THE ANATOMICAL RECORD 298:1144–1161 (2015)

Revealing the Face of an Ancient Egyptian: Synthesis of Current and Traditional Approaches to EvidenceBased Facial Approximation 1

2 3 € KAITLIN E. LINDSAY,1 FRANK J. RUHLI, AND VALERIE BURKE DELEON * Department of Art as Applied to Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland 2 Centre for Evolutionary Medicine, Institute of Anatomy, University of Zurich, Z€ urich 8057, Switzerland 3 Center for Functional Anatomy & Evolution, Johns Hopkins University School of Medicine, Baltimore, Maryland

ABSTRACT The technique of forensic facial approximation, or reconstruction, is one of many facets of the field of mummy studies. Although far from a rigorous scientific technique, evidence-based visualization of antemortem appearance may supplement radiological, chemical, histological, and epidemiological studies of ancient remains. Published guidelines exist for creating facial approximations, but few approximations are published with documentation of the specific process and references used. Additionally, significant new research has taken place in recent years which helps define best practices in the field. This case study records the facial approximation of a 3,000-year-old ancient Egyptian woman using medical imaging data and the digital sculpting program, ZBrush. It represents a synthesis of current published techniques based on the most solid anatomical and/or statistical evidence. Through this study, it was found that although certain improvements have been made in developing repeatable, evidence-based guidelines for facial approximation, there are many proposed methods still awaiting confirmation from comprehensive studies. This study attempts to assist artists, anthropologists, and forensic investigators working in facial approximation by presenting the recommended methods in a chronological and usable format. Anat Rec, 298:1144–1161, C 2015 Wiley Periodicals, Inc. 2015. V

Key words: computed topography; mummy studies; facial reconstruction; 3D image analysis

INTRODUCTION Forensic Facial Approximation Forensic facial approximation is the procedure of predicting a face from the morphology of the skull. The Scientific Working Group for Forensic Anthropology (2011) has defined the aims of facial approximation to be: “to estimate the antemortem facial appearance of an individual from unknown skeletal remains; to suggest the identity of persons to whom the remains might belong; and to capture public attention regarding the case” (p. C 2015 WILEY PERIODICALS, INC. V

Grant sponsor: M€ axi Foundation Switzerland and The Vesalius Trust for Visual Communication in the Health Sciences. *Correspondence to: Dr. Valerie Burke DeLeon, Department of Anthropology, University of Florida, P.O. Box 117305, Gainesville, Florida 32611; E-mail: [email protected] Received 16 January 2015; Accepted 30 January 2015. DOI 10.1002/ar.23146 Published online in Wiley Online Library (wileyonlinelibrary. com).

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1). Facial approximations are used to assist in identification of the dead and in archaeological museum exhibits as an alternative or supplement to the display of human remains. One of the main practical functions of an approximation is to draw interest toward the individual in question, not necessarily to create a portrait that is accurate in every detail; in forensics, facial approximation is never used in isolation as a means of identification. However, accuracy is highly desirable since it would increase the chance of recognition and subsequent identification. Thus, facial approximations are always a team effort requiring input from anthropological, anatomical, and artistic considerations.

History of Facial Approximation The idea of anatomical sculpting over bone began in eighteenth century Italy with the practice of anatomica plastica, wax muscles modeled over the skeleton. This technique was developed by Giulio Gaetano Zumbo (1656–1701), who used it to create medical teaching models. He and other artists, including Abraham Chovet (1704–1790) and Ercole Lelli (1702–1766), brought the practice to a high art and the results are startlingly lifelike; however, their purpose was strictly anatomical. The first interest in reconstruction for identification began as an academic exercise among anatomists in the nineteenth century: the anatomist Hermann Welker (1822– 1897) is known to have made drawings of skulls purported to be Rapheal’s and Kant’s in order to overlay them on drawings of a self portrait and death mask, respectively. Wilhelm His (1831–1904) measured tissue depths in cadavers in order to model a bust of Johann Sebastian Bach onto a cast of his skull; comparisons were then made with Bach’s portraits. Arthur Kollmann (1858–1941) used the same method to reconstruct the skull of Dante. Kollmann later worked with a sculptor, W. Buckly, to create what is considered the first true scientific reconstruction: a Stone Age woman from France constructed using tissue depth data collected from hundreds of women from the region. Approximations of archaeological specimens continued into the early part of the twentieth century when the Russian anthropologist Mikhail Mikhaylovich Gerasimov (1907–1970) became interested in reconstructing the faces of the recently deceased. He developed a method of approximation by modeling heads onto skulls and then comparing them to photographs of the individual before they had passed on. Wilkinson (2004) describes that this was a two-step process: first, the construction of the head and neck muscles and second, the addition of a thin layer of clay to represent skin. He also devised methods of predicting the facial features (eyes, ears, mouth, and nose) using the form of the skull and claimed an incredible accuracy rate near 100% (Gerasimov, 1968 and 1971 as cited in Ullrich and Stephan, 2011). Unfortunately, his techniques were never fully documented and no one since has been able to approach his reported capabilities. What is known of his techniques is known as the Russian method. Early workers in the United States included McGregor and Wilder, who reconstructed archaeological specimens in the early 20th century. It was not until the anthropologist Wilton Krogman became interested in the

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technique in 1946, however, that reconstructions began to be performed in America with more regularity. Betty Pat Gatliff, a forensic artist, and Clyde Snow, an anthropologist, later built on Krogman’s work to create the American method of 3D reconstruction. This involves cutting and placing vinyl tissue depth markers on the skull, connecting the markers with strips of clay, and then filling in the remaining areas with sculpture of the facial features (Gatliff, 1984). Meanwhile, methods for 2D reconstruction were also developed using Krogman’s initial work: first by J. Lawrence Angel and later by the anthropologist Caldwell. Additional improvements were made by Taylor (2001) and George (1987). Notable figures in Europe included Helmer and Neave, the latter of whom created a combination of the Russian and American methods while working with the Manchester Mummy Project. Appropriately, this is known as the Manchester method. Neave placed depth markers on the skull in the same fashion as the American method, and then built the facial anatomy muscleby-muscle like the Russian method, but using the depth markers as a guide to their thickness (Prag and Neave, 1997). Facial feature development also incorporated guidelines proposed by Gatliff (1984), Krogman and Iscan, and George (1987). There is currently no standardized method for creating facial approximations. Besides the three general schools of thought, there are also many variations of facial feature prediction, which have been proposed (see below). Although the Russian, American, and Manchester methods are often presented as distinct entities, in reality most practitioners probably use aspects of more than one. The following section, therefore, describes a generalized method for manual 3D facial approximation using both depth markers and musculature.

