Facial soft tissue thicknesses in craniofacial identification: Data collection protocols and associated measurement errors

Craniofacial identification standards: A review of reliability, reproducibility, and implementation

There are numerous anatomical and anthropometrical standards that can be utilised for craniofacial analysis and identification. These standards originate from a wide variety of sources, such as orthodontic, maxillofacial, surgical, anatomical, anthropological and forensic literature, and numerous media have been employed to collect data from living and deceased subjects. With the development of clinical imaging and the enhanced technology associated with this field, multiple methods of data collection have become accessible, including Computed Tomography, Cone-Beam Computed Tomography, Magnetic Resonance Imaging, Radiographs, Three-dimensional Scanning, Photogrammetry and Ultrasound, alongside the more traditional in vivo methods, such as palpation and direct measurement, and cadaveric human dissection. Practitioners often struggle to identify the most appropriate standards and research results are frequently inconsistent adding to the confusion. This paper aims to clarify how practitioners can choose optimal standards, which standards are the most reliable and when to apply these standards for craniofacial identification. This paper describes the advantages and disadvantages of each mode of data collection and collates published research to review standards across different populations for each facial feature. This paper does not aim to be a practical instruction paper; since this field encompasses a wide range of 2D and 3D approaches (e.g., clay sculpture, sketch, automated, computer-modelling), the implementation of these standards is left to the individual practitioner.

Global facial soft tissue thicknesses for craniofacial identification (2023): a review of 140 years of data since Welcker's first study

This year (2023) marks 140 years since the first publication of a facial soft tissue thickness (FSTT) study. Since 1883, a total of 139 studies have been published, collectively tallying > 220,000 tissue thickness measurements of > 19,500 adults. In just the last 5-years, 33 FSTT studies have been conducted. Herein, we add these data (plus an additional 20 studies) to the 2018 T-Table to provide an update of > 81,000 new datapoints to the global tallied facial soft tissue depths table. In contrast to the original 2008 T-Table, some notable changes are as follows: increased FSTTs by 3 mm at infra second molar (ecm2-iM2'), 2.5 mm at gonion (go-go'), 2 mm at mid-ramus (mr-mr'), and 1.5 mm at zygion (zy-zy'). Rolling grand means indicate that stable values have been attained for all nine median FSTT landmarks, while six out of nine bilateral landmarks continue to show ongoing fluctuations, indicating further data collection at these landmarks holds value. When used as point estimators for individuals with known values across 24 landmarks (i.e., C-Table data), the updated grand means produce slightly less estimation error than the 2018 T-Table means (3.5 mm versus 3.6 mm, respectively). Future efforts to produce less noisy datasets (i.e., reduce measurement and sampling errors as much as possible between studies) would be useful.

Sphenoid sinuses' volume and area analysis of Brazilian individuals' CBCTs, related to sex, age, skin color, and nutritional status using DDS-Pro™ software

The purpose of this study was to analyze the volume and area of sphenoid sinuses of Brazilian individuals' cone-beam computed tomography (CBCT) images using the beta version of the DDS-Pro™ 2.14.2_2022 software (DPP Systems, Czestochowa, Poland), to assess a potential correlation to sex, age, skin color, and nutritional status, and to evaluate differences between the right and left sides. Three-dimensional volume and area measurements were made with the software using CBCT images of 113 living Brazilian individuals of both sexes (67 females and 46 males). TEM, rTEM, and R were used to assess the reproducibility of inter- and intra-examiner measurements. The measurement means were estimated with 95% confidence intervals according to sex and age group. There were no significant differences between the left and right sides for both volume and area and between the sexes and black and white individuals. Volume and area were significantly higher in 18 years or older (p < 0.05) and in individuals with normal body mass index (BMI) (p < 0.05). The obtained results do not allow indicating the use of sphenoid sinuses volume and area measurements to estimate sexual dimorphism, and the same occurred for skin color. However, such measures can help to estimate age. Further studies are suggested with a larger sample, especially for the nutritional status variable.

Facial reconstruction using 3-D computerized method: A scoping review of Methods, current Status, and future developments

Facial reconstruction (otherwise known as facial approximation) is an alternative method that has been widely accepted in forensic anthropological and archaeological circumstances. This method is considered useful for creating the virtual face of a person based on skull remain. Three-dimensional (3-D) traditional facial reconstruction (known as sculpture or manual method) has been recognized for more than a century; however, it was declared to be subjective and required anthropological training. Until recently, with the progression of computational technologies, many studies attempted to develop a more appropriate method, so-called the 3-D computerized facial reconstruction. This method also relied on anatomical knowledge of the face-skull relationship, divided into semi- and automated based computational method. The 3-D computerized facial reconstruction makes it more rapid, more flexible, and more realistic to generate multiple representations of faces. Moreover, new tools and technology are continuously generating fascinating and sound research as well as encouraging multidisciplinary collaboration. This has led to a paradigm shift in the 3-D computerized facial reconstruction to a new finding and new technique based on artificial intelligence in academia. Based on the last 10-years scientific-published documents, this article aims to explain the overview of the 3-D computerized facial reconstruction and progression as well as an issue relating to future directions to encourage further improvement.

