Ancestral Variations in the Shape and Size of the Zygoma

Automated reconstruction: Predictive models based on facial morphology matrices

Forensic Facial Approximation (FFA) has evolved, with techniques advancing to refine the intercorrelation between the soft-tissue facial profile and the underlying skull. FFA has become essential for identifying unknown persons in South Africa, where the high number of migrant and illegal labourers and many unidentified remains make the identification process challenging. However, existing FFA methods are based on American or European standards, rendering them inapplicable in a South African context. We addressed this issue by conducting a study to create prediction models based on the relationships between facial morphology and known factors, such as population affinity, sex, and age, in white South African and French samples. We retrospectively collected 184 adult cone beam computed tomography (CBCT) scans representing 76 white South Africans (29 males and 47 females) and 108 French nationals (54 males and 54 females) to develop predictive statistical models using a projection onto latent structures regression algorithm (PLSR). On training and untrained datasets, the accuracy of the estimated soft-tissue shape of the ears, eyes, nose, and mouth was measured using metric deviations. The predictive models were optimized by integrating additional variables such as sex and age. Based on trained data, the prediction errors for the ears, eyes, nose, and mouth ranged between 1.6 mm and 4.1 mm for white South Africans; for the French group, they ranged between 1.9 mm and 4.2 mm. Prediction errors on non-trained data ranged between 1.6 mm and 4.3 mm for white South Africans, whereas prediction errors ranging between 1.8 mm and 4.3 mm were observed for the French. Ultimately, our study provided promising predictive models. Although the statistical models can be improved, the inherent variability among individuals restricts the accuracy of FFA. The predictive validity of the models was improved by including sex and age variables and considering population affinity. By integrating these factors, more customized and accurate predictive models can be developed, ultimately strengthening the effectiveness of forensic analysis in the South African region.

The accuracy of virtual surgical planning assisted management for L-shaped reduction malarplasty: A retrospective study

This study aims to evaluate the accuracy of L-shaped reduction malarplasty with bone setback or resection on the zygoma and the mortice and tenon joint structure on the zygomatic arch under the guidance of virtual surgical planning (VSP). Adult patients with zygomatic protrusion or hypertrophy were enrolled and divided. L-shaped reduction malarplasty with or without bone resection and with the mortice and tenon joint structure on the zygomatic arch was conducted either by digital procedures comprising VSP and three-dimensional (3D) printing titanium templates (Group I) or by conventional methods (Group II). Positions of representative landmarks and superimposition models were analyzed by 3D cephalometry. Satisfaction rate and incidences of clinical complications were compared as well. Satisfactory reduction of zygomatic protrusion or hypertrophy was recognized among all 78 patients. Improved symmetry and great surgical accuracy were observed according to the cephalometry analyses. The bone segment movement of virtual plans and actual results in Group I were measured and showed no obvious difference for the inward movement (5.42 ± 0.98 mm vs. 5.33± 0.93 mm, P = 0.6906) and the sagittal overlap (4.77 ± 1.32 mm vs. 4.87± 1.21 mm, P = 0.7386) at the zygoma roots, along with the step length at the long-arm of the L-shaped osteotomy line (2.43 ± 1.11 mm vs. 2.39± 0.89 mm, P = 0.8665). The high resemblance between virtual plans and actual results was depicted via superimposition models. Meanwhile, a higher satisfaction rate (28 in 36, 78% vs. 20 in 42, 48%) and a lower incidence rate of complications (11 in 36, 31% vs. 21 in 42, 50%) were found in Group I. Within the limitations of the study it seems that the application of VSP in reduction malarplasty could significantly contribute to better surgical accuracy and reduced difficulties in the operation, which would be beneficial to patients with zygoma hypertrophy or prominence.

Effects of surgical factors on the outcomes of zygoma reduction malarplasty: a quantitative computed tomography study

BACKGROUND

Malarplasty is widely performed for zygoma reduction. The effects of body segmentation, plate bending, and postoperative arch location on zygomatic movement have not been analyzed using computed tomography (CT).