Manual 3D Facial Approximation Method The first step in creating an approximation is careful study of the skull. Sex of the subject is determined according to the general form, size, and robustness of the skull, while age may be ascertained using dentition and suture closure. If forensic evidence such as the postcranial skeleton is present, this should be taken into account as well. Facial approximation texts additionally recommend a broad characterization of ethnicity, but this is problematic due to the inherent variability of the human species. It has been suggested that defining ethnicity based on the cranium may have applicability in North American forensic identification cases due to this area’s historical and sociocultural background, but is of no particular value in other areas of anthropology (Sauer, 1992). Any additional features that might inform the facial approximation, such as stature, unusual proportions, dentition, and pathologies, are researched and discussed at this stage as well. Taylor (2001) and Wilkinson (2004) both emphasize that study of the skull’s subtle asymmetries allows the asymmetry of the face to be properly reflected. The skull also dictates the proportions of the face, and it is likely that the most accurate aspect of any approximation is the proportional relationships between features. After collecting information from the skull, a tissue depth table is selected. There are a multitude of tissue depth studies available with a wide range of publication

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dates, data collection methods, and focus on population subgroups based on age, sex, ancestry, and build (see Appendix); however, many of these studies are based on small numbers of subjects. In the past, a single or small number of tissue depth tables would be chosen to work with based on the subject’s sex, age, and ancestry. However, a recent analysis of all available tissue depth studies suggested that test subjects are often placed into groups arbitrarily, and, given that differences among those arbitrary groups is small, overlap between groups is high, and measurement error so great, all tissue depth data should be pooled into a single table (Stephan and Simpson, 2008). Those authors have made the combined table freely available online at www.craniofacialidentification.com and update it annually to include new tissue depth studies. Once a tissue depth table is chosen, markers are cut to size and placed on the skull. All craniofacial muscles are then built by locating their origins and insertions on the skull and using the depth markers as a guide to thickness. The amount of neck and shoulders depicted is up to the practitioner; their inclusion creates a more convincing bust but involves additional potentially misleading guesswork. The parotid gland and buccal fat pad are added at this stage as well. Recently, an anatomical study showed that the temporal fat pad creates a surface contour not reflected by the temporalis muscle alone and suggested the fat pad be modeled in craniofacial approximations separately from the temporalis (Stephan and Devine, 2009). Finally, a layer representing skin and subcutaneous fat is placed over the facial anatomy and surface features such as wrinkles and texturing are added. This is generally considered the most artistic phase of the approximation and benefits from a practitioner’s sculptural experience. The choice of whether and how to depict skin and hair color is informed by the context of the approximation. Forensic investigations may or may not have evidence to suggest coloration, and conservative choices must be made so as not to confuse possible recognition. This is not a concern in archeological contexts and these approximations are often given detailed, realistic skin colors. Hairstyle, makeup, jewelry, and glasses may then be added if desired or justified.

Prediction of Facial Features There are existing techniques that may help estimate the form of the eyes, ears, mouth, and nose (discussed below), although the degree of the methods’ basis in anatomic evidence is not always clear. Compared to skeletal cases, soft tissue preservation in mummies may provide additional guidance in approximating facial features, although specific working guidelines for the interpretation of ancient desiccated, frozen, or otherwise diagenetically or taphonomically modified soft tissue are limited. Wilkinson (2008) alludes to a procedure that allowed the living face of Ramses II to be reconstructed from photographs of his unwrapped mummy, but she provides no specific process or reasoning for the forms of any of the features seen in the finished bust. She does mention that ear size, shape, protrusion, and form, nasal tip, vermillion line, hair line, and wrinkle patterns–details that have little to no effect on the skull–may be visible on desiccated mummies. In any case, it is clear that each

mummy case should be evaluated individually for any soft tissue features that might inform the approximation. Traditionally, facial approximations placed eyeballs precisely centered in the bony orbit, but they are now known to be somewhat lateral and superior from center (Stephan et al., 2009, confirming Wolff, 1933, among others). The eyeball is about 24 or 25 mm in diameter and the iris is about 12 mm (Wolff, 1933;Taylor, 2001). Until recently, the eyeball’s projection from the socket was found using a tangent drawn from the upper and lower orbital rims; anatomical studies have since found that it projects much further forward, around 16 mm from the lateral orbital rim to the apex of the cornea (Stephan et al., 2009) or such that a tangent drawn from the orbital rims touches the iris, not cornea (Wilkinson and Mautner, 2003). Stephan and Davidson (2008) found that the lateral canthis lays on average 4.5 mm medial to the lateral orbital rim, while the medial canthis lays 4.8 mm lateral to the medial rim. In profile, they found the lateral canthis lies about 5 mm posterior to the corneal apex. The lateral canthis is usually described as lying beside the malar tubercle and the medial defined by the lacrimal crest; thus, the lateral canthis is usually higher than the medial. The position of the epicanthic fold is described as lying medially, centrally, or laterally, and may be predicted using the shape of the supraorbital margin (Fedosyutkin and Nainys, 1993 as cited in Wilkinson, 2004). The eyebrows generally follow the form of the supraorbital margin and Taylor (2001) suggests depicting them conservatively while keeping ethnicity and sex in mind. The choice of iris color should similarly be made conservatively with the recommendation of the anthropologist. The ears leave no impression on the skull and thus are very difficult to predict accurately. The tragus lies over the external auditory meatus (Gatliff, 1984) and the ear is tilted back and out from the skull. Various sources say the tilt is 15 (Gatliff, 1984), that the tilt follows the angle of the jawline (Gerasimov, 1955 as cited in Wilkinson, 2010), that the ear height is equal to the height of the nose (Taylor, 2001), and that the ear width is about half that of its height (Gerasimov, 1971 as cited in Wilkinson, 2004). The form and size of the mastoid process has been proposed to predict the protrusion of the ears (Taylor, 2001; Fedosyutkin and Nainys, 1993 and Gerasimov, 1971 as cited in Wilkinson, 2004) and Fedosyutkin and Nainys went further in suggesting that the angle of the mastoid process predicts attached or detached earlobes. Ears play little role in face recognition and it is an accepted practice to use generalized ears placed in the correct position over the external auditory meatus (Taylor, 2001; Wilkinson, 2004). The mouth and lips are highly mobile, have no direct impressions on the skull, and have forms which vary within ethnic groups and change with age. The mouth dimensions are usually predicted using the teeth, but Taylor (2001) warns that all guidelines must also consider the age, ethnicity, and sex of the individual. The total height of upper and lower lips at the midline is commonly understood to be equal to the total enamel height of upper and lower incisors. The meeting of upper and lower lips overlays the lower third to lower quarter of the upper incisors. Wilkinson et al. (2003) confirmed that lip height is correlated to enamel height, but

