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Ultrasonic assessment of facial soft tissue thicknesses in adult Egyptians
Forensic Science International 117 (2001) 99±107
Ultrasonic assessment of facial soft tissue thicknesses in adult Egyptians Inas Hassan El-Mehallawi*, Eman Mostafa Soliman Forensic Medicine and Clinical Toxicology Department, Faculty of Medicine, Tanta University, Tanta, Egypt Received 2 May 2000; accepted 2 October 2000
Abstract The production of a three-dimensional plastic face on an unknown human skull has been practiced sporadically since the latter part of the last century. In recent years, the technique has been revived and applied to forensic science cases. The morphometric method of forensic facial reconstruction rests heavily on the use of facial soft tissue depth measurements. Moreover, it has been established that measurements made on the living are of more value than those made on the dead. In view of the well-known genetic complexities of the Egyptians, and the lack of knowledge of average facial soft tissue depths of the Egyptians that makes facial reconstruction questionable, it was decided to set up a table of norms for facial tissue thicknesses in 204 adult Egyptians aged 20±35 years. Tissue depths at 17 established landmarks (according to Aulsebrook et al. [Forensic Sci. Int. 79 (1996) 83]) were obtained using ultrasonic probing. The study revealed a unique spectrum of measurements for the Egyptians that might be useful for facial reconstruction purposes with obvious sexual dimorphism in facial soft tissue thickness. Additionally, the study provided evidence for the presence of interpopulation differences in average facial soft tissue thicknesses as evidenced from the comparison of the present data of Egyptians with those previously reported for some other populations. # 2001 Elsevier Science Ireland Ltd. All rights reserved. Keywords: Forensic; Facial reconstruction; Soft-tissue thickness; Identi®cation
1. Introduction The face is the most important part of our features because of the role it plays in communication [1]. Forensic facial reconstruction is the scienti®c art of visualizing a face on the skull for personal identi®cation [2]. It is generally accepted that facial reconstruction can be divided into four categories: (1) replacing and repositioning damaged or distorted soft tissues on to a skull; (2) the use of photographic transparencies and *
Corresponding author. Tel.: 20-040-3346283; fax: 20-040-3331800. E-mail address: [email protected] (I.H. El-Mehallawi).
drawings in an identikit-type system; (3) the technique of graphic, photographic or video superimposition; (4) plastic or three dimensional reconstruction of a face over a skull using modeling clay [3]. There are two basic methods of modeling the face: a morphoscopic method using an ``anatomical approach'' of reconstructing the musculature, fat and skin [4] and a morphometric method which rests heavily on the use of average facial soft tissue depth measurements that have been gathered by previous researchers over various anatomical sites of the skull and jaws [5,6]. Facial soft tissue measurements of some races were carried out on cadaver material using the needle depth probing method. However, the accuracy of these
0379-0738/01/$ ± see front matter # 2001 Elsevier Science Ireland Ltd. All rights reserved. PII: S 0 3 7 9 - 0 7 3 8 ( 0 0 ) 0 0 4 5 3 - 9
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I.H. El-Mehallawi, E.M. Soliman / Forensic Science International 117 (2001) 99±107
measurements is questionable and has an inherent error as the degree of dehydration of human soft tissue is marked during the initial stages of death [7]. As results obtained from the measurement of live tissues are more feasible and applicable in the construction of faces, many other methods have been employed including lateral cephalometric radiographs [8], computed tomographic scanning (CT) ultrasonics (US) and magnetic resonance image (MRI) [9±11]. More recently, a combination of video and laser equipment has allowed 2000 measurements to be taken and stored within 30 s. The data from an unknown skull are then electronically ``clothed'' within standard soft tissue from the memory bank and modi®ed on screen to produce various images [12]. Most of the previous methods for determining of soft tissue thickness have disadvantages of potential radiation hazards and limitation to use [13]. Moreover, the use of MRI and CT scanning are as accurate as that of ultrasonic for measuring soft tissue depth but are relatively expensive procedures and are not freely available. It has been reported that the average individual rarely maintains a constant weight and is therefore dif®cult to collect subjects with constant weight to height ratio. A small variation in weight is generally dispersed throughout the body and does not necessarily re¯ect in the face. The factors constituting likeness are more dependent on proportions than on ®nite measurements and so are not destroyed by a small variation in weight [3]. It has been emphasized that all available data should be evaluated to ®nd standards that are valid for speci®c ethnic groups [14]. As shown by Table 1 not all major racial groups of man are represented and the numbers of most of these samples are so small as to be of questionable statistical validity. It has been reported that studying subjects taken from a wide range of ethnic background, ages and states of health, further compounds the dif®culty of setting up basic norms for soft tissue depths. Studies of this type should restrict subject selection narrow parameters of age, ethnicity and health [3]. To our knowledge no information exists of the soft tissue thickness of the faces of Egyptian people and this lack of information makes facial reconstruction of them questionable. The aim of this study was to compile a set of soft tissue depth norms for the
Egyptians for the purpose of face reproductions and to compare the results with those previously reported for other populations. 2. Subjects and methods The sample comprised 204 Egyptian volunteers (120 males and 84 females) ranging in age from 20 to 35 years (mean 28:5 3:8) and in good health. As far as could be ascertained all were representative of the Egyptian nationality. After obtaining informed consent, the subjects were questioned to exclude those with anything that could affect the normal weight such as chronic infections, diabetes or renal disease. All subjects were examined. Those with facial fractures, swellings, malformations, distortions and asymmetries of the face were excluded from the study. Other reasons for exclusion were those subjects having missing anterior teeth or those who were edentulous. These states produce an altered lip support and a disturbed vertical dimension, respectively. The subjects were weighed and measured for height. To ensure average body weight, body mass index was calculated according to the equation: Body mass index (BMI weight (in kilograms) divided by height (in meters) squared [23]. As the optimal BMI of the selected age group (20± 35 years) varies between 19 and 25 [23]. Selection of subjects was limited to those people differing by less than 10% on either side of the stipulated average ratio [3]. The diagnostic ultrasound equipment used was Dornier 5200 S using 7.5 MHz transducer. The transducer was applied to the chosen points without pressure and soft tissue thicknesses in these points were recorded. According to Aulsebrook et al. [3] the sites chosen as landmarks for ultrasonic probing should conform to a set of requirements. They should (1) where possible, be similar to those used by other workers to ensure comparability; (2) be the same marks for all subjects; (3) be positioned over ¯at bone where possible; (4) be planned to lie at summits of prominences like glabella and angle of jaw or in depressions and folds such as the soft nasion or nasolabial fold. Certain anatomic bulges and grooves are common to all faces. In front view, the features of the face can
Reference
Date
Number of points
Welcker [15] His [16] Kollmann and Buchly [17] Birkner [18] Fischer [19] Von Eggeling [20] Stadtmuller [21] Suzuki [22] Rhine and Campbell [5] Aulsebrook et al. [3]
1883 1895 1898 1905 1905 1909 1923±25 1948 1980 1996
9 15 18 18 18 18 20 23 31 LR16a OR20b US18c
Phillips and Smuts [6] Present study Totals
1996 1998 ±
21 17 ±
a
LR: lateral cephalometric radiographs. OR: oblique cephalometric radiographs. c US: ultrasonic landmarks. b
Male Female Total White Mongoloid
Black
Egyptian
Zulu
Mixed
Methods Tissue puncture by using needle Tissue puncture by using needle Tissue puncture by using needle Tissue puncture by using needle Tissue puncture by using needle Tissue puncture by using needle Tissue puncture by using needle Tissue puncture by using needle Tissue puncture by using needle Lateral, oblique cephalometry ultrasound Computerized tomography Ultrasound ±
13 24 21 6 2 3 15 48 68 55
± 4 4 ± ± ± 3 7 23 ±
13 28 25 6 2 3 18 55 91 55
13 28 25 ± ± ± 2 ± 32 ±
± ± ± 6 2 ± 14 55 ± ±
± ± ± ± ± 3 2 ± 59 ±
± ± ± ± ± ± ± ± ± ±
± ± ± ± ± ± ± ± ± 55
± ± ± ± ± ± ± ± ± ±
16 120 391
16 84 141
32 204 532
± ± 100
± ± 77
± ± 64
± 204 204
± ± 55
32 ± 32
I.H. El-Mehallawi, E.M. Soliman / Forensic Science International 117 (2001) 99±107
Table 1 Subjects of facial soft tissue thickness studies
101
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I.H. El-Mehallawi, E.M. Soliman / Forensic Science International 117 (2001) 99±107
Independent sample student t-test (sample mean versus population mean): t
X sample mean ÿ U population mean S:E: standard error of the sample
3. Results
Fig. 1. Surface contours that determine landmark selection. (1) Forehead; (2) nose; (3) lips; (4) chin; (5) eyes; (6) cheek (upper hard cheek and lower soft cheek); (7) temple; (8) jaw; (9) ear (according to Aulsebrook et al. [3]).
