Background/Objectives: Three-dimensional (3D) analysis of maxillofacial structures in dysmorphic patients offers clinical advantages over 2D analysis due to its high accuracy and precision in measuring many morphological parameters. Currently, no reliable gold standard exists for calculating 3D volumetric measurements of maxillofacial structures when captured by 3D surface imaging techniques. The aim of this scoping review is to provide an overview of the scientific literature related to 3D surface imaging methods used for volumetric analysis of the dysmorphic maxillofacial structures of patients affected by CL/P or other syndromes and to provide an update on the existing protocols, methods, and, when available, reference data. Methods: A total of 17 papers selected according to strict inclusion and exclusion criteria were reviewed for the qualitative analysis out of more than 4500 articles published between 2002 and 2024 that were retrieved from the main electronic scientific databases according to the PRISMA-ScR guidelines. A qualitative synthesis of the protocols used for the selection of the anatomical areas of interest and details on the methods used for the calculation of their volume was completed. Results: The results suggest a great degree of heterogeneity between the reviewed studies in all the aspects analysed (patient population, anatomical structure, area selection, and volume calculation), which prevents any chance of direct comparison between the reported volumetric data. Conclusions: Our qualitative analysis revealed dissimilarities in the procedures specified in the studies, highlighting the need to develop uniform methods and protocols and the need for comparative studies to verify the validity of methods in order to achieve high levels of scientific evidence, homogeneity of volumetric data, and clinical consensus on the methods to use for 3D volumetric surface-based analysis.

Background: The characterization of facial sexual dimorphic patterns in healthy populations serves as valuable normative data to tailor functionally effective surgical treatments and predict their aesthetic outcomes and to identify dysmorphic facial traits related to hormonal disorders and genetic syndromes. Although the analysis of facial sexual differences in juveniles of different ages has already been investigated, few studies have approached this topic with three-dimensional (3D) geometric morphometric (GMM) analysis, whose interpretation may add important clinical insight to the current understanding. This study aims to investigate the location and extent of facial sexual variations in juveniles through a spatially dense GMM analysis. Methods: We investigated 3D stereophotogrammetric facial scans of 304 healthy Italians aged 3 to 18 years old (149 males, 155 females) and categorized into four different age groups: early childhood (3–6 years), late childhood (7–12 years), puberty (13–15 years), and adolescence (16–18 years). Geometric morphometric analyses of facial shape (allometry, general Procrustes analysis, Principal Component Analysis, Procrustes distance, and Partial Least Square Regression) were conducted to detail sexually dimorphic traits in each age group. Results: The findings confirmed that males have larger faces than females of the same age, and significant differences in facial shape between the two sexes exist in all age groups. Juveniles start to express sexual dimorphism from 3 years, even though biological sex becomes a predictor of facial soft tissue morphology from the 7th year of life, with males displaying more protrusive medial facial features and females showing more outwardly placed cheeks and eyes. Conclusions: We provided a detailed characterization of facial change trajectories in the two sexes along four age classes, and the provided data can be valuable for several clinical disciplines dealing with the craniofacial region. Our results may serve as comparative data in the early diagnosis of craniofacial abnormalities and alterations, as a reference in the planning of personalized surgical and orthodontic treatments and their outcomes evaluation, as well as in several forensic applications such as the prediction of the face of missing juveniles.

Forensic anthropologists dealing with personal identification (PI) of human remains have recently stressed the need to explore the potential of “secondary identifiers” for identifying victims who died in particular events for whom images often represent the main antemortem data available. Being the face the part most exposed in images, characteristics as pigmented skin lesions (PSLs), can be crucial if combined with other input. Since no data is available on frequencies and distribution of facial PSLs in the general population, this study aims at systematically collecting such data to verify their potential in PI and to open a debate on the aid that “secondary identifiers”, regardless of their specific nature, can give to the identification of the deceased in specific forensic contexts. A retrospective analysis on three-dimensional facial models of 1039 Italian subjects (from 4 to 84 years old) was conducted to examine the incidence of PSLs discriminated according to size and position in well-defined facial areas. From the collected data we developed a probabilistic approach providing the likelihood ratio (LR) for two settings: (1) the relative frequencies of nevi in the various facial areas, providing the deriving compound probability of owning a certain facial PSLs pattern; and (2) codes describing the facial nevi pattern of each individual of our population, thus testing their uniqueness and so their potential in PI. The calculated LRs mostly proved high identifying strength, particularly when provided by the compound probability-based approach. Data on incidence and position of facial nevi, their generated codes, and the probabilistic approach here presented, all constitute a starting point for advancing secondary identifiers. Nonetheless, although this preliminary study proved facial PSLs as valuable and potentially useful for identification, their significance and validity should be interpreted with caution as we are still at the first theoretical step clearly based on ideal conditions, and thus further investigations are due on the limitations of their use in practical identifying settings. Therefore, being this systematic study only a preliminary one in its nature, it is recommended not to use this kind of approach until further studies will test its validity in several practical conditions.

