Journal of Forensic and Legal Medicine 29 (2015) 43e53
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Journal of Forensic and Legal Medicine j o u r n a l h o m e p a g e : w w w . e l s e v i e r . c o m / l o c a t e / j fl m
Original communication
In vivo facial tissue depth for Canadian Mi'kmaq adults: A case study from Nova Scotia, Canada* Tanya R. Peckmann a, *, Mikkel Harris b, Meaghan Huculak c, f, Ashleigh Pringle d, Michel Fournier e, f a
Saint Mary's University, Department of Anthropology, Forensic Sciences Program, 923 Robie Street, Halifax, Nova Scotia, B3H 3C3, Canada Apartment 704, 75 Stewart Street, Oakville, Ontario, L6K 1X7, Canada LMD Integrated Forensic Identification Services, Ridge-Meadows Royal Canadian Mounted Police Detachment, 11990 Haney Place, Maple Ridge, British Columbia, V2X 9B8, Canada d Saint Mary's University, Department of Anthropology, Halifax, Nova Scotia, B3H 3C3, Canada e Royal Canadian Mounted Police, Forensic Facial Identification Services, P.O. Box 3900, Fredericton, New Brunswick, E3B 4Z8, Canada b c
a r t i c l e i n f o
a b s t r a c t
Article history: Received 9 September 2014 Received in revised form 16 November 2014 Accepted 6 December 2014 Available online 13 December 2014
This study examines facial tissue depth in Canadian Mi'kmaq adults. Using ultrasound, measurements were taken at 19 landmarks on the faces of 152 individuals aged 18e75 years old. The relationships between tissue thickness, age, and sex were investigated. A positive linear trend exists between tissue thickness and age for Mi'kmaq males and females at multiple landmarks. Seven landmarks show significant differences in facial tissue depth between males and females aged 18e34 years old; no landmarks show significant differences in facial tissue depth between males and females aged 35e45 years old and 46e55 years old. Significant differences were shown in facial tissue depth between Mi'kmaq and White Americans and Mi'kmaq and African Americans. These data can assist in 3-D facial reconstructions and aid in establishing the identity of unknown Mi'kmaq individuals. © 2014 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.
Keywords: Forensic anthropology Canadian first nations Adults Craniofacial reconstruction Facial tissue depth Ultrasound
Three-dimensional facial reconstruction is used by forensic artists to assist in the identification of unknown human remains. Many techniques are used in creating three-dimensional facial reconstructions. In Canada, forensic artists use the Manchester method, which applies clay muscles on to the skull cast while carefully measuring the thickness of tissues overlying the bone. Flexible rubber markers, which correspond to tissue thickness, are glued to the skull at specific landmarks. The artist uses the markers as guidelines for creating the reconstruction. The majority of facial feature morphology can be determined following scientific
* This project was funded in part by the Royal Canadian Mounted Police. As an organization, the Royal Canadian Mounted Police did not directly contribute to or influence the project design or implementation. * Corresponding author. Tel.: þ1 902 496 8719. E-mail addresses:
[email protected] (T.R. Peckmann), mikkel.harris@ gmail.com (M. Harris),
[email protected] (M. Huculak), ashleigh.
[email protected] (A. Pringle),
[email protected] (M. Fournier). f Two authors (Huculak and Fournier) employed by the funding source participated in the project design, collection of data, revising the written article, and in the decision to submit the article for publication.
procedure with lip and ear shapes the most difficult features to determine.1
1. Introduction There are many population-based studies for facial tissue depth measurements.2e39 However, no comprehensive study exists that uses ultrasonic techniques and collaborates with Canadian Mi'kmaq adults to measure facial tissue depth thickness. By utilizing tissue depth data that more accurately represent the ancestral population of the decedent, we are increasing the probability for identifying unknown adults and, therefore, providing them with the human dignity of being ‘named’. In 2008, 5.4% of Canada's population identified with Aboriginal tis, Inuit) ancestry.40 Between 1996 and 2006, (First Nations, Me Canada's Aboriginal population grew by 45 percent e nearly six times more than the non-Aboriginal population.41 The First Nations population increased by 29%, 3.5 times greater that the non-Aboriginal population.41 The situation of many of Canada's Aboriginal people is one of the country's most pressing public policy questions.
http://dx.doi.org/10.1016/j.jflm.2014.12.004 1752-928X/© 2014 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.
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T.R. Peckmann et al. / Journal of Forensic and Legal Medicine 29 (2015) 43e53
Table 1 Anatomical landmarks and descriptions.a Point number
Description
1 Glabella
Approximately 10 mm above and directly between the subject's eyebrows Directly between eyes Palpating to determine where bone ends and cartilage begins Approximately 5 mm to the right of the nostril Centered between nose and mouth Centered in fold of chin, below lips Centered on forward-most projecting point of chin Centered on inferior surface of mandible Centered on eye, at level of eyebrow Centered on eye, where inferior bony margin lies Upper lip, lined up superiorly/inferiorly with lateral edge of nostril Lower lip, lined up superiorly/inferiorly with lateral edge of nostril Cheek region, lateral: lined up with bottom of nose; vertical: center of transducer lined up beneath lateral border of eye Cheek region, lateral: lined up with mouth; vertical; same as 13 Inferior border of mandible, vertically lined up same as 13 Lined up laterally with corner of the eye, on the bone Lined up with the lateral border of the eye, on the zygomatic process Found by palpating Anterior to and 5 mm superior to tragus
2 Nasion 3 End of nasals 4 Lateral nostril 5 Mid-philtrum 6 Chin-lip fold 7 Mental eminence 8 Beneath chin 9 Superior eye orbit 10 Inferior eye orbit 11 Supracanine 12 Subcanine 13 Supra M2
14 Lower cheek 15 Mid mandible 16 Lateral eye orbit 17 Zygomatic 18 Gonion 19 Root of zygoma a
Modified from Manhein et al.3
Research shows that Aboriginal people are experiencing a higher incidence of suicide, injury, substance abuse, and chronic and infectious diseases compared to the general population. These problems are the result of a combination of historical, social and economic crises among Aboriginal Canadians.42 Canadian Aboriginals are at a higher risk for being victims than the Canadian population in general.43 Also, an estimated 1017 Indigenous women are reported missing in Canada.44 The percentage of unsolved murder cases involving Aboriginal people is also higher than the national average. Forty-one percent of murder cases in Canada involve Aboriginal women over 30 years old compared to 33% nationally.45
Fig. 2. Printout of ultrasound data for landmark 10.