be clearly demarcated as (1) forehead (2) nose (3) lips (4) chin (5) eyes (6) cheek (upper hard cheek and lower soft cheek) (7) temple (8) jaw (9) ear (Fig. 1). Thus, according to Aulsebrook et al. [3] selection of 17 ultrasonic landmarks on the face where determined in this study in view of the surface contours of the face (Table 2, Fig. 2). For comparison of soft tissue thickness of Egyptians with other ethnic populations the average facial tissue thickness for each morphologic area and the standard deviation was calculated and compared to its corresponding in the results of Aulsebrook et al. [3] for the purely African Negroids (Zulu; who have remained free from genetic admixture with other populations), Phillips and Smuts [6] for South Africans of mixed racial origins, Rhine and Campbell [5] for Caucasoids White and Black Americans and Suzuki [22] for Japanese. Statistical presentation and analysis of the present study was conducted using the range, mean, standard deviation, standard error and independent sample student t-tests [24]. Independent sample student t-test (two sample means): X1 ÿ X2 t q S:E:21 S:E:22
From the ultrasonic measurements of facial soft tissue thickness of 204 Egyptian subjects, a set of mean depth values was obtained for 17 Landmarks on the face. Maximum thickness in soft tissue depth was obtained in the mid-masseteric point (US12; males 13 1:66, females 15:05 1:75), in the cheek region. While the thinnest tissue depth was obtained in the infra-orbital point (US5; males 4:17 0:64, females 4:31 0:46) and in the frontal point (US1, males 4:18 0:75, females 4:24 0:49, Table 3). Moreover, the Egyptian female face showed greater thickness in the supra-orbital (US3), mid-zygoma (US6), philtrum ridge (US8), supra-labial (US9), mid-masseteric (US12), sub-Labial (US13), sub-commissural (US14), mental tubercle anterior and lateral (US15 and US16) and insertion masseteric anterior and posterior (US17 and US18) than their corresponding locations in the male Egyptians (t 4:35, 3.77, 5.5, 10.97, 8.49, 6.20, 18.16, 19.41, 8.68, 9.73 and 6.83; P < 0:001, respectively. See Table 3). Table 4 compares Aulsebrook's data [3] on Zulu population (Negroid races), Phillips and Smuts' data on mixed races of South Africans [6], Rhine and Campbell's data on American Black and White subjects [5] and Suzuki's data on Japanese [22] with the present data on Egyptian subjects of both sexes. In the forehead region, the Egyptian male subjects exhibited the lowest tissue thickness as compared to male subjects from other populations (Zulu Negroid, mixed races and Black Americans). The same ®nding was observed in the female Egyptians with a slight difference where they have signi®cantly thicker forehead than the white female Americans. In the eye region, the mean soft tissue thickness in supra-orbital point (US3) in the Egyptian subjects (males 5.13 mm 0:94, females 5.69 mm 0:85) were intermediate between each of the male Zulu, mixed races of South Africans, White Americans and
I.H. El-Mehallawi, E.M. Soliman / Forensic Science International 117 (2001) 99±107
103
Table 2 Ultrasonic landmarks (according to Aulsebrook et al. [3]) Region
Code
Landmarks
Description
Forehead
US1
Frontal
Eye
US2
Lateral glabella
Eye
US3
Supra-orbital
Eye
US5
Infra-orbital
Cheek
US6
Mid-zygomatic
Cheek
US7
Root of zygoma
Lips
US8
Philtrum ridge
Lips
US9
Supra-labial
Lips
US10
Supra-commissural
Lips
US11
Commissural
Cheek
US12
Mid-masseteric
Lips Lips Chin Chin
US13 US14 US15 US16
Sub-labial Sub-commissural Mental tubercle, anterior Mental tubercle, lateral
Cheek
US17
Jaw
US18
Insertion of masseter, ant. (antero-masseteric) Insertion of masseter, post. (postero-masseteric)
A point on the forehead in a vertical line with the pupil of the eye and on the same horizontal level at the deepest point in the depression between the frontal eminence and the maximum curve of the supraorbital margin A point on the soft tissue supraorbital ridge on a vertical line with the inner canthus of the eye A point on the soft tissue supraorbital ridge in vertical alignment with the pupil of the eye This point is located after palpation of the lower bony orbital margin. It is on the flat plane lying just below the lower rim of the eye socket and is in vertical alignment with the pupil of the eye A point overlying the bony zygion, on the maximum horizontal and vertical outer curvature of the zygomatic arch A point on the skin surface immediately above the mandibular condyle and superficial to the posterior root of the zygoma A point on the lateral ridge of the philtrum mid-way between the base of the columella and upper lip margin Over the maximum bulge of the canine eminence mid-way between the angle of the mouth and the root of the alar cartilage A point on a horizontal level with US9 and on a vertical line with US11. It is positioned over the root of the first premolar A point on a horizontal level with the cheilion and immediately posterior to the commissural bulge. It is frequently superficial to the crown of the first premolar A point on the skin surface lying over the center of an area bounded by the lower borders of the zygomatic arch and mandible, the anterior fibers of the masseter and the posterior border of the ascending ramus A point within the labiomental crease in vertical alignment with US9 A point in a vertical line with US10 lying on a horizontal level with US13 The most prominent point on the lateral bulge of the chin mound A point posterior to US15 above, on the same horizontal level and in vertical alignment with US10 and US14 Determined by palpation, this point lies at the anterior edge of the insertion of the masseter muscle into the mandible This point lies at the lower and posterior edge of the insertion of masseter into the mandible, just anterior to the gonion
Japanese populations with statistically signi®cant differences (P 0:05). Similarly, the mean soft tissue thickness in the infra-orbital point (US5) in the Egyptians (males 4.17 mm 0:64, females 4.31 mm 0:46) were intermediate between each of the male Zulu, the mixed races of South Africans, the Black and White Americans and the Japanese populations (Table 4). In the cheek region, the mid-masseteric point (US12) showed thinner soft tissue thickness in the male Egyptians (13 mm 1:66) than the male Zulu, the Black and White Americans and Japanese. While in the female Egyptians (15.05 mm 1:75), it was
thicker than those of the female mixed racial South Africans and Japanese and thinner than Black and White female Americans with statistically signi®cant differences (P 0:05, Table 4). In the lip region, all the tissue thicknesses in the Egyptians; philtrum ridge (US8; males 7.13 mm 0:53, females 7.69 mm 0:92), supra-labial (US9; males 5.79 mm 0:59, females 6.73 mm 0:62), supra-commissural (US10; males 9.33 mm 1:16, females 9.19 mm 1:16), sub-labial (US13; males 7.55 mm 0:62, females 8.21 mm 0:9) and subcommissural (US14; males 8.6 mm 0:76, females 11.16 mm 1:25) were signi®cantly less than their
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I.H. El-Mehallawi, E.M. Soliman / Forensic Science International 117 (2001) 99±107
Fig. 2. Ultrasonic landmarks on the face. These are located on vertical meridia and horizontal parallels and should be viewed in relation to Fig. 1 (according to Aulsebrook et al. [3]).
