D. De Angelis

Unidentified bodies and human remains: An Italian glimpse through a European problem

The identification of cadavers (the main activity of forensic odontologists and anthropologists) is a crucial issue in forensic pathology, but the official entity of this problem is still poorly known in most countries, apart from a few American reports. In this article the authors present a descriptive study of unidentified decedents over a 14-year period (1995-2008) in Milan. The number of cadavers or human remains arriving at the morgue with no identity amounts to 454 - 3.1% of all autopsies at the Institute of Legal Medicine, with a mean of 32 unidentified subjects every year; 62% reached a positive identification in a period of time ranging from a few days to 10 years. 17% on an average remain unidentified. Most identification processes involved forensic odontology and anthropology. This study aims at revealing the problem and hopefully may provide some food for thought for forensic pathologists, anthropologists and odontologists so that they may focus on this issue and on possible solutions in their countries.

Metric and morphological assessment of facial features: A study on three European populations

Identification from video surveillance systems is becoming more and more frequent in the forensic practice. In this field, different techniques have been improved such as height estimation and gait analysis. However, the most natural approach for identifying a person in everyday life is based on facial characteristics. Scientifically, faces can be described using morphological and metric assessment of facial features. The morphological approach is largely affected by the subjective opinion of the observer, which can be mitigated by the application of descriptive atlases. In addition, this approach requires one to investigate which are the most common and rare facial characteristics in different populations. For the metric approach further studies are necessary in order to point out possible metric differences within and between different populations. The acquisition of statistically adequate population data may provide useful information for the reconstruction of biological profiles of unidentified individuals, particularly concerning ethnic affiliation, and possibly also for personal identification. This study presents the results of the morphological and metric assessment of the head and face of 900 male subjects between 20 and 31 years from Italy, Germany and Lithuania. The evaluation of the morphological traits was performed using the DMV atlas with 43 pre-defined facial characteristics. The frequencies of the types of facial features were calculated for each population in order to establish the rarest characteristics which may be used for the purpose of a biological profile and consequently for personal identification. Metric analysis performed in vivo included 24 absolute measurements and 24 indices of the head and face, including body height and body weight. The comparison of the frequencies of morphological facial features showed many similarities between the samples from Germany, Italy and Lithuania. However, several characteristics were rare or significantly more or less common in one population compared to the other two. On the other hand, all measurements and indices, except for labial width and intercanthal-mouth index showed significant differences between the three populations. As far as comparisons with other samples are concerned, the three European Caucasian samples differed from North American Caucasian, African and Asian groups as concerns the frequency of the morphological traits and the mean values of the metric analysis. The metric and morphological data collected from three European populations may be useful for forensic purposes in the construction of biological profiles and in screening for personal identification.

Dental superimposition: a pilot study for standardising the method

Dental superimposition is becoming more and more important because of the increasing number of illegal immigrants (at least in Italy), with no clinical history, no personal effects or relatives useful for genetic comparison, whose friends and acquaintances can usually only produce photographs. Very few authors have been involved in devising and using this method. The goal of the present study is to establish whether it is possible, and under which conditions, to identify individuals by dental superimposition of teeth visible in an ante-mortem photograph and dental casts of an unidentified body, and to develop a protocol for the spatial orientation analysis of the dentition and qualitative and semi-quantitative analysis of superimpositions. A non-mathematical scoring system has been applied to each superimposition as a first step towards the optimisation of a cheap, quick, semi-quantitative method of identifying individuals when other more used methods are not applicable.

The “blind age assessment”: applicability of Greulich and Pyle, Demirjian and Mincer aging methods to a population of unknown ethnic origin

PurposeAge estimation is one of the most crucial issues in case of unknown deceased as well as in the living and is very frequently of radiological interest. Three methods for age estimation have been designated as the most reliable among the others: Greulich and Pyle, Demirjian and Mincer. The literature provides several studies concerning their applicability in different geographic contexts. However, not always can ancestry be ascertained, for example, in the case of badly preserved corpses. In these cases, age assessment must be performed without the corrections suggested by the literature for different ethnic groups. One may therefore wonder how reliable the result of age assessment performed without knowing the racial group to which the subject belongs may be. This study aimed at testing the applicability of the Greulich and Pyle Atlas, the Demirjian and the Mincer methods on a mixed population to compare skeletal and dental methods of age estimation.Materials and methodsX-ray films of 167 subjects aged between 4 and 31 years from more than 18 countries were recruited. One hundred and nine orthopantomographs (OPG) of children aged between 4 and 15.5 years were evaluated by Demirjian’s method; whenever the highest Demirjian score was reached (31 cases), the Mincer method was applied. The skeletal maturation of 54 subjects aged between 7 and 19 years was determined by the Greulich and Pyle method.ResultsThe lowest average variance from chronological age was shown by the Greulich and Pyle method, followed by Demirjian. The Mincer method showed very high mean variances.ConclusionsMean variances from the different methods do not significantly differ from data reported in the literature and demonstrate that the reliability of Demirjian, and Greulich and Pyle as they stand may be applied satisfactorily to remains or individuals of unknown ethnic origin.RiassuntoObiettivoLa stima dell’età costituisce uno degli argomenti più cruciali nel campo del riconoscimento dei cadaveri sconosciuti e dei viventi, e molto frequentemente risulta di interesse radiologico. Tre metodi sono stati scelti come più affidabili: il metodo Greulich e Pyle, il Demirjian ed il Mincer. La letteratura ha sviluppato diversi studi per verificare la loro applicabilità nei diversi contesti geografici. Tuttavia, non sempre il gruppo etnico di appartenenza può essere accertato, per esempio nei casi di cadaveri in avanzato stato di decomposizione: in tali casi la stima dell’età deve essere eseguita senza le correzioni fornite dalla letteratura per i diversi gruppi etnici. È necessario pertanto approfondire quanto sia affidabile il risultato fornito dai metodi di Greulich e Pyle, Demirjian e Mincer su una popolazione di origine etnica mista, allo scopo di mettere a confronto i metodi scheletrici e dentari di stima dell’età.Materiali e metodiSono state raccolte le radiografie di 167 soggetti di età compresa fra i 4 ed i 31 anni provenienti da più di 18 paesi. Centonove ortopantomografie di bambini di età compresa fra i 4 ed i 15,5 anni sono state valutate con metodo Demirjian; nei casi in cui è stato raggiunto il massimo punteggio Demirjian, si è applicato il metodo Mincer. La maturazione scheletrica di 54 soggetti di età compresa fra i 7 ed i 19 anni è stata quindi determinata con il metodo di Greulich e Pyle.RisultatiLa minor differenza media dall’età cronologica è stata evidenziata dal metodo Greulich e Pyle, seguito dal Demirjian. Il metodo Mincer ha mostrato differenze medie molto elevate.ConclusioniLe differenze medie fra i diversi metodi non differiscono significativamente dai dati riportati in letteratura e dimostrano che i metodi Demirjian e Greulich e Pyle possono essere applicati con successo a resti o individui di origine etnica sconosciuta.

