A facial reconstruction and identification technique for seriously devastating head wounds

A 77-year-old woman in the Czech Republic committed suicide by train. The face of the woman was reconstructed with this technique. Because of seriously devastating head injuries, the mechanism of trauma was unknown. Several wounds were found in the face and are schematically visualized in Fig.3.

Visual facial identification of an unknown body after a seriously devastating head injury is very difficult and in some cases impossible. These injuries are frequently seen from accidents wherein a train strikes a pedestrian. The most damaged are those parts of the body struck directly by the front of the train.

The identification technique presented here is based on the removal of skull bone fragments, subsequent fixation of soft tissue onto a universal commercial polystyrene head model, precise suture of dermato-muscular flaps, and definitive adjustment using cosmetic treatments.

After reconstruction, identifying marks such as scars, eyebrows, facial lines, facial hair, and partly hairstyle become evident. It is then possible to present a modified picture of the reconstructed face to relatives. After comparing the results with photos of the person before death, this technique has proven to be very useful for identifying unknown bodies when other identification techniques are not available. This technique is useful for its being rather quick and especially for its results.

Fig.1 Body condition of the deceased person before the reconstruction technique.

Fig.2 Soft tissue of the head after bone fragment removal.

Fig.3 Wound scheme of the 77-year-old woman and the polystyrene head model.

Soft tissue preparation began after a standard dissection of organ complexes (Fig.2). In case of missing soft tissue, it is possible to find suitable substitutes in the dermato-muscular flap from the back or medial side of the thigh. Masseter muscle, temporal muscle, the cartilaginous part of the nasal septum, and eye bulbs were removed from the prepared tissue for better facial structure. After this preparation, the soft tissue was fixed in the proper anatomical position on the polystyrene head model (Figs.4-5). For better reconstruction results, the dermato-muscular flaps were sewn using atraumatic continuous suture (6-0). In the end, skin lesions were corrected using makeup mixed with calcium carbonate.

Fig.4 Fixing soft tissue onto the polystyrene head model while respecting anatomical position.

Fig.5 Fixing soft tissue onto the polystyrene head model while respecting anatomical position.

Fig.6 Frontal view of the reconstructed face.

Fig.7 View of the left side of the reconstructed face (slightly obliquely).

It is apparent from Figs. 6 and 7 that after facial reconstruction it is possible to assess identifying marks such as the shape of the eyebrows, the position of wrinkles, and the approximate shape of the face. Next, the direction and range of the wounds were assessed and clarified. For a more precise evaluation of the reconstruction, a photograph of the deceased from when she was alive can then be used for comparison (Figs. 8 and 9).

Fig.8 Photo of the deceased person when alive.

Fig.9 Photographs for comparison.

Because every person’s facial configuration is unique, visual facial identification is a basic method of identification in criminology. Many authors have focused on facial identification techniques, and facial reconstructions when skulls have been found are especially well known.

The identification of an unknown body using the reconstruction and identification technique described herein was found to be ideal for building upon commonly used dissection procedures as a first-line technique, and especially so for its speed, useful results, and low cost. The reconstruction can subsequently be compared with a photo of the deceased prior to death. It makes it possible to present a modified picture of the reconstructed face to relatives in cases of devastating head injuries.