Age- and sex-related changes in the normal human external nose

Quantitative analysis of surgical landmarks of the face in fixed cadaveric heads: clinical and anatomical implications

PURPOSE

This study aimed to examine and analyze the presence of sexual dimorphism and symmetry/asymmetry in fixed cadaveric heads and their contributions to clinical practice.

METHODS

Measurements were conducted on 6 cadavers and 24 fixed cadaveric heads (n = 30) using a digital microcaliper to assess cranial dimensions, including surgical landmarks, facial index (FI), orbital index (OI), and the danger triangle of the face, offering crucial references for surgeons during surgical interventions.

RESULTS

Analyses were conducted on cadavers consisting of 10 females (33.3%) and 20 males (66.7%). Males demonstrated significantly higher values than females in terms of Zy-Zy (Zy = Zygion), nasal body, and width/length of the columella. Hyperleptoprosop types were the most frequently observed, followed by the leptoprosop type. Females exhibited megaseme characteristics according to OI on both sides. Additionally, the danger triangle of the face was greater in males compared than in females, suggesting a higher risk of infection in this region among males.

CONCLUSION

The observed sex differences in facial and nasal dimensions, along with facial indices, are crucial for customizing surgical procedures to individual patients. For example, the greater distance in the danger triangle among males highlights the importance of considering anatomical variations to avoid complications, such as septic cavernous sinus thrombosis. Integrating these measurements into preoperative planning can enhance the precision of facial reconstruction and aesthetic surgeries, thereby improving patient outcomes and safety.

CT comparison of the nasal airway anterior and posterior to the piriform aperture in patients with and without nasal obstruction

BACKGROUND

Nasal airway stenosis may lie anterior and/or posterior to the piriform aperture. We intended to compare the nasal airway anterior and posterior to the piriform aperture in patients with and without nasal obstruction.

METHODS

Segmented computed tomography cross-sectional areas of the nasal airway anterior (CT-CSAant) and posterior to the piriform aperture (at the level of the head of the inferior turbinate; CT-CSApost) were compared between patients with nasal obstruction (cases) and trauma controls. CT-CSA were approximately perpendicular to the direction of the nasal airflow. Anterior to the piriform aperture, they were tilted about 30o, 60o and 90o to the nasal floor. Posterior to the piriform aperture, they were tilted about 50o, 80o and 100o to the nasal floor. In cases, we examined the Pearson's correlation of active anterior rhinomanometry with CT-CSAant and CT-CSApost.

RESULTS

Narrow and bilateral CT-CSApost were similarly large between 56 cases and 56 controls (all p > 0.2). On the contrary, narrow and bilateral CT-CSAant were significantly smaller in cases than in controls (all p < 0.001). The ratio of the size of CT-CSAant-30 to that of CT-CSApost-80 was significantly lower in cases (median: 0.84; lower to upper quartile: 0.55-1.13) than in controls (1.0; 0.88-1.16; Mann-Whitney U test; p = 0.006). Bilateral CT-CSAant correlated significantly with total inspiratory flow (all p < 0.026) in contrast to bilateral CT-CSApost (all p > 0.056).

CONCLUSIONS

The nasal airway anterior to the piriform aperture was smaller in patients with nasal obstruction due to skeletal nasal stenosis than that in controls. On the contrary, the nasal airway posterior to the piriform aperture was similarly large between patients with and without nasal obstruction. Furthermore, in patients with nasal obstruction, the anterior nasal airway was narrower compared to that located posterior to it. On the contrary, control patients' anterior nasal airway was as large as the posterior one.

Nasal Morphology in a Young Adult Middle-Eastern Population: A Stereophotogrammetric Analysis

AIM

This study aimed to describe gender-specific three-dimensional morphology of the soft-tissue nose in Lebanese young adults and to explore the associations between nasal morphology with age and body mass index (BMI).

MATERIALS AND METHODS

Three-dimensional photographs were captured for 176 young healthy Lebanese adults (75 males and 101 females) aged 18.1-37.68 years. Linear and angular nasal measurements were computed and compared between genders, in addition to other established norms. Associations with age and BMI were also assessed.

RESULTS

All linear measurements were greater in males than in females, and only the nasolabial angle was significantly larger in females by 2.97 degrees on average. Most of the measurements were found to be larger than the Caucasian norms. A few significant correlations were found between the measurements and age or BMI.

CONCLUSION

This study is the first to present the sex-specific norms for nasal morphology in the Lebanese population and highlights the presence of gender dimorphism in the majority of measurements. Additional studies are needed to validate our data and expand the associations with age and BMI.

CLINICAL SIGNIFICANCE

The data offered in this study could help enhance the accuracy of facial reconstructive surgery and aid in personalized treatment planning for both medical and cosmetic nasal interventions. How to cite this article: Saadeh M, Shamseddine L, Fayyad-Kazan H, et al. Nasal Morphology in a Young Adult Middle-Eastern Population: A Stereophotogrammetric Analysis. J Contemp Dent Pract 2024;25(3):199-206.

Differences in Nasal Shapes and the Degree of Changes Over a Decade or More: A Paired Analysis

OBJECTIVES

This study investigated age-related differences in nasal morphometry and the degree of changes within an individual over at least a 10-year period by pairing previous and recent three-dimensional reconstructed computed tomography (CT) images.

METHODS

Forty-eight adult Korean patients who underwent at least two CT scans of the nasal region with an interval of at least 10 years were selected. Patients were categorized into six subgroups according to sex and age (20-39 years, 40-49 years, and ≥50 years) at the time of initial imaging. Eight nasal parameters were measured on the initial and recent images, and paired comparisons between the two images were performed based on the data. The differences in the degree of change by age were also analyzed.

