (10) + 10 mm)/(bizygomatic (45) + 10 mm) = 0.90 ± 0.02

Large

(Bicoronal (10) + 10 mm)/(bizygomatic (45) + 10 mm) > 0.92

Small

(Bicoronal (10) + 10 mm)/(bizygomatic (45) + 10 mm) < 0.88

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).
Table 3.9

Eyebrow pattern standards

Eyebrow pattern

Overhanging

There is a strong development of the supraorbital margin and brow ridge, the eyebrows are shifted downward, 1–2 mm lower than the supraorbital rim

Arched

This is related to a smooth forehead and high orbit, with the eyebrow following the curve of the supraorbital margin

Triangular

There is thickening of the outer part of the supraorbital rim and a strong brow ridge, the eyebrow is arranged over the supraorbital margin forming an angle

Outline of eyebrows

Straight

Supraorbital margin straight; superciliary arch horizontal

Arched

Supraorbital margin arcuate; lateral end of superciliary arch directed upward

Broken

Supraorbital margin wavy; lateral end of superciliary arch directed upward

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).
Table 3.10

Relationship between the eyeball and the orbit

Eyes

Protrusion of the eyeballs

 

This is related to the depth of the orbital cavity, vertical inclination of the orbit, and the thickness and degree of overhang of its upper rim

Deep-set eye

The supraorbital rim is greatly thickened and protrudes relative to the infraorbital rim

Supraorbital margin projects inferiorly (“closed orbit”)

(orbital height (52))/(exocanthion to endocanthion) < 0.81

Prominent eye

Supraorbital margin does not project inferiorly

(orbital height (52))/(exocanthion to endocanthion) > 0.81

Eyeball prominence

Normal prominence is when the iris touches a tangent across the mid-supraorbital to mid-infraorbital bone

eyeball protrusion = 18.3 − (0.4 × orbit depth)

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).
Table 3.11

Position of the inner (endocanthus) and outer (exocanthus) corners of the eye

Eyes

 

The slope of the fissure is defined by a straight line that connects the malar (Whitnall’s) tubercle on the lateral border of the orbit with the anterior lacrimal crest on the medial border of the orbit

The curves of the eyelid margins are not symmetrical and the upper lid is more pronounced than the lower, its height being greatest nearer the medial angle, whereas that of the lower lid is nearer the lateral angle

The lateral canthal angle is more acute than the medial and lies in close contact with the globe, whereas the medial canthus extends toward the nose 5–7 mm away from the globe, being separated by the caruncula and the plica semilunaris

The radius of the upper eyelid curve is 16.5 mm and that of the lower eyelid is 22 mm

The outer canthus (exocanthus) is positioned at the same height as the malar (Whitnall’s tubercle) and medial to it

Where the malar tubercle is absent, the outer canthus can be positioned 8–11 mm below the line of the frontozygomatic suture

The inner canthus (endocanthus) is situated 2–5 mm lateral to the anterior lacrimal crest

Eye fissure

 

The length of the eye fissure is 60–80% of the width of the orbit

Medium

(Exocanthion to endocanthion − 14 mm)/(upper facial breadth (43)+ 10 mm)= 0.25 ± 0.01

Large

(Exocanthion to endocanthion − 14 mm)/(upper facial breadth (43)+ 10 mm)> 0.26

Small

(Exocanthion to endocanthion − 14 mm)/(upper facial breadth (43)+ 10 mm)< 0.24

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.
Table 3.12

Eyelid pattern

Eyelid patterns

Lateral

There is an overhang in the lateral part of the supraorbital rim

Central

There is an overhang in the central part of the supraorbital rim

Upper eyelid fold

Moderate

Supraorbital margins straight or slightly rounded

Defined

Supraorbital margins arched and sharp

Absent

Supraorbital margins arched, supraorbital overhang markedly shifted medially

Irregular

Supraorbital margin wave shaped or oblique in distal part

Epicanthic fold

Present

Crest descending from medial supraorbital margin directed toward anterior lacrimal crest

This is characteristic of a high orbit, a low-or medium-height nasal bridge, and a long lacrimal fossa

Absent

Crest descending from medial supraorbital margin directed inside orbit

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.
Table 3.13

Standards for nose shape prediction

Nose

Height of the nose

 

This equals the distance from nasion to 1–2 mm below the nasal spine

Medium

(Supraorbitale to subspinale)/(trichion to gnathion + 6 mm) = 0.32 ± 0.015

Large

(Supraorbitale to subspinale)/(trichion to gnathion + 6 mm) > 0.335

Small

(Supraorbitale to subspinale)/(trichion to gnathion + 6 mm) < 0.305

Nasal length

Europeans: nasion to prosthion = 0.74 (bony nasion to subspinale) + 3.5

Nasal length

Nasion to pronasale (mm) in nasion–prosthion plane = 0.9 (bony nasion to acanthion) – 2