correspondings in the other compared studies (Table 4). In the chin region, the mean soft tissue thickness at the mental tubercle anterior (US15) was thinner in the male (5.47 mm 0:43) and female (7.29 mm 0:89) Egyptians than the male Zulu, male and female mixed
racial South Africans, Black and White Americans and the male Japanese. While the female Egyptians had thicker soft tissue thickness than the female Japanese. Similarly, tissue thickness at the mental tubercle lateral (US16) were thinner in the male Egyptians compared to male Zulu (P 0:05, Table 4). In the jaw region, the mean soft tissue thickness at the point of insertion masseteric posterior (US18) was signi®cantly less in the male Egyptians (11.65 mm 1:73) than the male Zulu, the mixed racial South Africans and the Black Americans, while it was thicker than the male Japanese (P 0:05, Table 4). Similarly, the mean soft tissue thickness in the jaw (insertion masseteric posterior, US18) of female Egyptians (13.14 mm 1:2) was thinner than the female Black Americans, while it was thicker than the female White Americans and the female Japanese (Table 4). 4. Discussion Over the years, many approaches have been taken in attempts to make an identi®cation from the skull [25]. One of these, three dimensional forensic facial reconstruction is the rebuilding of the soft tissues of the face
Table 3 Ultrasonic measurements of Egyptian facial soft tissue thickness (mm) Code
US1 US2 US3 US4 US5 US6 US7 US8 US9 US10 US11 US12 US13 US14 US15 US16 US17 US18 a
Landmarks
Frontal Lateral glabellar Supra orbital Lateral nasal Infra orbital Mid zygoma Root of zygoma Philtrum ridge Supra-labial Supra commissural Commissural Mid-masseteric Sub-labial Sub-commissural Mental tubercle ant Mental tubercle lat Insertion of masseteric anterior Insertion of masseteric posterior Signi®cant at P 0:05.
Male n 120
Female n 84
Min
Max
Mean
S.D.
Min
Max
Mean
S.D.
3 4.2 3.4 ± 3.3 5 4.2 6 4.8 7.4 9.2 10 6.5 7 4.4 4.7 5.9 9.4
5.6 6.8 7.1 ± 5.4 7.8 7.1 7.9 6.7 11 13 16 8.6 9.7 6.2 8.5 8.6 15
4.18 5.31 5.13 ± 4.17 6.46 5.75 7.13 5.79 9.33 10.55 13.00 7.55 8.60 5.47 6.78 7.19 11.65
0.75 0.81 0.94 ± 0.64 0.81 0.90 0.53 0.59 1.16 1.23 1.66 0.62 0.76 0.43 1.20 0.94 1.73
3.5 4 4.5 ± 3.6 6.1 5.4 6.6 5.8 7.6 9.4 13 7 9.7 6.2 7.1 7.3 11
5 6.6 7.2 ± 5 7.8 6.7 9.4 7.8 11 13 18 9.3 14 9 8.8 15 15
4.24 5.70 5.69 ± 4.31 6.83 6.07 7.69 6.73 9.19 10.81 15.05 8.21 11.16 7.29 8.00 8.52 13.14
0.49 0.75 0.85 ± 0.46 0.47 0.42 0.92 0.62 1.16 1.06 1.75 0.90 1.25 0.89 0.56 0.99 1.20
t
P
0.64 3.49 4.35 ± 1.72 3.77 3.03 5.50 10.97 0.85 1.57 8.49 6.20 18.16 19.41 8.68 9.73 6.83
>0.05 <0.001a <0.001a ± >0.05 <0.001a <0.001a <0.001a <0.001a >0.05 >0.05 <0.001a <0.001a <0.001a <0.001a <0.001a <0.001a <0.001a
Table 4 Comparisons of facial soft tissue thickness (mm) between Egyptians and other populations
Lateral glabellar Supra orbital Lateral nasal Infra orbital Mid zygoma Root of zygoma Philtrum ridge Supra-labial Supra commissural
Commissural
Mid-masseteric Sub-labial Sub-commissural Mental tubercle ant Mental tubercle lat Insertion of masseteric anterior Insertion of masseteric posterior a
Present study, n 204
Aulsebrook et al. [3]; n 55
Phillips and Smuts [6]; n 32
Rhine and Campbell [5]; n 91
Point
Egypt Egypt (M); n (F); n 120 84
Point
Zulu (M); n 55
Zulu (F)
Pointa
Pointb
US1 US2 US3 US4 US5 US6 US7 US8 US9 US10 US11 US12 US13 US14 US15 US16 US17
4.18 5.31 5.13 ± 4.17 6.46 5.75 7.13 5.79 9.33 10.55 13.00 7.55 8.60 5.47 6.78 7.19
4.24 5.70 5.69 ± 4.31 6.83 6.07 7.69 6.73 9.19 10.81 15.05 8.21 11.16 7.29 8.00 8.52
US1 US2 US3 US4 US5 US6 US7 US8 US9 US10 US11 US12 US13 US14 US15 US16 US17
4.79d 5.53 6.05d 4.80 6.56d 7.02d 5.91 9.79d 9.52d 12.64d 13.70d 18.05d 10.30d 11.54d 8.99d 8.61d 9.47d
± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ±
11
4.51d
4.78d
11
8.75d
8.00d
4.25
3.50d
±
±
±
12
5.46d
5.79
12
4.75d
4.50d
8.25d
7d
se
4.50d
3.60d
13 15 17 5
5.97d 7.54d 9.10d 12.25d
6.42d 8.25d 8.44d 10.13d
13 15 17 5
7.75d 13.25d 11.75d 12.25d
8.25d 12.75d 12.25d 11.25d
5.75d 10.0d 8.50d 10.00d
6.00d 10.75d 8.00d 8.50d
or ma ± ±
3.70d 5.40d ± ±
3.00d 4.70d ± ±
21 8
12.68 12.02d
12.99d 11.70d
21 8
22.00d 12.00d
21.25d 12.00d
19.50d 10.75d
19.25d 9.50d
m1 ml
14.50d 10.50d
12.30d 8.50
9
8.94d
9.57d
9
12.25d
12.25d
11.25d
10.00d
pg
6.20d
5.30d
US18
11.65
13.14
US18
15.38d
±
19
14.20d
19
14.75d
14.25d
11.50
12.00d
go
6.80d
4.00d
Mixed (M); n 16
Mixed (F); n 16
13.50
Blk (M); Blk (F); n 44 n 15
Locations of facial tissue measurements according to the method of Phillips and Smuts [6] and corresponding to the present study. Locations of facial tissue measurements according to the method of Rhine and Campbell [5] and corresponding to the present study. c Locations of facial tissue measurements according to the method of Suzuki [22] and corresponding to the present study. d Signi®cant compared to the present study at P 0:05. b
White (M); n 24
Suzuki [22]; n 55 White (F); n 8
Pointc
Japanese (M); n 48
Japanese (F); n 7
106
I.H. El-Mehallawi, E.M. Soliman / Forensic Science International 117 (2001) 99±107