RESULTS

We quantitatively analyzed the effects of surgical factors on zygomatic movements via superimposition of preoperative and postoperative CT images using three-dimensional software. Our results showed that segmentation had the most significant effect on the horizontal reduction of malar eminence (β = 0.593, r = 0.696, adjusted r² = 0.479, F = 79.595; p < 0.001). In addition, upward and posterior arch movements had significant effects on the anterior and posterior movements of the eminence (β = - 0.379 for vertical arch movement, β = 0.324 for arch setback, r = 0.603, adjusted r² = 0.352, F = 31.943; p < 0.001). The major factors that influenced inward arch movement at the coronoid process included segmentation and inward movement at the arch osteotomy site. To prevent interference of the coronoid process and arch, surgeons should pay attention to the degree of segmentation (β = 0.349) and inward movement at the arch osteotomy site (β = 0.494; r = 0.688, adjusted r² = 0.464, F = 50.412; p < 0.001).

CONCLUSIONS

Surgical factors related to malarplasty affect the movement of specific parts of the zygoma. In addition, accurate application is possible by considering the anatomical structure of the application area when using the bending plate.

Digital Reconstructions Using Linear Regression: How Well Can It Estimate Missing Shape Data from Small Damaged Areas?

Skeletal remains analyzed by anthropologists, paleontologists and forensic scientists are usually found fragmented or incomplete. Accurate estimations of the original morphologies are a challenge for which several digital reconstruction methods have been proposed. In this study, the accuracy of reconstructing bones based on multiple linear regression (RM) was tested. A total of 150 digital models from complete zygomatics from recent past populations (European and African American) were studied using high-density geometric morphometrics. Some landmarks (i.e., 2, 3 and 6) were coded as missing to simulate incomplete zygomatics and the missing landmarks were estimated with RM. In the zygomatics, this simulated damage affects a few square centimeters or less. Finally, the predicted and original shape data were compared. The results indicate that the predicted landmark coordinates were significantly different from the original ones, although this difference was less than the difference between the original zygomatic and the mean zygomatic in the sample. The performance of the method was affected by the location and the number of missing landmarks, with decreasing accuracy with increasing damaged area. We conclude that RM can accurately estimate the original appearance of the zygomatics when the damage is small.

Quantification and visualization of the tooth extraction effects on face with spatially-dense geometric morphometrics

PURPOSE

To apply geometric morphometrics and multivariate statistics to evaluate changes of the face for female Chinese patients who underwent orthodontic treatment with different type of anchorage control.

METHODS

Forty-six adult female patients were enrolled including 33 four first premolars extraction cases (17 patients with mini-implants for maximum anchorage control and 16 patients without mini-implants) and 13 non-extraction cases with minimum treatment duration of 15 months. Spatially-dense correspondence were established among all the images The pre-and post-treatment average faces of the two extraction groups and the non-extraction group were generated. Partial least squares regression was used to test the statistical significance of the effects of treatment for different anchorage choice.

RESULTS

The upper and lower lips were retruded significantly after treatment in the extraction groups. In the maximum anchorage control group, the temple and cheek were depressed by approximately 1mm and the zygomatic regions were increased in the mid-face. However, these changes were not statistically significant. In comparison, no statistically significant facial changes occurred in the non-extraction group.

CONCLUSIONS

The anchorage choice and the removal of four first premolars extraction influence lip shape as well as the perioral regions. However, extraction treatment does not impact the appearance of the cheeks and temples on a statistically level, as compared to orthodontic treatment without premolar extractions. Spatially-dense geometric morphometric facilitates comprehensive treatment effects quantification and visualization on the full facial changes for improving orthodontic outcome evaluation.

Orbital and Periorbital Dysmorphology in Untreated Pfeiffer Syndrome

BACKGROUND

Visual impairment secondary to orbital and periorbital dysmorphology is frequent in Pfeiffer syndrome patients. The etiopathogenesis of this aberrancy, however, remains unclear.

METHODS

Untreated Pfeiffer syndrome patients (n = 31) and normal control subjects (n = 43) were compared. Craniometric and volumetric analyses related to the orbital and periorbital anatomy were performed using Materialise (Leuven, Belgium) software.

RESULTS

Overall, orbital cavity volume of Pfeiffer patients is reduced by 28 percent (p < 0.001), compared to normal, starting before 3 months of age (p = 0.004). Globe volume was diminished by 10 percent (p = 0.041) before 3 months of age, yet tended to catch up thereafter. However, the retrobulbar soft-tissue volume remained smaller beyond 1 year of age (17 percent, p = 0.003). Globe volume projection beyond the bony orbit increased in all observed ages (82 percent, p < 0.001). The volumes of sphenoid bone, maxilla, and mandible proportionately were restricted by 24 to 25 percent (p = 0.003 to 0.035) before 3 months of age. The volume of maxilla and mandible gradually approximate normal; however, the sphenoid bone volume in Pfeiffer patients remains less than normal (p = 0.002) into childhood. The anteroposterior length of both the zygoma and the maxilla was reduced by 14 percent (p < 0.001). Anterior positioning of the zygoma is less by 23 percent (p < 0.001) in Pfeiffer patients overall, with anterior positioning of maxilla reduced similarly by 23 percent (p < 0.001).