Nasal height

European females: nasion to subspinale = 0.63 (bony nasion to subspinale) + 17

European males: nasion to subspinale = 0.78 (bony nasion to subspinale) + 9.5

Width of the nose

 

This is defined between the midpoints of the canines or their alveoli

The maximum width of the nasal aperture is three-fifths (3/5) of the maximum width of the soft nose

Medium

Nasal breadth/(bizygomatic breadth (45) + 10 mm) = 0.25 ± 0.01

Large

Nasal breadth/(bizygomatic breadth (45) + 10 mm) > 0.26

Small

Nasal breadth/(bizygomatic breadth (45) + 10 mm) < 0.24

The base of the nose

Horizontal

Horizontal nasal spine

Elevated

Up-turned nasal spine

Prolapsed

Down-turned nasal spine

The tip of the nose

Bifid

Bifurcated nasal spine

Nasal depth

Female; subspinale to pronasale = 0.5 (bony rhinion to subspinale) + 1.5 male; subspinale to pronasale = 0.4 (bony rhinion to subspinale) + 5

Pronasale

Anterior projection (mm) perpendicular to nasion–prosthion plane= 0.83Y − 3.5

Pronasale

Projection from subspinale in Frankfort horizontal plane = 0.93 (bony rhinion to subspinale) – 6

Deviated

Deviation of nose is opposite to the deviation of the nasal septum and in the same direction as the nasal spine (right or left)

Wide

Wider than the nose ridge. It is correlated with a short, wide, groovy, nasal spine and low, wide nasal foramen

Moderate

Equal to the width of the nose ridge

Narrow

It is correlated with a long, narrow, pronounced nasal spine and long, narrow nasal foramen

Rounded

Length of anterior nasal spine equal to or smaller than width of its base; tip of spine forming an obtuse angle

Pointed

Length of anterior nasal spine larger than width of its base; tip of spine pointed

Wing of the nose

 

The wing of the nose begins at the lateral edge of the piriform foramen at the level of nasal spine

The height of the upper border of the alae is in line with the crista conchalis

An exposed nasal septum is characteristic of a crest-shaped base of the nose

Medium

(Conchale to subspinale)/(supraorbitale to subspinale) = 0.21 ± 0.02

High

(Conchale to subspinale)/(supraorbitale to subspinale) > 0.23

Low

(Conchale to subspinale)/(supraorbitale to subspinale) < 0.19

Level

Left and right conchale and left and right lower points of the piriform aperture situated on the same level

Right higher

Right conchale or right lower point of the piriform aperture higher than left

Left higher

Left conchale or left lower point of the piriform aperture higher than right

Nasal bridge depth

Medium

Sellion not much deeper than glabella to rhinion line

Large

Sellion much deeper than glabella to rhinion line

Small

Sellion on glabella to rhinion line

Nasal bridge breadth

Medium

(Minimal breadth of nasal bones at nasal saddle level (57) + 6 mm)/(naso-gnathic left to naso-gnathic right + 6 mm) = 0.85 ± 0.04

Large

(Minimal breadth of nasal bones at nasal saddle level (57) + 6 mm)/(naso-gnathic left to naso-gnathic right + 6 mm) > 0.89

Small

(Minimal breadth of nasal bones at nasal saddle level (57) + 6 mm)/(naso-gnathic left to naso-gnathic right + 6 mm) < 0.81

Nasal saddle width

Medium

(Naso-gnathic left to naso-gnathic right + 6 mm)/(canine left to canine right) = 0.38 ± 0.03

Large

(Naso-gnathic left to naso-gnathic right + 6 mm)/(canine left to canine right) > 0.41

Small

(Naso-gnathic left to naso-gnathic right + 6 mm)/(canine left to canine right) < 0.35

 

Nasal ridge index = minimal breadth of nasal bone × 100/anterior length of nasal bone

10–30 = narrow; 30–45 = medium; 45–75 = broad

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.
Table 3.14

Anatomical standards relating to mouth shape

Mouth

Width of the mouth

 

Equal to the distance between the mandibular second molars

Mouth corners positioned on radiating lines (perpendicular to the palate arc) from the first premolar–canine junction

Intercanine distance = 75% of overall mouth width

The distance between the first premolars equal to mouth width

Mouth corners positioned vertically below the infraorbital foramina

Medium

Estimated on regression equation mouth width/(bigonial breadth + 20 mm) = 0.52 ± 0.02

Large

Estimated on regression equation mouth width/(bigonial breadth + 20 mm) > 0.54

Small

Estimated on regression equation mouth width/(bigonial breadth + 20 mm) < 0.50

Position of the fissure

 

