Int J Legal Med
DOI 10.1007/s00414-015-1292-1
METHOD PAPER
A standardized nomenclature for craniofacial
and facial anthropometry
Jodi Caple 1 & Carl N. Stephan 1
Received: 20 April 2015 / Accepted: 11 November 2015
# Springer-Verlag Berlin Heidelberg 2015
Abstract Standardized terms and methods have long been
recognized as crucial to reduce measurement error and in-
crease reliability in anthropometry. The successful prior use
of craniometric landmarks makes extrapolation of these land-
marks to the soft tissue context, as analogs, intuitive for foren-
sic craniofacial analyses and facial photogrammetry. Howev-
er, this extrapolation has not, so far, been systematic. Instead,
varied nomenclature and definitions exist for facial landmarks,
and photographic analyses are complicated by the generaliza-
tion of 3D craniometric landmarks to the 2D face space where
analogy is subsequently often lost, complicating anatomical
assessments. For example, landmarks requiring palpation of
the skull or the examination of the 3D surface typology are
impossible to legitimately position; similar applies to median
landmarks not visible in lateral photographs. To redress these
issues without disposing of the craniometric framework that
underpins many facial landmarks, we provide an updated and
transparent nomenclature for facial description. This nomen-
clature maintains the original craniometric intent (and base
abbreviations) but provides clear distinction of ill-defined
(quasi) landmarks in photographic contexts, as produced
when anatomical points are subjectively inferred from
shape-from-shading information alone.
Keywords Forensic science . Skull . Face . Skeletons .
Cephalometry . Craniometry . Corpulometry . Capulometry
* Jodi Caple
jodi.caple@uqconnect.edu.au
1
The Laboratory for Human Craniofacial and Skeletal Identification
(HuCS-ID Lab), School of Biomedical Sciences, The University of
Queensland, Brisbane 4072, Australia
Standardized terms and methods have long been recognized
as crucial to the reduction of measurement error in anthropom-
etry and for unity of description in anatomical morphology.
Classic examples abound, such as establishment of special
committees for standardization [1–3] and the production of
international agreements for the unification of anthropometry
[1, 2]. Speaking volumes to the weight of the subject is the
(repeated) publication of the International Agreement for the
Unification of C raniometric and Cephalometric
Measurements across three major journals within 13 years
during the initial consolidation of the discipline:
L’Anthropogie (1906) [1], Science (1912) [4], and The Amer-
ican Journal of Physical Anthropology (1919) [5]. Signifi-
cance in the historical context is further highlighted by
Hrdlička’s call in his first entry to the first volume of the
American Journal of Physical Anthropology for Bdefinite uni-
fication and perfection of anthropometry in its entire range;
[and] systematization of the methods of treating and recording
data^ [6] p.13. Naturally, increased standardization of anthro-
pometric nomenclature found use in anatomy (see e.g., [7] or
for more recent examples [8–10]), thereby contributing to the
parallel and exemplary efforts in that discipline to standardize
human morphology nomenclature—see six editions of the
Parisiensia Nomina Anatomica beginning in 1955 [11], now
updated by the 1998 Terminologica Anatomica [10], which
comprises 5640 entries [12] and including landmarks like
nasion, bregma, lambda, inion, asterion, gonion, vertex,
basion, and opisthion [10].
In terms of anthropometry standardization, three other
events are especially deserving of mention. First is Paul
Broca’s [13, 14] initial push for naming and describing Bpoints
de repère^, as Howells says, Bto make them the property of
craniologists once and for all^ [15] p.477. Second, von
Török’s [16] extensive systemization and formulation of cra-
nial landmarks, with the definition of over 5000 cranial