The facial soft tissue thickness related facial reconstruction by ultrasonographic imaging: A review

The facial soft tissue thickness is crucial for facial reconstruction. Ultrasound is one method to evaluate facial thickness. There are two main modes of ultrasound that can be used for measurement: A-mode and B-mode. Because of its advantage, B-mode is frequently used in many recent studies. The factors that contribute to the varying results of facial soft tissue thickness are classified as method error and biological factors. The following factors should be considered when designing a study: subject type, subject posture and facial expression, ultrasound machine, ultrasound mode, transducer type, frequency, gel type and application, transducer orientation, landmark selection, and thickness measurement. According to the results of previous research, the main biological factors that likely affected facial thickness are sex, age, body mass index, and ancestry. However, there is still insufficient evidence to conclude how the thickness differs among various methods of measurement and which method produces the best results for facial reconstruction. Future ultrasonographic imaging research associated with facial thickness should determine the accuracy of the facial reconstruction to compare with other techniques and evaluate the gold standard of the facial reconstruction. Furthermore, the standardized landmarks and ultrasonographic imaging of each landmark should be clarified for consistency across the populations.

The development and testing of Thai facial soft tissue thickness data in three-dimensional computerized forensic facial reconstruction

Forensic facial reconstruction is a useful tool to assist the public in recognizing human remains, leading to positive forensic investigation outcomes. To reproduce a virtual face, facial soft tissue thickness is one of the major guidelines to reach the accuracy and reliability for three-dimensional computerized facial reconstruction, a method that is making a significant contribution to improving forensic investigation and identification. This study aimed to develop a facial soft tissue thickness dataset for a Thai population, and test its reliability in the context of facial reconstruction. Three-dimensional facial reconstruction was conducted on four skulls (2 males and 2 females, with ages ranging between 51 to 60 years). Two main tools of three-dimensional computer animation and modeling software-Blender and Autodesk Maya-were used to rebuild the three-dimensional virtual face. The three-dimensional coordinate (x, y, z) cutaneous landmarks on the mesh templates were aligned homologous to the facial soft tissue thickness markers on the three-dimensional skull model. The final three-dimensional virtual face was compared to the target frontal photograph using face pool comparison. Four three-dimensional virtual faces were matched at low to moderate levels, ranging from 30% to 70% accuracy. These results demonstrate that the facial soft tissue thickness database of a Thai population applied in this study could be useful for three-dimensional computerized facial reconstruction purposes.

Relationships between the hard and soft dimensions of the nose in Pan troglodytes and Homo sapiens reveal the positions of the nasal tips of Plio-Pleistocene hominids

By identifying homogeneity in bone and soft tissue covariation patterns in living hominids, it is possible to produce facial approximation methods with interspecies compatibility. These methods may be useful for producing facial approximations of fossil hominids that are more realistic than currently possible. In this study, we conducted an interspecific comparison of the nasomaxillary region in chimpanzees and modern humans with the aim of producing a method for predicting the positions of the nasal tips of Plio-Pleistocene hominids. We addressed this aim by first collecting and performing regression analyses of linear and angular measurements of nasal cavity length and inclination in modern humans (Homo sapiens; n = 72) and chimpanzees (Pan troglodytes; n = 19), and then performing a set of out-of-group tests. The first test was performed on four subjects that belonged to the same genus as the training sample, i.e., Homo (n = 2) and Pan (n = 2), and the second test, which functioned as an interspecies compatibility test, was performed on Pan paniscus (n = 1), Gorilla gorilla (n = 3), Pongo pygmaeus (n = 1), Pongo abelli (n = 1), Symphalangus syndactylus (n = 3), and Papio hamadryas (n = 3). We identified statistically significant correlations in both humans and chimpanzees with slopes that displayed homogeneity of covariation. Prediction formulae combining these data were found to be compatible with humans and chimpanzees as well as all other African great apes, i.e., bonobos and gorillas. The main conclusion that can be drawn from this study is that our set of regression models for approximating the position of the nasal tip are homogenous among humans and African apes, and can thus be reasonably extended to ancestors leading to these clades.

Towards the restoration of ancient hominid craniofacial anatomy: Chimpanzee morphology reveals covariation between craniometrics and facial soft tissue thickness

In modern humans, facial soft tissue thicknesses have been shown to covary with craniometric dimensions. However, to date it has not been confirmed whether these relationships are shared with non-human apes. In this study, we analyze these relationships in chimpanzees (Pan troglodytes) with the aim of producing regression models for approximating facial soft tissue thicknesses in Plio-Pleistocene hominids. Using CT scans of 19 subjects, 637 soft tissue, and 349 craniometric measurements, statistically significant multiple regression models were established for 26 points on the face and head. Examination of regression model validity resulted in minimal differences between observed and predicted soft tissue thickness values. Assessment of interspecies compatibility using a bonobo (Pan paniscus) and modern human subject resulted in minimal differences for the bonobo but large differences for the modern human. These results clearly show that (1) soft tissue thicknesses covary with craniometric dimensions in P. troglodytes, (2) confirms that such covariation is uniformly present in both extant Homo and Pan species, and (3) suggests that chimp-derived regression models have interspecies compatibility with hominids who have similar craniometric dimensions to P. troglodytes. As the craniometric dimensions of early hominids, such as South African australopithecines, are more similar to P. troglodytes than those of H. sapiens, chimpanzee-derived regression models may be used for approximating their craniofacial anatomy. It is hoped that the results of the present study and the reference dataset for facial soft tissue thicknesses of chimpanzees it provides will encourage further research into this topic.