Currently, there are no data for facial tissue thickness in Canadian Aboriginal adult populations. Rhine (1983) produced a small database for Southwestern American Indian groups however, only 24 adult cadavers were measured using the needle puncture method. The current project utilizes ultrasound technology to measure facial soft tissue depths in living Canadian Mi'kmaq adults. These data will help create images that more accurately reflect what the person looked like during life. Although skeletal remains often cannot be assigned to Mi'kmaq ancestry, these data can be used in geographic areas where large numbers of Mi'kmaq peoples reside or are missing. Some studies have shown that age, sex, and ancestry have significant and detectable influences on facial soft tissue depth.3,7,11,13,46 However, other research has shown this difference to be negligible.47e50 The purpose of this research is to examine facial tissue depth data for Canadian Mi'kmaq adults. The goals for this project are to: (1) report standard summary statistics, including means, standard deviations, and ranges of tissue thicknesses for adult males and females of varying ages; (2) determine if a relationship exists between tissue thickness, age and sex; and (3) compare the results of this study to contemporary published data for White American and African American adults.
Fig. 1. Frontal and lateral views of female volunteer showing anatomical landmarks.
T.R. Peckmann et al. / Journal of Forensic and Legal Medicine 29 (2015) 43e53 Table 2 Descriptive statistics of facial tissue depths (mm) of adult Canadian Mi'kmaq males. Anatomical landmarks 18e34 years old (N ¼ 24) Mean 1 Glabella 2 Nasion 3 End of nasals 4 Lateral nostril 5 Mid-philtrum 6 Chin-lip fold 7 Mental eminence 8 Beneath chin 9 Superior eye orbit 10 Inferior eye orbit 11 Supracanine 12 Subcanine 13 Supra M2 14 Lower cheek 15 Mid mandible 16 Lateral eye orbit 17 Zygomatic 18 Gonion 19 Root of zygoma
7.4 8.4 5.5 16.8 12.1a 10.7b 14.0a 10.3a 8.7 8.2 12.7 13.3 14.4 13.8 14.9 8.6 11.8 9.3 7.7
SD 1.48 0.46 0.40 5.80 1.72 1.67 2.40 2.69 2.26 2.53 2.47 3.00 7.61 6.70 6.66 4.89 5.17 4.36 2.59
Range 4.8e10.7 6.2e15.2 2.8e10.1 5.4e27.9 8.6e14.7 5.4e13.1 8.2e18.5 6.8e17.1 4.3e13.9 4.4e16.1 9.2e20.1 7.6e23.1 6.4e31.6 4.8e28.1 5.2e30.2 3.8e27.8 4.0e30.5 3.6e18.1 3.4e12.9
Anatomical landmarks 46e55 years old (N ¼ 5) Mean 1 Glabella 2 Nasion 3 End of nasals 4 Lateral nostril 5 Mid-philtrum 6 Chin-lip fold 7 Mental eminence 8 Beneath chin 9 Superior eye orbit 10 Inferior eye orbit 11 Supracanine 12 Subcanine 13 Supra M2 14 Lower cheek 15 Mid mandible 16 Lateral eye orbit 17 Zygomatic 18 Gonion 19 Root of zygoma a b c d e f g h i
n n n n n n n n n
¼ ¼ ¼ ¼ ¼ ¼ ¼ ¼ ¼
7.7 8.6 5.4 15.8 10.2f 11.7 16.0 11.5f 9.2 10.8 12.6f 15.5 18.7 19.7 11.3 7.7 9.9 9.1 6.5
SD 1.76 2.12 1.75 7.75 1.84 1.75 3.44 3.03 1.33 2.56 3.44 2.95 7.96 7.30 4.42 3.07 3.52 2.00 3.43
Range 5.1e9.9 6.0e11.7 3.4e7.2 3.6e23.0 8.6e12.1 9.0e13.5 11.7e21.2 7.2e14.1 7.2e10.7 8.0e13.9 9.0e17.1 12.7e20.3 8.6e27.3 11.5e28.7 8.0e18.9 3.9e10.9 6.0e13.1 4.8e18.7 3.3e10.7
35e45 years old (N ¼ 13) Mean 8.0 8.6 5.5 21.4c 11.3 11.8 14.5d 10.7e 9.2 8.8 13.2c 14.9 22.3 23.9c 17.1 7.5 10.5 10.2c 7.3c
SD 1.45 1.63 1.99 4.07 1.61 2.31 2.80 2.29 1.72 2.79 4.29 2.38 11.36 10.10 9.12 2.26 4.35 4.72 2.61
Range 6.2e10.0 5.2e10.7 2.4e9.8 14.7e29.3 8.6e14.9 8.8e17.3 10.5e20.7 6.6e13.5 5.6e11.7 4.2e14.3 8.4e23.3 11.3e19.5 8.8e42.2 9.6e41.6 6.4e31.8 4.0e10.6 5.4e17.1 4.4e19.7 4.2e13.3
56þ years old (N ¼ 14) Mean 8.4 8.7g 5.6 21.6 9.6h 12.2 16.1 10.2 9.7 11.5 12.8i 15.8i 17.6 22.0 14.3 8.8 12.2 11.8 7.6
SD 1.52 1.65 1.62 3.81 1.91 1.76 3.23 1.84 1.63 4.19 3.81 2.21 6.61 7.28 4.89 2.20 3.69 6.16 3.06
Range 5.9e11.0 6.0e10.9 3.2e8.7 16.5e28.8 6.0e13.4 7.8e15.7 11.4e23.3 6.3e12.9 6.0e12.0 5.6e22.3 8.7e21.8 12.7e21.3 6.2e26.9 6.2e31.0 9.1e25.3 4.5e11.6 7.4e21.2 4.2e25.3 3.6e16.4
21. 22. 12. 10. 9. 4. 13. 11. 12.