measurements that served as foundations for modern-day
craniometry practice [15]. Third, the internationalization of
the Frankfurt Horizontal plane (FH), which stands as such an
exemplary beacon of standardization success that it deserves
special mention in the form of a brief historical review: the
German Horizontal [17, 18], originally proposed by Hermann
von Ihering [19], was the forerunner to the FH as a German
alternative [13, 14, 20] to French methods for orientating skulls
after Broca [18, 21]. It was adopted by anthropologists/
craniologists in 1884, following discussions held at the
Craniometrical Conferences in Munich (1877), Berlin (1880)
and Frankfurt am Main (1882) as a consensus method to orient
dry skulls in a standard upright position [17, 18, 22]. It is from
this latter congress that the plane takes its well-known name
and modified implementation [18, 22]. Note the spelling Bfurt^
after the official 19th Century German published in
Correspondenz-Blatt [22], not Bfort^ after Middle Age Old
English/Latin fiddling. The FH was not without controversy
or heartache on its proposal given already established French
protocols [18, 21], but ultimately, it emerged as the global
standard above the French school, in part due to advantages
such that the plane worked well for both craniometry and
cephalometry, producing directly comparable orientations
between the two modes of analysis [20, 23].
In biological anthropology, standardization of skeletal land-
marks has strived for further improvement with notable works
such as Martin’s Lehrbuch der Anthroplogie [24–27], Howells’
The Designation of the Principle Anthrometric Landmarks on
the Head and Skull [15], Montagu’s Handbook of
Anthropometry [28], Olivier’s Pratique Anthropologique [29],
and more recently, Krogman and Sassouni’s Syllabus in Roent-
genographic Cephalometry [30], Howells’ Cranial Variation
in Man [31], and Buikstra and Ubelaker’s Standards for Data
Collection from Human Skeletal Remains [32]—the latter
drawing heavily on Moore-Jansen and colleagues’ Data Col-
lection Procedures for Forensic Skeletal Material [33]. With
the rise of computing power, computerized morphometrics has
also expanded traditional craniometric chords and indices into
more powerful multivariate shape tools [34–37], concurrently
extending and formalizing landmark Btypes^ first described by
von Török as Bnatural^ and Bartificial^| (the latter being geo-
metrically determined [15, 16]), to the modern classification
scheme of Type I, II, and III landmarks after Bookstein [34].
The success of craniometric landmark standardization and
the crossover with cephalometry has encouraged the extrapo-
lation of the craniometric landmarks to the soft tissue context
of the face as analogs of their craniometric equivalents. This is
especially attractive for craniofacial analyses in regard to
growth and forensic identification, where many landmarks
of equivalency exist across the soft and hard tissues (e.g.,
glabella, nasion/sellion, zygion, opisthsocranion, pogonion,
etc.), but it should be noted here that not all soft tissue land-
marks possess hard tissue equivalents or vice versa, so a
Int J Legal Med
specially tailored nomenclature is required. While forensic
photogrammetry and craniofacial identification are the
targeted beneficiaries of this undertaking, there may be appli-
cations to other anthropometry-based contexts such as ergo-
nomics and industrial design [38–40], especially of head-
related equipment (see e.g., [41, 42]) and particularly with
the extension of sparse landmarks to dense point clouds.
Farkas’ Anthropometry of the Head and Face [43] and
Kolar and Salter’s Craniofacial Anthropometry [44] already
provide foundational work in the sparse anthropometric land-
mark domain; however, room nevertheless exists for further
nomenclature, landmark, and definition improvement. Cur-
rently, a plethora of ambiguous and unstandardized lay terms
exist in the literature; Bchin lip fold,^ Bfissure,^ or
Bmentolabial sulcus^ for supramentale [45–49] is but one
example. Further, forensic facial photogrammetry has wielded
landmarks in such a way that many masquerade as
craniometric analogs when they are in fact nothing of the kind.
Farkas forewarned of this mistaken use and against treating
3D soft tissue landmarks as 2D photographic equivalents [43,
50]. His warnings have, however, rarely made it to forensic
examinations where these landmarks are misleadingly
established as analogous points (see e.g., [51–58]), and in
some cases, only to have their reliability criticized post-
analyses [58–60].
The aims of this paper are, therefore, fourfold: (i) to provide
a brief overview of gaps in current standardization, especially
in the facial and craniofacial identification domains of anthro-
pometry; (ii) to clarify some commonly confused craniofacial
landmarks (e.g., gnathion/menton); (iii) to provide an im-
proved nomenclature maintaining intent of craniometric ana-
logs but providing at-a-glance differentiation of soft and hard
tissue landmarks— including two types of pseudo-landmarks
on 2D photographic images; and (iv) to provide a quick ref-
erence guide to the most commonly used craniofacial land-
marks for adults and subadults.
To facilitate aims (i) and (iv), we introduce three new terms:
norma medialis, corpulometry (corp-ul-om-i-tree), and
capulometry (cap-ul-om-i-tree). The former is an addition to
the five standard attitudes of the skull [61] to complement
norma lateralis and describe the medial view of a skull sec-
tioned in the median plane (Fig. 1). Corpulometry and
Capulometry are used to enhance the classification of anthro-
pometry into its constituent parts, thereby facilitating system-
atic description (Fig. 2). It is, for example, clearly apparent
that osteometry is not a separate pursuit to somatometry (as
traditionally held) but rather one component of the latter: hu-
man bodies possess a skeleton that can be readily measured
osteometrically as a part of somatometric analysis. This is
especially clear in an era of computerized medical imaging
where skeletons can be segmented from within living bodies
or cadavers, to be extracted and analyzed. The same applies to
craniometry under the banner of cephalometry. Consequently,
Int J Legal Med
Fig. 1 Craniometric landmarks for 3D analysis. Definitions are provided in Table 2. a Norma Lateralis; b Norma Frontalis; c Norma Medialis; d Norma
Basalis; e Norma Occipitalis; and f Norma Verticalis. Bold line indicates FH
partner pursuits to osteometry and craniometry to describe the
soft tissue (only) components of somatometry and cephalom-
etry are in demand. This is readily attained using Latin pre-
fixes, given the pre-established use of Greek for anthropomet-
ric labels. For soft tissue measurements of the body we sub-
sequently introduce the term corpulometry and capulometry
after the Latin corpus meaning body and caput meaning head
(Fig. 2).
Weaknesses of current nomenclature
Inconsistency
Current nomenclature suffers from multiple inconsistencies:
& Otherwise precisely defined landmarks have been
misappropriated (and inconsistently so) to neighboring
landmarks. For example, the term supradentale has been
used for both alveolare [52, 62] and prosthion [62, 63].
Other examples are the use of gnathion for menton [63,
64] and mid-philtrum for subspinale [52].
& Imprecise lay terms have been used for otherwise precise-
ly defined landmarks. This is most frequent in the
craniofacial identification literature where Bartistic rules
of thumb^ are common [65], and/or where surface exam-
ination of the face is undertaken for ultrasound measure-
ment [47]. Examples include the use of the Bupper lip^ for
an approximation of labrale superius or labiale superius
[46, 66]; Bbeneath chin^ for menton [46, 47, 57, 67];
Bzygomatic arch^ for zygion [68]; Blateral piriform point^
for alare [69]; and Blateral nostril^ for alar curvature point
[45–48]. More grotesque examples include Bbetween the
eyebrows^ [47] or Bthe bald spot between the eyebrows^
[70] for approximations of glabella—better described as
the most anterior midline point on the forehead or frontal
bone in the region of the superciliary ridges when the head
is orientated in the FH [1].
& Multiple technical terms exist for the same landmark (e.g.,
alveolare/infradentale superius), and some terms are
named illogically. Infradentale superius, for example, im-
plies a landmark inferior to the teeth that is superior—an
unintuitive consequence of establishing a complement of
infradentale.
& Single and common landmark labels (e.g., alare) are used
to define non-analogous points on both the hard and soft
tissue profiles. In the case of alare, it symbolizes the most
lateral part of the nasal aperture on the skull, and the most
 Int J Legal Med