for an unknown skull in an attempt to reproduce the likeness of its previous owner for the purposes of identi®cation. It is well established that, if a system for predicting the likeness of an individuals is to be effective, it should be developed from genetically related peoples [3]. The present study has obtained a set of average facial soft tissue measurements for the living healthy adult Egyptians (20±35 years) using ultrasonography. The study revealed a unique spectrum of measurements for the Egyptians with tissue thickness is greatest in the mid-masseteric point and lowest in the infraorbital and frontal points. Moreover, the present study provided evidence of a notable sexual dimorphism in facial soft tissue thickness among Egyptians. However, opposite to most of the previous studies [5,22] there was signi®cantly greater thickness in the female Egyptian facial soft tissues compared to the males' especially in the eye (supra-orbital), cheek, lip, chin and jaw regions. In agreement with our ®ndings, Phillips and Smuts [6] in their study on mixed racial population recorded thicker thickness in the female faces compared to the males in some regions (forehead, eye and cheek regions). On the other hand, the present study proved the presence of interpopulation differences in the facial soft tissue thickness as evident from the average measurements in the Egyptian sample when compared with those of other ethnic groups including the African Negroids; Zulu [3] mixed racial population of South Africans; Caucasian, Negroid, Khoi and San [6], Black and White Americans [5] and Mongoloids; Japanese [22]. In most of the recorded measurements at the forehead, eye, cheek and jaw regions, the Egyptians soft tissue thicknesses were signi®cantly less than the Negroid Zulu, Black and White Americans and the mixed racial South Africans, while they were thicker than the Mongoloid Japanese in all regions except the lip and chin regions. It must be remembered that the current methods of reproduction of faces operate from average ®gures of depth measurements. Indeed, the restorer may look on the average tissue thickness as guides and the skull as a pattern from which to emphasize the idiosyncrasies inherent in the skull. This requires that a very careful analysis of the skull from which the peculiarities and
idiosyncrasies are extracted must precede any application of tiny islands of clay, of average depth, to produce a large topological surface with a highly unique shape. Thereafter, the intervening modeling is applied by feel ideally by professional researchers with years of study and sculptural expertise. On the occasion of introducing the computer system in the facial reconstruction method, it is essential to establish supplements of anatomical and anthropometrical criteria and reliable standard data bases of facial components and soft tissue thickness. When these tasks are ful®lled, computed aided facial reconstruction will increase the chance of positive identi®cation from unknown skull [2]. After all it is the appearance of the live person that remains in the memories of those who will be asked to view the facial reconstruction. 5. Conclusion Finally, it is to be realized that Egyptian faces have unique spectrum of soft tissue thickness. As there has been no comparable study in this concern, the results obtained from this study might be representative of the facial tissue thickness of the Egyptian population group for facial reconstruction purposes till analysis of larger population sample is accomplished. Acknowledgements The authors would like to thank Dr. K. El. Shafey, Lecturer of Radiology, Tanta University for his valuable assistance in obtaining ultrasonographic measurements for the subjects of the present study.
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I.H. El-Mehallawi, E.M. Soliman / Forensic Science International 117 (2001) 99±107 [5] J.S. Rhine, H.R. Campbell, Thickness of facial tissues in American Blacks, J. Forensic Sci. 24 (4) (1980) 847±858. [6] V.M. Phillips, N.A. Smuts, Facial reconstruction: utilization of computerized tomography to measure facial tissue thickness in a mixed racial population, Forensic Sci. Int. 83 (1996) 51±59. [7] R.G. Schwar, J.D. Loubser, H.A. Oliver, The Forensic ABC in Medical Practice: A Practical Guide, Haum, Pretoria, 1987, pp. 427±437. [8] R.M. George, The lateral craniographic method of facial reconstruction, J. Forensic Sci. 32 (1987) 1305±1330. [9] G.W. Cole, S.J. Handler, K. Burnett, The ultrasonic evaluation of skin thickness in scleroderma, J. Clin. Ultrasound. 9 (1981) 501±503. [10] E.W. Lam, A.G. Hannam, W.W. Wood, J.S. Fache, W. Watanabe, Imaging orofacial tissues by magnetic resonance, Oral Surg. Oral Pathol. 68 (1989) 2±8. [11] G.V. Lebedinskaya, T.S. Balueva, V.S. Vaselovaskaya, Principles of facial reconstruction, in: M.Y. Iscan, R.P. Helmer (Eds.), Forensic Analysis of the Skull: Craniofacial Analysis, Reconstruction and Identi®cation, Wiley, New York, 1993, pp. 183±198. [12] B. Knight, The establishment of identity of human remains, in: E. Arnold (Ed.), Forensic Pathology, A Division of Hodder and Stoughton London, Melbourne, Auckland, 1991, pp. 121± 122. [13] H. Alexander, D.L. Miller, Determining skin thickness with pulsed ultrasound, J. Invest Dermatol. 72 (1979) 17±19. [14] S. Satravaha, K.F. Schlegel, The signi®cance of the integumentary pro®le, Am. J. Orthod Dentofacial Orthop. 92 (1987) 422±426. [15] H. Welcker, Schiller's Schadel und Todtnemaske nebst Mittheilumgen uber Schadel und, Todtenamaske kants Braunschweig (1883). J.S. Rhine, H.R. Campbell, Thickness of facial tissues in American Blacks, J. Forensic Sci. 24 (4) (1980) 847±858 (reprint). [16] W. His, Johann Sebastian Bach's Gebeine and Antiltz nebst Bemerkungen uber Dessen Bilder, Abhandlung durch Mathematik and physik 22 (1895) 240±380. J.S. Rhine, H.R. Campbell, Thickness of facial tissues in American Blacks, J. Forensic Sci. 24 (4) (1980) 847±858 (reprint).
