Facial approximation: an evaluation of mouth-width determination.

Facial approximation techniques rely on the prediction of soft tissues from the skull, yet few prediction methods have been scientifically evaluated, despite being frequently used in the past. This study tests several published and commonly used methods for determining mouth width from the skull. The methods tested are: 1) that mouth width is equal to the distance between the pupils; 2) that mouth width is equal to the distance between the medial borders of the iris; and 3) that mouth width is equal to the distance between the most lateral junctions of the canines and the first premolars. The study primarily examines living Australian European and Central/South East Asian participants (of both sexes) using photogrammetric methods. The results of this study indicate that methods 1 and 3 are highly inaccurate. Method 1 overestimated mouth width, on average, by approximately 11 mm (SD, 4 mm), while method 3 underestimated mouth width by approximately 13 mm (SD, 3 mm). Method 2 was the most accurate of the methods evaluated, but on average underrepresented mouth width by approximately 2 mm (SD, 4 mm). All three methods produced mouth-width predictions that, in general, were statistically different from actual mouth widths (P < 0.05). A new guideline, describing mouth width as canine width plus 57% of the cumulative distance between the lateral canine borders and the pupil centers on each side was found not to differ at statistically significant levels from actual mouth widths (P > 0.05). On average, this guideline did not under/overestimate actual mouth width, with the difference between them being 0 mm (SD, 3 mm). The increased accuracy of this new guideline in comparison to others suggests that it is the most appropriate for facial approximation. However, it should be further tested using independent samples. The finding that commonly used mouth-width prediction guidelines are not accurate suggests that many facial approximations previously made have incorrect mouth widths. This could reduce the recognition of these facial approximations and may, especially if other guidelines are inaccurate, render the facial approximations unrecognizable as their respective target individual (individual to whom the skull belongs).