Facial Soft Tissue Thickness Database for Craniofacial Reconstruction in Korean Adults

Abstract: One hundred Korean adults (50 men, 50 women) were scanned in the upright position using a cone‐beam CT (CBCT) scanner. The soft tissue (ST) thicknesses were measured at 31 landmarks, 10 midline and 21 bilateral landmark sites, and the means and standard deviations were obtained for male and female subjects. While 18 of 31 landmarks showed sex differences, the majority showed higher values for male subjects with the exception of a few landmark sites corresponding to the zygoma area, which showed smaller values in men than in women. The mandibular area showed greater differences between the right and left sides. Overall, the ST thickness measurements obtained in this study can be used as a database for the forensic craniofacial reconstruction of Korean adult faces.     

Semi-automated ultrasound facial soft tissue depth registration: method and validation

A mobile and fast, semi-automatic ultrasound (US) system was developed for facial soft tissue depth registration. The system consists of an A-Scan ultrasound device connected to a portable PC with interfacing and controlling software. For 52 cephalometric landmarks, the system was tested for repeatability and accuracy by evaluating intra-observer agreement and comparing ultrasound and CT-scan results on 12 subjects planned for craniofacial surgery, respectively. A paired t-test evaluating repeatability of the ultrasound measurements showed 5.7% (n = 3) of the landmarks being significantly different (p < 0.01). US and CT-scan results showed significant differences (p < 0.01) using a Wilcoxon signed rank test analysis for 11.5% (n = 6) of the landmarks. This is attributed to a difference in the volunteer's head position between lying (CT) and sitting (US). Based on these tests, we conclude that the proposed registration system and measurement protocol allows relatively fast (52 landmarks/20 min), non-invasive, repeatable and accurate acquisition of facial soft tissue depth measurements.     

Evaluation of anthropometric accuracy and reliability using different three-dimensional scanning systems

The aim of this study was to evaluate the accuracy and reliability of standard anthropometric linear measurements made with three different three-dimensional scanning systems namely laser surface scanning (Minolta Vivid 900), cone beam computed tomography (CBCT), 3D stereo-photogrammetry (Di3D system) and to compare them to physical linear measurements. The study sample consisted of seven cadaver heads. The reliability and accuracy were assessed by means of a series of 21 standardized, linear facial measurements derived from 15 landmarks taken both directly on the face with a set of digital callipers and indirectly from a three-dimensional (3D) soft tissue surface models derived from CBCT, laser surface scans and 3D photographs. Statistical analysis for the reliability was done by means of intraclass correlation coefficients (ICCs). Accuracy was determined by means of the absolute error (AE) and absolute percentage error (APE) by comparison of the 3D measurements to the physical anthropometrical measurements. All the 3D scanning systems were proved to be very reliable (ICC>0.923-0.999) when compared to the physical measurements (ICC; 0.964-0.999). Only one CBCT measurement (t-g) and one Di3D measurement (t-sn left) had a mean AE of more than 1.5mm. There are clear potential benefits of using 3D measurements appose to direct measurements in the assessment of facial deformities. Measurements recorded by the three 3D systems appeared to be both sufficiently accurate and reliable enough for research and clinical use.     

Age and sex related measurement of craniofacial soft tissue thickness and nasal profile in the Chinese population

The purpose of this study was to acquire accurate data of craniofacial soft tissue thickness (CFSTT) and nasal profile in Chinese people of Han population. A total of 31 anatomical landmarks and 4 nasal profile parameters were determined using magnetic resonance imaging (MRI) in 425 subjects (233 males and 192 females). In the present study, the mean CFSTT values of male subjects exceeded those of female subjects at most anatomical landmarks except at seven (22.58%) and 6 out of the 7 landmarks were bilateral anatomical landmark points. The age-related and sex × age interactions were found to be statistically significant at all landmarks. Significant differences were found in the nasal profile data of males and females, and 15 out of 20 different groups had significant differences between sexes, and the mean values of nasal length, nasal height, nasal depth and nasal breadth in males were all greater than those in females. Furthermore, both CFSTT and nasal profile showed good correlation with age. The thickest CFSTT of male and female were found at the respective ages of 45-59 and 35-44, and the nasal profile becomes more constant after 24 years of age. CFSTT of the lower part of the face shows greater variation compared to the upper part, so special care needs to be applied when reconstructing the lower portion of the face. Our data on CFSTT and nasal profile for the Chinese Xi'an Han population is important in understanding craniofacial characteristics of the Chinese population and might be potentially helpful in forensic identification.     