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proposed differing regression equations for white Europeans and Asians from the Indian subcontinent. Mouth width has been described using the medial edge of the iris (Broadbent and Mathews, 1957), using the center of the pupil (Krogman & Iscan, 1986 as cited in Wilkinson, 2004), using a radiating line from the first premolarcanine juncture (Gatliff, 1984; Taylor, 2001; Wilkinson, 2004), and a “75% rule” where intercanine distance is 75% of the mouth width (Stephan and Henneberg, 2003). Wilkinson et al. (2003) found the medial iris to be a better predictor of mouth width than interpupillary distance, while Stephan and Murphy’s (2008) paper recommends inter-infraorbital foramen distance or the 75% rule. Occlusion of the teeth is associated with degree of lip protrusion, thickness of the lips, and whether the upper lip is pulled upward at rest, uncovering the teeth (Taylor, 2001; Gerasimov, 1971 as cited in Wilkinson, 2004). Evidence suggests that the width of the philtrum is equal to the distance between the middle of the first maxillary incisors (Fedosyutkin and Nainys, 1993 as cited in Wilkinson, 2004), and that philtrum width is correlated with mouth width regardless of age, sex, or ethnicity (Latta, 1988). Taylor (2001) suggests that the shape of the philtrum relates to the angle of the maxillary central incisors. The nasolabial fold is defined by the origins of the levator labii superioris and zygomaticus (Angel, 1978 as cited in Wilkinson, 2004), and runs from the upper edge of the alae to the first or second upper molar. The fold is deeper in people with a deep (greater than 5 mm) canine fossa, missing teeth, or advanced age (Fedosyutkin and Nainys, 1993 as cited in Wilkinson, 2004). The nose is composed mostly of cartilage, and while it is not essential to recognition of faces in frontal view, it has a strong effect on profiles. Wilkinson (2004) and Taylor (2001) recommend that general considerations of ethnicity and age be taken into account when considering the nose. George (1987) describes multiple forms each for the nasal bridge, nasal tip, angle of the nose, and “openess” of the nostrils and ala as observed in profile, all of which are difficult to predict since the direction and shape of the nasal cartilages, presence and amount of subcutaneous fat, and presence or absence of the nasalis muscle have no obvious relationships to the nasal bones or septal cartilage (Anderson et al., 2008). Nonetheless, nose projection guidelines have been of interest for decades and multiple prediction methods have been proposed. Generally, these methods have focused on locating the pronasale, the most anterior point of the nose, as well as suggesting whether a nose is upturned, downturned, or level. These methods include Krogman and Iscan’s “Threefold-ANS” method (1986), Gerasimov’s “Two-Tangent” Method (1955 as cited in Rynn and Wilkinson, 2006), Prokopec and Ubelaker’s Method (2002), Macho’s Method (1986 and 1989), George’s Method (1987), Stephan et al.’s Method (2003) and Rynn, Wilkinson, and Peter’s Method (2010). The anterior nasal spine has received much attention as a predictor of both the direction of the nose and the shape of the nose tip. However, it has been suggested that in practice Gerasimov used the floor of the nasal cavity, not the anterior nasal spine, as an indicator of the direction of the nose (Ullrich and Stephan, 2011). Tip shape has also been suggested to reflect the morphology of the lateral border of the nasal aperture (Rynn et al., 2010).

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Recently, a new method to check nose tip shape has been proposed: it involves tipping the skull posteriorly and using the shape of the upper part of the nasal aperture as a guideline (Davy-Jow et al., 2012). The wings of the ala are known to sit anterior and inferior to the nasal aperture, and the maximum width of the nasal aperture is around three-fifths of the maximum width of the soft tissue nose (Taylor, 2001; Rynn et al., 2010). Sforza et al. (2010) found that nasal volume, area, and linear measurements increase while nasal tip angle decreases with age. An inherent caveat of any facial approximation is that the fattiness of the face cannot be predicted from the skull; thus, approximations assume that the individual is of average weight. This has real implications for the chance of recognition of below- and above-average weight individuals since BMI is correlated with facial soft tissue depths (De Greef et al., 2009), and faces with no appreciable differences in facial form are perceived as different individuals when reconstructed using tissue depth measurements for emaciated, normal, and obese faces (Starbuck and Ward, 2007). It is also believed that practitioner experience affects the accuracy of approximations. Quatrehomme et al. (2007) found that a scientist with no experience in facial approximation and given no instructions produced approximations with a lower resemblance rating than an experienced practitioner given an anthropological analysis of the skull, and that resemblance ratings increased even further when the experienced practitioner performed a 2D lateral craniographic method of approximation (described by George, 1987) before performing the 3D manual approximation. It has also been suggested that while limited experience probably does contribute to low recognition rates, there are also many inaccuracies inherent to prediction guidelines since they fail to utilize published anatomical data, and moreover, “many untested subjective guidelines have been used in facial approximation and craniofacial superimposition despite the fact that quantified and well-studied relationships exist in other disciplines” (Stephan, 2011).