Fig. 2 Anthropometry and its

domains. a Traditional binary
division of anthropometry into
two streams, one dealing with
whole bodies and the other
skeletons. b Reorganization of
anthropometry recognizing that
living persons and cadavers both
possess skeletons—osteology
stream is indicated by dark grey
fields and bold flow lines. Note:
missing terms in current
nomenclature for soft tissue only
components of somatometry and
cephalometry. c Revised
nomenclature, with living person/
cadaver stream highlighted
(osteology stream of B remains
intact), and with soft tissue
counterparts to osteometry and
craniometry listed

lateral apex of the wings of the nose (not to be confused
with the mid-junction of the ala with the soft face) [43]. A
good example of the misappropriated use of alare is in
craniofacial identification where soft tissue thickness mea-
surement at these landmarks (see e.g., [71]) would de-
scribe awkward measurements of the nose rather than of
the junction points of the nasal wings with the cheek as
intended [72]. At the opposite end of the spectrum, some
craniometrically analogous points are given entirely dif-
ferent names, inconsistent with otherwise typical anthro-
pometric practice (see use of the prime [′] below). For
example, hard tissue nasion, which often represents the
most posterior point on the bony frontonasal contour
(defined by the junction with the frontonasal suture), has
a soft tissue equivalent sellion, which frequently falls in-
ferior to nasion.
& Soft tissue analogs of craniometric landmarks are some-
times designated, in their abbreviated format, by the prime
of the craniometric landmark (e.g., g and g′), but inconsis-
tently so. Compare, for example, Swennen [73] versus
George [62] and Krogman [30] versus Farkas [43]). The
prime has also been used in an entirely different intent by
Farkas [43] to label lateral versions of midline landmarks
(e.g., labiale superius for the midline landmark vs. labiale
superius′ for the lateral landmark). Complicating matters
further is the instance mentioned above where some soft
Int J Legal Med

tissue analogs possess an entirely different label to their

craniometric counterparts (see e.g., nasion and sellion, or
the supramentale—also known as Point B in the ortho-
dontic literature [55]—whose soft tissue equivalent can be
any one of the following: labiomentale (lm; [70]), inferior
labial sulcus (ils; [70]), sublabiale (sl; [43]), chin lip fold
[47], mentolabial sulcus (mls; [72]) or chin fissure [74]).

Misappropriation of landmarks to 2D images

Landmarks that, by definition, depend on 3D surface typology

have been hijacked to 2D images, such that their labels are
used for points that are established without access to the nec-
essary prerequisite information. For example, glabella is rou-
tinely established on lateral face photographs, but it is impos-
sible to see unless the brow precisely rises to an apex along the
median plane ([43]; Figs. 3, 4, and 5). Where the brow ridges
project either side of the median plane, the most anterior point
on the brow ridge will not represent the glabella. Similarly,
mid-philtrum is hidden by the philtral columns in a lateral
view. In an anterior view, alar curvature point cannot be lo-
cated in most individuals since it falls posterior to, and is
tucked behind, the nasal ala. Another prime example is
gonion, which cannot be established in frontal photographs
for two reasons: (i) as a craniometric homolog, it must be
palpated; and (ii) gonion falls behind the curve of the cheeks
in the frontal view, such that it cannot be seen (an effect ex-
Fig. 3 Example of landmarks positioned using a 2D anterior view only
aggerated by increased perspective distortion at short subject-
(lateral view of this result is illustrated at the right) and b 2D left lateral
to-camera distances [24, 75–77]) (see Figs. 3 and 4). Problem- view only (anterior view of this result is illustrated at the right). White
atic in photogrammetry is also the common practice of estab- filled dots represent landmarks positioned by different observers. Black
lishing landmarks, defined by curvature (commonly filled dots represent ground truth positions. Light grey dots represent
landmarks obscured by the soft tissues
Bookstein type II and III landmarks) from texture or shape-
from-shading information. This practice depends almost en-
tirely on subjective speculation since curvature detail is glabella, sellion, pronasale, mid philtrum, sublabiale,
conjectured from color or shading—an undertaking further pogonion, alar curvature point, cheilion, zygion, and gonion
confounded by lighting and exposure. Consequently, these (see Fig. 3). Written definitions of each anthropometric land-
landmarks can only be considered quasi at best and are un- mark, after Farkas [43], were provided to participants as a
likely to precisely or accurately represent their original ana- reference. Ground truth landmark positions were determined
tomical intent. using the palpation marks (by superimposition of images) and,
To demonstrate limits of placing capulometric analogs of for other landmarks, rotational viewing of the face in 3D.
craniometric landmarks on 2D images, we took two 3D head These ground truths were then compared to landmarks
scans of ten living subjects (five males, five females; established in 2D single views and the millimeter Euclidean
>18 years) using a non-contact Di3D™ stereophotogrammetry distances between the two calculated using the Pythagorean
system. The first 3D photo was acquired with the subject in a theorem:
standing position and with neutral expression. The second 3D qffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffi
photograph was taken in the exact same manner, but after d ¼ ðx2 −x1 Þ2 þ ðy2 −y1 Þ2 þ ðz2 −z1 Þ2
landmarks determinable by palpation (zygion and gonion)
had been marked on the face ahead of time with a small dot Results are visually displayed in Figs. 3 and 4 and are
of water-based ink. numerically summarized in Table 1. Mismatch between the
Following 3D photo acquisition, each subject examined placement of glabella, mid-philtrum, and pogonion in 2D
every unmarked 3D face scan in frontal and left lateral views equivalent lateral face views and gonion in frontal views (up
to position ten well-known anthropometric landmarks: to 11.2 and 25.7 mm respectively) was readily observed,
 Int J Legal Med

simply because the ground truth position cannot be visualized

in 2D. Figure 5 shows an example of mapping the most anterior
coordinates of a 3D face point cloud in one of the ten subjects.
This demonstrates how the profile line does not extend precise-
ly down the midline of the face, even when the head is captured
orthogonally and at infinite subject-to-camera distance. The
invalidity of unwittingly or generically labeling landmarks on
2D facial images as craniometric analogs is thereby demonstrat-
ed. When determined on insufficient anatomical grounds [see
59, 60], it is not surprising therefore that landmarks like gonion,
zygion, glabella, and pogonion display high levels of dispersion
unacceptable for forensic examination [see again 59, 60].