2. Materials and methods Facial tissue depth measurements were collected from living adults, aged 18e75 years, of Mi'kmaq descent. There were 152 volunteers comprised of 56 males and 96 females: 18e34 year olds (24 males, 21 females), 35e45 year olds (13 males, 22 females), 46e55 year olds (5 males, 24 females), 56þ year olds (14 males, 29 females). All volunteers self-identified as belonging to the Mi'kmaq First Nations community. All procedures were in accordance with the ethical standards from Saint Mary's University Research Ethics Board and approval was obtained from the Mi'kmaq community. All volunteers provided consent for use of their photographs in publications. Following the protocol of Manhein et al. (2000), a biographical data sheet and consent form were signed by each volunteer. Each volunteer was photographed in the frontal and lateral views. These
45
Table 3 Descriptive statistics of facial tissue depths (mm) of adult Canadian Mi'kmaq females. Anatomical landmarks 18e34 years old (N ¼ 21)
1 Glabella 2 Nasion 3 End of nasals 4 Lateral nostril 5 Mid-philtrum 6 Chin-lip fold 7 Mental eminence 8 Beneath chin 9 Superior eye orbit 10 Inferior eye orbit 11 Supracanine 12 Subcanine 13 Supra M2 14 Lower cheek 15 Mid mandible 16 Lateral eye orbit 17 Zygomatic 18 Gonion 19 Root of zygoma
SD
Range
Mean
SD
Range
6.6 7.6 6.0 21.2 10.4 10.2 14.8a 9.8 8.7 10.3a 15.2b 14.8 27.7 24.5 9.5 5.1 7.4 6.1 5.2
0.98 1.22 1.22 2.91 1.21 1.16 2.80 2.26 1.77 3.71 3.67 2.56 6.16 6.15 5.01 1.40 2.50 1.49 1.05
4.8e8.0 6.0e9.6 3.6e8.2 15.3e25.3 7.6e13.5 7.6e12.9 9.8e20.5 5.2e13.7 5.0e12.5 3.8e17.7 9.0e24.5 9.4e18.5 8.8e36.6 9.4e35.4 4.8e28.3 3.2e10.2 3.8e14.3 3.8e9.4 4.0e8.2
7.2 7.7 6.5 21.3 9.7 10.7 15.0c 9.3 8.6 9.8 13.4c 14.8 24.8 24.7 9.7 6.5 8.0 7.4 5.4
1.58 1.61 2.03 3.39 3.12 1.66 3.91 2.40 1.65 2.85 5.06 2.42 5.93 4.77 4.07 4.52 2.97 3.65 2.11
4.6e11.6 5.2e12.2 3.6e13.2 15.5e28.7 7.0e22.4 8.0e14.3 3.5e22.3 5.7e14.2 5.8e11.9 3.3e14.5 7.3e27.3 8.3e19.9 6.6e32.8 10.7e32.8 4.8e21.5 2.8e23.9 4.6e15.3 4.0e21.1 3.2e11.9
Anatomical landmarks 46e55 years old (N ¼ 24)
1 Glabella 2 Nasion 3 End of nasals 4 Lateral nostril 5 Mid-philtrum 6 Chin-lip fold 7 Mental eminence 8 Beneath chin 9 Superior eye orbit 10 Inferior eye orbit 11 Supracanine 12 Subcanine 13 Supra M2 14 Lower cheek 15 Mid mandible 16 Lateral eye orbit 17 Zygomatic 18 Gonion 19 Root of zygoma a b c d e f g h
n n n n n n n n
¼ ¼ ¼ ¼ ¼ ¼ ¼ ¼
35e45 years old (N ¼ 22)
Mean
56þ years old (N ¼ 29)
Mean
SD
Range
Mean
SD
Range
7.0 7.9 5.8 21.6d 8.8 11.3 14.7d 11.1d 8.9 11.6 12.7e 14.1 21.0d 19.0 11.4 7.0 9.6 8.0 6.6d
1.29 1.38 1.92 3.61 1.36 2.58 2.96 4.47 1.64 3.32 4.29 2.97 9.16 7.41 4.53 2.37 3.37 3.29 2.57
4.6e9.4 4.8e11.2 2.6e9.7 15.3e26.8 6.8e11.7 8.2e18.2 8.8e22.3 6.0e28.3 5.0e11.9 1.5e17.9 8.0e21.7 10.4e22.1 6.8e39.6 5.5e33.2 5.4e20.1 3.7e13.5 4.8e16.9 3.6e18.7 3.8e12.1
7.70 8.00 4.90 22.00 8.30 11.20 15.30f 10.8 9.40 11.60 12.7g 14.20h 16.80 18.60 14.70f 9.00 13.10 8.90 8.30
1.49 1.11 1.34 3.91 0.95 1.99 2.71 2.28 2.22 3.11 4.76 2.35 6.97 6.49 5.37 3.06 3.55 3.94 2.92
5.6e12.9 6.1e10.2 2.6e7.6 12.7e28.7 6.4e10.2 6.5e15.7 8.8e21.1 7.1e16.5 5.0e14.1 5.6e20.9 6.9e27.5 9.6e18.9 7.0e30.2 5.9e27.7 6.6e26.6 4.2e15.9 6.6e18.5 4.6e20.3 3.8e16.3
20. 19. 21. 23. 22. 28. 24. 26.
images provide forensic artists with information for cartilaginous features that are difficult to reconstruct, e.g. ears and nose. The height and weight of each participant were measured and recorded. This information was used for calculating the BMI for each volunteer. A portable ultrasound machine in B-mode was used: a Hitachi-Aloka Prosound 2 (Hitachi-Aloka Medical, Ltd., CT, USA) system using the following presets: SmP mode (superficial/small parts), frequency 10.0 M, image depth R04, Acoustic power 100%, and an Hitachi-Aloka UST-568 7.5 Mhz transducer. These presets are homologous to those used by Manhein et al. (2000). The machine has a large-capacity built-in memory and a USB memory port for transferring the images from the machine to a personal computer. Tissue depth data were collected for 19 landmarks on the face (Table 1, Fig. 1). The subjects were seated in an upright position. The ultrasound transducer was coated with gel and lightly applied to
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T.R. Peckmann et al. / Journal of Forensic and Legal Medicine 29 (2015) 43e53
Table 4 Comparisons of tissue thickness and age for adult Canadian Mi'kmaq males (n ¼ 56) and females (n ¼ 96). p-values Anatomical landmarks
Mi'kmaq Mi'kmaq Mi'kmaq males & females Mi'kmaq males & females Mi'kmaq males & females Mi'kmaq males & females (56þ yr) (M: N ¼ 14) (46e55 yr) (M: N ¼ 5) (35e45 yr) (M: N ¼ 13) males (N ¼ 56) females (N ¼ 96) (18e34 yr) (M: N ¼ 24) (F: N ¼ 29) (F: N ¼ 24) (F: N ¼ 22) (F: N ¼ 21)
1 Glabella 2 Nasion 3 End of nasals 4 Lateral nostril 5 Mid-philtrum 6 Chin-lip fold 7 Mental eminence 8 Beneath chin 9 Superior eye orbit 10 Inferior eye orbit 11 Supracanine 12 Subcanine 13 Supra M2 14 Lower cheek 15 Mid mandible 16 Lateral eye orbit 17 Zygomatic 18 Gonion 19 Root of zygoma
0.181 0.755 0.772 0.027 0.000* 0.016 0.067 0.807 0.251 0.001* 0.921 0.021 0.191 0.010 0.638 0.685 0.907 0.164 0.704
0.004 0.296 0.022 0.271 0.000* 0.050 0.707 0.201 0.150 0.056 0.048 0.653 0.000* 0.001* 0.000* 0.000* 0.000* 0.003 0.000*
0.031 0.131 0.316 0.070 0.001* 0.264 0.325 0.464 0.985 0.039 0.017 0.082 0.000* 0.000* 0.004 0.002* 0.001* 0.002* 0.000*
0.120 0.130 0.177 0.975 0.060 0.154 0.691 0.163 0.296 0.318 0.923 0.866 0.480 0.799 0.014 0.419 0.078 0.093 0.040
0.458 0.498 0.633 0.180 0.233 0.680 0.453 0.827 0.691 0.560 0.961 0.380 0.588 0.838 0.964 0.649 0.858 0.676 0.967
0.174 0.186 0.206 0.765 0.052 0.095 0.469 0.424 0.631 0.936 0.917 0.068 0.742 0.153 0.812 0.832 0.462 0.130 0.507
*p < 0.003.