107
[17] J. Kollmann, W. Buchly, Die Persistenz der Rassen and die Reconstruction der physiognomie Prahistorischer Schadel, Archiv fur Anthropologie 25 (1898) 329±359. J.S. Rhine, H.R. Campbell, Thickness of facial tissues in American Blacks, J. Forensic Sci. 24 (4) (1980) 847±858 (reprint). [18] F. Birkner, Beitrage zur Rassenanatomie der chinesen, Korrespondenz Deutsches Gesicht Anthropologie Ethnologie Urgeschte 35 (1905)144±148. J.S. Rhine, H.R. Campbell, Thickness of facial tissues in American Blacks, J. Forensic Sci. 24 (4) (1980) 847±858 (reprint). [19] E. Fischer, Anatomische Untersuchungen and den kopfweichteilen Zweier papua, korrespondenz Deutsches Gesicht Anthropologie Ethnologie Uurgeshte 36 (1905) 118±122. J.S. Rhine, H.R. Campbell, Thickness of facial tissues in American Blacks, J. Forensic Sci. 24 (4) (1980) 847±858 (reprint). [20] H. Von Eggeling, Anatomische Untersuchungen an den kopfen von Herros, einem Herero und einem Hottentottenkind, Medizinsch-Na urwissenschaftliche Gesellschaft (1909). J.S. Rhine, H.R. Campbell, Thickness of facial tissues in American Blacks, J. Forensic Sci. 24 (4) (1980) 847±858 (reprint). [21] F. Stadtmuller, Zur Beurteilung der Plastischen Rekonstruktions-Methods der Physiognomie auf dem Schadel, Zeitschrift Fur Morphologic und anthropologie 22 (1925) 337±372. J.S. Rhine, H.R. Campbell, Thickness of facial tissues in American Blacks, J. Forensic Sci. 24 (4) (1980) 847±858 (reprint). [22] K. Suzuki, On the thickness of soft parts of the Japanese face, J. Anthropol. Soc. Nippon 60 (1948) 7±11. V.M. Phillips, N.A. Smuts, Facial reconstruction: utilization of computerized tomography to measure facial tissue thickness in a mixed racial population, Forensic Sci. Int. 83 (1996) 51±59 (reprint). [23] R.F. Kushner, Body weight and mortality, Nutr. Rev. 50 (1993) 127. [24] R.G. Knapp, M.C. Miller, Clinical Epidemiology and Biostatistics, 1st Edition, National Medical Series (NMS), Egyptian Edition, Mass Publishing Co., 1992, p. 110. [25] M.Y. Iscan, R.P. Helmer (Eds.), Forensic Analysis of the Skull: Craniofacial Analysis, Reconstruction and Identi®cation, Wiley, New York, 1993, pp. 97±104.
Ultrasonic assessment of facial soft tissue thicknesses in adult Egyptians Inas Hassan El-Mehallawi*, Eman Mostafa Soliman Forensic Medicine and Clinical Toxicology Department, Faculty of Medicine, Tanta University, Tanta, Egypt Received 2 May 2000; accepted 2 October 2000
Abstract The production of a three-dimensional plastic face on an unknown human skull has been practiced sporadically since the latter part of the last century. In recent years, the technique has been revived and applied to forensic science cases. The morphometric method of forensic facial reconstruction rests heavily on the use of facial soft tissue depth measurements. Moreover, it has been established that measurements made on the living are of more value than those made on the dead. In view of the well-known genetic complexities of the Egyptians, and the lack of knowledge of average facial soft tissue depths of the Egyptians that makes facial reconstruction questionable, it was decided to set up a table of norms for facial tissue thicknesses in 204 adult Egyptians aged 20±35 years. Tissue depths at 17 established landmarks (according to Aulsebrook et al. [Forensic Sci. Int. 79 (1996) 83]) were obtained using ultrasonic probing. The study revealed a unique spectrum of measurements for the Egyptians that might be useful for facial reconstruction purposes with obvious sexual dimorphism in facial soft tissue thickness. Additionally, the study provided evidence for the presence of interpopulation differences in average facial soft tissue thicknesses as evidenced from the comparison of the present data of Egyptians with those previously reported for some other populations. # 2001 Elsevier Science Ireland Ltd. All rights reserved. Keywords: Forensic; Facial reconstruction; Soft-tissue thickness; Identi®cation
1. Introduction The face is the most important part of our features because of the role it plays in communication [1]. Forensic facial reconstruction is the scienti®c art of visualizing a face on the skull for personal identi®cation [2]. It is generally accepted that facial reconstruction can be divided into four categories: (1) replacing and repositioning damaged or distorted soft tissues on to a skull; (2) the use of photographic transparencies and *
Corresponding author. Tel.: 20-040-3346283; fax: 20-040-3331800. E-mail address: [email protected] (I.H. El-Mehallawi).
drawings in an identikit-type system; (3) the technique of graphic, photographic or video superimposition; (4) plastic or three dimensional reconstruction of a face over a skull using modeling clay [3]. There are two basic methods of modeling the face: a morphoscopic method using an ``anatomical approach'' of reconstructing the musculature, fat and skin [4] and a morphometric method which rests heavily on the use of average facial soft tissue depth measurements that have been gathered by previous researchers over various anatomical sites of the skull and jaws [5,6]. Facial soft tissue measurements of some races were carried out on cadaver material using the needle depth probing method. However, the accuracy of these
0379-0738/01/$ ± see front matter # 2001 Elsevier Science Ireland Ltd. All rights reserved. PII: S 0 3 7 9 - 0 7 3 8 ( 0 0 ) 0 0 4 5 3 - 9
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I.H. El-Mehallawi, E.M. Soliman / Forensic Science International 117 (2001) 99±107
measurements is questionable and has an inherent error as the degree of dehydration of human soft tissue is marked during the initial stages of death [7]. As results obtained from the measurement of live tissues are more feasible and applicable in the construction of faces, many other methods have been employed including lateral cephalometric radiographs [8], computed tomographic scanning (CT) ultrasonics (US) and magnetic resonance image (MRI) [9±11]. More recently, a combination of video and laser equipment has allowed 2000 measurements to be taken and stored within 30 s. The data from an unknown skull are then electronically ``clothed'' within standard soft tissue from the memory bank and modi®ed on screen to produce various images [12]. Most of the previous methods for determining of soft tissue thickness have disadvantages of potential radiation hazards and limitation to use [13]. Moreover, the use of MRI and CT scanning are as accurate as that of ultrasonic for measuring soft tissue depth but are relatively expensive procedures and are not freely available. It has been reported that the average individual rarely maintains a constant weight and is therefore dif®cult to collect subjects with constant weight to height ratio. A small variation in weight is generally dispersed throughout the body and does not necessarily re¯ect in the face. The factors constituting likeness are more dependent on proportions than on ®nite measurements and so are not destroyed by a small variation in weight [3]. It has been emphasized that all available data should be evaluated to ®nd standards that are valid for speci®c ethnic groups [14]. As shown by Table 1 not all major racial groups of man are represented and the numbers of most of these samples are so small as to be of questionable statistical validity. It has been reported that studying subjects taken from a wide range of ethnic background, ages and states of health, further compounds the dif®culty of setting up basic norms for soft tissue depths. Studies of this type should restrict subject selection narrow parameters of age, ethnicity and health [3]. To our knowledge no information exists of the soft tissue thickness of the faces of Egyptian people and this lack of information makes facial reconstruction of them questionable. The aim of this study was to compile a set of soft tissue depth norms for the