The closed fissure is positioned at the level of the upper edge of the anterior teeth of the mandible

The open fissure is positioned at the mid-line of the maxillary incisors

Height of the lips

 

Approximately equal to the height of the enamel of the upper and lower incisors

European: maximum upper lip height (mm) = 0.4 + (0.6 × max. maxillary tooth enamel height)

European: maximum lower lip height (mm) = 5.5 + (0.4 × max. mandibular tooth enamel height)

Indian subcontinent: maximum upper lip height (mm) = 3.4 + (0.4 × max. maxillary tooth enamel height)

Indian subcontinent: maximum lower lip height (mm) = 6 + (0.5 × max. mandibular tooth enamel height)

Medium

(Subspinale to supradentale)/(supraorbitale to gnathion (2) + 6 mm) = 0.12 ± 0.011

High

(Subspinale to supradentale)/(supraorbitale to gnathion (2) + 6 mm) > 0.131

Low

(Subspinale to supradentale)/(supraorbitale to gnathion (2) + 6 mm) < 0.109

Width of the philtrum

 

The width of the philtrum corresponds to the distance between the midpoints of the upper central incisors

Prognathism

Overbite or maxillary prognathism

The upper lip projects more anteriorly than the lower lip

An underbite or edge-to-edge occlusion

The lower lip protrudes more anteriorly than the upper lip

Line between closed lips

Arched (upward or downward)

The direction of these lines generally coincides with the line formed when the teeth are closed

Straight (upward or downward)

 

Occlusion and malocclusion

Edge-to-edge bite

Upper and lower anterior teeth fitting together edge-to-edge

Moderate overbite

Anterior upper teeth slightly projecting over lower ones

Roof-shaped

Marked overbite

Cornice-shaped bite

Marked maxillary and mandibular alveolar prognathism

Stepwise

Anterior mandibular teeth projecting anteriorly relative to anterior maxillary teeth

Gaping

Anterior maxillary and mandibular teeth curved and not fitting together

Oblique

Some teeth fit together normally, others show malocclusion

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).
Table 3.15

Relationship between the zygomatic bones, the canine fossa, and the soft cheeks

Horizontal profile of the face

 

The cheekbones define the width of the face and its horizontal profile

The horizontal profile of the face depends on the width and height of the curvature of the cheekbones, the depth of the canine fossae, and the nasomalar and zygomaxillary angles

Size of malar bones

Medium

Malar bones medium width and gently inclined backward; (bizygomatic breadth (45) + 10 mm)/(minimal frontal breadth (9) + 10 mm) = 1.37 ± 0.03

Large

Malar bones wide and frontally positioned; (bizygomatic breadth (45) + 10 mm)/(minimal frontal breadth (9) + 10 mm) > 1.40

Small

Malar bones narrow and inclined backward; (bizygomatic breadth (45) + 10 mm)/(minimal frontal breadth (9) + 10 mm) < 1.34

Smile line

 

The nose-cheek (nasolabial) fold extends from the upper edge of the nostril toward the upper first molar

Protrusion of the smile line

 

It depends on the depth of the following parts:

•● The canine fossa

•● The degree of horizontal face profiling

•● The projection of the frontal surface of the cheekbones

•● The presence or absence of teeth

Nose-cheek folds pronounced

The canine fossae are deep, and profiling of the face is strong

Depth of the canine fossa

Shallow

Up to 3 mm

Moderate

Between 4 and 6 mm

Deep

Over 6 mm

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.
Table 3.16

Relationship between ear morphology and skeletal structure

Ear

 

The tragus of the ear corresponds to the upper rim of the external auditory meatus

The height of the ear approximates the length of the nose

Protrusion of the ear

Upper

The supramastoid crest on the temporal bone is strongly developed and protrudes

Lower

The outer surface of the mastoid process is rough

Total

All these features are present

Lobe of the ear

Lobe attached

The mastoid processes are directed downward when the skull is in the Frankfort horizontal plane

Lobe free

The mastoid points forward when the skull is in the Frankfort horizontal plane

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.
Table 3.17

Relationship between the mental region of the mandible and chin shape

 

The presence of convexities in the lower part of the mandibular body is a notable feature both of the skull and of the face.

Width of the chin

 

This is defined by the degree of elevation in the mental region of the mandible and the width its base.

Shape of the chin

High

The height of the mandibular body diminishes from the chin triangle to the rami.

Wide

Everted gonial regions of the mandible are associated with the wider variants of the lower face and more developed masseter muscles.