Reference data on the asymmetry of facial thirds of children is still scarce, although it can offer meaningful comparative information for clinical studies. This study aims to provide reference data on the facial asymmetry of Italian children using a 3D analysis of facial thirds divided according to the trigeminal nerve distribution (upper, middle, and lower). A 3D surface-based approach was conducted on the digital models of the faces of 135 children (74 M, 61 F), acquired by stereophotogrammetry. In addition to sex, two different age classes were analyzed (4–8 years and 9–12 years). For each facial third, the asymmetry was expressed as root-mean-square distance (RMS) by calculating the point-to-point distances between the original and the reflected 3D models. A 3-way ANOVA test verified significant differences between the two sexes, the two age classes, and the three facial thirds (p-value < 0.05), and also their interaction. Significant differences were found between the sexes (females were more symmetric, p = 0.005) and the two age groups (younger were more symmetric p < 0.001). According to Tukey’s HSD post-hoc test, among the thirds, the middle one proved to be significantly more symmetrical (p < 0.001). No significant interaction impacting the asymmetry was found when the main factors were considered in any combination. Reference data on the “normal” facial asymmetry of Italian children was provided for further clinical purposes. Normal children have low average RMS values (0.30–0.51 mm) and younger, in particular females, proved more symmetrical than older children, while among the facial surfaces, the middle proved most symmetrical in both sexes, although with little clinical relevance. Since there is no consensus on the amount of symmetry deemed clinically acceptable, further studies on larger randomized samples are auspicial.

Background/Objectives: Facial asymmetry is gaining an increasing diagnostic interest in many clinical contexts. Several three-dimensional surface-based methods have been proposed for its assessment; however, they might provide non-equivalent data. Since there is a lack of comparative studies in these terms, this study aims to compare three methods for assessing the asymmetry of the face and facial thirds, thus addressing whether the potential differences can be considered clinically acceptable or not. Methods: Two ‘maxillofacial’ methods based on the trigeminal nerve distribution and one ‘orthodontic’ method based on reference horizontal planes were used to identify the facial thirds on 3D facial models of 80 Italian healthy adults to calculate the asymmetry of the face, and the upper, middle, and lower thirds of the face differently selected by each method. As a measure of asymmetry, the Root Mean Square value was calculated through a mirroring surface-based registration. Intra- and inter-operator reliability was verified for each method. Differences and interchangeability between the methods were tested, respectively, by two-way repeated measures ANOVA (Analysis of Variance) and Bland–Altman and Similarity Percentage model analysis. Additionally, the time required to perform each method was assessed. Results: All methods demonstrated excellent intra- and inter-operator reliability. While the ANOVA analysis found significant differences (p < 0.001) for the majority of facial Regions of Interest between each method, the Bland–Altman analysis revealed that the differences were clinically acceptable (<0.50 mm) for all facial regions between the trigeminal methods, and for the face and the upper third of the face between the orthodontic method, which was revealed to be faster, and the trigeminal ones. The additional similarity percentage model provided visual support for the complete interchangeability of the two trigeminal methods, as evidenced by the lower Coefficient of Variation value. Conclusions: There is no best method for assessing facial asymmetry that applies to all types of clinical settings, as we have shown that different methods may not be completely interchangeable. However, we suggest that the methods based on the trigeminal subdivision can be used interchangeably in contexts where the morpho-functional analysis of maxillofacial regions with different embryological origins is considered. Thus, the clinical setting imposes the choice of one method over another and, as we have pointed out, the consequent comparison of data with those obtained with methods whose interchangeability has been demonstrated.

Sex estimation is a cornerstone of biological profiling in forensic anthropology. However, in cases involving badly decomposed, burnt, or fragmented remains, traditional assessments may be unfeasible, requiring alternative approaches, such as radiological and medical imaging. The cranium is a valuable indicator of sex, yet its dimorphic traits may be fragmented or altered, hindering interpretation. In such scenarios, radiological techniques targeting protected cranial structures—such as the paranasal sinuses—offer a promising alternative. Although these sinuses exhibit sexual dimorphism, their full potential for sex estimation remains partially underexplored. This study aimed to develop a logistic regression model for sex estimation in a contemporary Italian population based on volumetric measurements of the frontal, maxillary, and sphenoid sinuses, combined with selected cranial linear dimensions (biorbital breadth, upper facial height, and nasal spine length). CT scans from 222 individuals were analyzed. Volumetric measurements were obtained from 3D sinus models individually segmented from the CT scans, while linear cranial dimensions were measured on volume-rendered 3D skull reconstructions. Two predictive models were developed on a training subset and subsequently validated on an independent validation subset, both achieving an overall accuracy of approximately 80% in both phases. The most predictive variables were the volumes of the right frontal and maxillary sinuses, upper facial height, and nasal spine length, which showed the most significant sexual dimorphism. These findings are consistent with the literature on sexual dimorphism of paranasal sinuses and reflect the anatomical variability of structures like the sphenoid sinus. This study demonstrates that volumetric assessment of paranasal sinuses combined with selected cranial dimensions can provide more reliable sex estimation in forensic contexts. The integration of radiological imaging with statistical modelling offers a practical framework for situations where conventional skeletal analysis is compromised, reinforcing the role of advanced radiology in expanding the methodological toolkit of forensic anthropology.