RESULTS

Over an average image interval of 12 years, men exhibited an increase in the nasofrontal angle (3.2°±5.4°, P=0.041), profile nasal length (1.7±1.7 mm, P=0.002), and nasal bridge height (1.2±1.6 mm, P=0.002). Conversely, they showed a decrease in the nasofacial angle (-2.3°±2.9°, P=0.010). Women also demonstrated an increase in the nasofrontal angle (2.5°±5.2°, P=0.010), profile nasal length (1.4±1.9 mm, P<0.001), and nasal bridge height (1.3±1.6 mm, P<0.001). However, they exhibited a decrease in the nasofacial angle (-2.0°±2.1°, P<0.001), glabella angle (-9.1°±9.8°, P<0.001), and pyriform angle (-8.5°±10.1°, P<0.001). With the exception of the nasal bridge height (P=0.036) and pyriform angle (P=0.022), the degree of changes in most parameters did not show significant differences across age groups.

CONCLUSION

Our findings indicate that the aging nose exhibits a greater nasal length with inferior angulation of the nasal tip, with an increase in the nasofrontal angle, profile nasal length, and nasal bridge height, along with a decrease in the nasofacial angle. The degree of most nasal morphologic changes demonstrated no significant differences by specific age group.

Regression analysis of nasal shape from juvenile to adult ages for forensic facial reconstruction

The nose is a prominent feature for facial recognition and reconstruction. To investigate the relationship of the nasal shape with the piriform aperture in Korean adults and juveniles, we performed regression analysis. By regression analysis, prediction equations for nasal shape were obtained in relation to the shape of the piriform aperture considering sex and age groups. Three-dimensional skull and face models, rendered from computed tomography images, were assessed (331 males and 334 females). Juveniles (<20 years) were divided into three age groups according to the development of the dentition. Adults were divided into three age groups of two decades each, according to their age. To measure the nasal area, nine landmarks and nine measurements were chosen, while seven landmarks and five measurements were selected to measure the piriform aperture area. Four measurements were defined to explain the direct relationship between the nasal aperture and nasal shape. First, descriptive statistical analyses were performed according to sex and age groups. Subsequently, the correlation of nasal soft tissue measurements with piriform measurements was analyzed. Last, we performed a linear regression analysis of the measurements with higher correlations, considering sex and age groups as variables. Prediction equations were used to estimate the nasal bridge length, height, protrusion, and width. Equations considering sex and age groups showed better explanation ability. Measurements related to the height of the nasal bridge presented improvement. This study may assist in the more accurate approximation of nasal shape in facial reconstruction.

Mesorrhine Type of Nose among Medical Students of a Medical College

Introduction

The nose is an attraction point in our face and one of the important sense organs of our body. The knowledge of the type of nose is essential for surgeons undertaking esthetic repair and reconstruction of noses The aim of this study was to find out the prevalence of the mesorhine type of nose among medical students of a medical college.

Methods

A descriptive cross-sectional study was done among medical students of medical college after obtaining ethical approval from the Institutional Review Committee. Students of age groups 16-25 years from different religions with various castes/ethnicities were included. Those with craniofacial abnormalities, nasal deviation and a history of nasal trauma were excluded. All the nasal parameters were measured with the help of vernier's calliper and the nasal index was calculated. Convenience sampling method was used. The point estimate was calculated at a 95% Confidence Interval.

Results

Among 215 medical students, the prevalence of mesorrhine type of nose was 130 (60.46%) (53.92-67, 95% Confidence Interval).

Conclusions

The prevalence of mesorrhine type of nose among medical students was similar to other studies done in similar settings.

Keywords

medical students; nose; prevalence; sexual dimorphism.

Colour information biases facial age estimation and reduces inter-observer variability

Age estimation is a perceptual task that people perform automatically and effortlessly on a daily basis. Colour has been identified as one of the facial cues that contributes to age perception. To investigate further the role of colour in age perception, we manipulated the chromatic content of facial images holistically. In Experiment 1, images were shown in colour or grey scale; in Experiment 2, images were shown with red-green contrast increased or decreased; in Experiment 3, images were shown with modified yellow-blue contrast. We examined whether the presence of chromatic information biases the perception of age and/or affects inter-observer variability in age judgements, and whether specific chromatic information affects the perception of age. We found that the same face tended to be judged as younger with increased red-green contrast compared to decreased red-green contrast, suggesting that red-green contrast directly affects age perception. Inter-observer variability in age ratings was significantly lower when participants were asked to rate colour compared with grey scale versions of images. This finding indicates that colour carries information useful cues for age estimation.

The reliability of analytical reference lines for determining esthetically pleasing lip position: An assessment of consistency, sensitivity, and specificity

INTRODUCTION

This study aimed to identify a simple yet reliable soft-tissue parameter for the clinical determination of esthetic lip position by investigating the most consistent reference lines and assessing their sensitivity and specificity.

METHODS

A total of 5745 records from Chinese patients aged >18 years were screened. In part I of the study, lateral view photographs of 96 subjects (33 males, 63 females) with esthetic facial profiles were selected. The profile esthetics of each photograph was first scored by 52 dental students, followed by 97 laypeople on a 5-point attractiveness scale. For the top 25% of photographs with the highest score for each sex (8 males, 16 females), the consistency of 6 commonly used reference lines were assessed to determine the esthetic lip position. In part II of the study, lip positions relative to Steiner's (S) and Ricketts' (E) lines in the profile photographs of 86 patients (43 males, 43 females) deemed to have an esthetically unpleasing profile were compared with those in 86 Chinese movie star idols (43 males, 43 females).

RESULTS

In part I of the study, the S, E, and Burstone's (B) lines exhibited the lowest standard deviations for the upper and lower lips. B line was excluded from further analysis because of its higher mean absolute values, and S and E lines were used for the subjective assessment in part II of the study. In part II, the S line showed a sensitivity of 86.0% and 86.0% and a specificity of 81.4% and 83.7% for males and females, respectively. In contrast, the E line presented a sensitivity of 88.4% and 93.0% and a specificity of 79.1% and 74.4% for males and females, respectively.

CONCLUSIONS

S, E, and B lines were the most consistent soft-tissue parameters among both sexes; however, because of the smaller absolute values, the S line would be more convenient among the 3 for a quick clinical assessment of lip position. Moreover, the performance of both S and E lines was similar among both sexes, which supports using these lines in assessing the esthetic lip position.