Height of the chin

Medium

(Supramentale to gnathion + 6 mm)/(supraorbitale to gnathion + 6 mm)= 0.215 ± 0.015

Large

(Supramentale to gnathion + 6 mm)/(supraorbitale to gnathion + 6 mm) > 0.23

Small

(Supramentale to gnathion + 6 mm)/(supraorbitale to gnathion + 6 mm) < 0.20

 

Chin height index = Height of the chin triangle × 100/Height of the ramus along the second premolar

100–110 = normal; 110–115 = high; 115–120 = very high

Chin prominence

Straight

Most projecting point of chin slightly anterior to vertical line

Prominent

Most projecting point of chin markedly anterior to vertical line

Receding

Most projecting point of chin on vertical line or behind it

Width of the chin

Medium

(Mentale left to mentale right)/(bigonial width + 20 mm)= 0.35 ± 0.02

Large

(Mentale left to mentale right)/(bigonial width + 20 mm) > 0.37

Small

(Mentale left to mentale right)/(bigonial width + 20 mm) < 0.33

Shape of the chin in frontal view

Rounded

Outline rounded, genial tubercles unexpressed

Triangular

Outline pointed, genial tubercles close together

Square

Outline square, genial tubercles wide apart

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).
Table 3.18

Landmarks, lines, and profile curves suggested by Chai et al. (1984)

Landmarks on face and skull

Facial lines

Skeletal lines

Profile outlines

g: glabella

ex-ex

ec-ec

Cranial vault

tr: trichion

g-gn

g-gn

Brow ridge

v: vertex

se-se

se-se

Nasal

n: nasion

ch-ch

-gn-

Gonial angle

sn: subnasal

en-eh

 

Lower jaw

gn: gnathion

en-eh

 

Occipital

pg: pogonion

-gn-

 

Forehead

rhi: rhinion

  

Chin

ns: nasospinale

  

Zygomatic

pr: prosthion

   

inf: infradentale anterior

   

t: tragion

   

eu: euryon

   

al: alare

   

che: cheilion

   

en: endocanthion

   

ex: exocanthion

   

zy: zygion

   

go: gonion

   

ca: caninion

   

se: superciliary

   

ec: ectoconchion

   

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
  1. 1.

    The vault of the skull and the head height must be similar.

     
  2. 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.

     
  3. 3.

    The lateral angle of the eye lies within the bony lateral wall of the orbit.

     
  4. 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.

     
  5. 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.

     
  6. 6.

    The outline of the zygomatic arch can be seen and aligned in those individuals with minimal soft tissue thickness.

     
  7. 7.

    The anterior nasal spine lies posterior to the base of the nose near the most posterior portion of the lateral septal cartilage.

     
  8. 8.

    The porion aligns posterior to the tragus and inferior to the crus of the helix.

     
  9. 9.

    The prosthion lies posterior to the anterior edge of the upper lip.

     
  10. 10.

    The pogonion lies posterior to the indentation observable in the chin where the orbicularis oris muscle crosses the mentalis muscle.

     
  11. 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.

     
  12. 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
  1. 1.

    The length of the skull from bregma to menton fits within the face. Bregma is usually covered with hair.

     
  2. 2.

    The width of the cranium fills the forehead area of the face.

     
  3. 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.

     
  4. 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.

     
  5. 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.

     
  6. 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.

     
  7. 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.

     
  8. 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.

     
  9. 9.

    The width and length of the nasal aperture falls inside the borders of the nose.

     
  10. 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.

     
  11. 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.

     
  12. 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.
Table 3.19

Examination criteria for the assessment of anatomical consistency between the skull and the face

Outline

Soft tissue thickness

Positional relationships

1. Forehead line

1. Zygion

1. Distance from the supraorbital margin to the midline of eyebrow

2. Buccal line

2. Gnathion

2. Distance from the medial orbital margin to the endocanthion

3. Mandibular line

3. Pogonion

3. Distance from the lateral orbital margin to the ectocanthion

4. Nasal dorsum line

4. Gonion

4. Eye-slit standard ratio (eye-slit height from the lower orbital margin/orbital height)

5. Nasion

5. Distance from the lateral margin of nasal aperture to the ala

6. Rhinion

6. Distance from the lower margin of nasal aperture to the lowest portion of external nasal tip

7. Subnasale

7. Placement of the cheilion to upper teeth

Taken from Yoshino et al. (1995)

Table 3.20

Criteria for assessing anatomical consistency between skull and face in frontal view

Outline

Soft-tissue thickness

Positional relationship

Skull

Face

Skull

Face

Skull

Face

Temporal line

Forehead

Zygion

Zygion

Supraorbital margin

Eyebrow

Lateral line of zygomatic bone

Cheek outline

Gonion

Gonion

Medial orbital margin

Endocanthion

Mandibular line

Lower jaw outline

Gnathion

Gnathion

Lateral orbital margin (Whitnall’s malar tubercle)