Egyptians for the purpose of face reproductions and to compare the results with those previously reported for other populations. 2. Subjects and methods The sample comprised 204 Egyptian volunteers (120 males and 84 females) ranging in age from 20 to 35 years (mean 28:5 3:8) and in good health. As far as could be ascertained all were representative of the Egyptian nationality. After obtaining informed consent, the subjects were questioned to exclude those with anything that could affect the normal weight such as chronic infections, diabetes or renal disease. All subjects were examined. Those with facial fractures, swellings, malformations, distortions and asymmetries of the face were excluded from the study. Other reasons for exclusion were those subjects having missing anterior teeth or those who were edentulous. These states produce an altered lip support and a disturbed vertical dimension, respectively. The subjects were weighed and measured for height. To ensure average body weight, body mass index was calculated according to the equation: Body mass index (BMI weight (in kilograms) divided by height (in meters) squared [23]. As the optimal BMI of the selected age group (20± 35 years) varies between 19 and 25 [23]. Selection of subjects was limited to those people differing by less than 10% on either side of the stipulated average ratio [3]. The diagnostic ultrasound equipment used was Dornier 5200 S using 7.5 MHz transducer. The transducer was applied to the chosen points without pressure and soft tissue thicknesses in these points were recorded. According to Aulsebrook et al. [3] the sites chosen as landmarks for ultrasonic probing should conform to a set of requirements. They should (1) where possible, be similar to those used by other workers to ensure comparability; (2) be the same marks for all subjects; (3) be positioned over ¯at bone where possible; (4) be planned to lie at summits of prominences like glabella and angle of jaw or in depressions and folds such as the soft nasion or nasolabial fold. Certain anatomic bulges and grooves are common to all faces. In front view, the features of the face can
Reference
Date
Number of points
Welcker [15] His [16] Kollmann and Buchly [17] Birkner [18] Fischer [19] Von Eggeling [20] Stadtmuller [21] Suzuki [22] Rhine and Campbell [5] Aulsebrook et al. [3]
1883 1895 1898 1905 1905 1909 1923±25 1948 1980 1996
9 15 18 18 18 18 20 23 31 LR16a OR20b US18c
Phillips and Smuts [6] Present study Totals
1996 1998 ±
21 17 ±
a
LR: lateral cephalometric radiographs. OR: oblique cephalometric radiographs. c US: ultrasonic landmarks. b
Male Female Total White Mongoloid
Black
Egyptian
Zulu
Mixed
Methods Tissue puncture by using needle Tissue puncture by using needle Tissue puncture by using needle Tissue puncture by using needle Tissue puncture by using needle Tissue puncture by using needle Tissue puncture by using needle Tissue puncture by using needle Tissue puncture by using needle Lateral, oblique cephalometry ultrasound Computerized tomography Ultrasound ±
13 24 21 6 2 3 15 48 68 55
± 4 4 ± ± ± 3 7 23 ±
13 28 25 6 2 3 18 55 91 55
13 28 25 ± ± ± 2 ± 32 ±
± ± ± 6 2 ± 14 55 ± ±
± ± ± ± ± 3 2 ± 59 ±
± ± ± ± ± ± ± ± ± ±
± ± ± ± ± ± ± ± ± 55
± ± ± ± ± ± ± ± ± ±
16 120 391
16 84 141
32 204 532
± ± 100
± ± 77
± ± 64
± 204 204
± ± 55
32 ± 32
I.H. El-Mehallawi, E.M. Soliman / Forensic Science International 117 (2001) 99±107
Table 1 Subjects of facial soft tissue thickness studies
101
102
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Independent sample student t-test (sample mean versus population mean): t
X sample mean ÿ U population mean S:E: standard error of the sample
3. Results
Fig. 1. Surface contours that determine landmark selection. (1) Forehead; (2) nose; (3) lips; (4) chin; (5) eyes; (6) cheek (upper hard cheek and lower soft cheek); (7) temple; (8) jaw; (9) ear (according to Aulsebrook et al. [3]).
be clearly demarcated as (1) forehead (2) nose (3) lips (4) chin (5) eyes (6) cheek (upper hard cheek and lower soft cheek) (7) temple (8) jaw (9) ear (Fig. 1). Thus, according to Aulsebrook et al. [3] selection of 17 ultrasonic landmarks on the face where determined in this study in view of the surface contours of the face (Table 2, Fig. 2). For comparison of soft tissue thickness of Egyptians with other ethnic populations the average facial tissue thickness for each morphologic area and the standard deviation was calculated and compared to its corresponding in the results of Aulsebrook et al. [3] for the purely African Negroids (Zulu; who have remained free from genetic admixture with other populations), Phillips and Smuts [6] for South Africans of mixed racial origins, Rhine and Campbell [5] for Caucasoids White and Black Americans and Suzuki [22] for Japanese. Statistical presentation and analysis of the present study was conducted using the range, mean, standard deviation, standard error and independent sample student t-tests [24]. Independent sample student t-test (two sample means): X1 ÿ X2 t q S:E:21 S:E:22
From the ultrasonic measurements of facial soft tissue thickness of 204 Egyptian subjects, a set of mean depth values was obtained for 17 Landmarks on the face. Maximum thickness in soft tissue depth was obtained in the mid-masseteric point (US12; males 13 1:66, females 15:05 1:75), in the cheek region. While the thinnest tissue depth was obtained in the infra-orbital point (US5; males 4:17 0:64, females 4:31 0:46) and in the frontal point (US1, males 4:18 0:75, females 4:24 0:49, Table 3). Moreover, the Egyptian female face showed greater thickness in the supra-orbital (US3), mid-zygoma (US6), philtrum ridge (US8), supra-labial (US9), mid-masseteric (US12), sub-Labial (US13), sub-commissural (US14), mental tubercle anterior and lateral (US15 and US16) and insertion masseteric anterior and posterior (US17 and US18) than their corresponding locations in the male Egyptians (t 4:35, 3.77, 5.5, 10.97, 8.49, 6.20, 18.16, 19.41, 8.68, 9.73 and 6.83; P < 0:001, respectively. See Table 3). Table 4 compares Aulsebrook's data [3] on Zulu population (Negroid races), Phillips and Smuts' data on mixed races of South Africans [6], Rhine and Campbell's data on American Black and White subjects [5] and Suzuki's data on Japanese [22] with the present data on Egyptian subjects of both sexes. In the forehead region, the Egyptian male subjects exhibited the lowest tissue thickness as compared to male subjects from other populations (Zulu Negroid, mixed races and Black Americans). The same ®nding was observed in the female Egyptians with a slight difference where they have signi®cantly thicker forehead than the white female Americans. In the eye region, the mean soft tissue thickness in supra-orbital point (US3) in the Egyptian subjects (males 5.13 mm 0:94, females 5.69 mm 0:85) were intermediate between each of the male Zulu, mixed races of South Africans, White Americans and