Post-pubertal developmental trajectories of laryngeal shape and size in humans

Laryngeal morphotypes have been hypothesized related to both phonation and to laryngeal pathologies. Morphotypes have not been validated or demonstrated quantitatively and sources of shape and size variation are incompletely understood but are critical for the explanation of behavioral changes (e.g., changes of physical properties of a voice) and for therapeutic approaches to the larynx. This is the first study to take this crucial step and results are likely to have implications for surgeons and speech language pathologists. A stratified human sample was interrogated for phenotypic variation of the vocal organ. First, computed tomography image stacks were used to generate three-dimensional reconstructions of the thyroid cartilage. Then cartilage shapes were quantified using multivariate statistical analysis of high dimensional shape data from margins and surfaces of the thyroid cartilage. The effects of sex, age, body mass index (BMI) and body height on size and shape differences were analyzed. We found that sex, age, BMI and the age-sex interaction showed significant effects on the mixed sex sample. Among males, only age showed a strong effect. The thyroid cartilage increased in overall size, and the angulation between left and right lamina decreased in older males. Age, BMI and the age-height interaction were statistically significant factors within females. The angulation between left and right lamina increased in older females and was smaller in females with greater BMI. A cluster analysis confirmed the strong age effect on larynx shape in males and a complex interaction between the age, BMI and height variables in the female sample. The investigation demonstrated that age and BMI, two risk factors in a range of clinical conditions, are associated with shape and size variation of the human larynx. The effects influence shape differently in female and male larynges. The male-female shape dichotomy is partly size-dependent but predominantly size-independent.

Effects of modified step Le Fort I advancement surgery on nostril area and inferior nasal structures volume in class III patients: a retrospective clinical study

OBJECTIVE

The effect of the modified step Le Fort I osteotomy on the inferior nasal structures and the nostril area was evaluated.

MATERIALS AND METHODS

This study included 24 patients who had modified step Le Fort I osteotomy. Inferior nasal concha volume (INCV), meatus nasi inferior volume (MNIV), the sum of both structures volume (TV), and nostril area (NA) were evaluated in pre- (T0) and postoperative (T1) periods.

RESULTS

For all patients, NA increased both on the right side (p = 0.011) and left side (p = 0.050) after surgery. The INCV and TV values were lower in T1 than those in T0; however, a statistically significant decrease of INCV and TV was found only in the right side of males (p = 0.039 and p = 0.050, respectively). No significant difference was found in MNIV between T0 and T1 measurements (p > 0.05).

CONCLUSION

Maxillary advancement with the modified step Le Fort I osteotomy technique increased the NA, which may have a positive effect on breathing function. On the other hand, although TV tended to decrease, MNIV did not change after surgery as the same decreasing tendency also existed in INCV.

CLINICAL RELEVANCE

Step Le Fort I advancement surgery technique usually affects nasal structures positively regarding the nasal airway.

Evaluatıon of Master’s Thesıs Topıcs of The Faculty of Medıcıne, Department of Anatomy

Amaç: Dünyada ve ülkemizde lisansüstü eğitimin tamamlanmasında tez yazımı zorunlu bir durumdur. Tez yazımı aynı zamanda kişiye bilimsel araştırma basamağı olarak büyük bir fırsat sunmaktadır. Çalışmamızda Türkiye’deki tıp fakültesi anatomi anabilim dallarında yapılan yüksek lisans tezlerinin çalışma konularının zaman içerisindeki değişimlerinin tespit edilmesi amaçlanmıştır. Gereç ve Yöntemler: Veriler Yükseköğretim Kurulu Ulusal Tez Merkezi’ne kayıtlı, 1988-2021 yılları arasında yayınlanmış 557 tezin incelenmesiyle retrospektif olarak elde edilmiştir. Çalışmaya dahil edilen tezlerde yazarın cinsiyeti, tezin yayınlandığı yıl, tez danışmanın akademik unvanı ve tezin çalışıldığı araştırma konusu incelenmiştir. Bulgular: Çalışmamızda 557 yüksek lisans tezi incelenmiş olup bu tezlerin %4,8’i 2000 yılı ve öncesi, %17,8’i 2001-2010 yılları arasında, %77,4’ü 2011-2021 yılları arasında yayınlandığı belirlenmiştir. Tezlerde çalışılan konuların %39,3’ü radyolojik çalışma, %20,3’ü antropometrik çalışma, %19,4’ü kadavra çalışması, %14,9’u hayvan deneyi modelleri, %2,7’si klinik çalışma, %1,8’i anket çalışması, %0,9’u radyolojik-antropometrik çalışma, %0,4’ü hücresel çalışma, %0,2’si anatomi tarihçesi ve %0,2’si anatomi terminolojisi olduğu tespit edilmiştir. 2010 yılı ve öncesi en çok kadavra çalışmaları tercih edilirken 2011 yılı ve sonrası radyolojik çalışmaların daha çok yapıldığı gözlenmiştir (p=0,001). Sonuç: Teknolojinin gelişimine paralel olarak birçok bilim dalı da kendi içerisinde gelişmekte ve güncel çalışmalara fırsat oluşturmaktadır. Anatomi Anabilim Dalı da teknolojik gelişimlere uyum sağlamış ve çalışmamızın bir sonucu olarak tez konularının kadavra çalışmalarından radyolojik çalışmalara evrilmesi bu durumu kanıtlar niteliktedir. Bununla birlikte deneysel hayvan modelleri ve hücresel araştırmaların da oldukça artmış olduğu görülmüştür. Anatomik oluşumların hastalıklar ile ilişkilendirilerek gelişmesi morfoloji bilimine de oldukça katkı sağlamıştır.