Ectocanthion

Orbit

Eye-slit

Lateral margin of piriform aperture

Alare

Cutting edge of upper central incisor

Stomion

Teeth (premolar)

Cheilion

Occlusal line

Oral slit

Taken from Yoshino (2012)

Table 3.21

Criteria for assessing anatomical consistency between skull and face in lateral/oblique view

Outline

Soft-tissue thickness

Positional relationship

Skull

Face

Skull

Face

Skull

Face

Frontal bone contour

Forehead outline

Trichion

Trichion

Supraorbital margin

Eyebrow

Outline from nasion to rhinion

Nasal dorsum line

Glabella

Glabella

Lateral orbital margin (Whitnall’s malar tubercle)

Ectocanthion

Mental outline

Chin outline

Nasion

Nasion

Nasion

Higher than nasal root

Gonial outline

Jaw angle outline

Rhinion

Rhinion

Lateral margin of piriform aperture

Alare

Slightly inferior to nasospinale

Subnasale

Lower margin of piriform aperture

Subnasale

Pogonion

Pogonion

Incisor

Stomion

Gnathion

Gnathion

Teeth (canine premolar)

Cheilion

Taken from (Yoshino et al. 1995)

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.
Table 3.22

Lines, landmarks and index from Lan (1995)

Determining lines

Landmarks index

Index of soft tissue thickness

Index number of index

1. Ectocanthion line. Between two ectocanthions, used as a horizontal base line to mark the horizontal relationship of the superimposition.

Superciliary and supraorbital line

Vertex

Endocanthion: Distance between endocanthion and supraorbital/orbital height

2. Front central line. From glabella to gnathion, vertical to the ectocanthion line, used to mark the vertical relationship of the superimposition.

Orbital height

Euryon

Ectocanthion: Distance between ectocanthion and supraorbital/Orbital height

3. Superciliary line. Between two superciliaries, parallel with the ectocanthion line, and vertical to the front central line.

Ectocanthion and supraorbital line

Zygion

Distance between Endocanthions: Distance between bi-endocanthions/Distance between junctures of external orbit

4. Subnasal line. At the subnasale, vertical to the front central line, used to mark the superimposition of subnasale and infra-apertura piriformis.

Endocanthion and supraorbital line

Tragion

Distance between Ectocanthions: Distance between bi-ectocanthions/Distance between junctures of external orbit

5. Cheilion line. Between two cheilions, vertical to front central line, used to mark the superimposition of cheilion and maxillary teeth.

Subnasale and infra-apertura piriformis

Gonion

Stomion line: Distance between supradental alveolus and stomion line/Distance between infradental alveoli and stomion line

6. Gnathion line. At gnathion, vertical to the front central line, used to mark the superimposition of soft tissue of gnathion and pogonion.

Cheilion line and infra-apertura piriformis

Gnathion

Distance between gonions: Distance between gonions on skull/Distance between gonions on human image

7, 8. Endocanthion vertical lines (left and right). From the endocanthion line to the cheilion line, parallelwith the front central line, used to mark the relationship of endocanthion and maxillary teeth.

Endocanthion vertical line to maxillary tooth (left)

Opisthocranion

Distance between cheilions: Distance between cheilions/Distancebetween gonions on skull

9, 10. Ectocanthion vertical lines (left-right). From the ectocanthion line to the gonion line, parallel with the front central line, and are used to mark the horizontal superimposition of ectocanthion and gonion.

Endocanthion vertical line to maxillary tooth (right)

Trichion

Morphological curves include the following: (1) head vault curve, (2) arcus superciliary curve, (3) nose curve, (4) lower jaw curve,(5) gonion curve, (6) head back curve, (7) forehead curve, (8) pogonion curve, and (9) zygomatic curve.

Distance between two junctures of external orbit

Glabella

Distance between bi-endocanthions

Nasion

Cheilion to mandibular tooth

Sellion

Ectocanthion and endoconchion

Subnasale

Prosthion and cheilion line

Pogonion

lnfradentale anterius and cheilion

Distance between gonions

Distance between gonions on the skull

Distance between zygions

Distance between cheilions

Gonion and tragion on the skull

Gonion and ectocanthion vertical line on the skull

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.
Table 3.23

Facial and skull measurements and indices (a)

Measurement details and indices of facial skull

Cranioscopic observations in the skull [visual (v) and mensural (m)] in comparison with the chepaloscopic observations from the facial photograph (visual)

Skull

Photo

Skull

Photo

Skull

Photo

Skull

Photo

Face

Face (v)

Orbit

Eyes (v)

Nasal area

Nose (v)

Malar bone

Cheek (v)

Vertical

n-gn

n-pr

n-rhi

rhi-ns

n-ns

orb-ht

Facial Ht (m).

