A quick Introduction to Soft Tissue Studies

Craniofacial Superimposition

Published on February 1, 2023

Written by María Alejandra Guativonza Higuera

Quantifying the relationship between the skull and facial soft tissue is highly relevant for Craniofacial Identification techniques. Facial soft tissue thickness, measured as the distance between the surface of the skin and the surface of the underlying bone tissue at a specific pair of homologous craniometric and cephalometric landmarks, poses as an important set of criteria for the evaluation of anatomical consistency.  Additionally, these measurements provide a basis for quantification and thus, repeatability of the results obtained in both Craniofacial Reconstruction (CFR) and Craniofacial Superimposition (CFS)

A number of studies have focused on measuring the facial soft tissue depth in a wide array of populations and using a variety of methods to obtain measurements. Without going into too much detail, dissection or needle puncture in cadavers are low-cost methods that yield immediate results and allow easy registration of soft tissue. However, there are some limitations since they provide an inaccurate representation of in vivo soft tissue due to cadaveric processes such as rigor mortis, bloating, loss of muscle mass, and embalming, as well as the cadaver being in the supine position. 

Techniques such as palpation or direct measurement in live subjects are useful to establish relationships between facial surface and underlying bone tissue, but it does not allow direct observation of the tissues and there is a limited number of features that can be measured. Additionally, palpation and measuring objects might distort the soft tissue that is being measured if pressure is applied. This same drawback ensues with the use of ultrasound, due to applied pressure, while radiographs and computed tomographies (CT-CBCT) expose the subject to radiation. Conversely, MRI has none of these issues and an excellent display of three-dimensional soft tissue, although it shows an inferior display of bone, and is also acquired in the supine position. 

Many authors [1]-[5] have warned about the wide variation in soft tissue depth measures acquired through different measurement techniques, irrespective of whether living persons or cadavers were considered, or the orthostatic or supine position of the subject. Other factors that influence the appearance of facial soft tissue are the differences in positional relationships associated with sex, age, or weight fluctuation. 

Facial soft tissue plays a key role in CFS and CFR. Both techniques require the estimation of soft tissue thickness present at the locations of anthropometric landmarks. Currently, such estimation is performed by simply using average values obtained in population studies. This can limit the fidelity of the results, as average values are used to estimate very individual-specific pieces of information. Moreover, many populational studies have a relatively small sample size, thus the average values they provide are subject to noticeable sampling error. This is especially true when additional factors such as sex or age are also considered. For this reason, larger studies, even when not very specific to a population group, provide much more reliable average soft-tissue values and in turn lead to better results. 

Stephan [6] has provided a metastudy that collects average values of multiple soft tissue thickness studies for both adults and sub-adults. This offers more accurate information that could be applied to different craniofacial techniques regardless of population. This study has proven useful when used in Skeleton-ID to apply the CFS technique in datasets from various populations. Soft tissue thickness average and standard deviation can be visualized in the form of cones once the overlay has taken place in-app.

As mentioned previously, the studies carried out have had issues regarding the distribution of their samples, such as age, sex, weight or population variation, sample size, inaccuracies associated with the different methods of acquisition, and frequently failed to address the direction of the measurement taken, the positional relationship between cranial and facial landmarks, the rate of muscle and fat within the soft tissue and other potentially relevant information. 

Despite all this, the current circumstances are as favorable as ever, with CT and CBCT scanners widespread among dental clinics and hospitals. In particular, CBCT scans, which are taken in an orthostatic position (with the subject standing up and gravity affecting their facial features as it would in most photographs) are commonplace in dental clinics around the world. 

At Panacea, we have automated multiple steps of the processing required to obtain soft tissue depth data from DICOM images, which means we can get results from larger samples much faster. If there is no study for the population of your interest, a quick fix would be to use Stephan’s metastudy, but if you want to take it into your own hands to create a population-specific study, you can contact us at pilotstudy@panacea-coop.com to collaborate with our research team.

Adult Soft Tissue Depth Data
PopulationAuthor(s)Acquisition method
AustralianSimpson & Henneberg (2002), Domaracki & Stephan (2006), Stephan & Preisler (2018)Needle puncture, ultrasound
BelgianDe Greef et al. (2009)Ultrasound
BrazilianGaldames et al. (2008), Tadeschi-Oliveira et al. (2009), Moritsugui et al. (2022)Needle puncture, CBCT
CanadianVander Pluym et al. (2007), Peckmann et al. (2015)MRI
ChileanGaldames et al. (2008)Ultrasound
ChineseBirkner (1906), Stadtmuller (1923), Jia et al. (2016)Ultrasound
Chinese-AmericanChan et al. (2011)Ultrasound
EgyptianEl-Mehallawi & Soliman (2001)Ultrasound
FrenchTilotta et al. (2009), Guyomarc’h et al. (2013)CT
GermanWelcker (1883), His (1895), Czekanowski (1907), Stadtmuller (1923), Berger (1965), Leopold (1968), Bankowski (1958), Helmer (1984)Radiographs, needle puncture, ultrasound
IndianRhine (1983), Sahni et al. (2002), Meundi et al. (2019) Needle puncture, MRI
JapaneseSuzuki (1948), Utsuno et al. (2014)Radiographs
KoreanHwang et al. (2012)CBCT
LebaneseSimpson, E., & Henneberg, M. (2002)Needle puncture
MediterraneanAyoub et al. (2019)Radiographs
NamibianVon Eggeling (1904)Needle puncture/dissection
PapuanFischer (1905)Needle puncture
PortugueseCodihna (2009)Needle puncture
Slavic originsLebedinskaya & Veselovskaya (1986)Ultrasound
South AfricansPhillips & Smuts (1996), Cavanagh & Steyn (2011), CT
Sri LankanSandamini et al. (2018)MRI
SwissKollman & Büchly (1899)Needle puncture
TurkishKurkcuoglu et a.l (2011)Radiographs
US blackRhine & Campbell (1980), Manhein et al. (2000), Williamson & Nawrocki (2002)Needle puncture, ultrasound
US hispanicManhein et al. (2000)Ultrasound
US whiteWeinig (1958), Hodson et al. (1985), George (1987), Manhein et al. (2000)Radiographs, Ultrasound
USParks et al. (2014)CT
ZuluAulsebrook et al. (1996)Radiographs
Sub-adult Soft Tissue Depth Data
PopulationAuthorsAcquisition method
CanadianPeckman et al. (2013)Ultrasound
EuropeanDumont (1986), Nanda & Meng (1990)Radiographs
ItalianGibelli et al. (2016)Radiographs
JapaneseUtsuno et al. (2004) (2010)Radiographs
South AfricanBriers et al. (2015), Briers & Steyn (2018)Radiographs
UK whiteWilkinson (2002)Ultrasound
US blackManhein et al. (2000)Ultrasound
Us hispanicManhein et al. (2000)Ultrasound
US whiteManhein et al. (2000)Ultrasound


Written by:

María Alejandra Guativonza

María Alejandra Guativonza Higuera is a pre-doctoral researcher at Panacea Cooperative Research. She holds a degree in Anthropology from Universidad de Los Andes (Bogotá, Colombia) and a master’s degree in Physical and Forensic Anthropology from Universidad de Granada (Granada, Spain) and is pursuing a Ph.D. at this institution.

She has worked on projects with Chemonics International Sucursal Colombia and the Colombian Missing Persons Search Unit (UBPD) with the help of the National Forensic Institute. She is currently part of the research team at Panacea Coop, focusing on craniofacial identification methods.


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Handbook on Craniofacial Superimposition

Methodolgy and protocol for forensic human identification with Craniofacial Superimposition.