Cephalometric landmark standards and recent trends in craniofacial identification (2018-22): Avoiding imposters by describing variant landmarks as supplemental

Abstract

• Cephalometric landmarks are used to define facial soft tissue thicknesses (FSTTs) • Standardised landmarks maximise data value, e.g., enabling inter-study comparisons • Recent FSTT papers (last 5 years) often deviate from standardised landmark sets • Some FSTT papers label non-standard landmarks as standard, which is problematic • Novel landmarks add value, but should be clearly identified as novel/supplementary To review the recent facial soft tissue thickness literature (2018- 22 ) to determine if authors are currently adhering to standardised cephalometric landmarks and nomenclature, thereby supporting best scientific practices. Facial soft tissue thickness (FSTT) studies published between 2018 – 2022 were identified using Google Scholar with the search phrase: facial AND soft tissue AND thickness AND craniofacial AND identification AND/OR forensic. Twenty-three resulting papers were reviewed for their landmark content. Across the 23 studies, a mean of 12 common landmarks were measured from a max. set of 36 (mean = 19). Twenty of 23 papers used at least one non-standardised or novel landmark. This included studies that awarded standard landmark names, but whose definition(s) diverged from standards. Other novelties included non-standard use of landmark abbreviations (e.g., description of only one landmark for what is in fact cephalometric pairs of landmarks), confusion of proximally located landmarks with one another, departure from pre-existing technical terminology to imprecise lay vocabulary, and entirely new landmark formulations. Despite prior calls to the importance of standardisation in FSTT research, recent literature continues to exhibit broad departures from established standards. While novel landmarks provide highly valuable information, in any study, they should supplement a minimum set of standard landmarks so that cross-comparisons between studies using identically collected measurements are possible. Future FSTT research should award greater attention to including and meeting established FSTT cephalometric standards.