Short. S

Medium. M

Long. L

Contour (v).

Elliptical. E

Ovoid. O

Round. R

Quadra. Q

Pentago. P

Asy. A.R.L

Facial Ht

Short

Medium

Long

Contour

Elliptical

Ovoid

Round

Square

Pentago

Asy. A.R.L

Orb. Profile (v)

Weak. W

Mod. Weak.E

Mod. Strong. S

Brow. Ridge. med (v)

Straight. A

Arched. B

Angular. C

Asy. A.R.L

Eyes

Prom.

Mod.Prom

Mod.Deep

Deep

Eye Brow med

Straight

Arched

Angular

Asy. A.R.L

Na.Area(m)

Narrow. N

Medium. M

Broad. B

Asy. A.R.L

Na. Notch(v)

Deep.D

Mod.M

Slight.S

Smooth.A

Nose

Narrow

Medium

Broad

Asy.A.R.L

Root

Prom.

Mod.

Slight

Absent

Malar(v) Prom.P

Medium.M

Shallow.S

Asy.A.R.L

Zygomatic Arch(v)

V.prot.V

Prot.P

Mod.M

Reced.R

Asy.A.R.L

Cheek

Prom.

Medium

Shallow

Asy.A.R.L

Zygoma

V.Prom

Prom.

Mod.

Smooth

Asy.A.R.L

Horizontal

ft-ft

ect-ect

mf-ect

mf-mf

zy-zy

go-go

ecm-ecm

bdth. na. ridge

na. bdth

Fr. lines (v)

Prom. P

Mod. M

Shallow. S

Fr. Emin (v)

Prom. P

Mod. M

Incip. I

Absent. A

Mandible

G.A.C.C.R.

(m)

Lower. L

Equal. E

Higher. H

Fr. lines

Prom.

Mod.

Incip.

Fr. Prot

Prom.

Mod.

Incip.

Absent

L. Face

Round

Oval

Triangular

Brow

Ridge. lat (v)

Straight. A

Arched. B

Angular. C

Asy. A.R.L

Ecto/Endo. Axis (v)

Horizontal. H

Oblique

Internal. I

External. E

Asy. A.R.L

Eye brow last

Straight

Arched

Angular

Asy. A.R.L

Eye opening Axis

Horizontal

Oblique

Internal

External

Asy. A.R.L

Na.Ridge

Straight.S

Prom.P

Convex.X

Concave.C

Wavy.W

Asy. A.R.L

Ri.Bdth

Narrow.N

Medium.M

Broad.B

Ri.Prom

Low.L

Medium.M

Raised.R

Bridge

Straight.S

Prom.P

Convex/Hump

Concave

Wavy

Asy. A.R.L

Br.bdth

Narrow

Medium

Broad

Br.Prom

Low

Medium

Raised

Can.Fos. (v)

Prom.P

Mod.M

Shallow.S

Smile/Nor No.Ch.Fold

Con.

Mod.

Incip.

Others

ba-pr

ba-na

lgth. jaw

bi-cdl

pr-alv

ol-sta

Mand Form (v)

Narrow. N

Medium. M

Broad. B

Asy. A.R.L

Roc. Jaw (v)

P.A

JawContour

Narrow

Medium

Broad

Asy. A.R.L

L.J.P.P.A

Overhang (V)

Complete. C

Medial. M

Lateral. L

Central. E

Absent. A

Eye Folds

Complete

Medial

Lateral

Central

Absent

Lat.Dep.P.A

Lat.Bul.P.A

Pl.Ap. (m)

Narrow.N

Medium.M

Broad.B

Asy.A.R.L

Gut.Evi.P.A

ns.level.

Low

Medium

High

Lat.Dep

Lat.Bulge Alae

Narrow

Medium

Broad

Asy.A.R.L

Exposed

Nostril A/P

Indices

T. Facial

U. Facial

Mand.

Orbital

Inter. Orb

Nasal

Na. ridge

Max. Alv

Palatal

Alveolar

Chin ht.

Gon. Evr. (v)

V. Prom. V

Prom. P

Mod. M

Incip. I

Asy. A.R.L

Chin. W. (v)

Narrow. N

Mod. M

Broad. B

Chin. H. (m)

Rami. Ht. (m)

Diff.

High. H

Normal. N

High Mand

P.L.P

V. Prom

Prom

Mod.

None

Asy. A.R.L

Chin. W.

Narrow

Mod.

Wide

Chin. Ht.

High

Normal

High Chin

  

Pi.Edge(v)

Low.L

Mod.M

Raised.R

Na.Base

Straight.S

Al.Arched.L

Arched.A

Spine (v)

N/M/B

Sp.dir

Horizontal.H

Upwar.U

Downward.D

Asy.A.R.L

Alar edge

Flat

Mod.