The development and testing of Thai facial soft tissue thickness data in three-dimensional computerized forensic facial reconstruction

Forensic facial reconstruction is a useful tool to assist the public in recognizing human remains, leading to positive forensic investigation outcomes. To reproduce a virtual face, facial soft tissue thickness is one of the major guidelines to reach the accuracy and reliability for three-dimensional computerized facial reconstruction, a method that is making a significant contribution to improving forensic investigation and identification. This study aimed to develop a facial soft tissue thickness dataset for a Thai population, and test its reliability in the context of facial reconstruction. Three-dimensional facial reconstruction was conducted on four skulls (2 males and 2 females, with ages ranging between 51 to 60 years). Two main tools of three-dimensional computer animation and modeling software-Blender and Autodesk Maya-were used to rebuild the three-dimensional virtual face. The three-dimensional coordinate (x, y, z) cutaneous landmarks on the mesh templates were aligned homologous to the facial soft tissue thickness markers on the three-dimensional skull model. The final three-dimensional virtual face was compared to the target frontal photograph using face pool comparison. Four three-dimensional virtual faces were matched at low to moderate levels, ranging from 30% to 70% accuracy. These results demonstrate that the facial soft tissue thickness database of a Thai population applied in this study could be useful for three-dimensional computerized facial reconstruction purposes.

The nose as a feature of forensic practice

The nose is a prominent facial structure which is too often overlooked by forensic medicine practitioners. Studies that consider the role of the nose in forensic practice are scattered throughout scientific literature. We provide a brief review of these.

Diagnostic Features for Human Categorisation of Adult and Child Faces

Knowing how humans differentiate children from adults has useful implications in many areas of both forensic and cognitive psychology. Yet, how we extract age from faces has been surprisingly underexplored in both disciplines. Here, we used a novel data-driven experimental technique to objectively measure the facial features human observers use to categorise child and adult faces. Relying on more than 35,000 trials, we used a reverse correlation technique that enabled us to reveal how specific features which are known to be important in face-perception - position, spatial-frequency (SF), and orientation - are associated with accurate child and adult discrimination. This showed that human observers relied on evidence in the nasal bone and eyebrow area for accurate adult categorisation, while they relied on the eye and jawline area to accurately categorise child faces. For orientation structure, only facial information of vertical orientation was linked to face-adult categorisation, while features of horizontal and, to a lesser extent oblique orientations, were more diagnostic of a child face. Finally, we found that SF diagnosticity showed a U-shaped pattern for face-age categorisation, with information in low and high SFs being diagnostic of child faces, and mid SFs being diagnostic of adult faces. Through this first characterisation of the facial features of face-age categorisation, we show that important information found in psychophysical studies of face-perception in general (i.e., the eye area, horizontals, and mid-level SFs) is crucial to the practical context of face-age categorisation, and present data-driven procedures through which face-age classification training could be implemented for real-world challenges.

Quantitative Microbial Risk Assessment of Antimicrobial Resistant and Susceptible Staphylococcus aureus in Reclaimed Wastewaters

The annual risks of colonization, skin infection, bloodstream infection (BSI), and disease burden from exposures to antibiotic-resistant and susceptible Staphylococcus aureus (S. aureus) were estimated using quantitative microbial risk assessment (QMRA). We estimated the probability of nasal colonization after immersion in wastewater (WW) or greywater (GW) treated across a range of treatment alternatives and subsequent infection. Horizontal gene transfer was incorporated into the treatment model but had little effect on the predicted risk. The cumulative annual probability of infection (resulting from self-inoculation) was most sensitive to the treatment log₁₀ reduction value (LRV), S. aureus concentration, and the newly calculated morbidity ratios and was below the health benchmark of 10^-4 infections per person per year (ppy) given a treatment LRV of roughly 3.0. The predicted annual disability-adjusted life years (DALYs), which were dominated by BSI, were below the health benchmark of 10^-6 DALYs ppy for resistant and susceptible S. aureus, given LRVs of 4.5 and 3.5, respectively. Thus, the estimated infection risks and disease burdens resulting from nasal colonization are below the relevant health benchmarks for risk-based, nonpotable, or potable reuse systems but possibly above for immersion in minimally treated GW or WW. Strain-specific data to characterize dose-response and concentration in WW are needed to substantiate the QMRA.

External Nose Anthropometry of Healthy Turkish Young Adults

ABSTRACT

Although many studies in the literature examine distances and angles about the nose, there are no clear standard values for different races and ethnic groups. The aim of this study is to determine the anthropometric measurement standards related to the external nose in Turkish young adults between the ages of 18 and 25. The subjects participating in this study were 100 female and 100 male volunteers. Six landmarks (nasion, subnasale, pronasale, alar, subalar and maxillofrontale) on the nose were chosen, and these landmarks were identified on the photographs. Then, using these landmarks, a total of seven distances (nose height, dorsum of nose length, distance between the subnasale and pronasale, nose width, right nostril floor width, left nostril floor width and root of nose width) and four angles (nasofrontal, nasofacial, nasomental and nasolabial angles) measurements were made. There were statistically significant differences between gender in nine parameters. One parameter (nasofrontal angle) is higher in females, and seven parameters (nose height, dorsum of nose length, nose width, right nostril floor width, left nostril floor width, root of nose width and nasofacial angle) are higher in males. It is accepted that distances and angles about the nose differ according to race and ethnicity. The authors believe that the results obtained in this study will help determine the standard values that can be used for the Turkish population between the ages of 18 and 25.

Nasal changes in different age groups

Objective

The objective of this study was to evaluate nasal changes in different age groups and to detect gender difference in nasal dimensions.

Materials and Methods

Clinical measurement and profile photographic records of 279 randomly selected subjects were obtained for the evaluation of nasal changes. Thirty-nine subjects were excluded, and the final sample consisted of 240 subjects. The subjects were divided into four groups by age: Group 1 (16-20 years), Group 2 (21-30 years), Group 3 (31-40 years), and Group 4 (41-50 years). Each group was further subdivided on the basis of gender. Data were collected and analyzed by two-way multivariate analysis of variance with Duncan's multiple range post hoc test.

Results

In both males and females, nasal height and breadth increased with except nasal index and nasolabial angle. More nasal changes were seen in males as compared to females of the same age group.

Conclusions

Nonconsistent age-related changes were found for nasal index and nasolabial angle. The rest of the nasal parameters increased with age and differ between the genders. Larger nasal changes were seen in males as compared to females of the same age group.