In vivo facial tissue depth study of Chinese-American adults in New York City

This study examines facial tissue depth in adult Chinese-Americans. Using ultrasound, measurements were taken at 19 landmarks across the faces of 101 individuals aged from 18 to 87 years. Summary statistics are reported for a sample of 67 individuals of normal weight (as determined by a body mass index [BMI] of 19-25). Statistical analyses were used to assess relationships between tissue thickness, age, and BMI. Results indicate that no significant relationship exists between tissue thickness and age for males, and for only 3/19 points in females. Also, only four points showed significant relationships between tissue thickness and sex. However, significant relationships exist between BMI and tissue thickness at multiple points for both males and females. Compared to other American and Asian populations in the literature, Chinese-Americans generally had thinner facial tissue; though, this difference was not assessed statistically. Finally, data generated in this study will add to the body of knowledge concerning facial tissue depth variation in modern humans.     

四川汉族青少年面部中线软组织厚度的数字X线测量

目的测量四川汉族青少年(8～20岁)人群面部中线软组织厚度,探讨其生长发育变化规律,为法医人类学的面部重建提供的基础数据。方法选取974例(男496,女478)头颅侧位数字X线片,分13个年龄段(8～20岁),选择面部10个标志点的软组织厚度测量,并进行描述性统计学分析。结果四川汉族青少年人群面部10个标志点的中线软组织平均厚度,在青少年阶段大多数测量标志点随年龄增长而增厚;男女性面部中线软组织厚度统计学分析存在性别差异(P<0.05),在15岁之后差异增大,且LLI点显著差异性在9～20岁之间均存在(P<0.01)。结论四川汉族青少年面部中线软组织厚度有随年龄增长而增厚的趋势,男女面部软组织厚度存在性别差异。     

Non-destructive dental-age calculation methods in adults: intra- and inter-observer effects

The aim of the present study was to obtain data on the reliability and reproducibility of two non-destructive dental-age estimation methods in adults by calculating inter- and intra-observer effects. Both a morphological and a radiological technique available in the scientific literature were evaluated on a number of recently extracted teeth: the morphological technique was evaluated on a total of 160 teeth by two examiners, while three examiners applied the radiological technique on apical radiographs of 72 extracted teeth. Paired t-tests were used to calculate intra- and inter-observer differences. For the morphological method, both examiners were able to produce dental-age estimations that did not differ significantly from the real age of the teeth, obtaining a mean error between 0.5 and 1.8 years and a standard deviation of this error between 9.0 and 11.3 years. When using the radiological technique according to the original protocol, all three examiners produced age estimations that were statistically comparable to the real age of the teeth with a mean error of 0.5-2.5 years and a standard deviation of 4.6-9.8 years. For both techniques, intra-observer differences were observed. Based on the results of this study, it can be concluded that both non-destructive dental-age estimation techniques were able to produce reasonably accurate dental-age estimations, at least when these techniques were applied appropriately. However, the forensic odontologist is recommended to use different age estimation techniques and perform repetitive measurements in order to verify the reproducibility of the calculations performed.     

Accuracy of facial soft tissue thickness measurements in personal computer-based multiplanar reconstructed computed tomographic images

The purpose of this study was to determine the precision and accuracy of facial soft tissue measurement using personal computer (PC)-based multiplanar reconstructed (MPR) computed tomography (CT) images and to evaluate the effect of the various CT scanning protocols on the facial soft tissue thickness measurement. Thirteen different CT imaging protocols were used to image a cadaver head. MPR reformations and three-dimensional (3D) reconstructions viewed on a laptop PC were used to make measurements at six specific sites on each set of images. These measurements were compared to physical measurements at the same sites. Increasing the slice thickness resulted in decreased image quality. Within the same slice thickness, increasing the pitch ratio in the spiral mode, resulted in decreasing image quality. The image quality of conventional CT scanning was relatively poorer than that of the spiral CT scanning. However, the mean deviation from the physical measurement was within 0.43 mm in every instance. This mean deviation was quite small and clinically acceptable for measuring the soft tissue thickness of the facial area. PC-based MPR CT images of the face using routine scanning CT protocols can be used to accurately measure soft tissue thickness in the facial region. However, for more fine and accurate data collection, scanning protocols with slice thicknesses less than 5mm, and a spiral/helical mode pitch less than 2:1 are recommended.     