Aim of This Study This is a case report of the study and 3D facial approximation of an ancient Egyptian mummy head using medical imaging data and the digital sculpting program, ZBrush. Although published guidelines exist for creating facial approximations, few approximations are published with documentation of the specific process and references used. This is especially problematic for digital manual techniques, which have different strengths and weaknesses compared to physical techniques and change rapidly with the advent of new software. Hayes (2011) points out that approximations within both anthropology and forensics are often presented as “fact,” without proper documentation of the process that led to the results and with little appreciation for the level of uncertainty inherent to all approximations. The most recent reviews with practical working guidelines for creating craniofacial approximations were published in 2001 (Forensic Art and Illustration, by K.T. Taylor) and 2004 (Forensic Facial Reconstruction, by C. Wilkinson), and while they remain invaluable resources to artists and investigators, significant new research has

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Fig. 1. The mummy. (A) Anterior. (B) Right. (C) Left. (D) Posterior. (E) Superior. (F)Inferior. Photographs by H. Sonderegger, Institute of Anatomy, University of Zurich.

taken place since that time which has ramifications for best practices in the field. The goal of the current study is to provide a synthesis of evidence-based facial approximation methods using this mummy as an example. It is hoped this work will assist artists, anthropologists, and forensic investigators working in craniofacial approximation by providing careful documentation of the technique after careful review of various existing techniques and relevant literature in the discipline.

MATERIALS AND METHODS The Subject The subject was an isolated mummified Ancient Egyptian head partially covered in textile wrappings in the collection of the Centre for Evolutionary Medicine, Institute of Anatomy, University of Zurich (Fig. 1). The circumstances of its collection are unknown as it was stored in a Swiss museum without catalog information. Previous carbon-14 dating placed the person’s death at 1150 BCE-795 BCE. This places the subject’s death in the late New Kingdom or Third Intermediate Period during the 20th, 21st, or 22nd Dynasty. These dynasties,

especially the 21st, were the peak of the embalmers’ practice, and the specimen exhibits several hallmarks of Egyptian mummification, including layers of textile wrappings and excerebation. The mummy did not appear to receive subcutaneous packing in the head or neck and also lacks the artificial eyes common to 21st Dynasty mummies.

Data Visualization The head was imaged using computed topography (CT) and ultra-short echo time MRI modalities in 2007 as reported in R€ uhli, von Waldburg, Nielles-Vallespin, B€oni, and Speier. Imaging data were visualized using R software (Visualization Sciences Group, version AmiraV 5.3.3). CT scans using 80 and 100 kV parameters as well as ultra-short echo time MRI (parameters reported in R€ uhli et al., 2007) DICOM datasets of the mummy were examined. The 100 kV CT scan (49.0 mA) provided the best visualization of bony tissues relevant for the facial approximation, and all further analyses were conducted using this image volume. The 100 kV CT scan was a 512 3 512 3 805 volume with voxel dimensions of 0.457 3 0.457 3 1.0 mm3. To improve visualization, data were

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resampled using Lanczos interpolation to voxel dimensions 0.2 3 0.2 3 0.2 mm3. Soft tissues and layers of textile wrappings were easily visualized, including skin and eyeball remains. No evidence of brain tissue was found and solidified resin was present in the posterior braincase. Also noted was a heterogeneous mass of material pooled in the pharynx and several small, high-density material fragments in the mouth and pharynx (Fig. 2). Other notable observations included five areas of damage (Fig. 3a): 1. A cut across the neck that separated the head from body at approximately the seventh cervical vertebrae. 2. Straight-edged midline damage to the philtrum area caused by unpublished tissue sampling experiments at the Centre for Evolutionary Medicine, University of Zurich. The upper incisors were broken. 3. A hole on the right lateral cranium measuring 5.2 cm by 3.6 cm at its widest points. Associated damage to the overlying soft tissue and wrappings were apparent. 4. An oval-shaped hole on the superior cranium measuring 2.4 cm by 3.2 cm at its widest points. Uninterrupted skin covered the damage in the bone. 5. Extensive damage to the left nasal and orbit area extending through the outer wrappings, orbit walls and floor and though the skull to the left sphenoid sinus.

RESULTS Assessment of the Skull Visual assessment of the skull revealed a somewhat square mandibular angle, but pointed chin, gracile brow ridge, and generally rounded forms indicating the female sex. The third molars, found fully erupted but with slightly less wear than the first two molars, noticeable wear on the teeth in general, and visible cranial vault sutures were all suggestive of a middle-aged adult. The spheno-occipital synchondrosis was found fully fused but with evidence of its location still visible, again suggesting a fully adult person beyond her mid-20’s. Overall, inspection of the skull indicated that the mummy was an adult woman around 30 to 40 years of age. This is not unusual since the average life expectancy in dynastic Egypt was 36 (Masali and Chiarelli, 1976). Evidence for ethnic affinities was not visually apparent beyond the observation of strong maxillary prognathism.

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Next, Amira’s segmentation editor was used to fill unnecessary spaces, such as the interior of bones and sinuses, while retaining all surface details needed for the approximation. A combination of smoothing and simplification functions in Amira reduced the surface polygon count to 4.5 million faces with minimal loss of detail. The skull surface was then exported from Amira as an OBJ file. The OBJ was opened in the open source program Meshlab (v1.3.1, http://meshlab.sourceforge.net/ ), and automatic detection and clean-up utilities were used to remove problem geometry. The resulting OBJ was then imported to ZBrush (Pixologic, version 4R2).

Tissue Depth Markers Once the skull was successfully imported, ZBrush’s 3D space was calibrated and tissue depth markers placed. First, the skull was rotated in 3D space such that its anatomic coordinates matched the world coordinates within ZBrush: in other words, the skull was roughly centered over the Z axis, the Frankfurt horizontal was placed parallel to the X-Y plane and the skull was rotated about the Z axis such that the frontal view was placed at 0 , lateral at 90 , and so on. This was helpful to take advantage of ZBrush’s viewport ability to snap to these world coordinates. Next, ZBrush was calibrated to real world units. The transpose action line was set to measure nasal breadth, the calibration distance was set to 25 (a value previously determined in Amira) and units were set to millimeters. With the space set properly, the tissue depth markers were placed using cylinder primitives stretched to size and appended to the skull as subtools (Fig. 4). The tissue depth table chosen was the 2012 Adult Tallied-Facial-Soft-Tissue-Depth-Data Table, or T-Table (Stephan, 2012). The 2012 table integrates all tissue depth studies published prior to January of 2012 (see Appendix) and was downloaded at craniofacialidentification.com. The markers were placed on the mummy’s skull according to Stephan and Simpson (2008). The placement of the rhinion, subnasale, and mid-philtrum markers were conservatively estimated since these areas of bone were affected by damage to the skull. All length values used were the total weighted means listed in the 2012 Adult T-Table except nasion, mid-nasale, and rhinion, which visually appeared to overestimate the most likely amount of tissue overlying the bridge of the nose of an adult female. These locations were therefore reduced by one standard deviation from 6.0, 4.0, and 3.0 mm to 4.5, 3.0, and 2.0 mm, respectively.