Photographic Nasal Soft Tissue Analysis From Preadolescence to Young Adulthood: Anthropometric Measurements

ABSTRACT

The nose has a tremendous effect on facial esthetics and overall facial harmony, accordingly it contributes to the physical appearance of individuals. The aim of this study is to establish sex-related nasal soft tissue norms for preadolescents, adolescents, and young adults in Anatolian population. A total of 300 volunteers (150 males and 150 females) with ages varying from 10 to 24 years were divided into 6 subgroups according to gender and educational status. The anthropometric measurements of the nose in preadolescent, adolescent, and young adult males and females were performed on digital photographs. A total of 16 nasal parameters, 13 linear and 3 angular measurements, were analyzed for sex-related variations. A significant sexual dimorphism was observed for nasofrontal and nasolabial angles in adolescent and young adult groups (P < 0.001, P = 0.011, and P = 0.007, respectively). All linear measurements of the nose were larger in males as compared to females, except for left alar thickness, which were similar between males and females in young adult group. Of the 16 nasal measurements, 13 were found to be sexually dimorphic in certain age groups (P < 0.05). In Anatolian population, the nasal shape and dimensions displayed significant sexual dimorphism in preadolescents, adolescents, and young adults. The average values of nasal soft tissue in this population could serve as a database for the planning of cosmetic and reconstructive rhinoplasty in the pediatric and adult population and obtaining the desired outcomes.

Lip Anthropometry of Healthy Turkish Young Adults

ABSTRACT

The lips play an important role in evaluating and recognizing the craniofacial complex and our perception of facial beauty and attractiveness. The aim of this study was to evaluate the anthropometric measurements of the lips of Turkish young adults and to look for sexual dimorphism. Anterior view photographs were taken of 100 females and 100 males who volunteered to participate in the study. Seven landmarks were determined, stomion (st), sublabiale (sl), subnasale (sn), labiale superius (ls), labiale inferius (li), crista philtre (cp), and chelion (ch). Then, using these landmarks, lower lip height (st-sl), upper lip height (sn-st), philtrum length (sn-ls), upper vermilion height (ls-st), lower vermilion height (li-st), cutaneous lower lip height (li-sl), philtrum width (cp-cp), and mouth width (ch-ch) were measured. It was observed that there was a statistical difference between genders in the parameters of st-sl, sn-st, sn-ls, li-sl, and ch-ch (P = 0.001, for these parameters). Besides, using these distances, 6 anthropometric ratios (ls-st/li-st, sn-ls/ls-st, li-sl/li-st, sn-st/st-sl, cp-cp/ch-ch, and ls-li/ch-ch) were calculated. Among the ratios investigated, sn-ls/ls-st, li-sl/li-st, and cp-cp/ch-ch were statistically significantly larger in males compared females (P = 0.012, P = 0.002, and P = 0.001, respectively). We believe that the results obtained in this study regarding lip anthropometry will help determine the standard values that can be used for the Turkish population aged 18 to 25.

Influence of skeletal class and facial type on nose dimensions in a Brazilian subpopulation: a CBCT study

Evaluating factors that may influence the nose dimensions and, therefore, contribute to the singularity of a person, is important for obtaining a precise facial reconstruction (FR) in forensic anthropology. Thus, the aim in this study was to evaluate the influence of sex, skeletal class, and facial type on nose dimensions of Brazilian individuals using cone-beam computed tomography (CBCT) scans. CBCT images of 54 males and 67 females were classified according to skeletal class (class I, II, or III) and facial type (brachycephalic, dolichocephalic and mesocephalic). Linear and angular measurements of the nose were performed using the CS 3D Imaging software. The measurements obtained for males and females were compared by one-way ANOVA. Two-way ANOVA was used to compare the measurements in the different skeletal classes and facial types. Significance level was set at 5%. All linear measurements were greater in males (p < 0.05); the angular measurements, however, did not differ between sexes (p > 0.05). Linear and angular measurements of class III males were significantly different from the other classes; the same was observed for the angular measurements in females (p < 0.05). Regarding facial types, some linear measurements were significantly greater in dolichocephalics males (p < 0.05). For females, there was no influence of facial type (p > 0.05), except for the nasal convexity angle. Nose dimensions differed in specific points among different skeletal classes and facial types, and there was sexual dimorphism in all linear nose dimensions. This information may be applicable for nose reconstructions, allowing more reliable FR.

Preoperative analysis of upper lip in patients with upper cleft lip/palate before lip repair

Background

The postoperative morphological appearances vary widely patients with unilateral cleft lip with or without cleft palate (UCL/P), whether it is complete or incomplete cleft. The main reason of bilateral lip asymmetry after cleft lip surgery lies in the lack of personalized measurement and design before surgery. In this study, we aim to individually investigate areas of the upper lip on cleft and non-cleft sides in patients with unilateral cleft lip with or without cleft palate (UCL/P).

Methods

Ninety-two patients with UCL/P (group 1: <1 year, group 2: 1–2 years) were included in the study. Group 1 included 37 patients with incomplete UCL/P and 29 with complete UCL/P; group 2 included 11 and 15 patients, respectively. The total area of the upper lip on the cleft side (Q8) was divided into Q3, Q4, and Q5 (further divided into a1 and a2), and the upper lip on the non-cleft side (Q7) was divided into Q2 and Q1 (further divided into A1 and A2). Area ratios between the cleft and the non-cleft sides were calculated, and certain parameters were tested for correlations with these ratios.

Results

Values of Q8/Q7 were partially overlapped between patients with complete and incomplete UCL/P. Significant correlations were noted between differences in height of the philtrum column (a–h) and the prolabial area ratio between the cleft and the non-cleft side (Q3/Q2) (P=0.032). Moreover, a significant correlation was noted between a1/A1 and the ratio of the lateral labial area between the cleft and the non-cleft side (Q5/Q1) (P=0.001).

Conclusions

The conventional classification of unilateral cleft lip as incomplete and complete does not completely and accurately reflect individual malformations. Therefore, it is necessary to analyze unilateral cleft lips individually to determine the repair technique and to predict postoperative outcomes.

3D Facial morphology in children affected by spinal muscular atrophy type 2 (SMAII)

OBJECTIVES

The main objective of this study was to assess the three-dimensional facial characteristics of children affected by spinal muscular atrophy (SMA), a severe muscular disorder characterized by hypotonia, areflexia, weakness, and respiratory impairment.