According to Community Health Nurses, ‘normal’ BMI for Aboriginal peoples falls within the overweight/obese BMI-for-age category according to standards set by the United States Centre for Disease Control (CDC) (N. Paul, Pers Comm, July 12, 2013). Therefore, selecting facial tissue depth measurements only for adults of normal BMI-for-age, as defined by the CDC, was not useful for the goals of this study, which was to produce facial tissue depth measurements that are representative of the standard weight for Mi'kmaq adults. As a result, facial tissue depths that fell within the normal and overweight/obese BMI-for-age, as defined by the CDC, were used to construct the facial tissue depth tables. This ensured that the tissue depth measurements accurately reflected the standard weight of Canadian Mi'kmaq adults. Microsoft Excel (Microsoft Canada Co., ON, Canada) spreadsheets and MINITAB 16 (Minitab Inc., PA, USA) statistical software package were used for statistical analyses. Summary statistics were used for assessing the relationships between tissue thickness, age,
each measurement site on the face for 3e5 s. The distance between the skin and bone was measured using internal calipers in the ultrasound machine (Fig. 2). The images were saved on the ultrasound machine's internal hard drive and stored for future reference; the images were also saved to a USB drive each day to ensure there was always a back-up copy of the data. Measurements were only collected from the right side of the face. Slight asymmetry does occur in humans but one side of the face was chosen to complete the scanning in a timely manner.51 Canadian Aboriginal populations display skeletal facial structures similar to Asian populations. A high percentage of young people of Canadian Aboriginal descent are overweight or obese. Studies have reported that First Nations populations have a greater incidence of obesity than the general population.52,53 Thirty-five percent of volunteers in this study were categorized as “Normal” BMI and 65% were categorized as “Overweight” or “Obese”; a recent study cites that BMI tends to heavily influence the lower face.54
Table 5 Summary of a one-way ANOVA showing the significant differences of tissue thickness within Canadian Mi'kmaq males for differing adult age groups.* Age groups
Anatomical landmarks 1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
18e34 years (A) 35e45 years (B) 46e55 years (C) 56þ years (D)
e e e e
e e e e
e e e e
D e e A
D e e A
e e e e
e e e e
e e e e
e e e e
A e e D
e e e e
e e e e
B A e e
B,D A e A
e e e e
e e e e
e e e e
e e e e
e e e e
*Different letters indicate a significant difference at the landmark among the age groups (p < 0.003).
Table 6 Summary of a one-way ANOVA showing the significant differences of tissue thickness within Canadian Mi'kmaq females for differing adult age groups.* Age groups
Anatomical landmarks 1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
18e34 years (A) 35e45 years (B) 46e55 years (C) 56þ years (D)
D e e A
e e e e
e D e B
e e e e
C,D D A A,B
e e e e
e e e e
e e e e
e e e e
e e e e
e e e e
e e e e
C,D D A A,B
C,D C,D A,B A,B
D D e A,B
D D e A,B
D D D A,B,C
D D A A
D D e A,B
* Different letters indicate a significant difference at the landmark among the age groups (p < 0.003).
T.R. Peckmann et al. / Journal of Forensic and Legal Medicine 29 (2015) 43e53
47
Fig. 3. Significant differences of tissue thickness within Canadian Mi'kmaq males for differing adult age groups. For example, A-B is read as: there are significant differences between 18 and 34 year olds (A) and 35e45 year olds (B).
and sex. Males and females were analyzed separately and data were categorized into four age groups (18e34, 35e45, 46e55, 56þ years of age). These age categories correspond to the protocol of Manhein et al. (2000) protocol for adult White American and African American adults and allow for comparisons with previous data. The mean, standard deviation, and range of the tissue depths for each anatomical landmark in each age category were calculated. Pearson's Correlations were used to test the relationship between age and tissue thickness for males and females independently. Two-Sample (Independent Sample) t-tests were used to verify if there were significant differences between sex and tissue thickness. In addition, Two-Sample t-tests were used to investigate whether the differences in facial tissue depths were statistically significant between the sexes of differing adult age groups. A OneWay Analysis of Variance (ANOVA) was calculated to test significant differences within the sexes of differing adult age groups for males and females independently. A Paired Difference t-test was
used to calculate the intra-observer error of each anatomical landmark for 25 volunteers. An examination of facial tissue depth variation in people of different ancestries was achieved through comparing data from Mi'kmaq adults to contemporary published data for White American and African American adults3; as there are currently no tissue depth data for Mi'kmaq adults, facial reconstructions use data from other populations. All variables tested as statistically normal using Bonferroni correction (p < 0.003); males and females were tested separately and all ages combined. As the variables were not skewed, means and standard deviations were used as the most appropriate measures of central tendency. The Two-Sample t-tests were selected as the appropriate statistical test because the sample was randomly and independently selected, the variances were similar for the measurements, and the data exhibited a normal distribution based on Ryan-Joiner Normality Tests (Normal Probability Plots) generated by MINITAB.