Preparing the Skull for Facial Approximation The skull was digitally extracted from the soft tissue and textile layers surrounding it based on density thresholding. Repairs were then made to the damaged parts of the facial bones and teeth in Amira (Fig. 3b) according to the recommendations for virtual reconstruction of biological material by Zollikofer and Ponce de Leon (2005). Since all areas of facial damage appeared postmortem, it was appropriate to return the skull to anatomic position for the purpose of the facial approximation. Due to its importance to the final outcome of the project, every effort was made to maintain the biological and scientific integrity of the skull throughout this process.

2D Facial Approximation A 2D facial approximation was prepared to help guide the 3D sculpting process as suggested by Taylor (2001). The shape of the face was established by connecting the ends of the tissue depth markers and following the curvatures suggested by the skull (Taylor, 2001). After reviewing the literature, the techniques selected to approximate the facial features were those which appeared to be based in the most solid anatomical and/ or statistical evidence. Evidence was defined as the results of a published experiment which proposed or compared methods of predicting soft tissue features from the skull using real patient data: photographs, imaging

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Fig. 2. Radiological findings in CT scan visualized in Amira.

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Fig. 3. (A) Areas of damage. From left to right: Facial damage, CT of cut wrappings around facial damage, hole in right lateral cranium, CT of cranial holes, hole in superior cranium. Textured areas are regions of thinned bone. (B) Facial damage repair as part of this study: Nasal fragment and maxillary incisors moved back to anatomic position, and orbit and nasal area repaired using a reflection of the intact contralateral bones.

data, or cadaver dissection. Where no evidence-based method was available for a feature, other lines of reasoning were used to select a prediction method (see below). The eyeballs were placed 1.4 mm superior and 2.3 mm lateral from the center of the orbit as measured from the most superior (disregarding the superior orbital notch), inferior, medial, and lateral points on the orbital margins in accordance with the anatomical studies by Stephan et al. (2009) and Stephan and Davidson (2008). The eyeballs were drawn 24 mm in diameter with the irises 12 mm in diameter (Wolff, 1933; Taylor, 2001) and

with the corneal apexes projecting 16 mm from the deepest point on the lateral orbital margins (Stephan et al, 2009). The medial canthi were placed 4.8 mm lateral to the medial orbital margins and 12 mm below nasion, while the lateral canthi were placed 4.5 mm medial to the lateral orbital margins, 8 mm inferior to the frontomalare orbitale points, and projecting 10 mm anterior to the deepest point on the lateral orbital margin viewed in profile (Stephan and Davidson, 2008). The epicanthic fold was positioned medially, underneath the overhang in the supraorbital margin, and since the skull exhibited

Fig. 4. Placement of tissue depth markers. All values used were the total weighted mean listed in the 2012 Adult T-Table except nasion, midnasal, and rhinion, which were reduced one standard deviation. Measurements in millimeters.

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Fig. 5. Lateral nose approximation using Rynn, Wilkinson, and Peters’ method (2010). All measurements in mm. (A) Craniometric dimensions measured: Nasion-Acanthion, Rhinion-Subspinale, NasionSubspinale. Note that position of anterior nasal spine and rhinion are estimated. (B) Predicted cephalometric dimensions: Pronasale anterior projection from Nasion-Prosthion plane (NPP), Pronasale height down

from nasion in NPP, Pronasale projection in Frankfurt Horizontal Plane. Second point on nose tip located with Two-tangent method. (C) Additional predicted dimensions: Nasal length from soft nasion to pronasale, Nasal height from soft nasion to subnasale, Nasal depth from subnasale to pronasale.

a weak brow ridge and low nasal root, the medial third of the eyebrow was placed in the orbit with the lateral two thirds rising to meet the supraorbital margin (Fedosyutkin and Nainys, 1993 as cited in Wilkinson, 2004, p. 114). The ears were conservatively treated, with their height roughly equaling the height of the nose. The tragus was placed over the external auditory meatus and the ears were tilted to match the angle of the jaw (Wilkinson, 2004, p. 120–121). The mastoid processes pointed anteriorly, so the earlobes were shown detached (Fedosyutkin and Nainys, 1993 as cited in Wilkinson, 2004, p. 120). Subtle asymmetry of the skull suggested that the right ear should be somewhat more visible than the left in the frontal view. The parting of the lips was placed just superior to the edges of the upper incisors and total height of the mouth was determined by summing the upper and lower enamel heights of the first incisors (Taylor, 2001, p. 398– 399). Because the skull displayed strong maxillary prognathism, the lips were shown fairly full (Wilkinson, 2004, p. 115) and with the upper lip protruding farther than the lower (Fedosyutkin and Nainys, 1993 as cited in Wilkinson, 2004, p. 118). Mouth width was determined using the 75% rule of Stephan and Henneberg (2003), which when checked also proved to align with the medial edge of the irises (Wilkinson, 2004, p. 116). Asymmetry in the maxilla suggested the left corner of the mouth should be somewhat higher than the right. The nose projection was calculated using Rynn, Wilkinson, and Peters’ (2010) regression equations to locate pronasale with a second point on the tip of the nose

located using Gerasimov’s two tangent technique per those authors’ suggestion (Fig. 5). In order to take the measurements necessary, the position of the rhinion and anterior nasal spine were estimated in the lateral view of the skull. The tip of the nasal bone where rhinion is located was estimated by extending the curvatures created by the anterior aspect of the nasal bones and the edge of the piriform aperture until the lines intersected. The direction of the anterior nasal spine was informed by the trajectory of the maxillary floor of the nasal cavity to either side of the vomer as viewed in ZBrush. This is the area which Ullrich and Stephan (2011) claim was Gerasimov’s true predictor of the lower nose tangent. The ala were also placed according to the statistically significant results of Rynn et al (2010): the most inferior point on the alar curvature is 4 mm inferior to the most inferior point of the piriform aperture border, the most posterior point on the alar groove is 6 mm anterior to the most posterior point on the border of the piriform aperture, and the maximum aperture width is three fifths the maximum nasal width. Since the inferior turbinate was not present, the most superior point of the alar groove was placed on the same vertical level as the change of direction in the edge of the piriform aperture as seen in profile (Wilkinson, 2004, p. 104). In the frontal view, the skull showed slight asymmetry in the base of the piriform aperture; thus the right nostril was placed somewhat lower than the left. The 2D facial approximation (Fig. 6) was scanned and formatted in Photoshop (Adobe, version CS5.5) and placed as a material on the default XPlane tool in ZBrush. The XPlane with the drawing was appended to

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Fig. 6. Two-dimensional facial approximation.

the skull and depth markers as a subtool and rotated and scaled to match their orientation. Once the drawing was registered, the sculpture could be directly compared and contrasted to the 2D drawings.