MATERIALS/METHODS

Stereophotogrammetric facial scans from 22 SMA type II patients aged 2-7 years were obtained. Data were analysed using both inter-landmark distances and principal component analysis and compared with data collected from matched control subjects.

RESULTS

Patients had wider transverse facial diameters, but smaller biocular width. Middle and lower anterior face heights were increased, whereas the mandibular ramus was shorter, with a reduced posterior-to-anterior face height ratio. Facial width-to-length ratio was reduced. In the sagittal plane, mandibular body length, and facial divergence were increased, whereas the gonial angles were decreased. In the horizontal plane, lower facial convexity was greater in patients, whereas mandibular convexity was smaller. Patients had smaller and down-slanted eye fissures, with a larger and more vertically developed nose.

LIMITATIONS

This study assessed a relatively small number of patients, due to the rare frequency of SMA type II.

CONCLUSIONS/IMPLICATIONS

SMA type II children possess peculiar facial alterations that may be due to the altered muscular activity. As feeding problems may derive also by malocclusion and masticatory muscular alterations, a detailed assessment of the craniofacial individual alterations should be considered in the standards of care of these patients.

Facial reconstruction: Validation of the Tedeschi-Oliveira method for estimating the pronasale point in Brazilians

Forensic facial reconstruction aids in the process of human identification by facial recognition. The nose plays an important role in this process; however, its soft tissues wither away during cadaveric decomposition. There are few studies in the area of facial recognition of the Brazilian population, especially concerning Brazilian nasal prediction guides. This study aimed to test the hypothesis that the angle formed by the tangents drawn from the rhinion and prosthion points (nose tip) is equal to 90º, as proposed by the pioneer study by Tedeschi-Oliveira et al. (2016). It is important to highlight that this is the only method to date developed to predict the nasal tip in Brazilians, and has not yet been tested in other populations. Images of computed tomography scans of 228 individuals (171 females and 57 males) were screened according to the same criteria used by the authors of the primary study. The images were analyzed using the Horos® program, version 1.1.7 - 64 bit. The mean angle studied was about 90º, and any difference between this mean and the real angle measured did not significantly compromise the accuracy of the nose tip location. The findings tested in the present study corroborate the hypothesis investigated by Tedeschi-Oliveira et. al. Therefore, we suggest that the method be used in forensic practice to estimate nose tips in Brazilians.

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.

Three-dimensional evaluation of important surgical landmarks of the face during aging

BACKGROUND

One surgical objective is creating an aesthetically satisfying outcome. The morbidity increases with age. Standard values for areas of the face, which are frequently surgically treated, are needed for the surgeon.

METHODS

240 Caucasians aged 21-65 were divided into six subgroups by gender and age. They were scanned by a three-dimensional (3D) scanner. Distances and angles in faces between landmarks were evaluated.

RESULTS

During aging, the relation of the eye's width to the eye's height became significantly smaller (M: p=0.001, F: p≤0.0001). The outer contour of the nose became significantly sharper with increasing age (M: p=0.001, F: p=0.0021). Seen from caudal, the nose formed an isosceles triangle with the base between the left and right alar curvature and the base had an average length of 31.35mm±2.97mm. The leg of this triangle had an average length of 33.67mm±2.09mm. The nose got longer and wider during aging; the age-dependent changes between the different groups of males (p≤0.0001) and the difference between females and males were significant (p≤0.0001). The thickness of the nasal wings remained the same size during a lifetime. Females had significantly greater heights for both lips (p≤0.0001, p=0.027). In males and females, the heights decreased with increasing age.

CONCLUSION

This study provided a database of measurements of parts of the face, especially those parts that can underlie various surgical treatments.

Prediction of nasal morphology in facial reconstruction: Validation and recalibration of the Rynn method

BACKGROUND

Prediction of the nose from the skull remains an important issue in forensic facial approximation. In 2010, Rynn et al. published a method of predicting nose projection from the skull. With this method, three craniometric measurements (x, y, z) are taken, and these are then used in regression formulae to estimate the nasal dimensions.

AIM

The purpose of this study was to examine and test the accuracy of the Rynn et al. method and if necessary to adapt the formulae for this population.

SUBJECTS AND METHODS

A sample of 90 CT scans of Turkish adults was used in the study. The actual and predicted dimensions were compared using t-test. The age of the individuals ranged from 20 to 40 years by sex.

RESULTS

The descriptive statistics and correlations were calculated, and the actual and predicted measurements were compared. The differences between the actual and predicted values were statistically significant (p < 0.01), with -1 mm for males and -1.5 mm for females. Validation accuracies ranged from 76 to 92% in females and 72 to 82% in males. Recalibration equation accuracies ranged from 88 to 100% in females and 90 to 100% in males.

CONCLUSION

The results showed that the recalibration of the Rynn et al. method and its formulae gave satisfactory results with less error and can be employed in facial approximation cases.

Correlation Between Soft Tissue Injury and the Type of Nasal Fracture Based on Stranc-Robertson Classification

Nasal fractures are the most common facial bone fractures, and soft tissue injuries are frequently accompanied. This study intends to make a deep analysis on the relationship between the 2.Patients diagnosed with nasal fracture between 2015 and 2017 were included. Patients younger than 17 years and those with previous facial fractures or aesthetic surgeries were excluded. Nasal fractures were classified according to the Stranc-Robertson (S-R) classification, and the severity of soft tissue injury was evaluated by length and depth. The authors compared the frequency of soft tissue injury between frontal and lateral groups. Second, the authors investigated whether the incidence of soft tissue injuries increases as a function of the increase in the S-R classification both in frontal and lateral group (from plane I to III). The authors also analyzed the difference in severity of soft tissue injuries in each group. Pearson chi-square analysis, linear by linear and Jonckheere-Terpstra tests were used for statistical analysis.Of 621 patients, 296 were frontal plane and 325 were lateral plane. The frontal group had a higher incidence of soft tissue injury than the lateral group (P = 0.004). The incidence of soft tissue injury and severity by depth increased as a function of the increase in the S-R classification only in the frontal group (P = 0.046, 0.019).In nasal fractures, frontal impact is more associated with frequency and severity of soft tissue injury than lateral impact. This seems to be related to the anatomical characteristics of nasal area and mechanism of injuries in each group.

