10 Face and Neck
This chapter presents a comprehensive series of photographic views of the face and neck. The exact settings and all details required to create these images are discussed in depth, and all possible combinations of pose, angle, and expression are explored. Use of appropriate images from these series will allow accurate and thorough documentation of the face and neck for a broad range of applications in general otolaryngology, head and neck oncology, and facial plastic surgery.
Camera angle, composition, face, focus, image series, neck
The photographs that follow represent standardized views of the face and neck for use in a wide variety of clinical situations. All were taken with the same equipment and settings: Nikon D800, Micro-Nikkor 105 mm, f/11, 1/125, ISO 100, using the 4-light setup from Chapter 3. Be sure to view the online content available on MediaCenter.thieme.com that includes all referenced images; for brevity and clarity, only one side is depicted but both should be photographed for actual patient use.
10.1.1 Full Face, Frontal
The patient faces directly forward, looking straight ahead (Fig. 10.1). The superior border of the frame is just above the top of the head. The inferior border is at midneck level. An equal border of background is visible on both sides of the frame—the patient is centered exactly. The camera is held at the same level as the center of the face and level in all planes. A neutral expression is used. The head should be level and vertical, confirmed by the height of the medial canthi and the root of the helices, or by a vertical line from the midpoint of the hairline through the nose, philtrum, and midline of the mentum. With any method, caution should be used as most patients have at least some degree of subtle facial asymmetry. The focus point is placed on either eye.
This view is the same as “Full Face, Frontal,” except as noted below (Fig. 10.2). The patient turns their body and head 45 degrees left or right, respectively, looking straight ahead in line with their body. The exact degree of rotation can be confirmed by placing a marker on the floor or wall on which the patient can focus. Many advocate aligning the tip of the nose with the midpupil or the border of the cheek, but this can lead to inconsistency based on the patient’s degree of nasal tip or cheek projection. The focal point is placed on the front eye.
10.1.3 Full Face, Left and Right Profile
This view is the same as “Full Face, Frontal,” except as noted below. The patient turns their body and head 90 degrees left or right, respectively, looking straight ahead in line with their body. Neither the far brow nor eye are visible. Confirm the head alignment with the Frankfort horizontal plane, i.e., a horizontal line through the top of the external auditory canal (porion) and the inferior border of the orbit (orbitale). Use the front eye as the focal point.
10.1.4 Full Face, Left and Right Rear Oblique
These views are the same as “Full Face, Left and Right Oblique,” except the patient turns 135 degrees left or right from the camera as opposed to 45 degrees. Focus on the ear.
10.1.5 Full Face, Rear
This view is the same as “Full Face, Frontal,” except the patient turns 180 degrees from the camera. Focus on the occiput.
10.1.6 Full Face and Neck, Frontal, Left and Right Oblique, Left and Right Profile, Left and Right Rear Oblique, Rear
These views are the same as the “Full Face” series of views described earlier, but with the lower border just below the sternal notch instead of midneck (Fig. 10.3). The arms and shoulders should be allowed to hang naturally at the sides and the patient should sit straight up, but not stiffly.
10.1.7 Neck, Frontal), Left and Right Oblique, Left and Right Profile, Left and Right Rear Oblique, Rear
These views are the same as the “Full Face and Neck” views described earlier, but with the upper border at the base of the external auditory canal (Fig. 10.4).