CONCLUSIONS

Pfeiffer syndrome patients develop decreased retrobulbar soft-tissue and globe volume, along with a restricted orbital cavity volume in infancy. Significant hypoplasia of the sphenoid bone is associated with more severe central facial (maxilla) retrusion, compared to lateral facial structures (zygoma).

CLINICAL QUESTION/LEVEL OF EVIDENCE

Risk, II.

Radiologic Analysis of Malar Arch Movement in Reduction Malarplasty Without Bony Resection

BACKGROUND

Reduction malarplasty has been popular among Asians with a wide facial width. In general, malar setback after bony resection is regarded as the standard objective of reduction malarplasty. However, unnecessary bony resection may lead to various postoperative complications. Therefore, we suggest the use of reduction malarplasty without bony resection to achieve a similar narrowing effect of the facial width, based on radiographic analysis of malar arch movement.

PATIENTS AND METHODS

This retrospective study analyzed 48 patients with a wide midface who underwent reduction malarplasty between September 2018 and December 2019. We included 40 cases of advancement repositioning malarplasty (AR) without bony resection and 8 cases of setback reduction malarplasty (SR) with bony resection. The three-dimensional position of the malar arch expressed by coordinates (x, y, and z) on three-dimensional computed tomography scans was used to compare the positional change between the surgical methods. The paired t-test, Wilcoxon text, and independent t-test were used in data analysis, and statistical analysis was performed using SPSS 23.0 software.

RESULTS

Medial and superior movement of the freed malar arch segment was significantly different between AR and SR (P < 0.05). Although medialization and superiorization were not significantly different between AR and SR, there was a significant difference in anterior-posterior movement between AR and SR (P < 0.05).

CONCLUSION

The radiologic analysis based on malar arch movement between AR and SR showed similar narrowing effects on medialization and superiorization of the malar arch regardless of bony resection. Therefore, the AR can be effectively applied in case of arch dominant type or malar asymmetry. In addition, further comprehensive study including analysis on movement of facial soft tissue following malar bony movement is expected based on this study in near future.

Nose approximation among South African groups from cone-beam computed tomography (CBCT) using a new computer-assisted method based on automatic landmarking

Considering the high demand for the identification of unknown remains in South Africa, a need exists to establish reliable facial approximation techniques that will take into account sex and age and, most importantly, be useful within the South African context. This study aimed to provide accurate statistical models for predicting nasal soft-tissue shape from information about the underlying skull subtract among a South African sample. The database containing 200 cone-beam computer tomography (CBCT) scans (100 black South Africans and 100 white South Africans). The acquisition and extraction of the 3D relevant anatomical structures (hard- and soft-tissue) were performed by an automated three-dimensional (3D) method based on an automatic dense landmarking procedure using MeVisLab © v. 2.7.1 software. An evaluation of shape differences attributed to known factors (ancestry, sex, size, and age) was performed using geometric morphometric and statistical models of prediction were created using a Projection onto Latent Structures Regression (PLSR) algorithm. The accuracy of the estimated soft-tissue nose was evaluated in terms of metric deviations on training and un-trained datasets. Our findings demonstrated the influence of factors (sex, aging, and allometry) on the variability of the hard- and soft-tissue among two South African population groups. This research provides accurate statistical models optimized by including additional information such as ancestry, sex, and age. When using the landmark-to landmark distances, the prediction errors ranged between 1.769mm and 2.164mm for black South Africans at the tip of the nose and the alae, while they ranged from 2.068mm to 2.175mm for the white subsample. The prediction errors on un-trained data were slightly larger, ranging between 2.139mm and 2.833mm for the black South African sample at the tip of the nose and the alae and ranging from 2.575mm to 2.859mm for the white South African sample. This research demonstrates the utilization of an automated 3Dmethod based on an automatic landmarking method as a convenient prerequisite for providing a valid and reliable nose prediction model that meets population-specific standards for South Africans.