I.H. El-Mehallawi, E.M. Soliman / Forensic Science International 117 (2001) 99±107
103
Table 2 Ultrasonic landmarks (according to Aulsebrook et al. [3]) Region
Code
Landmarks
Description
Forehead
US1
Frontal
Eye
US2
Lateral glabella
Eye
US3
Supra-orbital
Eye
US5
Infra-orbital
Cheek
US6
Mid-zygomatic
Cheek
US7
Root of zygoma
Lips
US8
Philtrum ridge
Lips
US9
Supra-labial
Lips
US10
Supra-commissural
Lips
US11
Commissural
Cheek
US12
Mid-masseteric
Lips Lips Chin Chin
US13 US14 US15 US16
Sub-labial Sub-commissural Mental tubercle, anterior Mental tubercle, lateral
Cheek
US17
Jaw
US18
Insertion of masseter, ant. (antero-masseteric) Insertion of masseter, post. (postero-masseteric)
A point on the forehead in a vertical line with the pupil of the eye and on the same horizontal level at the deepest point in the depression between the frontal eminence and the maximum curve of the supraorbital margin A point on the soft tissue supraorbital ridge on a vertical line with the inner canthus of the eye A point on the soft tissue supraorbital ridge in vertical alignment with the pupil of the eye This point is located after palpation of the lower bony orbital margin. It is on the flat plane lying just below the lower rim of the eye socket and is in vertical alignment with the pupil of the eye A point overlying the bony zygion, on the maximum horizontal and vertical outer curvature of the zygomatic arch A point on the skin surface immediately above the mandibular condyle and superficial to the posterior root of the zygoma A point on the lateral ridge of the philtrum mid-way between the base of the columella and upper lip margin Over the maximum bulge of the canine eminence mid-way between the angle of the mouth and the root of the alar cartilage A point on a horizontal level with US9 and on a vertical line with US11. It is positioned over the root of the first premolar A point on a horizontal level with the cheilion and immediately posterior to the commissural bulge. It is frequently superficial to the crown of the first premolar A point on the skin surface lying over the center of an area bounded by the lower borders of the zygomatic arch and mandible, the anterior fibers of the masseter and the posterior border of the ascending ramus A point within the labiomental crease in vertical alignment with US9 A point in a vertical line with US10 lying on a horizontal level with US13 The most prominent point on the lateral bulge of the chin mound A point posterior to US15 above, on the same horizontal level and in vertical alignment with US10 and US14 Determined by palpation, this point lies at the anterior edge of the insertion of the masseter muscle into the mandible This point lies at the lower and posterior edge of the insertion of masseter into the mandible, just anterior to the gonion
Japanese populations with statistically signi®cant differences (P 0:05). Similarly, the mean soft tissue thickness in the infra-orbital point (US5) in the Egyptians (males 4.17 mm 0:64, females 4.31 mm 0:46) were intermediate between each of the male Zulu, the mixed races of South Africans, the Black and White Americans and the Japanese populations (Table 4). In the cheek region, the mid-masseteric point (US12) showed thinner soft tissue thickness in the male Egyptians (13 mm 1:66) than the male Zulu, the Black and White Americans and Japanese. While in the female Egyptians (15.05 mm 1:75), it was
thicker than those of the female mixed racial South Africans and Japanese and thinner than Black and White female Americans with statistically signi®cant differences (P 0:05, Table 4). In the lip region, all the tissue thicknesses in the Egyptians; philtrum ridge (US8; males 7.13 mm 0:53, females 7.69 mm 0:92), supra-labial (US9; males 5.79 mm 0:59, females 6.73 mm 0:62), supra-commissural (US10; males 9.33 mm 1:16, females 9.19 mm 1:16), sub-labial (US13; males 7.55 mm 0:62, females 8.21 mm 0:9) and subcommissural (US14; males 8.6 mm 0:76, females 11.16 mm 1:25) were signi®cantly less than their
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I.H. El-Mehallawi, E.M. Soliman / Forensic Science International 117 (2001) 99±107
Fig. 2. Ultrasonic landmarks on the face. These are located on vertical meridia and horizontal parallels and should be viewed in relation to Fig. 1 (according to Aulsebrook et al. [3]).
correspondings in the other compared studies (Table 4). In the chin region, the mean soft tissue thickness at the mental tubercle anterior (US15) was thinner in the male (5.47 mm 0:43) and female (7.29 mm 0:89) Egyptians than the male Zulu, male and female mixed
racial South Africans, Black and White Americans and the male Japanese. While the female Egyptians had thicker soft tissue thickness than the female Japanese. Similarly, tissue thickness at the mental tubercle lateral (US16) were thinner in the male Egyptians compared to male Zulu (P 0:05, Table 4). In the jaw region, the mean soft tissue thickness at the point of insertion masseteric posterior (US18) was signi®cantly less in the male Egyptians (11.65 mm 1:73) than the male Zulu, the mixed racial South Africans and the Black Americans, while it was thicker than the male Japanese (P 0:05, Table 4). Similarly, the mean soft tissue thickness in the jaw (insertion masseteric posterior, US18) of female Egyptians (13.14 mm 1:2) was thinner than the female Black Americans, while it was thicker than the female White Americans and the female Japanese (Table 4). 4. Discussion Over the years, many approaches have been taken in attempts to make an identi®cation from the skull [25]. One of these, three dimensional forensic facial reconstruction is the rebuilding of the soft tissues of the face
Table 3 Ultrasonic measurements of Egyptian facial soft tissue thickness (mm) Code
US1 US2 US3 US4 US5 US6 US7 US8 US9 US10 US11 US12 US13 US14 US15 US16 US17 US18 a
Landmarks
Frontal Lateral glabellar Supra orbital Lateral nasal Infra orbital Mid zygoma Root of zygoma Philtrum ridge Supra-labial Supra commissural Commissural Mid-masseteric Sub-labial Sub-commissural Mental tubercle ant Mental tubercle lat Insertion of masseteric anterior Insertion of masseteric posterior Signi®cant at P 0:05.
Male n 120
Female n 84
Min
Max
Mean
S.D.
Min
Max
Mean
S.D.