Fig. 4. Significant differences of tissue thickness within Canadian Mi'kmaq females for differing adult age groups. For example, AB-D is read as: there are significant differences between 18 and 45 year olds (A and B) and 56þ year olds (D).
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T.R. Peckmann et al. / Journal of Forensic and Legal Medicine 29 (2015) 43e53
Table 7 Comparison of facial tissue depth means (mm) of adult Canadian Mi'kmaq males to adult White American males.a Anatomical landmarks
18e34 years old
35e45 years old
Canadian Mi'kmaq (N ¼ 24)
White American (N ¼ 28)
Difference
Canadian Mi'kmaq (N ¼ 13)
White American (N ¼ 10)
Difference
1 Glabella 2 Nasion 3 End of nasals 4 Lateral nostril 5 Mid-philtrum 6 Chin-lip fold 7 Mental eminence 8 Beneath chin 9 Superior eye orbit 10 Inferior eye orbit 11 Supracanine 12 Subcanine 13 Supra M2 14 Lower cheek 15 Mid mandible 16 Lateral eye orbit 17 Zygomatic 18 Gonion 19 Root of zygoma
7.4 8.4 5.5 16.8 12.1b 10.7c 14.0b 10.3b 8.7 8.2 12.7 13.3 14.4 13.8 14.9 8.6 11.8 9.3 7.7
5.0 6.0 1.9 7.5 11.9 11.1d 10.0 7.2d 5.3 5.8 11.9d 11.5 28.5 25.1 14.8 4.2 7.8 20.0 7.8
þ2.4 þ2.4 þ3.6 þ9.3 þ0.2 0.4 þ4.0 þ3.1 þ3.4 þ2.4 þ0.8 þ1.8 14.1 11.3 þ0.1 þ4.4 þ4.0 10.7 0.1
8.0 8.6 5.5 21.4e 11.3 11.8 14.5f 10.7g 9.2 8.8 13.2e 14.9 22.3 23.9e 17.1 7.5 10.5 10.2e 7.3e
5.5 6.4 2.4 9.8 10.6 13.1 12.0 8.0 5.9 6.2 10.1 10.2 24.6 21.1 15.6 4.3 8.2 19.6 6.6
þ2.5 þ2.2 þ3.1 þ11.6 þ0.7 1.3 þ2.5 þ2.7 þ3.3 þ2.6 þ3.1 þ4.7 2.3 þ2.8 þ1.5 þ3.2 þ2.3 9.4 þ0.7
Anatomical landmarks
46e55 years old
1 Glabella 2 Nasion 3 End of nasals 4 Lateral nostril 5 Mid-philtrum 6 Chin-lip fold 7 Mental eminence 8 Beneath chin 9 Superior eye orbit 10 inferior eye orbit 11 Supracanine 12 Subcanine 13 Supra M2 14 Lower cheek 15 Mid mandible 16 Lateral eye orbit 17 Zygomatic 18 Gonion 19 Root of zygoma a b c d e f g h i j k l
56þ years old
Canadian Mi'kmaq (N ¼ 5)
White American (N ¼ 5)
Difference
Canadian Mi'kmaq (N ¼ 14)
White American (N ¼ 5)
Difference
7.7 8.6 5.4 15.8 10.2h 11.7 16.0 11.5h 9.2 10.8 12.6h 15.5 18.7 19.7 11.3 7.7 9.9 9.1 6.5
6.0 7.2 1.8 10.4 8.0i 11.6 11.0 7.2 7.7 6.8 10.0i 10.0 28.2 21.4 15.4 5.4 8.2 19.0 5.4
þ1.7 þ1.4 þ3.6 þ5.4 þ2.2 þ0.1 þ5.0 þ4.3 þ1.5 þ4.0 þ2.6 þ5.5 9.5 1.7 4.1 þ2.3 þ1.7 9.9 þ1.1
8.4 8.7j 5.6 21.6 9.6k 12.2 16.1 10.2 9.7 11.5 12.8l 15.8l 17.6 22.0 14.3 8.8 12.2 11.8 7.6
5.6 6.6 2.0h 10.8 9.4 12.2 11.8 5.6 5.6 5.0 9.2 11.8 23.6 20.6 11.4 5.2 6.4 14.0 5.2
þ2.8 þ2.1 þ3.6 þ10.8 þ0.2 0.0 þ4.3 þ4.6 þ4.1 þ6.5 þ3.6 þ4.0 6.0 þ1.4 þ2.9 þ3.6 þ5.8 2.2 þ2.4
Based on Manhein et al.3 n ¼ 21. n ¼ 22. n ¼ 27. n ¼ 12. n ¼ 10. n ¼ 9. n ¼ 4. n ¼ 3. n ¼ 13. n ¼ 11. n ¼ 12.
3. Results Intra-observer error, using a paired t-test, was assessed on 25 participants who were measured twice. The test demonstrated no significant differences (p > 0.9) at any landmarks for facial tissue depths. Tables 2 and 3 present the means, standard deviations, and ranges for the different age categories of Canadian Mi'kmaq males and females. Thirty-five percent of volunteers in this study were categorized as “Normal” BMI and 65% were categorized as “Overweight” or “Obese”. For Canadian Mi'kmaq, regardless of age or sex, facial tissue depth generally was thickest and had the greatest variation in the cheek (landmarks 10, 13, 14, 16, 17) and jaw (landmark 15) regions when compared to other landmarks.