A new nomenclature

An improved craniofacial landmark nomenclature is conse-

quently in demand to boost standardization and limit

Fig. 5 Anterior most points (white fill) mathematically calculated from

the point cloud of the 3D photograph for the subject depicted in Fig. 3
using R [55]. Note equal projection bilaterally in some regions

(unnecessary) errors in comparison of non-homologous land-

marks. The new nomenclature must be simple, compact, and
should communicate meaning at-a-glance without possibility
for confusion. For craniofacial analysis, retaining
capulometric analogs of craniometric landmarks where possi-
ble would be an advantage. This extends to 2D image analysis
where type II/III soft tissue landmarks that approximate
craniometric equivalents (e.g., Bpogonion^ established from
lateral view photographs) should be designated as such and
should be differentiable from even less reliable points

Table 1 Average Euclidean distances and standard deviations (mm)

between precisely located 3D landmarks and those located in anterior-
only or and lateral-only face views

Landmark Anterior (mm) Lateral (mm)

g′ 3.4±1.5 11.2±4.4
s′ 3.5±1.6 2.5±1.0
pn′ 1.8±0.4 2.9±1.1
mp′ 1.2±0.3 5.1±2.5
sm′ 2.4±0.9 8.2±3.8
pg′ 3.5±1.1 5.1±3.0
Fig. 4 Example of landmark clustering in a male and female subject: a an ac′ 4.3±1.5 2.8±1.7
anterior view of landmarks placed in a left lateral view and b a left lateral
ch′ 1.1±0.2 4.3±1.2
view of landmarks placed in an anterior view. White filled dots represent
landmarks positioned by different observers. Black filled dots represent zy′ 9.5±5.1 6.8±1.6
ground truth positions. Light grey dots represent landmarks obscured by go′ 25.7±8.7 8.0±1.8
soft tissues
Int J Legal Med

Fig. 6 Major 3D capulometric

landmarks listed in Table 3: a
anterior view and b right lateral
view. Grey crosses represent
landmarks obscured by soft
tissues in the depicted view.
Bold line represents the FH

established from shape-from-shading information (e.g.,
Bpogonion^ in frontal view photographs). Our solution is the
following:
& Traditional craniometric names, abbreviations, and defini-
tions stand (e.g., glabella=g; Fig. 1).
& All soft tissue capulometric landmarks are designated by a
prime (′), irrespective of their position (medial/lateral) or
whether or not they possess a craniometric counterpart
(e.g., soft tissue glabella=g′; sellion=se′; Figs. 6 and 7).
& Two superscripts are used to differentiate the less than
ideal quasi-landmarks on photographs, either for skulls,
faces, or both:
– Superscript Bp^ (for pseudo) to denote 2D extrapolations
of type II/III 3D landmarks to particular photographic
views, such as gp′ for pseudo-glabella in a lateral face
photograph, or gp for pseudo-glabella in a lateral skull
photograph (Fig. 8).
– The German scharfes S, or eszett, Bß^, to denote estima-
tions based on shape-from-shading information, such as
pgß′ for pseudo-pogonion in a frontal face photograph
(Fig. 8). Note: the eszett is a convenient and compact
representation of the double Bs^ drawn from the leading
letters in Bshape-from-shading,^ and its derivation from
the German language pays tribute to extensive German
influence on anthropometry. The eszett should not be
confused for the Greek beta (β).
The single additional superscript preserves compact nota-
tion, practicality, and efficiency of effort, while boosting de-
scriptive power. The beauty of this system is that all four types
of landmarks are easily differentiable, but their identical base
labels maintain their original intent of approximations of the
ground truth 3D craniometric landmark, e.g., pg≠pg′≠pgp′≠
pgß′ (see Figs. 1, 8, and 9 for illustration of these terms).
Below, we provide a summary of the major craniofacial land-
marks using this terminology and some insights to their
derivation.
A standardized craniofacial reference set
Craniometric landmarks (3D representation)
If a standard set of soft tissue landmarks for the head is to be
constructed, using craniometric analogs where possible, then

Fig. 7 Supplementary 3D capulometric landmarks for the major facial features: a eye, b nose, c mouth, and d ear. Definitions are listed in Table 3
 Int J Legal Med

Fig. 8 Capulometric landmarks

positioned on facial photographs
using the new nomenclature: a
anterior view and b right lateral
view. In most cases, similar
nomenclature would apply to
photographs of skulls with the
major exception that the prime is
dropped from the landmark label.
Bold line represents the FH

it is important to start with a well-defined craniometric list.
This was heavily constructed herein on sets provided by Mar-
tin [25, 27], with supplementations from White [78],
Krogman and Sassouni [30], Buikstra and Ubelaker [32],
Howells [15, 31], and others where indicated (Table 2).
Bookstein types (I, II, or III) accompany these landmarks
(Table 2) helping to elucidate their character and degree of
reliability [34]. As described by Bookstein [34], Type I land-
marks are the most favored as they tend most toward being
biological homologous points across individuals, are locally
defined, and can often be located with precision. Type II land-
marks are defined by geometric criteria and lack information
in at least one direction. Type III landmarks are extremal
points (often corresponding to instrumentally determined an-
thropometric points [15]), and while measurements using
them are reliable and easy to conduct, they are often difficult
or impossible to establish independently [15, 34].
Furthermore, Type III landmarks depend on surrounding
structures and/or the overall object orientation, whereas Type
II landmarks are locally defined. In some cases we note am-
biguity of whether landmarks should be defined as Type II or
Type III.
Figure 1 depicts the anatomical location of each of the
landmarks defined in Table 2. Note here that we use hand-
drawn illustrations to depict landmarks in their 3D state, as
they would naturally be determined from the skull by visual
inspection. Two-dimensional photographs are specifically re-
served to illustrate landmarks of a 2D nature as applicable to
2D photographic conditions (see, e.g., Fig. 8).
It is important to further note that many anthropometric
landmarks stray from perfection since they possess intrinsic
limitations. For example, glabella (g) is not always well-
manifested in younger individuals—metopion (m), for exam-
ple, often presents as the most anterior position on the frontal