3D Facial Approximation To create eyes, two sphere primitives were appended to the skull, scaled to 24 mm in diameter, and placed in

the orbits according to the 2D drawings (Fig. 7). The move brush was then used to stretch the spheres slightly to create the cornea. The facial muscles were added one at a time using ZSpheres in ZSketch mode. The facial muscles were built in the order suggested by Wilkinson (2004) and the depth markers and 2D drawings were used as a guide to their thickness. Additional anatomical reference was found in Clemente’s Anatomy, a Regional Atlas of the Human Body (1987). Each

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suggested by Anderson, Henneberg and Norris’s 2008 dissection study. In order to better access all parts of the nose, the shapes approximating the septal, lateral, and superficial aspect of the alar cartilages were built in one subtool while the wings of the ala, nostril rims, and columella were built in another. The ears were built simultaneously by toggling on symmetry mode. Each ear was then positioned individually using scale and rotate. Finally, the parotid gland and superficial temporal fat pad were modeled with ZSpheres according to Wilkinson (2004) and Stephan and Devine (2009), respectively. Once the facial anatomy sketch was complete, each ZSketch subtool was optimized and used to generate a unified skin mesh, which could be smoothed and sculpted. Each generated skin was then appended to the skull and smoothed and textured to better represent the facial anatomy. In anticipation of the surface sculpt, the neck and buccal fat pad were added using ZSpheres converted to unify skins as described above. The buccal fat pad filled the space beneath the zygomaticus and risorius muscles, and the neck was blocked-in as a single shape rather than muscle-by-muscle; special attention was given to the sternocleidomastoid and trapezius muscles, however. The neck position followed the gentle bend of the mummy’s vertebrae and ended near the sternoclavicular junction anteriorly and the first thoracic vertebra posteriorly. Flat colors were added to help distinguish the structures, and eye color was added using polypainting (Fig. 8). To create the skin surface, a new ZSphere was appended to the skull and a layer of ZSpheres was added over the facial anatomy and cranium. The depth markers were used as a general guide to this layer’s thickness, which represented the volume of skin, subcutaneous fat, and connective tissue lying over the musculature. A more refined modeling of the lips, brow ridge, and nose was performed at the ZSphere stage as well. Next, a unified skin of the head surface was created and appended as a subtool. The ear and neck subtools were added to this mesh by using the “Remesh All” and “Project All” functions. The skin surface was then further smoothed and sculpted. The nose tip shape was checked using Davy-Jow et al (2012) method of tipping the skull dorsally such that pronasale and rhinion overlapped and comparing the contour of the nose and nasal aperture. As expected for an upturned nose, the tip contour was wider than the aperture (Fig. 9).

Facial Approximation Fig. 7. Eye placement.

muscle was built on both sides of the face in a single subtool except select muscle groups built together in single subtools for simplicity (e.g., the mentalis, depressor labii inferioris, and depressor anguli oris were built in a single subtool). Thus each muscle or muscle group could be viewed and adjusted without affecting any other muscle. Although the 2D approximation showed the woman with her mouth closed, the sculpture shows the lips slightly parted so that a few teeth are visible. The shapes of the nose and ears were sculpted using the 2D drawings as a guide to size and placement. The nasal cartilage was angled downward from the nasal bones as

Figure 10 shows the completed approximation, which revealed an adult woman with an upturned nose and protruding lips. She is slightly asymmetrical with her left nostril and mouth corner higher than the right, and her lips are parted due to her strong maxillary prognathism. Additionally, her neck position reflects the actual location of her mummy’s vertebrae. The decision to retain a solid, clay-colored material on the model was made for objectivity’s sake since any representation of skin color would be speculative.

DISCUSSION The solidified resin in the braincase as well as the material in the pharynx show that the body was laid

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Fig. 8. ZSphere facial anatomy showing structures filled with flat color and with transparency and XPlane.

supine during mummification. The method of brain removal was presumably a transnasal craniotomy on the left side; the subsequent postmortem damage in this area has destroyed any direct evidence of the procedure, but since the right ethmoid plate is intact and there is no indication of a foramen magnum or cranial approach this seems a reasonable assumption. The pooled heterogeneous material in the pharynx is possibly mud mixed with resin or other debris; it seems to have been introduced through her mouth since the material is limited to the oropharynx and the esophagus has collapsed without evidence of the material working its way up from the thorax or abdomen. The high-density fragments in the

mouth and pharynx appear to us to be isolated teeth fragments. The skin may have been distinguishable from wrappings on the CT data due to resin or paint application. Evidence of embalming material in the mouth and around the eyes of this mummy visualized by ultra-short echo time MRI was previously reported in R€ uhli et al (2007). Judging from the multiple damaged areas on the head, this mummy has been subject to abuse or accidents several times in its history. Looters in antiquity often removed mummies’ heads, hands, and feet in their search for jewelry and amulets. Salter-Pedersen (2004) confirms that dislocations of body parts in Egyptian

REVEALING THE FACE OF AN ANCIENT EGYPTIAN

Fig. 9. Nose tip shape validation using Davy-Jow, Decker, and Ford’s method (2012).