Table 4 shows the results of t-tests used for comparing age and tissue thickness for males and females at each measurement site for each age category. For males, when all ages are combined, a significant relationship (p < 0.003) exists between age and tissue thickness at 2 of 19 landmarks (landmarks 5 and 10) in the mouth and cheek areas. For females, when all ages are combined, a significant relationship (p < 0.003) exists between age and tissue thickness at 7 of 19 landmarks (landmarks 5, 13, 14, 15, 16, 17, 19) in the mouth, cheek, and jaw areas. Both males and females exhibit significant relationships between age and tissue thickness in the mouth and cheek areas. Significant differences (p < 0.003) in facial tissue depth are predominantly observed in the 18e34 year old age category, which include the mouth (landmark 5), cheek (landmarks 13, 14, 16, 17), and jaw (landmarks 18, 19) regions. Bonferroni
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49
Table 8 A. Comparison of facial tissue depth means (mm) of adult Canadian Mi'kmaq females to adult White American females.a, B. Comparison of facial tissue depth means (mm) of adult Canadian Aboriginal females to adult White American females.* A Anatomical Landmarks
1 Glabella 2 Nasion 3 End of nasals 4 Lateral nostril 5 Mid-philtrum 6 Chin-lip fold 7 Mental eminence 8 Beneath chin 9 Superior eye orbit 10 Inferior eye orbit 11 Supracanine 12 Subcanine 13 Supra M2 14 Lower cheek 15 Mid mandible 16 Lateral eye orbit 17 Zygomatic 18 Gonion 19 Root of zygoma
18e34 years old
35e45 years old
Canadian Mi'kmaq (N ¼ 21)
White American (N ¼ 52)
Difference
Canadian Mi'kmaq (N ¼ 22)
White American (N ¼ 15)
Difference
6.6 7.6 6.0 21.2 10.4 10.2 14.8b 9.8 8.7 10.3b 15.2c 14.8 27.7 24.5 9.5 5.1 7.4 6.1 5.2
4.8 5.5 1.8 8.6 9.1 10.3 9.2 6.0 5.7 6.1 9.3 9.4 26.3 23.4 13.7 4.7 9.3 17.4 7.4
þ1.8 þ2.1 þ4.2 þ12.6 þ1.3 0.1 þ5.6 þ3.8 þ3.0 þ4.2 þ5.9 þ5.4 þ1.4 þ1.1 4.2 þ0.4 1.9 11.3 2.2
7.2 7.7 6.5 21.3 9.7 10.7 15.0d 9.3 8.6 9.8 13.4d 14.8 24.8 24.7 9.7 6.5 8.0 7.4 5.4
4.7 5.3 1.6 8.0 7.4 9.6 9.2 5.4 5.5 5.7 7.8 8.7 25.1 20.1 12.6 4.3 8.7 15.3 4.9
þ2.5 þ2.4 þ4.9 þ13.3 þ2.3 þ1.1 þ5.8 þ3.9 þ3.1 þ4.1 þ5.6 þ6.1 0.3 þ4.6 2.9 þ2.2 0.7 7.9 þ0.5
Canadian Mi'kmaq (N ¼ 24)
White American (N ¼ 6)
Difference
Canadian Mi'kmaq (N ¼ 29)
White American (N ¼ 9)
Difference
7.0 7.9 5.8 21.6e 8.8 11.3 14.7e 11.1e 8.9 11.6 12.7f 14.1 21.0e 19.0 11.4 7.0 9.6 8.0 6.6e
4.8 6.2 1.8 10.8 8.0 9.8 10.7 6.7 6.5 7.3 7.7 9.0 27.2 21.7 13.0 4.5 10.2 14.7 6.0
þ2.2 þ1.7 þ4.0 þ10.8 þ0.8 þ1.5 þ4.0 þ4.4 þ2.4 þ4.3 þ5.0 þ5.1 6.2 2.7 1.6 þ2.5 0.6 6.7 þ0.6
7.70 8.00 4.90 22.00 8.30 11.20 15.30g 10.8 9.40 11.60 12.7h 14.20f 16.80 18.60 14.70i 9.00 13.10 8.90 8.30
5.2 6.0 1.8 9.8 8.0 11.4 12.3 8.0 6.3 7.0 8.0 9.7 29.4 27.2 17.4 4.9 11.0 16.9 7.4
þ2.5 þ2.0 þ3.1 þ12.2 þ0.3 0.2 þ3.0 þ2.8 þ3.1 þ4.6 þ4.7 þ4.5 12.6 8.6 2.7 þ4.1 þ2.1 8 þ0.9
B Anatomical landmarks
1 Glabella 2 Nasion 3 End of nasals 4 Lateral nostril 5 Mid-philtrum 6 Chin-lip fold 7 Mental eminence 8 Beneath chin 9 Superior eye orbit 10 inferior eye orbit 11 Supracanine 12 Subcanine 13 Supra M2 14 Lower cheek 15 Mid mandible 16 Lateral eye orbit 17 Zygomatic 18 Gonion 19 Root of zygoma a b c d e f g h i
46e55 years old
56þ years old
Based on Manhein et al.3 n ¼ 20. n ¼ 19. n ¼ 21. n ¼ 23. n ¼ 22. n ¼ 28. n ¼ 24. n ¼ 26.
corrected tests show no significant relationship between age and tissue thickness (p < 0.003) for the 35e45, 46e55 and 56þ year old age categories. Tables 5 and 6 and Figs. 3 and 4 demonstrate results of the ANOVA used to test for significant differences of facial tissue thickness within males and females when all four age categories were compared to one another. Bonferroni corrected tests were performed to show which groups in this sample differ significantly (p < 0.003). For males, the cheek (landmarks 13 and 14) undergoes changes in early adult years, whereas the nose (landmark 4), mouth (landmark 5), and cheek (landmarks 10 and 14) undergo changes in late adult years. For females, the mouth (landmark 5) and cheek (landmark 13 and 14) undergo changes in the mid adult years,
whereas the forehead (landmark 1), nose (landmark 3), jaw (landmark 15, 18, 19), and cheek (landmark 16 and 17) undergo changes in late adult years. Table 7 though 10 present comparisons between tissue depth thickness for adults of Canadian Mi'kmaq, White American, and African American ancestry. Overall, Canadian Mi'kmaq males and females, when compared to White American males and females, respectively, show greater tissue thickness at all landmarks except for the cheek (landmark 13) and lateral jaw (landmark 18) regions. In general, when compared to African American males, Canadian Mi'kmaq males tend to show thicker tissue depth in the nose (landmarks 3 and 4) region and thinner tissue depth in the lateral jaw (landmark 18) area. When compared to African American
50
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Table 9 Comparison of facial tissue depth means (mm) of adult Canadian Mi'kmaq males to adult African American males.a Anatomical landmarks
1 Glabella 2 Nasion 3 End of nasals 4 Lateral nostril 5 Mid-philtrum 6 Chin-lip fold 7 Mental eminence 8 Beneath chin 9 Superior eye orbit 10 Inferior eye orbit 11 Supracanine 12 Subcanine 13 Supra M2 14 Lower cheek 15 Mid mandible 16 Lateral eye orbit 17 Zygomatic 18 Gonion 19 Root of zygoma a b c d e f
18e34 years old
35e45 years old
Canadian Mi'kmaq (N ¼ 24)
African American (N ¼ 19)
Difference
Canadian Mi'kmaq (N ¼ 13)
African American (N ¼ 3)
Difference
7.4 8.4 5.5 16.8 12.1b 10.7c 14.0b 10.3b 8.7 8.2 12.7 13.3 14.4 13.8 14.9 8.6 11.8 9.3 7.7
5.2 6.6 2.2 9.2 13.0 12.7 12.1 8.8 6.4 5.8 12.8 14.4 28.2 24.5 14.1 4.8 8.4 21.1 7.4
þ2.2 þ1.8 þ3.3 þ7.6 0.9 2.0 þ1.9 þ1.5 þ2.3 þ2.4 0.1 1.1 13.8 10.7 þ0.8 þ3.8 þ3.4 11.8 þ0.3
8.0 8.6 5.5 21.4d 11.3 11.8 14.5e 10.7f 9.2 8.8 13.2d 14.9 22.3 23.9d 17.1 7.5 10.5 10.2d 7.3d
5.3 5.7 1.7 10.3 11.0 12.7 12.3 7.0 6.3 7.0 10.3 10.7 27.3 23.7 13.3 3.7 6.3 20.7 5.7
þ2.7 þ2.9 þ3.8 þ11.1 þ0.3 0.9 þ2.2 þ3.7 þ2.9 þ1.8 þ2.9 þ4.2 5.0 þ0.2 þ3.8 þ3.8 þ4.2 10.5 þ1.6
Based on Manhein et al.3; there are no males over 45 years of age included in this study. n ¼ 21. n ¼ 22. n ¼ 12. n ¼ 10. n ¼ 9.