Fig. 9 Analogous 3D
craniometric and capulometric
landmarks illustrated together as
useful for craniofacial analyses: a
anterior view and b right lateral
view. Circles indicate
craniometric landmarks; crosses
represent capulometric
landmarks. Grey crosses represent
capulometric landmarks obscured
by soft tissues in the depicted
view. Note that these landmarks/
labels do not apply to
photographic overlay of skulls
and faces—for soft tissue
nomenclature pertaining to
photographs see Fig. 8. Bold line
represents the FH
Table 2 Craniometric landmarks including their abbreviations, definitions, and various classifications

Landmark 3D Notation Definition Bookstein type

Median points
Int J Legal Med

Alveolarea ale Median point at the inferior tip of the bony septum between the upper central incisors. Equivalent to Infradentale superius II
Alveolon alv Median point, at the rear of the hard palate, of a line joining the posterior most alveolar margins II
Acanthionb a Most anterior tip of the anterior nasal spine II
Apexa ap Instrumentally determined median point on the superior surface of the cranial vault at the coronal plane connecting left and III
right po
Basion ba Basion encompasses a small region, on the median plane at the anterior most extent of the foramen magnum. Its position as a II
landmark varies slightly depending on the measurement being taken. It can be the most posterior aspect of the foramen
magnum’s anterior rim or the most inferior median point on the foramen magnum’s anterior rim (such as used for taking
cranial height measurements)
Bregma b Where the sagittal and coronal sutures meet. Impossible to determine in juvenile skulls with anterior fontanelle, or with I
complete suture obliteration
Genion ge Most projecting tip of the internal mental spine on the lingual surface of the mandible II
Glabella g Most projecting anterior median point on lower edge of the frontal bone, on the brow ridge, in between the superciliary II
arches and above the nasal root. In adults, glabella usually represents the most anterior point of the frontal bone
Gnathionc gn Median point halfway between pg and me III
Hormion ho Median point where the vomer and sphenoid bones meet I
Incisiona inc Point at the occlusal surface where the upper central incisors meet II
Infradentaled id Median point at the superior tip of the septum between the mandibular central incisors II
Inion i Median point between the apices of the superior nuchal lines and at the base of the external occipital protuberance (not the tip II
of the protuberance)
Klition kl Median endocranial point at the center of the highest extent of the posterior margin of the sella turcica II
Lamda l Point at which the two legs of the lambdoid suture and sagittal suture meet (project from the main direction of the sutures in I
cases of obliteration or presence of wormian bones)
Linguale li Median most superior point of the mandibular symphysis, on the lingual surface II
Mentonc me Most inferior median point of the mental symphysis (may not be the inferior point on the mandible as the chin is often clefted III
on the inferior margin)
Metopiona m Median point, instrumentally determined on the frontal bone as the greatest elevation from a cord between n and b. In III
juveniles, the m, rather than the g, may be the most anterior point of the frontal bone.
Mid-philtrume mp Median point midway between ss and pr II
Nasion n Intersection of the nasofrontal sutures in the median plane I
Nasospinale ns The point where a line drawn between the inferior most points of the nasal aperture crosses the median plane. Note that this II
point is not necessarily at the tip of the nasal spine
Obelion ob Median point where the sagittal suture intersects with a transverse line connecting parietal foramina II
Ophryon on Median point that intersects the smallest frontal bone chord width II
Opisthion o Median point on the anterior side of the foramen magnum’s posterior rim II
Opisthocranion op Most posterior median point of the occipital bone, instrumentally determined as the greatest chord length from g. Usually above III
the external occipital protuberance
Orale ol Median most inferior point of the maxillary symphysis, on the lingual surface II
Pogonion pg Most anterior median point on the mental eminence of the mandible III
Table 2 (continued)

Landmark 3D Notation Definition Bookstein type

Prosphenion ps Median endocranial point, at the center of the sphenoethmoidal suture I

Prosthion pr Median point between the central incisors on the anterior most margin of the maxillary alveolar rim II
Rhinion rhi Most rostral (end) point on the internasal suture. Cannot be determined accurately if nasal bones are broken distally I
Sphenobasion sphba Median point at the spheno-occipital synchondrosis I
Sphenoidale sphen Median endocranial point on the anterior clinoid process, marking the anterior margin of the sella turcica I
Staphylion sta Median point of a line drawn between the anterior most apices of the posterior notches (free edges) of the horizontal plates I
of the palatine bones
Subspinaleb ss The deepest point seen in the profile view below the anterior nasal spine (orthodontic point A) II
Supraglabellare sg Deepest part of the supraglabella fossa in the median plane (cannot be determined in skulls without a supraglabella fossa) II
Supramentalef sm Deepest median point in the groove superior to the mental eminence (orthodontic point B) II
Supraorbitale so Median point at the height of the line joining the most superior points of the left and right superior orbital rims II
Vertex v Most superior point of the skull III
Bilateral Points
Alared al Instrumentally determined as the most lateral point on the nasal aperture in a transverse plane III
Alar curvature pointg ac Hard tissue approximation of soft tissue ac, approximately 5 mm lateral to al II
Antegonionh ag Apex of the antegonial notch II
Asterion ast Where the lambdoidal, parietomastoid, and occipitomastoid suture meet I
Auriculare au On the zygomatic root, vertically above the center of the external auditory meatus II
Condylion laterale cdl Most lateral point on the mandibular condyle III
Condylion mediale cdm Most medial point on the mandibular condyle III
Coronale co Most lateral point on the coronal suture III
Coronion cr The tip of the coronoid process of the mandible II
Dacryond d The point on the medial border of the orbit where the lacrimomaxillary suture meets the frontal bone. There is often a small I
foramen at this point
Ectoconchion ec Lateral point on the orbit at a line that bisects the orbit transversely II
Ectomolareg ecm Most lateral point on the buccal alveolar margin, at the center of the second molar position. Superscript number designates III
the maxillary landmark; subscript number designates the mandibular landmark