mummies indicate damage by looters rather than poor handling by the embalmers. The hole in the lateral cranium is also clearly postmortem since the wrappings have broken with it; this may be associated with looters or careless handling during excavation, transportation, or storage at some later time. The damage to the face is postmortem as well, but it seems unlikely such deep, extensive damage was accidental. The last area of damage, the oval-shaped hole in the superior cranium, is also of interest because it clearly has uninterrupted skin covering it: evidence of the defect is not visible externally. Many ancient cultures practiced the protosurgical technique of trephination (also spelled trepanation), the excision of a piece of cranial bone. The purpose was often the procurement of the bone itself as a fetish object, but in other cases was performed medically to relieve pain or pressure, as therapy for skull fractures, or to “cure” mental disorders (Sullivan, 1998). It is not uncommon to find trephined skulls with evidence of healing, meaning the patient survived the procedure. Evidence for trephination in Ancient Egypt has been reported (Ruffer, 1918; Oakley et al, 1959). An alternative explanation for the defect might be a pre, peri, or postmortem skull fracture, which did not break the skin. A number of manual facial approximations of Egyptian mummies using CT data have been recently reported in the English literature (Hill et al, 1993; Macleod et al, 2000; Manley et al, 2002; Cesarani et al., 2004; Gill-Robinson et al, 2006), but in every case the specific methods used by the forensic artists to create the approximations are either not addressed or mini-

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mally addressed with general statements about placing depth markers, building muscle from the skull, or using the Russian/American/Manchester method. In no cases were the specific techniques used to approximate the facial features (eyes, ears, nose, and mouth) mentioned. Although the artistic nature of forensic facial approximation limits the possibility of true repeatability, without documentation it is impossible to evaluate approximations performed in the past in the light of new anatomical data. Furthermore, significant new research has taken place in recent years which has ramifications on establishing best practices in the field. The methods of facial feature prediction used in this case study represent a synthesis of all available procedures in 2012: techniques which were based in the most solid anatomical and/or statistical evidence were referenced to perform the approximation. One interesting consequence of this process was that mouth width, which was determined using the intercanine-distanceas-75% rule, also aligned with the medial irises; either method of mouth width determination would have predicted the same result. Stephan and Henneberg wrote that the medial irises also predicted mouth width in the 2003 study, which proposed the 75% rule, but at the time no accurate method for eyeball placement in facial approximations had been devised. This case study thus represents indirect confirmation of the accuracy of eyeball placement proposed in Stephan et al (2009) as slightly superior and lateral from center in the bony orbit. Regarding mouth width, the 75% rule pragmatically remains the superior choice since the medial iris method is one step removed from reference to the skull. It was this same reasoning which drove the decision to use Gerasimov’s method for estimating ear tilt based on the angle of the jaw; although neither his nor any other suggestions (tilting the ear a specific number of degrees or in reference to the nose) are supported by anatomical or statistical evidence, it did at least reference the skull rather than an arbitrary number or other soft tissue feature. Ear prediction in particular lacks methodical research that might indicate which, if any, of the multiple guidelines proposed may hold value in the practice of facial approximation. Although placement of the eyeballs is better understood, it would be interesting to see a dissection study investigating the eyebrows or epicanthic fold; the methods proposed by Fedosyutkin and Nainys were selected for this work simply because their specificity lent them credibility as being based on actual observations, but to our knowledge these observations have never been repeated. The general direction of the nasal cavity floor was used as an indicator of the direction of the missing anterior nasal spine in this skull based on a suggestion by Ullrich and Stephan (2011), since it is not unreasonable from an anatomic viewpoint and since no other guidelines were available. Nose projection entails the highest number and most complex methods of prediction. A number of these– including the most recent (Rynn et al, 2010) selected to be performed in this study–depend at least in part on regression equations derived from relatively small and/ or limited ancestry data samples. Although the equations do outperform older methods, techniques based on anatomy or development would be intuitively more flexible. Anatomical studies such as Anderson et al (2008) might be helpful in this area of development.

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Fig. 10. Completed facial approximation with wrapped mummy, CT data reconstruction, and facial anatomy sculpt.

LIMITATIONS

CONCLUSIONS

As with all facial approximations, the drawings and sculpture displayed in this work should be considered as a possible appearance of the living individual, not an exact portrait. The reconstructed face was built using average tissue depth measurements, which assumes the individual was of average build. The methods used to approximate the facial features were selected by a qualitative impression of their basis in anatomical or statistical evidence after a thorough review of the literature. This work assumes that a basis in evidence is correlated with accuracy and thus that the approximation is as accurate as possible given the current limits of knowledge and state of the field.

Forensic facial approximation plays a unique role in archaeology and mummy studies by visualizing the appearance of people from the past. This case study revealed an ancient Egyptian mummy imaged by CT scan to be an adult woman from the 20th, 21st, or 22nd Dynasty. Areas of damage caused by looting and possible trephination or skull fracture were observed. After a thorough literature review of facial approximation techniques, the mummy’s face was approximated using only those methods based on the most solid anatomical or statistical evidence. The results of the project made it clear that although certain improvements have been made in devising

REVEALING THE FACE OF AN ANCIENT EGYPTIAN

repeatable and evidence-based guidelines for facial approximation, there are many proposed methods still awaiting confirmation from comprehensive studies. Experienced practitioners in contemporary facial approximation/reconstruction already claim a high rate of accuracy in their technique and there is much anecdotal evidence in support of this as well. The quality and credibility of facial approximations is sure to improve as additional studies are undertaken. In the meantime, it is hoped this work will assist artists, investigators, and anthropologists in visualizing the faces of unidentified or ancient remains by documenting the process of facial approximation in 2012 using modern software and a synthesis of the latest published evidence-based techniques.

ACKNOWLEDGEMENTS The authors thank David Rini for his advice, critique, and editorial work throughout this project; Heather Garvin for assistance and recommendations in forensic anthropology; Dr. Sarah Poynton for advice in scientific writing; and the rest of the faculty, staff, and students of the departments of Art as Applied to Medicine and Functional Anatomy and Evolution at Johns Hopkins University, especially Gary Lees and Dacia Balch, for their support.