females, Canadian Mi'kmaq females generally tend to show greater tissue depth in the nose (landmark 3 and 4) and chin (landmark 7) regions and thinner tissue depth in the lateral jaw (landmark 18) area. 4. Discussion The goals of this research were to examine the relationship between age and sex on facial tissue thickness in Canadian Mi'kmaq populations and to compare the data with those from White American and African American adults. Some researchers have utilized body mass index (BMI) e a classification system derived primarily from Caucasian groups from the United States and Europe e to further subcategorize data.6,32,51,55,56 All volunteers, regardless of body build, were included in this study and no further analysis based on BMI was conducted, which is consistent with recommendations proposed by Stephan and Simpson (2008).50 In addition, a study by Deurenderg et al. (1998)57 cites that BMI indices do not translate well from one population group to another. 4.1. Age While some research has shown a significant relationship between age and facial tissue thickness,1e3,15,18,47,58,59 others have shown very weak linear correlations.3,13,14 Wilkinson (2004)60 and Tyrell et al. (1997)61 cite that age-related changes are variable and growth trends difficult to determine. However, the most accurate data are likely to occur when large reference groups are utilized to derive standard values and when these reference groups are similar to the individual or population under investigation.62 The relationship between age and facial tissue depth can also be explained by variation in BMI and age,23 however an analysis based on BMI was not conducted for this research. Overall, for Canadian Mi'kmaq males and females as age increases, facial tissue thickness increases (Tables 2 and 3). These data are consistent with Sahni et al. (2008)8 who suggest that the increased tissue thickness that appears with increased age may be
related to skin wrinkling because as the human skin ages there is a reduced resistance to traction and thickness of collagen structures. The current data are also consistent with Rohrich and Pessa (2007)63 who conclude that as the face ages there is a change in volume and position of different fat compartments both superficial and deep. Although the relationship between age and tissue facial thickness is significant, the correlations are weak. This finding suggests that other factors are possibly influencing variation such as genetics, the effects of air temperature, hydration status, stage of menstrual cycle, and pregnancy.50 Future research should include larger sample sizes. 4.2. Sex Research has shown that, with the exception of the cheeks, overall facial tissue is thicker in males for most landmarks particularly in the brow, mouth, and jaw regions (3, 46, 56, 60). This pattern is also demonstrated in Canadian Mi'kmaq populations. In both males and females, the landmarks with the greatest standard deviation are found in the more fleshy parts of the face, i.e. the cheek and jaw areas. This result is consistent with research that shows nutritional status, i.e. physique, influences facial tissue depth, mainly in areas of the face with higher fat content or welldeveloped musculature.4,6,9,47,55,56,60 Stephan and Simpson (2008)50 cite that while overall facial tissue depth is greater in males (except for the cheeks), differences are “extremely small” (they report a range of variation of 0.0e1.9 mm) and, therefore, support “collapsing the data across the sexes and using weighted means to yield one set of data for all adults” (p. 1264). In the current research, most ranges of variation are, overall, greater than 1.9 mm (Tables 2 and 3). However, the 35e45, 45e55, and the 56þ year old age categories show no significant differences in facial tissue depth between males and females; these data could be collapsed into one age category, i.e. 35þ years old, that combines both sexes. Although differences were demonstrated in the 18e34 year old age category, collapsing these data that combines both sexes is also
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51
Table 10 Comparison of facial tissue depth means (mm) of adult Canadian Mi'kmaq females to adult African American females.a Anatomical landmarks
1 Glabella 2 Nasion 3 End of nasals 4 Lateral nostril 5 Mid-philtrum 6 Chin-lip fold 7 Mental eminence 8 Beneath chin 9 Superior eye orbit 10 inferior eye orbit 11 Supracanine 12 Subcanine 13 Supra M2 14 Lower cheek 15 Mid mandible 16 Lateral eye orbit 17 Zygomatic 18 Gonion 19 Root of zygoma Anatomical landmarks
1 Glabella 2 Nasion 3 End of nasals 4 Lateral nostril 5 Mid-philtrum 6 Chin-lip fold 7 Mental eminence 8 Beneath chin 9 Superior eye orbit 10 Inferior eye orbit 11 Supracanine 12 Subcanine 13 Supra M2 14 Lower cheek 15 Mid mandible 16 Lateral eye orbit 17 Zygomatic 18 Gonion 19 Root of zygoma a b c d e f
18e34 years old
35e45 years old
Canadian Mi'kmaq (N ¼ 21)
African American (N ¼ 18)
Difference
Canadian Mi'kmaq (N ¼ 22)
African American (N ¼ 21)
Difference
6.6 7.6 6.0 21.2 10.4 10.2 14.8b 9.8 8.7 10.3b 15.2c 14.8 27.7 24.5 9.5 5.1 7.4 6.1 5.2
4.6 6.0 1.7 8.4 9.2 11.8 10.8 6.7 5.1 6.2 10.0 10.9 26.6 21.7 12.6 5.0 10.2 17.0 6.4
þ2.0 þ1.6 þ4.3 þ12.8 þ1.2 1.6 þ4.0 þ3.1 þ3.6 þ4.1 þ5.2 þ3.9 þ1.1 þ2.8 3.1 þ0.1 2.8 10.9 1.2
7.2 7.7 6.5 21.3 9.7 10.7 15.0d 9.3 8.6 9.8 13.4d 14.8 24.8 24.7 9.7 6.5 8.0 7.4 5.4
4.5 5.2 1.5 8.4 8.8 11.7 11.2 6.4 6.0 6.9 9.6 11.5 26.8 22.5 13.1 4.9 9.8 16.2 5.6
þ2.7 þ2.5 þ5.0 þ12.9 þ0.9 1.0 þ3.8 þ2.9 þ2.6 þ2.9 þ3.8 þ3.3 2.0 þ2.2 3.4 þ1.6 1.8 8.8 0.2
46e55 years old Canadian Mi'kmaq (N ¼ 24)
African American (N ¼ 5)
Difference
7.0 7.9 5.8 21.6e 8.8 11.3 14.7e 11.1e 8.9 11.6 12.7f 14.1 21.0e 19.0 11.4 7.0 9.6 8.0 6.6e
4.8 6.0 2.0 8.4 8.2 10.0 10.8 7.2 5.8 5.8 9.0 12.4 26.8 21.2 13.4 4.8 9.8 14.8 6.0
þ2.2 þ1.9 þ3.8 þ13.2 þ0.6 þ1.3 þ3.9 þ3.9 þ3.1 þ5.8 þ3.7 þ1.7 5.8 2.2 2.0 þ2.2 0.2 6.8 þ0.6
Based on Manhein et al.3; there are no females over 55 years of age included in this study. n ¼ 20. n ¼ 19. n ¼ 21. n ¼ 23. n ¼ 22.