Endomolareg enm Most lateral point on the lingual alveolar margin, at the center of the second molar position. Superscript number designates III
the maxillary landmark; subscript number designates the mandibular landmark
Entomion en Where the squamous and parietomastoid sutures meet I
Euryon eu Instrumentally determined as the most lateral point of the cranial vault, on the parietal bone III
Frontomalare orbitale fmo Point on the orbital rim marked by the zygomaticofrontal suture II
Frontomalare temporale fmt Most lateral part of the zygomaticofrontal suture III
Frontotemporale ft Most anterior and medial point of the inferior temporal line, on the zygomatic process of the frontal bone II
Gonion go Point on the rounded margin of the angle of the mandible, bisecting two lines one following vertical margin of ramus and II
one following horizontal margin of corpus of mandible
Int J Legal Med
Table 2 (continued)

Landmark 3D Notation Definition Bookstein type

Infranasion in Intersection of the maxillonasal and nasofrontal sutures I

Int J Legal Med

Infratemporale it Most medial point on the infratemporal crest of sphenoid II

Jugale ju Vertex of the posterior zygomatic angle, between the vertical edge and horizontal part of the zygomatic arch II
Krotaphion k Posterior end of sphenoparietalis suture, where it meets the squamosal part of the temporal bone I
Lacrimalea la Intersection of the posterior lacrimal crest with the frontolacrimal suture I
Lingulare lg Superior most point of the lingula of the mandible II
Mastoidale ms The inferior most projecting point of the tip of the mastoid process II
Maxillofrontale mf Intersection of the anterior lacrimal crest with the frontomaxillary suture I
Medial orbitg mo Point on the anterior lacrimal crest at the same level as ectoconchion II
Mentale ml Most inferior point on the margin of the mandibular mental foramen II
Mid-infraorbitale mio Point on the anterior aspect of the inferior orbital rim, at a line that vertically bisects the orbit II
Mid-mandibular bordere mmb Point on the inferior border of the corpus of the mandible midway between pg and go II
Mid-ramuse mr Midpoint along the shortest antero-posterior depth of the ramus, in the masseteric fossa, and usually close to the level of the III
occlusal plane
Mid-supraorbitale mso Point on the anterior aspect of the superior orbital rim, at a line that vertically bisects the orbit II
Orbitale or Most inferior point on the inferior orbital rim. Usually falls along the lateral half of the orbital margin II
Porion po Most superior point on the upper margin of the external auditory meatus II
Pterion pt A circular region, marked by the sphenoparietalis suture at its center. This region marks the thinnest part of the cranial vault I
Sphenion sphn Anterior end of the sphenoparietalis suture, where it meets the frontal bone I
Stenion ste Most medial point on the spheno-squamosal suture (near foramen ovale) II
Stephanion st The point at which the inferior temporal line crosses the coronal suture I
Temporale inferiusg ti Most superior point on the arc of the inferior temporal line III
Temporale superiusg ts Most superior point on the arc of the superior temporal line III
Zygion zy Instrumentally determined as the most lateral point on the zygomatic arch III
Zygomaxillare zm Most inferior point on the zygomaticomaxillary suture III
Zygoorbitaleb zo Intersection of the orbital margin and the zygomaticomaxillary suture II

Landmarks are positioned assuming the FH position. Definitions are sourced from Martin [25, 27] unless otherwise noted
a
after White [78]
b
after Howells [15, 31]
c
after Krogman & Sassouni [30]
d
after Buikstra and Ubelaker [32]
e
after Stephan and Simpson [72]
f
after Phulari [56] and George [62]
g
defined by the authors
h
after Legrell et al. [85] and Stephan [86]
 Int J Legal Med

Table 3 Capulometric landmarks including their abbreviations, definitions, and various classifications