Lip morphology estimation models based on three-dimensional images in a modern adult population from China

Lips are the main part of the lower facial soft tissue and are vital to forensic facial approximation (FFA). Facial soft tissue thickness (FSTT) and linear measurements in three dimensions are used in the quantitative analysis of lip morphology. With most FSTT analysis methods, the surface of soft tissue is unexplicit. Our study aimed to determine FSTT and explore the relationship between the hard and soft tissues of lips in different skeletal occlusions based on cone-beam CT (CBCT) and 3dMD images in a Chinese population. The FSTT of 11 landmarks in CBCT and 29 lip measurements in CBCT and 3dMD of 180 healthy Chinese individuals (90 males, 90 females) between 18 and 30 years were analyzed. The subjects were randomly divided into two groups with different skeletal occlusions distributed equally: 156 subjects in the experimental group to establish the prediction regression formulae of lip morphology and 24 subjects in the test group to assess the accuracy of the formulae. The results indicated that FSTT in the lower lip region varied among different skeletal occlusions. Furthermore, sex discrepancy was noted in the FSTT in midline landmarks and linear measurements. Measurements showing the highest correlation between soft and hard tissues were between total upper lip height and Ns-Pr (0.563 in males, 0.651 in females). The stepwise multiple regression equations were verified to be reliable with an average error of 1.246 mm. The method of combining CBCT with 3dMD provides a new perspective in predicting lip morphology and expands the database for FFA.

Facial soft tissue depth measurements in cone-beam computed tomography: A study of a Brazilian sample

Forensic facial reconstruction (approximation) (FFR) is an aid to human identification when no presumed identity is available. It is based on average soft tissue thickness (STT) applied onto a skull. These averages vary at each landmark according to sex, ancestry, and Facial Growth Patterns (FGP). To obtain the reference, there are different protocols and conditions, such as needles in cadavers, ultrasound, magnetic resonance, and computer tomography. Using cone-beam computed tomography (CBCT), landmark placement and direction of measurement are critical. The purpose of this article is to detailly describe a method for STT measurement in CBCT DICOM files and to test it in the analysis of a multi-ancestral Brazilian sample, subdivided into sex, age and FGP. A sample of 100 (50 male and 50 female) CBCT exams were selected and the volume was primarily been repositioned to cephalometric standards. A detailed description of the location and measurement direction of 32 landmarks was provided and granted good reproducibility of the measurements. The averages were assessed by sex, age, and FGP. There were significant differences between males and females. The CBCT measuring protocol provided standardization of measurements and is a method to be used in future researches. Advantages of CBCT, such as the subject's upright position and adjustable volume positioning, also justify its usage. Limited differences of STT were related to age and FGP. The updated Brazilian soft tissue thickness chart is a reliable source of data for forensic and clinical purposes.

Soft tissue thickness in Brazilian adults of different skeletal classes and facial types: A cone beam CT - Study

The aim in this study was to evaluate the influence of skeletal class, facial type, and sex on soft tissue thickness (STT) of the craniofacial midline in a Brazilian subpopulation. Thus, 121 cone beam computed tomography (CBCT) scans (54 males and 67 females, age 21 to 40 yrs) composed the study sample. Patients were classified according to skeletal class (class I, II, and III) and facial type (brachycephalic, mesocephalic, and dolichocephalic), and STT was measured (mm) in 10 landmarks in the craniofacial midline for each CBCT scan. Multivariate analysis of covariance evaluated facial STT with regard to multiple independent variables (sex, age - covariate, facial type, and skeletal class). TEM and rTEM assessed the intra-examiner agreement. STT was significantly greater in males than in females for all regions measured (p < 0.05), except for the pogonion-pogonion' landmark (p>0.05). In general, class III individuals had significantly thicker soft tissue in the maxilla - subspinale-subnasale', prosthion-labrale superius', and incision-stomion' regions, while class II subjects had thicker soft tissue in the infradentale-labrale inferius' mandibular landmark (p < 0.05). Regarding facial type, dolichocephalic individuals showed significantly thicker soft tissue in the supramentale-supramentale' mandibular landmark, whereas brachycephalic subjects had thicker soft tissue in maxillary regions - prosthion-labrale superius' and incision-stomion' (p < 0.05). rTEM values were below 5% for most landmarks, and all TEM values were below 1 mm. Skeletal class and facial type influence STT, showing a soft tissue compensation, with deeper soft tissue in areas with lower skeletal development, and/or where bone is positioned more posteriorly.