Variability of bodily measures of normally dressed people using PhotoModeler Pro 5

Photogrammetry is used in forensic science to help identify perpetrators from crime scenes by way of surveillance video, but the reproducibility of manually locating hidden body-points such as the joints remains to be established. In this study, we quantified the inter- and intra-observer variability of bodily measures of clothed individuals in two different poses and examined whether body segment lengths could be used to distinguish between people of similar stature. Stature was reproduced within +/-1.5 cm in both the intra- and inter-observer study. Segment lengths were best reproduced when flexion in the joints was present in the intra-observer study, but only the length of the trunk could be used to distinguish between people of similar height. The reproducibility between the two poses was low. Other measures than stature should be used with caution and with the perpetrator and suspect in the same pose. Consistent guidelines for locating body-points should be developed.     

Relationship Between Pulp Tooth Area Ratio and Chronological Age Using Cone‐beam Computed Tomography Images

This study investigated the relationship between chronological age and pulp tooth area ratio (PTR) in maxillary central teeth using cone‐beam computed tomography (CBCT) images in the Turkish population. The sample consisted of CBCT images of 120 male and female subjects between 14 and 75 years old. The PTR of the maxillary central teeth was calculated using inVivo 5 software (Anatomage, San Jose, CA). Data were analyzed with independent t‐test and Pearson's rank correlation test. There was a significant negative correlation between chronological age and PTR (r = ?0.615). The results showed that the PTR of maxillary central teeth is a reliable method for age estimation in the Turkish population.     

Measurements of the Foramen Magnum and Mandible in Relation to Sex Using CBCT

The purpose of this study was to evaluate pre‐existing CBCT images of a large sample of adult females and males to provide data on foramen magnum and mandibular measures of sexual dimorphism for use as a reference sample in cases of establishing identity in unknown fragmentary skulls. The study group consisted of 161 adult patients. 3D images of the patients were assessed retrospectively. FM measurements were obtained from reformatted axial sections. Six mandibular measurements were taken. According to the results, the study identified four mandibular measurements as final predictors of sex which are as follows: the gonial angle (G‐angle) and ramus length (Ramus‐L), gonion–gnathion length (G–G‐L) and bigonial breadth (BG‐Br). It was found that the cross‐validated grouped overall predictive accuracy was 83.2% for FM and mandible measurements. It could correctly identify males in 77.3% and females in 87.4% of the cases. To assess sexual dimorphism, the gonial angle and ramus, gonion–gnathion lengths, and bigonial breadth of the mandible and sagittal diameter of the FM may be used on CBCT images.     

Development and Validation of a Technique for Casting Anatomical Features and Toolmarks

Time may elapse between examination of marks inflicted on the body and comparison with a potential weapon. Two‐dimensional photographs may be inadequate for effective comparison of a three‐dimensional mark with a putative instrument. Taking a cast and producing a positive image results in a lasting three‐dimensional record. This project aimed to develop and demonstrate the accuracy of an easy technique for production of long‐lasting positive images (using plaster of Paris and dental alginate). Casts of facial features of embalmed cadavers were used to produce a positive image of the face (death mask). Measurements of distances between facial anatomical landmarks were compared with measurements of distances between the same landmarks on the death masks to assess accuracy of reproduction. There were no significant differences between cadaver and death mask in 6 of 9 measurements, indicating this technique has high accuracy with less mobile facial features, but produces deformation of pliable features.     

Age, sex and body mass index in relation to calvarial diploe thickness and craniometric data on MRI

It might be critical to determine sex, body mass and age of the individual from skull in forensic medicine and anthropology. Our purpose in this study was to evaluate whether a relationship existed between the diploeic bone thickness measured from glabella, bregma, lambda, opisthocranion, and euryon regions and sex, age and body mass index of the individual. Glabella-opisthocranion, vertex-basion, euryon-euryon, basion-opisthion length were also determined for the same purpose. The anthropological landmarks were determined on sagittal and axial T1-weighted sequences and measurements were obtained on a workstation by two radiologists. A total of 107 subjects (F/M:59/48; mean age: 45.05+/-15.28, age range: 21-81) were included in the study. The mean body mass index was 25.51+/-4.44 [17.50-41]. There was a statistically significant linear correlation between age and diploe thickness from glabella, bregma, lambda, opisthocranion, right and left euryon. There was sexual dimorphism in all craniometric data including the distance between glabella-opisthocranion, vertex-basion, euryon-euryon, basion-opisthion, and calvarial volume. There was a statistically significant linear correlation between body mass index and basion-opisthion length. The diploe thicknesses from certain points of the calvarium are statistically related to each other. A standard cerebral MRI examination would be sufficient to obtain anthropological landmarks and craniometric data. According to this study, it might be possible to identify age, sex and body mass index of the individual from diploeic thickness and craniometric data.     