Long-Term Nasal Growth after Primary Rhinoplasty for Bilateral Cleft Lip Nose Deformity: A Three-Dimensional Photogrammetric Study with Comparative Analysis

Nasal deformity is associated with congenital cleft lip and palate. Primary rhinoplasty for reconstruction of the nasal deformity at the time of bilateral cleft lip repair is a controversial issue in cleft care due to traditional teaching concerning the potential impairment of nasal growth. This study assessed long-term nasal growth in patients with bilateral cleft lip and palate who underwent primary rhinoplasty by a single surgeon between 1995 and 2002 and reached skeletal maturity (n = 39; mean: 19 ± 2 years). Normal age-, gender-, and ethnicity-matched subjects (n = 52) were enrolled for comparative analyses. Three-dimensional nasal photogrammetric measurements (10 linear, 4 angular, 6 proportional, 1 surface area, and 1 volume parameter) were collected from patients with bilateral cleft lip and palate and normal subjects. Patients who underwent rhinoplasty presented with significantly (all p < 0.05) smaller nasal tip projection and nasal tip angles, but greater values for nasal dorsum length, nasal protrusion, alar width, columellar height, dome height, columellar angle, labiocolumellar angle, nasal tip height ratio, nasal index, alar width/intercanthal distance ratio, and alar width/mouth width ratio compared to normal subjects. There were no differences (all p > 0.05) in nasal height, tip/midline deviation, nasal dorsum angle, dome-to-columella ratio, columella height/alar width ratio, area surface, and volume parameters between the two groups. This study shows that primary rhinoplasty performed in patients with bilateral cleft lip and palate during infancy does not result in deficiency of the nasal dimensions relative to controls.

Variability of facial movements in relation to sexual dimorphism and age: three-dimensional geometric morphometric study

The aim of this study was to introduce suitable imaging technique and analytical methods for a detailed description of the facial movements in relation to sexual dimorphism and age in adult individuals. Removing of size factor from the analysis, we hypothesised that there will be no significant intersexual difference in facial mobility. We assume facial movements to be more pronounced in the older age category due to increasing the facial surface. We have compared five facial movements - raising eyebrows, closing eyes, pursing of the lips, inflating of the cheeks and smile - in relation to neutral expression of the human face. The material sample comprised three-dimensional facial surface models of healthy adult individuals of the Czech nationality (63 females, 58 males). Methods of geometric morphometry and multivariate statistics were used. Local tissue motion due to facial movements was expressed using colour-coded maps. The movement showing significant intersexual difference was inflating of the cheeks. Ageing in both sexes has significantly influenced the facial mobility on average after 50 years of age. Changes related to senescence have occurred in eye closing, smile and inflating of the cheeks. An enlarged facial surface has been noted in the group of individuals belonging to the older age category, what is probably the result of increased manifestation of skin folds and wrinkles. This is related to the loss of skin elasticity and overall weakening of the underlying muscles, especially in the infraorbital and cheeks area.

Variation and Likeness in Ambient Artistic Portraiture

An artist-led exploration of portrait accuracy and likeness involved 12 Artists producing 12 portraits referencing a life-size 3D print of the same Sitter. The works were assessed during a public exhibition, and the resulting likeness assessments were compared to portrait accuracy as measured using geometric morphometrics (statistical shape analysis). Our results are that, independently of the assessors' prior familiarity with the Sitter's face, the likeness judgements tended to be higher for less morphologically accurate portraits. The two highest rated were the portrait that most exaggerated the Sitter's distinctive features, and a portrait that was a more accurate (but not the most accurate) depiction. In keeping with research showing photograph likeness assessments involve recognition, we found familiar assessors rated the two highest ranked portraits even higher than those with some or no familiarity. In contrast, those lacking prior familiarity with the Sitter's face showed greater favour for the portrait with the highest morphological accuracy, and therefore most likely engaged in face-matching with the exhibited 3D print. Furthermore, our research indicates that abstraction in portraiture may not enhance likeness, and we found that when our 12 highly diverse portraits were statistically averaged, this resulted in a portrait that is more morphologically accurate than any of the individual artworks comprising the average.

The Relationship Between Hard Tissue and Soft Tissue Dimensions of the Nose in Children: A 3D Cone Beam Computed Tomography Study

This study using three-dimensional cone beam computed tomography (CBCT) images of children determined relationships between nasal skeletal and soft tissue measurements and assessed the association with sex, age, and skeletal maturation stage. Following reliability studies, skeletal and soft tissue parameters were measured on coded CBCTs of 73 children (28M:45F;6-13 yoa). Pearson and Mantel correlations were used to analyze associations between skeletal and soft tissues. Partial Mantel correlations were used to study the associations between skeletal and soft tissue, adjusting for sex, age, and skeletal maturation. Linear regression analyses were used to predict soft tissues sizes. Logistic regression was used to study the relationships between soft and skeletal tissue symmetry. Except for nasal aperture width and interalar width, skeletal landmarks best predicted corresponding soft tissue landmarks. Significant positive associations existed between skeletal and soft tissues after adjusting for sex, skeletal maturation, and age. Children's nasal skeletal tissues predicted nasal soft tissue reasonably well.

A longitudinal study of facial growth of Southern Chinese in Hong Kong: Comprehensive photogrammetric analyses

Introduction

Existing studies on facial growth were mostly cross-sectional in nature and only a limited number of facial measurements were investigated. The purposes of this study were to longitudinally investigate facial growth of Chinese in Hong Kong from 12 through 15 to 18 years of age and to compare the magnitude of growth changes between genders.