recommended; statistical significance in facial tissue depth differences does not necessarily mean that this will have an impact on the facial recognition of the individual. The consequence of using specific datasets for the recognition of a facial reconstruction is yet to be investigated. Since manual reconstruction does not necessary allow for accuracy below 1 mm, extensive division of datasets has not proven to be useful. 4.3. Ancestry When compared to White American males (Table 7), overall, Canadian Mi'kmaq males show increased facial tissue thickness in the nose (landmarks 2, 3, 4) and chin (landmarks 7 and 8) regions and decreased facial tissue thickness in the lateral jaw (landmark 18) region. When compared to White American females (Table 8), overall, Canadian Mi'kmaq females show increased facial tissue thickness in the nose (landmarks 2 and 4), chin (landmarks 7 and 8), and mouth (landmarks 11 and 12) regions and decreased facial tissue thickness in the lateral jaw (landmark 18) region. Canadian
Mi'kmaq males, when compared to African American males (Table 9), show increased facial tissue depths in the nose (landmarks 3 and 4) region and decreased facial tissue thickness in the cheek (landmark 13) and lateral jaw (landmark 18) regions. When compared to African American females (Table 10), Canadian Mi'kmaq females, overall, demonstrate an increase in facial tissue depth in the nose (landmarks 3 and 4) and chin (landmark 7) regions and decreased facial tissue thickness in the lateral jaw (landmark 18) region. These results suggest that the pattern of facial tissue thickness may be influenced by ancestry. The amount of influence from genetic, cultural, or environmental factors is unknown. Stephan and Simpson's (2008)50 review of published tissue thickness data cites that the lack of standardized methods for collecting and reporting tissue depth data introduces error from a number of sources (e.g. measurement method, landmark definitions, availability of raw data, etc.) and limits statistically meaningful interpretation of data between biological populations (p. 1259e60). They also note that the effect of population affinity on facial tissue thickness is not strong since studies display broad but
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similar ranges and central tendencies irrespective of population group (p. 1264). The authors also cite the effects of ‘race’ on tissue depth thickness as minimal (p. 1264). Future studies may want to include genetic information for geographic populations so that the effect of ‘race’, or ancestry, can be more accurately determined. Additionally, raw data should be available to all researchers so that observed differences between studies can be analyzed statistically; with the recently established C-Table data repository some raw data are now available.54 5. Conclusions The data demonstrate significant differences in tissue thickness between sexes, ages, and geographic populations. Since the 35e45, 45e55, and the 56þ year old age categories show no significant differences in facial tissue depth between males and females, these data could be collapsed into one age category, i.e. 35þ years old, that combines both sexes. Although differences were demonstrated in the 18e34 year old age category, collapsing these data that combines both sexes is also recommended. These data will add to the already existing databases of adults for use in 3-Dimensional facial reconstruction of unknown or missing individuals. They will provide forensic artists with a tool for generating images that will help identify missing Mi'kmaq peoples. Ethical approval None declared. Funding The Royal Canadian Mounted Police provides funding for this project. Conflict of interest Fournier was employed by the RCMP the duration of this project. The RCMP did not participate in the study design, analysis and interpretation of data; in the writing of the report; and in the decision to submit the article for publication. Acknowledgments Thank you is extended to Mrs. Philomena Moore, Principle (retired), Eskasoni Elementary and Middle School and Corporal Deborah Maloney, Royal Canadian Mounted Police, who helped recruit volunteers and without their assistance this project would not have been possible. Thank you to all the individuals who volunteered for this project and to the Mi'kmaq Community for working with us on this research. Thank you to the Royal Canadian Mounted Police for providing funding for this project. The authors wish to acknowledge the generous donations from the following organizations: Sobeys Atlantic Region, Nova Scotia Medical Examiner Service, Saint Mary's University. Additional gratitude is given to Dr. Susan Meek, Department of Biology, Saint Mary's University, for her assistance with the statistical analyses. References 1. Vanezis M, Vanezis P. Cranio-facial reconstruction in forensic identification: historical development and a review of current practice. Med Sci Law 2000;40: 197e205. 2. Lebedinskaya GV, Balueva TS, Veselovskaya EV. Principles of facial recon_ ¸ can MY, Helmer RP, editors. Forensic analysis of the skull: struction. In: Is craniofacial analysis, reconstruction, and identification. New York: Wiley-Liss; 1993. p. 183e98. 3. Manhein MH, Listi GA, Barsley RE, Musselman, Barrow NE, Ubelaker DH. In vivo facial tissue depth measurements for children and adults. J Forensic Sci 2000;45(1):48e60.
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