The identification of living persons on images: A literature review

Personal identification in the forensic context commonly concerns unknown decedents. However, recently there has been an increase in cases which require identification of living persons, especially from surveillance systems. These cases bring about a relatively new challenge for forensic anthropologists and pathologists concerning the selection of the most suitable methodological approaches with regard to the limitations of the photographic representation of a given person for individualization and identity. Facial features are instinctively the primary focus for identification approaches. However, other body parts (e.g. hands), and body height and gait (on videos) have been considered in cases of personal identification. This review aims at summarizing the state-of-the-art concerning the identification of the living on images and videos, including a critical evaluation of the advantages and limitations of different methods. Recommendations are given in order to aid forensic practitioners who face cases of identification of living persons.

Twins and the paradox of dental-age estimations: A caution for researchers and clinicians

The biological age difference among twins is frequently an issue in studies of genetic influence on various dental features, particularly dental development. The timing of dental development is a crucial issue also for many clinicians and researchers. The aim of this study was therefore to verify within groups of twins how dental development differs, by applying Demirjians method, Mincers charts of development of third molars and two of Camerieres methods for dental age estimation, which are among the most popular methods both in the clinical and the forensic scenario. The sample consisted of 64 twin pairs: 21 monozygotic, 30 dizygotic same-sex and 13 dizygotic opposite-sex with an age range between 5.8 and 22.6 years. Dental age was determined from radiographs using the mentioned methods. Results showed that dental age of monozygotic twins is not identical even if they share all their genes. The mean intra-pair difference of monozygotic pairs was low and similar to the difference in dizygotic same-sex twins; the maximum difference between monozygotic twins, however, was surprisingly large (nearly two years). This should lead to some circumspection in the interpretation of systematic estimations of dental age both in the clinical and forensic scenario.

Application of high resolution pQCT analysis for the assessment of a bone lesion: A technical note

Peripheral quantitative computed tomography (pQCT) has found new fields of application in bone medicine, but none of them concerns the forensic practice. This study exposes the potential of pQCT applied to a penetrating lesion in a vertebral body. A pQCT scanner was used for the measurements (XCT Research SA+; Stratec Medizintechnik GmbH, Pforzheim, Germany). A more precise reconstruction of the path of the lesion within the trabecular bone was reached, with more details concerning the morphological characteristics of the lesion inside the vertebral body, and the elaboration of a 3D model was created, which allowed the operator to define the volume of the lack of tissues related to the lesion. The application of pQCT scan proved to be a potentially useful tool for the assessment of bone lesions, although further studies are needed in order to verify its applicability to forensic context.

The effect of the medico-legal evaluation on asylum seekers in the Metropolitan City of Milan, Italy: a pilot study

In the present-day situation, the clinical forensic documentation of an asylum seeker’s narrative and his or her examination, together with the physical and psychological findings, may have very important effects on the outcome of the request for political asylum. Since 2012, the Municipality of Milan, the University Institute of Legal Medicine, and other institutions have assembled a team with the task of examining vulnerable asylum seekers and preparing a medical report for the Territorial Commission for International Protection (Prefecture, Ministry of Interiors), who will assess the application. We compared medico-legal reports and outcomes of 57 cases which were evaluated by the Commission after having undergone a medico-legal evaluation through the Istanbul Protocol criteria and examined, in particular, which medico-legal variables seem associated to the outcome. The results show that forensic assessment seems to have a significant and interesting correlation with the final assessment given by the Commission. For example, the higher the level of consistency, according to the Istanbul Protocol, the more frequently protection is granted. These data show how important clinical forensic medicine can be in such scenarios and how the presence of clinical forensic experts should be encouraged in such evaluations, as has been recently enshrined in Italy in the guidelines of a Ministerial Decree of April 3rd, 2017 for the assistance and the rehabilitation as well as the treatment of psychiatric disorders in refugees and asylum seekers who have undergone torture, rape, and other severe forms of psychological, physical, or sexual violence.