Assessing zygomatic shape and size for estimating sex and ancestry in a South African sample

Unidentified, decomposed and skeletonised human remains are frequently found in South Africa, therefore, standardised, reliable and relevant sex and ancestry estimation methods are required for forensic identification. This study assessed sex and ancestral variation in zygomatic size and shape in a South African population using geometric morphometric analyses. The zygoma of 158 South African individuals were sampled. Eight zygomatic landmarks were captured in 3-dimensions using a Microscribe G2 digitiser and assessed using procrustean geometric morphometrics. Shape and size differences were analysed using multivariate linear regression, discriminant function and canonical variate analyses. Males had significantly larger zygomas than females. Significant shape variation was found between ancestral groups. Bantu-speaking and Mixed ancestry individuals had narrower, shorter and more anteriorly projecting orbital margins, whilst Europeans had vertically elongated and receded orbital margins. European ancestral groups were most discernible from Bantu-speakers and Mixed ancestral groups. Ancestry estimation accuracies improved when ancestry was aggregated with sex. Pairwise ancestry-linked comparisons in females were as follows; Bantu-speakers (76%) from Europeans (72%), Bantu-speakers (71%) from Mixed ancestry (59%) and European (72%) from Mixed ancestry (63%). Similarly, ancestry-linked comparisons in males were as follows; Bantu-speakers (77%) from Europeans (81%), Bantu-speakers (53%) from Mixed ancestry (59%) and European (72%) from Mixed ancestry (82%). Size differences are putatively linked to variations in hormone-regulated growth and muscular robusticity between males and females. Shape variations between ancestral groups are likely attributable to the heterogenous genetic and ancestral origins of the South African population. It is challenging to distinguish between South Africa Bantu speakers and Mixed ancestry people due to Mixed ancestry individuals having variable genetic contributions from Khoesan, Bantu-speakers, Europeans and Asians. Bantu-speaking and Mixed ancestry people had zygomatic morphologies consistent with historical thermoregulatory adaptations to sub-Saharan climates, reported in African-descendants. Zygomatic morphology in European descendants suggests ancestral origins from colder climatic regions. This study demonstrated the utility of the zygoma in distinguishing between ancestral groups in South Africa, but further research is required to develop population-specific standards to distinguish between South African populations with shared African ancestry. The zygoma shows a promising ability to estimate sex and ancestry in South Africans, suggesting population specific standards for this bone may be of forensic interest.

Location of the split line of the deep temporal fascia when reducing a zygomatic arch fracture

BACKGROUND

The deep temporal fascia (DTF) is known to separate into two layers that descend to attach to the zygomatic arch. When surgeons reduce an isolated fracture of the zygomatic arch through a temporal approach, the temporal incision site needs to be superior to the split line of the DTF.

MATERIALS AND METHODS

Sixty-seven hemifacial cadavers were investigated after removing the skin, subcutaneous tissue, and superficial temporal fascia. The superficial layer of the DTF was exposed. We cut the superficial layer along the line along, which it adhered to the deep layer inseparably. The heights of the split line of the DTF from the superior border of the zygomatic arch and from the top of the helix were measured at three points: at the jugale, zygion, and 3 cm from the tragus.

RESULTS

In all cases there were thick identifiable deep layers of the DTF. The mean heights of the split line of the DTF from the superior border of the zygomatic arch were 49.8, 46.7, and 42.6 mm at the jugale, zygion, and 3 cm from the tragus, respectively; the corresponding mean heights of the split line from the top of the helix were 19.1, 15.6, and 11.4 mm.

CONCLUSIONS

Knowledge of the mean height of the split line of the DTF will be helpful for surgeons to determine the temporal incision site for ensuring the safe reduction of a zygomatic arch fracture.

Deformation of the zygomaticomaxillary and nasofrontal sutures during bone-anchored maxillary protraction and reverse-pull headgear treatments: An ex-vivo study

INTRODUCTION

Bone-anchored maxillary protraction (BAMP) is an emerging treatment that involves applying a protraction load to the maxillary bone. Although it is believed that such an approach results in better sutural separation, this has not been investigated. This study aimed to assess and compare the deformation of 1 circumaxillary suture (zygomaticomaxillary suture [ZMS]) and 1 facial suture (nasofrontal suture [NFS]) during BAMP and reverse-pull headgear (RPHG) treatment.

METHODS

The study was performed ex vivo on 15 pig heads. Miniplates were placed in the maxillary bone and the body of the mandible. A molar tube was bonded to the maxillary first molars. Six single-element strain gauges and 3 differential variable reluctance transducers were installed across the ZMS and NFS bilaterally. Each head underwent BAMP and RPHG unilaterally and bilaterally.