Landmark 3D Definition
Notation

Median Points
Columella c′ Midpoint of the nasal columella crest, intersecting a line between the two cs′ points
Glabella g′ Most anterior midline point on the forehead, in the region of the superciliary ridges
Gnathiona gn′ Median point halfway between pg′ and me′
Labiale inferius li′ Midpoint of the vermilion border of the lower lip (identical to labrale inferius)
Labiale superius ls′ Midpoint of the vermilion border of the upper lip (not identical to and not to be confused for Labrale superius)
Mentona me′ Most inferior median point of the chin
Metopion m′ Furthest chord length perpendicular to the n′-b′ chord
Mid-philtrumb mp′ Point midway between sn′ and ls′, in the median plane
Nasion n′ Point directly anterior to the nasofrontal suture, in the midline, overlying n
Nasale inferiusc ni′ Most inferior point of the apex nasi. Not locatable on upturned noses
Ophryon on′ Point, at the mid-plane, of a line tangent to the upper limits of the eyebrows. Can be used as an approximation of glabella
when the latter is not clearly identifiable
Opisthocranion op′ Most prominent posterior point overlying the occipital bone, which produces the greatest head length from glabella
Pogoniond pg′ Most anterior midpoint of the chin, located on the skin surface anterior to the identical bony landmark of the mandible
Pronasaled pn′ The most anteriorly protruded point of the apex nasi. In the case of a bifid nose, the more protruding tip is chosen
Rhinionb rhi′ Point overlying rhi, at the end of the internasal suture where bone ends and cartilage begins
Sellion se′ Deepest midline point of the nasofronal angle; not a substitute for n′
Stomion sto′ Midline point of the labial fissure when the lips are closed naturally, with teeth shut in the natural position; if not in the
midline, then below the philtrum
Subnasale sn′ Median point at the junction between the lower border of the nasal septum and the philtrum area
Supramentale sm′ Deepest midline point of the mentolabial sulcus
Trichion tr′ Midpoint of the hairline; determined on a widow’s peak as the projection through the midline from both sides
Vertex v′ Most superior point of the head
Bilateral Points
Alar curvature ac′ The most posterolateral point of the curvature of the base line of each nasal ala
pointd
Alare al′ The most lateral point on the nasal ala
Antitragionc at′ The apex of the antitragus
Corneal apexc ca′ The apex of the cornea. In an anterior view, this landmark is analogous to Farkas’ Pupil (p)d
Cheilion ch′ Outer corners of the mouth where the outer edges of the upper and lower vermilions meet
Ciliare lateralisc cl’ Most lateral peak / extent of the eyebrow
Ciliare medialisc cm’ Most medial and inferior corner of the eyebrow (not present when the eyebrows cross glabella)
Columella superius cs′ Most superior point on each columella crest of the nose, level with the top of the corresponding nostril
Crista philtri cph′ Point on each elevated margin of the philtrum just before projection to the vermilion line
landmarkd
Endocanthion en′ Most medial point of the palpebral fissure, at the inner commissure of the eye; best seen when subject is gazing upward
Exocanthion ex′ Most lateral point of the palpebral fissure, at the outer commissure of the eye; best seen when subject is gazing upward
Euryon eu′ Most lateral point of the head, located in the parietal region
d
Frontotemporale ft′ Point of concavity on each side of the forehead above the supraorbital rim, lateral to the elevation of the linea temporalis
Frontozygomaticus fz′ Most lateral point on the frontozygomatic suture, identified by palpation of the suture line at the superolateral corner of
the orbit
Goniond go′ Most lateral point on the mandibular angle, adjacent to go, identified by palpation
Inferior lacrimal ilp′ The apex of the inferior lacrimal papilla
papillac
Infra second-molar iM2′ Point overlying ecm2, the midpoint of the alveolus of the second mandibular molar
Intertragionc it′ Apex of groove between the tragus and antitragus
Maxillofrontale mf′ Anterior lacrimal crest of the maxilla at the frontomaxillary suture
Mid-alared ma′ Midpoint on the nasal alar where the ala thickness (not width) is measured
Mid-columellad mc′ Midpoint of the nasal columella crest on either side, where the columella thickness is measured (equivalent to
Subnasale′)
Int J Legal Med

Table 3 (continued)

Landmark 3D Definition
Notation

Mid-infraorbitalb mio′ Point anteriorly adjacent to the inferior orbital rim, at a line that vertically bisects the orbit
Mid-mandibular mmb′ Point directly overlying mmb, midway between pg′ and go′
borderb
Mid-ramusb mr′ Point directly overlying mr, best determined by X-ray but can be extrapolated from surface anatomy features
including the masseter muscle mass, the posterior margin of the mandible and the zygomatic arch
Mid-supraorbitalb mso′ Point anteriorly adjacent to the superior orbital rim, at a line that vertically bisects the orbit
Otobasion inferiusd obi′ Most inferior point of attachment of the ear lobe with the cheek
Otobasion obs′ Most superior point of attachment of the ear helix to the temporal region of the head
superiusd
Orbitale or′ Most inferior point on the lower orbital rim
Origohelixac oh′ Origin of the helix from the concha
Palpebrale inferius pi′ Most inferior point on the margin of the lower eyelid
Palpebrale superius ps′ Most superior point on the margin of the upper eyelid
Postaurale pa′ Most posterior point on the free margin of the pinna
Posterohelixa phi′ Posterior most aspect of the inner helix margin
internac
Posterotragionc pt′ Most posterior point on the tragus
Preaurale pra′ Point on the ear insertion line (obs′-obi′) opposite postaurale
Subalared sbal′ Inferior point at the junction of each nasal alar base with the philtrum area
Subanguli iac′ Inferior angle of the concha
conchalic
Subaurale sba′ Most inferior point of the earlobe
Superaurale sa′ Most superior point of the free margin of the pinna
Superciliare sci′ Most superior point on the superior margin of the unaltered eyebrow
Superciliare scc′ Superior most intersection of the eyebrow with a vertical line through ca′ (originally Eyebrow central)
centralise
Superciliare scl′ Superior most intersection of the eyebrow with a vertical line through ex′ (originally Eyebrow lateral)
lateralise
Superciliare scm′ Superior most intersection of the eyebrow with a vertical line through en′
medialisc
Superior lacrimal slp′ The apex of the superior lacrimal papilla
papillac
Supra-anguli sac′ Superior angle of the concha
conchalic
Supraconchalec sc′ Most superior point of the conchal rim where it crosses under the helix
Suprahelixa shi′ Superior most aspect of the inner helix margin
internac
Supra second- sM2′ Point overlying ecm2, the midpoint of the alveolus of the second maxillary molar
molar
Tragion t′ Located at the notch above the tragus of the ear (the cartilaginous projection anterior to the external auditory canal),
where the upper edge of the cartilage disappears into the skin of the face
Tuberculare tu′ Tip of Darwin’s tubercle; when present
Vermilion vs′ Most superior point of the vermilion border of the upper lip at its apex on either side (usually also at the junction of each
superiusc philtral column with the vermilion border). This represents the previously unnamed landmark used by Martin to
establish the Labrale superius (midpoint on a line tangent to the two high points in the curves of the upper
membranous lip)
Vermilion inferiusc vi′ Most inferolateral point of the vermilion border of the lower lip at the maximum curve change on either side
Zygiond zy′ Most lateral point overlying each zygomatic arch, identified as the point of maximum bizygomatic breadth of the face