Sexual Dimorphism of Maxillary Sinus Dimensions Using Cone‐Beam Computed Tomography

Sex determination of unknown persons plays an important role in forensic medicine. Cone‐beam computed tomography (CBCT) is an excellent imaging modality for accurate measurement of maxillary sinus dimensions. This study aimed to evaluate whether maxillary sinus measurements on CBCT scans can be applied for sex determination. The width, length, and height of maxillary sinuses in CBCT images of 100 patients (50 males and 50 females) were measured. Student's t‐test and discriminant function analysis were used to compare differences in the measured parameters between males and females. The correct predictive accuracy rate of sex determination was 78% in females and 74% in males with overall accuracy of 76%. Based on discriminant analysis, the most pronounced variable in differentiation of sex groups was maxillary sinus height. This study suggests that maxillary sinus measurements can be valuable for sex determination in forensic investigation, especially for cases in which other traditional methods are not applicable.     

Testing repeatability and error of coordinate landmark data acquired from crania

This study evaluates issues of precision, repeatability, and validation in three-dimensional (3D) landmark coordinates. Two observers collected 19 homologous cranial landmarks from three skulls during three separate digitizing sessions. Statistical analysis was conducted on the 171 interlandmark distances (ILDs) derived from the original coordinate data. A mixed model ANOVA detected significant within-subject error in 54 of the 171 ILDs (i.e., 32%). A GLM procedure revealed significant between-observer variation in 14 ILDs and significant observer-by-session differences in 13 ILDs. The majority of these differences involved ILDs with type 3 landmarks as endpoints, such as euryon and alare. Unlike type 1 and 2 landmarks which are biologically informative in all directions, type 3 landmarks contain a substantial arbitrary component. Thus, it is not surprising type 3 landmarks displayed significant digitizing error. Given these results, we caution researchers to be mindful of type 3 landmarks measurement discrepancies when selecting landmarks for coordinate data evaluation.     

Facial soft tissue thickness in northwest Indian adults

In order to reconstruct the face from a bare skull, the facial soft tissue thickness (FSTT) was determined at 29 standard anthropological landmarks by magnetic resonance imaging (MRI) in 173 male and 127 female adult subjects of northwest Indian origin. Repeatability and accuracy of the measurements was assessed by paired t-test and 95% confidence intervals. A stepwise discriminant function analysis selected nine landmarks for better sex classification in FSTT measurements. The thickness of soft tissue was different from that described in the literature and reported for samples from other countries. A correlation between skinfold thickness and body mass index (BMI) with that of FSTT was observed. The data of facial soft tissue thickness will help forensic experts in reconstructing the face from a skull for identification purposes.     

Investigation into the use of photoanthropometry in facial image comparison

Photoanthropometry is a metric based facial image comparison technique. Measurements of the face are taken from an image using predetermined facial landmarks. Measurements are then converted to proportionality indices (PIs) and compared to PIs from another facial image. Photoanthropometry has been presented as a facial image comparison technique in UK courts for over 15 years. It is generally accepted that extrinsic factors (e.g. orientation of the head, camera angle and distance from the camera) can cause discrepancies in anthropometric measurements of the face from photographs. However there has been limited empirical research into quantifying the influence of such variables. The aim of this study was to determine the reliability of photoanthropometric measurements between different images of the same individual taken with different angulations of the camera. The study examined the facial measurements of 25 individuals from high resolution photographs, taken at different horizontal and vertical camera angles in a controlled environment. Results show that the degree of variability in facial measurements of the same individual due to variations in camera angle can be as great as the variability of facial measurements between different individuals. Results suggest that photoanthropometric facial comparison, as it is currently practiced, is unsuitable for elimination purposes. Preliminary investigations into the effects of distance from camera and image resolution in poor quality images suggest that such images are not an accurate representation of an individuals face, however further work is required.