RESULTS

In unilateral experiments, both BAMP and RPHG resulted in tension on the ipsilateral ZMS and NFS and compression on the contralateral side, with higher magnitude in the BAMP group. In bilateral experiments, both modalities resulted in tension at the ZMS, with higher magnitude in the BAMP group. Deformation of the NFS was different between the 2 groups: tension in majority of the BAMP and compression in most of the RPHG heads.

CONCLUSIONS

Our study shows a higher magnitude of sutural separation in BAMP than in RPHG. The pattern of sutural deformation is consistent with a forward displacement of the midface in BAMP compared with an upward and backward rotation in the RPHG. Rotation of the maxilla was also present in some of the subjects who underwent BAMP.

Divided zygoma in Holocene human populations from Northern China

Objectives

Divided zygoma (DZ) occurs in contemporaneous human populations, with the highest incidences in people from East Asia and Southern Africa. The present study examines the prevalence and variation of this condition in the Holocene populations of Northern China for the first time.

Methods

In this study, 1145 skulls from various human populations living in Northern China from the Neolithic Age to recent dynasties (5000‐300 years BP) were examined. Specifically, cranial measurements and a CT scan were conducted to quantify craniofacial morphology.

Results

Fifteen skulls were identified with DZ, revealing an overall prevalence of 1.3% in the collection, while it was determined to be higher in North Asian and Northeast Asian regional groups. In skulls with unilateral DZ, the superior division of the zygoma was generally slender, while the inferior division of the zygoma was more robust. In skulls with bilateral DZ, the maxillae were generally more laterally extended. Moreover, unilateral DZ skulls displayed differences in cortical bone thickness between two sides of the facial skeleton.

Discussion

In context, the distribution pattern within these data points toward a greater prevalence of the DZ phenotype in North and Northeast Asian regional groups, suggesting a hypothesis that the DZ trait is more frequent in populations characterized by flat and broad faces. Accordingly, further studies into the DZ condition will deepen our understanding of developments in plasticity, variation, and recent evolution of the human cranium.

Facial approximations: Characteristics of the eye in a South African sample

Although guidelines for facial approximations, including those for the eye, are in use in South Africa, limited data on African populations exist to confirm its validity. As precise placement of the eyes in facial approximations is of importance for facial recognition, this study tested established guidelines by measuring specific instrumental dimensions. Forty-nine cadavers from the Sefako Makgatho Health Sciences University and the University of Pretoria were dissected to determine the position of the canthi and the size and position of the eyeball in the orbit. Thirty cone beam computer tomography scans and 30 computer tomography scans from the Oral and Dental and Steve Biko Hospitals respectively were used to determine the size of the eyeball. Results from this study were compared to the published guidelines. The most prominent discrepancies included a more rectangular shape of the orbit, an oval shaped eyeball and a different position of the canthi. In African faces, the medial canthus was found to be located higher than the lateral canthus. The distance between the endocanthion and superior orbital margin was 17.7mm and the exocanthion and superior orbital margin 19.5mm. Inter-population differences may have an effect on facial approximations and its accuracy as is often demonstrated in practice. The findings of this study should be taken into consideration when designing population specific guidelines for reconstruction of the eye in South Africans of African ancestry.

Evolution of the Jugal/Zygomatic Bones

This issue of the Anatomical Record is the second of a two-volume set on the zygoma (also called the cheek bone, the zygomatic bone, the malar, or the jugal, the latter term being used in vertebrates other than mammals). The zygoma is an important component of the craniofacial skeleton, in which the zygoma is a connection between the midfacial and the cranial skeletons; has a functional role as the origin of one of the masticatory muscles, the masseter muscle, and several facial muscles; has been considered as an essential buttress of the facial skeleton for resisting masticatory forces; and has importance for determining phylogenetic relationships. In humans, the zygoma is also of aesthetic significance for facial appearance, and its restoration following trauma has resulted in a large clinical literature. In this second half of the special issue on the zygoma, a series of papers discuss studies related to evolution of the zygoma and related parts of the craniofacial skeleton throughout the vertebrates, and in particular in human evolution. There are also a series of articles discussing variation of the zygoma in modern humans. This article is an overview in which we discuss the primary findings of these studies and some of their implications. Anat Rec, 300:12-15, 2017. © 2016 Wiley Periodicals, Inc.