Raised

Septum

Exposed

Par.Exposed

Unexposed

Na.tip

S/M.S/B

Na.tip.dir.

Horizontal

Upward

Downward

Asy.A.R.L

Taken from Jayaprakash et al. (2001)

Table 3.24

Facial and skull measurements and indices (b)

Measurement details and indices of facial skull

Cranioscopic observations in the skull [visual (v) and mensural (m)] in comparison with the chepaloscopic observations from the facial photograph (visual)

Skull

Photo

Skull

Photo

Skull

Photo

Alv. Edge

Lips (v)

Max. Alv. zone

Mouth (v)

Mastoid areas

Ear (v)

Vertical

n-gn

n-pr

n-rhi

rhi-ns

n-ns

orb-ht

Alv.Edge(v)

Prot.Upper.U

Prot.Lower.L

Prot.Total.T

Normal.N

Sheer(u/l).S

Teeth(v)

UpperProt.U

Lower Prot.L

Both Prot.B

Both Nor.N

Edge-Edge.E

Lips

Prot Upper

Prot Lower

Prot.Total

Normal

Flat(u/l)

Teeth

Upper Prot.

Lower Prot.

Both Prot.

Both Nor.

Normal

Index(m)

Narrow.N

Medium. M

Broad. B

Overbite(v)

Maxillary.X

Mandibular.M

Edge-Edge.E

Normal.N

Asy.A.R.L

Mouth

Narrow

Medium

Broad

Protrusion

Upper

Lower

Total

Normal

Asy.A.R.L

Mas.tip(v)

Con.Down.C

Downward.D

Forward.F

Mas.&S.M.Cr.Prot(v) S.M.

V.Prom.V

Prom.P

Normal.N

Incip.I

Ear Lobe

Attached

Par.Attached

Free

Helix.Prot

Upper

V.Prot

Prot

Mod

Least

Horizontal

ft-ft

ect-ect

mf-ect

mf-mf

zy-zy

go-go

ecm-ecm

bdth. na. ridge

na. bdth

Present/Edentulous

Trema

Diastema

Afrition

Conoid

Overriding/

Protruding

Tooth

Exposed/Unexposed

Trema

Diastema

Afrition

Conoid

Overriding/

Protruding

Lip.Clo.Line

Asy.A.R.L

Overrid.Teeth/Prot(v)

Absten.A

Maxilla.X

Mandible.M

Right.R

Left.L

Lip.Clo.Line

Absent

Upper

Lower

Right

Left

Mastoid(v)

V.Prom.V

Prom.P

Normal.N

Incip.I

Lower

V.Prot

Prot.

Mod.

Least

Indices

T. Facial

U. Facial

Mand.

Orbital

Inter. Orb

Nasal

Na. ridge

Max. Alv

Palatal

Alveolar

Chin ht.

 

Taken from Jayaprakash et al. (2001)

Alv alveolar, Asy asymmetry, A.R.L absent.right.left, B broad, Br bridge, Bul bulge, Can.For canine fossa, Clo closure, Con conspicuous, Cr crest, C.C.R coronoid-Condyle relationship, D vertical distance det. Ectocanthus-Tragion, Dep depression, Diff difference, Emin eminence, Evr eversion, Fr frontal, G.A gonial angle, Gon gonial, Gut. Evt gutter evidence, H/HT high/height, Incip incipient, L/R left & right ectocanthus to nasion distance ratio, Lat lateral, L lower, L.J.P lateral jaw prominence, Mand mandibular, Mas mastoid, Med medial, Mod moderate, M.S mod.ly sharp, Na nasal, No Ch nose cheek, Nor normal, Nost nostni, Par partly, Pentago pentagonoid, Phil philtrum, Pl. Ap piriform aperture, Pl. Edge piriform aperture, Prom prominent, Prot protrusion, P.L.P postero lateral prominence, Quedra quadrangular, Reced receding, Ri ridge, Rid riding, Rob robust, Roc rocker, S sharp, SL slight, Sp. dir spine direction, S.M supra mastoid, U/L upper/lower, V. prom very prominent, W width

Table 3.25

The criteria used for assessing the fit the skull with the face photograph during superimposition are the following