Landmarks are positioned assuming the FH position. Definitions are sourced from Kolar and Salter [44] unless otherwise noted
a
After hard tissue definitions by Krogman and Sassouni [30] (see Table 2)
b
After Stephan and Simpson [72]
c
Defined by authors
d
After Farkas [43]
e
After Bookstein [34]
 Int J Legal Med

bone in the median plane in subadults due to pronounced fron-
tal bossing, but notice that it is not in the region of the super-
ciliary ridges. Additionally, when sutures are obliterated in
older individuals, sutural landmarks must be either speculated,
or in the case of partial obliteration, projected from residual
traces of suture lines, usually at their extremities [25]. Asym-
metry or dysmorphology may further obscure or obfuscate
some landmarks.
To clarify some commonly confused landmarks that are
not the same, we follow the recommendations of
Krogman and Sassouni [30] for menton (me) and
gnathion (gn): menton being the most inferior median
point on the mental symphysis, while gnathion is the me-
dian point located halfway between pogonion and menton
(Table 1). Similarly, ophryon (on) should not be confused
for supraorbitale (so): ophryon is the median point that
intersects the smallest frontal bone chord width [25],
while supraorbitale is the median point at the intersection
of a line joining the most superior margins of the orbital
rims. Lastly, subspinale (ss) should not be confused with
acanthion (a)—the former is inferior to the latter
(Table 2).
Paired landmarks in craniofacial analysis
As indicated above, craniometric and capulometric land-
marks are often used jointly in craniofacial analysis. Radio-
graphic cephalometrics are a good example where stan-
dardization is already high; however, even there, problems
exist with inconsistencies between authors on how soft tis-
sue and hard tissue landmarks are differentiated [56]. In
craniofacial identification, craniometric and capulometric
landmarks are again used in a paired fashion, but with min-
imal standardization that is widely known to be problematic
[72, 80]. For instance, facial soft tissue thickness measure-
ments taken at hard tissue nasion have been measured in at
least six different ways: (i) directly anteriorly; (ii) to sellion;
(iii) to a point between the eyes; (iv) to basion; (v) to a point
in the plane of the superior limits of the folds of the two
upper eyelids; and (vi) additional variations (for more de-
tails, see [72]). To provide another example, the depth of
tissue at the cheek and at a point in the vicinity of the
mandibular ramus has been taken: at the level of the occlu-
sal plane [52, 66], the level of the lips [45, 47, 48], and at
the midramus height [64, 81].

Capulometric landmarks (3D representation) Table 4 Recommended landmark pairings for craniofacial analysis

Craniometric landmark Capulometric landmark

These landmarks are drawn primarily from Kolar and
Salter [44], with additional landmarks from Farkas [43] ac ac′
and some other authors where noted (see Table 3). fmt fz′
These landmarks have been supplemented with other ft ft′
points commonly used in the craniofacial literature, for g g′
example, soft tissue thickness research [71, 72], and gn gn′
where sparse, new additional landmarks have been go go′
added (e.g., at the eyebrows and ear). The capulometric id li′
landmarks can be visualized in Fig. 6, and can be ecm2 iM2′
found, together with their definitions, in Table 3. Major m m′
capulometric landmarks embodying facial feature detail me me′
are illustrated in Fig. 7. mp mp′
As with the craniometric landmarks, capulometric land- mr mr′
marks possess inherent limitations that must be recognized. mmb mmb′
For example, midramus (mr) is dependent on its hard tissue mio mio′
equivalent, which can prove difficult to palpate through the mso mso′
buccal soft tissues and is, thereby, most readily identified by n se′
radiographic cephalometry. Here, it should be noted that land- op op′
mark establishment on 2D computed tomography orthoslices pg pg′
without multislice 3D reconstruction retains its own set of pr ls′
problems and so should be avoided in favor of multislice rhi rhi′
reconstruction [79]. Similarly, sM2′ and iM2′ depend on locat- ecm2 sM2′
ing the second molars, which can be difficult without under- sm sm′
taking multislice reconstruction mentioned above. It is also v v′
worth noting that ophryon’s (on′) utility in the soft tissue zy zy′
context is questionable for individuals possessing artificially
shaped eyebrows. Head in FH plane
Int J Legal Med
A standard reference set of paired craniofacial landmarks
thereby holds value, and the set provided here has been drawn
together cognizant of past cephalometric practice and cranio-
facial identification literature, e.g., [46, 47, 52, 57, 64, 67, 82,
83]. The recommended landmark pairings are listed in Table 4
and illustrated in Fig. 9. It is worth noting that Farkas’ alar
curvature point (ac′) is used to designate the mid-junction of
the alar wing with the cheek, and we reserve alare (al′) for the
most lateral point of the nasal ala following prior recommen-
dations by Farkas [43] and prior usage by Stephan and
Simpson [72, 84].
Conclusion
This paper provides an improved classification scheme for
anthropometry and an improved nomenclature for craniofacial
landmarks that enables their class to be clearly differentiated
and communicated at-a-glance, in compact format, for both
soft and hard tissues. Besides facilitating unity of description,
this nomenclature holds special importance for facial photo-
grammetry where soft tissue landmarks are ill defined and are
often misrepresented as craniometric analogs. Using the new
notation, a standardized suite of craniometric (skull) and
capulometric (soft tissue face) landmarks are provided that
enables current confusions to be avoided.
Acknowledgments The authors would like to thank Jiro Manabe and
Rory Preisler from the University of Queensland for their assistance in
compiling parts of the landmark lists and definitions from the literature.
Compliance with ethical standards Informed consent was obtained
from all individual participants included in the study under #2015000108
from The University of Queensland’s Behavioural and Social Sciences
Ethical Review Committee. Additional informed consent was obtained
from all individual participants for whom identifying information is in-
cluded in the article, namely photographs. All procedures performed in
studies involving human participants were in accordance with the ethical
standards of the institutional research committee and with the 1964 Dec-
laration of Helsinki and its later amendments or comparable ethical
standards.
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