3 4.2 3.4 ± 3.3 5 4.2 6 4.8 7.4 9.2 10 6.5 7 4.4 4.7 5.9 9.4
5.6 6.8 7.1 ± 5.4 7.8 7.1 7.9 6.7 11 13 16 8.6 9.7 6.2 8.5 8.6 15
4.18 5.31 5.13 ± 4.17 6.46 5.75 7.13 5.79 9.33 10.55 13.00 7.55 8.60 5.47 6.78 7.19 11.65
0.75 0.81 0.94 ± 0.64 0.81 0.90 0.53 0.59 1.16 1.23 1.66 0.62 0.76 0.43 1.20 0.94 1.73
3.5 4 4.5 ± 3.6 6.1 5.4 6.6 5.8 7.6 9.4 13 7 9.7 6.2 7.1 7.3 11
5 6.6 7.2 ± 5 7.8 6.7 9.4 7.8 11 13 18 9.3 14 9 8.8 15 15
4.24 5.70 5.69 ± 4.31 6.83 6.07 7.69 6.73 9.19 10.81 15.05 8.21 11.16 7.29 8.00 8.52 13.14
0.49 0.75 0.85 ± 0.46 0.47 0.42 0.92 0.62 1.16 1.06 1.75 0.90 1.25 0.89 0.56 0.99 1.20
t
P
0.64 3.49 4.35 ± 1.72 3.77 3.03 5.50 10.97 0.85 1.57 8.49 6.20 18.16 19.41 8.68 9.73 6.83
>0.05 <0.001a <0.001a ± >0.05 <0.001a <0.001a <0.001a <0.001a >0.05 >0.05 <0.001a <0.001a <0.001a <0.001a <0.001a <0.001a <0.001a
Table 4 Comparisons of facial soft tissue thickness (mm) between Egyptians and other populations
Lateral glabellar Supra orbital Lateral nasal Infra orbital Mid zygoma Root of zygoma Philtrum ridge Supra-labial Supra commissural
Commissural
Mid-masseteric Sub-labial Sub-commissural Mental tubercle ant Mental tubercle lat Insertion of masseteric anterior Insertion of masseteric posterior a
Present study, n 204
Aulsebrook et al. [3]; n 55
Phillips and Smuts [6]; n 32
Rhine and Campbell [5]; n 91
Point
Egypt Egypt (M); n (F); n 120 84
Point
Zulu (M); n 55
Zulu (F)
Pointa
Pointb
US1 US2 US3 US4 US5 US6 US7 US8 US9 US10 US11 US12 US13 US14 US15 US16 US17
4.18 5.31 5.13 ± 4.17 6.46 5.75 7.13 5.79 9.33 10.55 13.00 7.55 8.60 5.47 6.78 7.19
4.24 5.70 5.69 ± 4.31 6.83 6.07 7.69 6.73 9.19 10.81 15.05 8.21 11.16 7.29 8.00 8.52
US1 US2 US3 US4 US5 US6 US7 US8 US9 US10 US11 US12 US13 US14 US15 US16 US17
4.79d 5.53 6.05d 4.80 6.56d 7.02d 5.91 9.79d 9.52d 12.64d 13.70d 18.05d 10.30d 11.54d 8.99d 8.61d 9.47d
± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ±
11
4.51d
4.78d
11
8.75d
8.00d
4.25
3.50d
±
±
±
12
5.46d
5.79
12
4.75d
4.50d
8.25d
7d
se
4.50d
3.60d
13 15 17 5
5.97d 7.54d 9.10d 12.25d
6.42d 8.25d 8.44d 10.13d
13 15 17 5
7.75d 13.25d 11.75d 12.25d
8.25d 12.75d 12.25d 11.25d
5.75d 10.0d 8.50d 10.00d
6.00d 10.75d 8.00d 8.50d
or ma ± ±
3.70d 5.40d ± ±
3.00d 4.70d ± ±
21 8
12.68 12.02d
12.99d 11.70d
21 8
22.00d 12.00d
21.25d 12.00d
19.50d 10.75d
19.25d 9.50d
m1 ml
14.50d 10.50d
12.30d 8.50
9
8.94d
9.57d
9
12.25d
12.25d
11.25d
10.00d
pg
6.20d
5.30d
US18
11.65
13.14
US18
15.38d
±
19
14.20d
19
14.75d
14.25d
11.50
12.00d
go
6.80d
4.00d
Mixed (M); n 16
Mixed (F); n 16
13.50
Blk (M); Blk (F); n 44 n 15
Locations of facial tissue measurements according to the method of Phillips and Smuts [6] and corresponding to the present study. Locations of facial tissue measurements according to the method of Rhine and Campbell [5] and corresponding to the present study. c Locations of facial tissue measurements according to the method of Suzuki [22] and corresponding to the present study. d Signi®cant compared to the present study at P 0:05. b
White (M); n 24
Suzuki [22]; n 55 White (F); n 8
Pointc
Japanese (M); n 48
Japanese (F); n 7
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for an unknown skull in an attempt to reproduce the likeness of its previous owner for the purposes of identi®cation. It is well established that, if a system for predicting the likeness of an individuals is to be effective, it should be developed from genetically related peoples [3]. The present study has obtained a set of average facial soft tissue measurements for the living healthy adult Egyptians (20±35 years) using ultrasonography. The study revealed a unique spectrum of measurements for the Egyptians with tissue thickness is greatest in the mid-masseteric point and lowest in the infraorbital and frontal points. Moreover, the present study provided evidence of a notable sexual dimorphism in facial soft tissue thickness among Egyptians. However, opposite to most of the previous studies [5,22] there was signi®cantly greater thickness in the female Egyptian facial soft tissues compared to the males' especially in the eye (supra-orbital), cheek, lip, chin and jaw regions. In agreement with our ®ndings, Phillips and Smuts [6] in their study on mixed racial population recorded thicker thickness in the female faces compared to the males in some regions (forehead, eye and cheek regions). On the other hand, the present study proved the presence of interpopulation differences in the facial soft tissue thickness as evident from the average measurements in the Egyptian sample when compared with those of other ethnic groups including the African Negroids; Zulu [3] mixed racial population of South Africans; Caucasian, Negroid, Khoi and San [6], Black and White Americans [5] and Mongoloids; Japanese [22]. In most of the recorded measurements at the forehead, eye, cheek and jaw regions, the Egyptians soft tissue thicknesses were signi®cantly less than the Negroid Zulu, Black and White Americans and the mixed racial South Africans, while they were thicker than the Mongoloid Japanese in all regions except the lip and chin regions. It must be remembered that the current methods of reproduction of faces operate from average ®gures of depth measurements. Indeed, the restorer may look on the average tissue thickness as guides and the skull as a pattern from which to emphasize the idiosyncrasies inherent in the skull. This requires that a very careful analysis of the skull from which the peculiarities and
idiosyncrasies are extracted must precede any application of tiny islands of clay, of average depth, to produce a large topological surface with a highly unique shape. Thereafter, the intervening modeling is applied by feel ideally by professional researchers with years of study and sculptural expertise. On the occasion of introducing the computer system in the facial reconstruction method, it is essential to establish supplements of anatomical and anthropometrical criteria and reliable standard data bases of facial components and soft tissue thickness. When these tasks are ful®lled, computed aided facial reconstruction will increase the chance of positive identi®cation from unknown skull [2]. After all it is the appearance of the live person that remains in the memories of those who will be asked to view the facial reconstruction. 5. Conclusion Finally, it is to be realized that Egyptian faces have unique spectrum of soft tissue thickness. As there has been no comparable study in this concern, the results obtained from this study might be representative of the facial tissue thickness of the Egyptian population group for facial reconstruction purposes till analysis of larger population sample is accomplished. Acknowledgements The authors would like to thank Dr. K. El. Shafey, Lecturer of Radiology, Tanta University for his valuable assistance in obtaining ultrasonographic measurements for the subjects of the present study.
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