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Czekanowski, J. (1907). Untersuchungen uber das Verhaltnis der Kopfmafse zu den Schadelmafsen. Archiv f€ ur Anthropologie, 6, 42-89. De Greef, S., Claes, P., Vandermeulen, D., Mollemans, W., Suetens, P., & Willems, G. (2006). Large-scale invivo Caucasian soft tissue thickness database for craniofacial reconstruction. Forensic Science International, 159, S126-S46. Domaracki, M., & Stephan, C.N. (2006). Facial soft tissue thicknesses in Australian adult cadavers. Journal of Forensic Sciences, 51, 5-10. Dumont, E. R. (1986). Mid-facial tissue depths of white children: An aid in facial feature reconstruction. Journal of Forensic Sciences, 31, 1463-1469. Edelman, H. (1938). Die profilanalyse: Eine studie an photographischen und rontgenographischen durchdringungsbildern. Zeitschrift fur Morpholologie und Anthropologie, 37, 166-88. Eggeling, Hv. (1909). Anatomische untersuchungen an den Kopfen con cier Hereros, einem Herero- und einem Hottentottenkind. In: Schultze (Ed.), Forschungsreise im westrichen und zentraien Sudafrika (pp. 323-348). Jena: Denkschriften. El-Mehallawi, I. H., & Soliman, E. M. (2001). Ultrasonic assessment of facial soft tissue thickness in adult Egyptians. Forensic Science International, 117, 99-107. Fischer. (1905). Anatomische Untersuchungen an den Kopfweichteilen zweier Papua. Korrespondenz Blatt der Anthropologischen Gesellschaft, 36, 118-122. Formby, W. A., Nanda, R.S., & Currier, G. F. (1994). Longitudinal changes in the adult facial profile. American Journal of Orthodontics and Dentofacial Orthopedics, 105, 464-476. Forrest, A. S. (1985). An investigation into the relationship between facial soft tissue thickness and age in Australian Caucasion cadavers. Brisbane: The University of Queensland. Garlie, T. N., & Saunders, S. R. (1999). Midline facial tissue thicknesses of subadults from a longitudinal radiographic study. Journal of Forensic Sciences, 44, 61-67. George, R. M. (1987). The lateral craniographic method of facial reconstruction. Journal of Forensic Sciences, 32, 1305-1330. Gerasimov, M. M. (1955). Vosstanovlenie lica po cerepu. Moskva: Izdat. Akademii Nauk SSSR. Helmer, R. (1984). Schadelidentifizierung durch elekronicshe Bildmischung: Zugleich ein Beitrag zur Konstitutionsbiometrie und Dickenmessung der Gesichtsweichteile. Heidelberg: Krminalistik-Verlag. Helwin, H. (1969). Die profilanalyse, eine Moglichkeit der identifizierung unbekannter Sch€ adel. Gegenbaurs Morphologisches Jahrbuch, 113, 467-499. His, W. (1895). Anatomische Forschungen uber Johann Sebastian Bach’s Gebeine und Antlitz nebst Bemerkungen uber dessen Bilder. Abhandlungen der Mathematisch-physischen classe der K€onigl, s€ achsischen gesellschaft der wissenschaften, 22, 379-420. Kasai, K. (1998). Soft tissue adaptability to hard tissues in facial profile. American Journal of Dentofacial Orthopedics, 113, 674-684. Kim, K-D., Ruprecht, A., Wang, G., Lee, J. B., Dawson, D. V., & Vannier, M. W. (2005). Accuracy of facial soft tissue thickness measurements in personal computer-based multiplanar reconstructed computed

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Sarnas, K-V, & Solow, B. (1980). Early adult changes in the skeletal and soft-tissue profile. European Journal of Orthodontics, 2, 1-12. Simpson, E., & Henneberg, M. (2002). Variation in soft-tissue thicknesses on the human face and their relation to craniometric dimensions. American Journal of Physical Anthropology, 118, 121-133. Smith, S. L., & Buschang, P. H. (2001). Midsagittal facial tissue thickness of children and adolescents from the Montreal growth study. Journal of Forensic Sciences, 46, 1294-1302. Smith, S. L., & Throckmorton, G. S. (2006). Comparability of radiographic and 3D-ultrasound measurements of facial midline tissue depths. Journal of Forensic Sciences, 51, 244-247. Stadtm€ uller, F. (1922). Zur Beurteilung der plastischen Rekonstruktionsmethode der Physiognomie auf dem Schadel. Zeitschrift fur Morpholologie und Anthropologie, 22, 337-372. Stewart, T. D. (1954). Evaluation of evidence from the skeleton. In: R. B. H. Gradwohl (Ed.), Legal Medicine (pp. 407-450). St. Louis: C. V. Mosby. Galadames, I. C. S., Lopez, M. C., Matamala, D. A. Z., Rojas, F. J. P., & Mu~ noz, S. R. T. (2008). Comparisons in soft-tissue thicknesses on the human face in fresh and embalmed corpses using needle puncture method. International Journal of Morpology, 26(10), 165-169. Subtelny, J. D. (1959). A longitudinal study of soft tissue facial structures and their profile characteristics, defined in relation to underlying skeletal structures. American Journal of Orthodontics, 45, 481-507. Sutisno, M. (2003). Human facial soft-tissue thickness and its value in forensic facial reconstruction. Sydney: The University of Sydney. Sutton, P. R. N. (1969). Bizygomatic diameter: The thickness of the soft tissues over the zygions. American Journal of Physical Anthropology, 30, 303-310. Suzuki, H. (1948). On the thickness of the soft parts of the Japanese face. Journal of Anthropological Society of Nippon, 60, 7-11. Taylor, R. G., & Angel C. (1998). Facial reconstruction and approximation. In: J. G. Clement & D. L. Ranson (Eds.), Craniofacial Identification in Forensic Medicine (pp. 177-185). New York: Oxford University Press. Tedeschi-Oliveira, S. V., Melani, R. F. H., Haddad de Almeida, N., & Saavedra de Paiva, L. A. (2009). Facial soft tissue thickness of Brazilian adults. Forensic Science International, 191, 70-79. Vander Pluym, J., Shan, W. W., Taher, Z., Beaulieu, C., Plewes, C., Peterson, A. E., et al. (2007). Use of magnetic resonance imaging to measure facial soft tissue depth. Cleft Palate Craniofacial Journal, 44, 5257. Weining, W. (1958). R€ontgenologische Untersuchungen zur Bestimmung der WeichteildickenmaBe des Gesichts. Frankfurt: Johann Wolfgang Goethe-Universit€ at. Welcker, H. (1883). Schiller’s Schadel und Todtenmaske, nebst Mittheilungen uber Schadel und Todtenmaske Kant’s. Braunschweig: Viehweg F and Son. Welcker, H. (1896). Das Profil des menschlichen Schadels mit RontgenStrahlen am Lebenden dargestellt. Korrespondenz-Blatt der Deutschen Gesellschaft fur Anthropologie Ethnologie und Urgeschichte, 27, 38-39.

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