Outline and soft tissue thickness

Positional relationship

Frontal view

Lateral view

Frontal view

Lateral view

Skull

Photo

Skull

Photo

Skull

Photo

Skull

Photo

Temporal line

Forehead

Frontal bone contour

Forehead outline

Frontal breadth

Breadth of forehead

Temporal line prominence

Temporal line imprint in the forehead

Zygomatic arch

Zygion

Nasion

Root of nose

Medial part of supraorbital ridge

Upper edge of medial portion of eyebrows

Medial part of supraorbital margin

Upper edge of medial portion of eyebrows

Lateral edge of piriform aperture

Lateral edge of alare

Inferior border of piriform aperture

Alar baseline

Lateral part of supraorbital margin

Lower edge of lateral part of the eyebrows

Lateral part of supraorbital margin

Lower edge of lateral part of eyebrow

Nasal spine

Tip of nose

Nasal spine

Tip of nose

Nasion

Higher than the root of nose

Nasion

Higher than the root of nose

Occlusal line

Lip closure line

Occlusal line

Lip closure line

Whitnall’s tubercle

Precisely aligns with the ectocanthus on the horizontal plane, vertically the ectocanthus lies medial to the tubercle

Whitnall’s tubercle

Lies posterior to the ectocanthus on the same horizontal plane

Mandibular outline

Lower jaw

Gonial outline

Jaw angle outline

Breadth of piriform aperture

Inner to alar breadth

Edge of piriform aperture

Posterior to the edge of ala

Mental outline

Chin outline

Mental outline

Chin outline

Nasal spine

Superior to the medial part of tip of nose

Occlusal line

Lip closure line

General outline of the skull

Fills the face photograph

General outline of the skull

Fills the face photograph

Zygion

Zygion

Nasal spine

Superior to the medial part of tip of nose

Auditory meatus

Medial to the upper edge of tragus on the same horizontal plane

Auditory meatus

Lateral to the upper edge of tragus on the same horizontal plane

Occlusal line

Lip closure line

Gonial flare

Jaw angle outline

    

Gonial flare

Postero-lateral jaw prominence

  

Taken from Jayaprakash et al. (2001)

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).
Table 3.26

Anatomical points of the face

Anatomical points of the face

Eyebrow midpoint

Midpoint of the inferior margin of the palpebra inferior (lower eyelid)

Inner canthus

Outer canthus

The most forward point of the midsagittal plane (located between the two eyebrows)

Point below the inferior margin of the cartilaginous septum of the nose

Superior margin of the upper lip midpoint

Inferior margin of the lower lip midpoint

Zygoma

Table 3.27

Points of the skull X-rays

Points of the skull X-rays

Arcus superciliaris midpoint (superciliary arch)

Inferior orbital rim midpoint

Inner canthus, placed 3 mm medially to the medial wall of the orbit1 or against the medial wall of the orbit2 or 2–3 mm laterally to the lacrimal crest and 4–5 mm below the dacryon (junction of the lacromaxillary suture and the frontal bone)3

Outer canthus, placed 5 mm laterally to the orbit margin1 or 3–4 mm medially to the “Whitnall’s malar tubercle”3; the “Whitnall’s malar tubercle,” placed on the orbital surface of the zygomatic bone 11 mm below the frontozygomatic suture, is the site of attachment of the rectus lateralis bulbi muscle, suspensory ligament, and levator palpebrae superioris muscle 4

Glabella

Inferior margin of the nasal spine

Upper infradental point (between the two medial upper incisors)

Lower infradental point (between the two medial lower incisors)

Zygomatic process of the maxilla

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).
Table 3.28

Anthropometrical points used for each individual

Landmarks

n

R-ex

R-zy

L-ex

L-zy

sn-ns

gn

R-al

R-go

L-al

L-go

R-ch

R-en

L-ch

L-en

n nasion, R-zy right zygion, L-zy left zygion, gn gnathion, R-go right gonion, L-go left gonion, R-en right endocanthion, L-en left endocanthion, R-ex right exocanthion, L-ex left exocanthion, sn-sn subnasal-subnasal, R-al right alare, L-al left alare, R-ch cheilion, L-che left cheilion

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).
Table 3.29

Orientation, primary, and secondary landmarks

Methods

Description

Orientation landmarks

Ectocanthion (ec)

Should overlap: used to define the orientation

Subnasal point (ns)

Nasion (n)

Primary landmarks

Glabella (g)

Expected to be very close on skull and face, landmarks should touch or overlap

Dacryon (d)

Frontotemporale (ft)

Secondarylandmarks

Gonial angle (go)

Bone and soft tissue landmarks not expected to overlap exactly but bony landmarks should be inside soft tissue landmarks

Gnathion (gn)

Zygion (zy)

Nasal aperture width/alare (al)

The description of the landmark on the skull (bony landmark) and the corresponding soft tissue landmark is given. Taken from Gordon and Steyn (2012)

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Authors and Affiliations

  • Sergio Damas
    • 1
  • Oscar Cordón
    • 1
  • Oscar Ibáñez
    • 2
  1. 1.Edificio de InvestigaciónEuropean Centre for Soft ComputingMieresSpain
  2. 2.Department of Computer Science & Artificial Intelligence (DECSAI)University of GranadaGranadaSpain

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