Methods and findings

Standardized frontal and lateral facial photographs were taken from 266 (149 females and 117 males) and 265 (145 females and 120 males) participants, respectively, at all three age levels. Linear and angular measurements, profile inclinations, and proportion indices were recorded. Statistical analyses were performed to investigate growth changes of facial features. Comparisons were made between genders in terms of the magnitude of growth changes from ages 12 to 15, 15 to 18, and 12 to 18 years. For the overall face, all linear measurements increased significantly (p < 0.05) except for height of the lower profile in females (p = 0.069) and width of the face in males (p = 0.648). In both genders, the increase in height of eye fissure was around 10% (p < 0.001). There was significant decrease in nasofrontal angle (p < 0.001) and increase in nasofacial angle (p < 0.001) in both genders and these changes were larger in males. Vermilion-total upper lip height index remained stable in females (p = 0.770) but increased in males (p = 0.020). Nasofrontal angle (effect size: 0.55) and lower vermilion contour index (effect size: 0.59) demonstrated large magnitude of gender difference in the amount of growth changes from 12 to 18 years.

Conclusions

Growth changes of facial features and gender differences in the magnitude of facial growth were determined. The findings may benefit different clinical specialties and other nonclinical fields where facial growth are of interest.

Using the 3D Facial Norms Database to investigate craniofacial sexual dimorphism in healthy children, adolescents, and adults

Background

Although craniofacial sex differences have been extensively studied in humans, relatively little is known about when various dimorphic features manifest during postnatal life. Using cross-sectional data derived from the 3D Facial Norms data repository, we tested for sexual dimorphism of craniofacial soft-tissue morphology at different ages.

Methods

One thousand five hundred fifty-five individuals, pre-screened for craniofacial conditions, between 3 and 25 years of age were placed in to one of six age-defined categories: early childhood, late childhood, puberty, adolescence, young adult, and adult. At each age group, sex differences were tested by ANCOVA for 29 traditional soft-tissue anthropometric measurements collected from 3D facial scans. Additionally, sex differences in shape were tested using a geometric morphometric analysis of 24 3D facial landmarks.

Results

Significant (p < 0.05) sex differences were observed in every age group for measurements covering multiple aspects of the craniofacial complex. The magnitude of the dimorphism generally increased with age, with large spikes in the nasal, cranial, and facial measurements observed after puberty. Significant facial shape differences (p < 0.05) were also seen at each age, with some dimorphic features already present in young children (eye fissure inclination) and others emerging only after puberty (mandibular position).

Conclusions

Several craniofacial soft-tissue sex differences were already present in the youngest age group studied, indicating that these differences emerged prior to 3 years of age. The results paint a complex and heterogeneous picture, with different groups of traits exhibiting distinct patterns of dimorphism during ontogeny. The definitive adult male and female facial shape was present following puberty, but arose from numerous distinct changes taking place at earlier stages.

Electronic supplementary material

The online version of this article (doi:10.1186/s13293-016-0076-8) contains supplementary material, which is available to authorized users.

Age-related and sex-related changes in the normal soft tissue profile of native Northern Sudanese subjects: a cross-sectional study

Information about age-related and sex-related normative measurements of the nasolabial region in native Northern Sudanese subjects is scanty. We have therefore used a hand-held laser scanner to measure nasolabial angles and distances, and collected the 3-dimensional coordinates of seven landmarks on the facial soft tissues from 654 healthy native Northern Sudanese subjects (327 male and 327 female, aged 4-30 years). From these we calculated five angles and two linear distances and took the mean (SD) for age and sex, and compared them using factorial analysis of variance. All measurements analysed were significantly modified by age in both sexes (p < 0.01) except for the distance from the lower lip to Ricketts' E-line. Sex had a significant effect on the mentolabial and maxillary prominence angles and both distances (p < 0.005). Nasal convexity and the interlabial angle became more obtuse with growth, while the nasolabial and mentolabial angles reduced progressively with female subjects having significantly more obtuse mentolabial angles (p < 0.001). The maxillary prominence angle progressively decreased during childhood, and increased after adolescence, with larger values in male subjects. The upper and lower lip distances from Ricketts' E-line were also significantly larger in male subjects (p < 0.003), but the difference reduced with age. Overall, there were several differences when we compared our data with published data for African and white subjects, which points to the need for ethnic-specific data. Measurements collected in the current study could be used for the quantitative description of facial morphology in native Northern Sudanese children, adolescents, and young adults.

Sexual dimorphism of facial appearance in ageing human adults: A cross-sectional study

In the forensic sciences, knowledge of facial ageing is very important in searching for both dead and living individuals. Ageing estimations typically model the biological profile, which can be compared to missing persons. The main goals of this current study were to construct ageing trajectories for adult human faces of both sexes and evaluate sexual dimorphism in relation to static allometry. Our study was based on the analysis of three-dimensional facial surface models of 194 individuals 20-80 years of age. The evaluation consisted of a dense correspondence analysis of facial scans and multivariate statistics. It was shown that both age and sex have a significant influence on facial form and shape. Male features included a longer face, with more protruded foreheads, eyebrow ridges and nose, including the region under the upper lip and mandible region, but more retruded cheeks compared to females. Ageing in both sexes shared common traits, such as more pronounced roundness of the face (rectangular in males), decreased facial convexity, increased visibility of skin folds and wrinkles connected with the loss of skin elasticity, and soft tissue stretching, especially in the orbital area and lower face; however, male faces exhibited more intense ageing changes. The above-mentioned sexual dimorphic traits tended to diminish in the elderly age category, though overall sexual dimorphism was heightened with age. The static allometric relationships between size and form or shape were similar in both sexes, except that the larger faces of elderly males displayed more intensive ageing changes.

Diseases of the nose and paranasal sinuses in child

Diseases of the pediatric nose and nasal sinuses as well as neighboring anatomical structures encompass a variety of pathologies, especially of inflammatory nature. Congenital disease, such as malformations and structural deviations of the nasal septum, as well as systemic metabolic pathologies affecting the nose and sinuses, rarely require medical therapy from an Otolaryngologist. The immunological function of the mucosa and genetic factors play a role in the development of disease in the pediatric upper airway tract, especially due to the constantly changing anatomy in this growth phase. Disease description of the nose and nasal sinuses due to mid-facial growth must also take developmental age differences (infant, toddler, preschool, and school age) into account. Epidemiological examinations and evidence based studies are often lacking in the pediatric population. The wide range of inflammatory diseases of the nose and paranasal sinuses, such as the acute and chronic rhinosinusitis, the allergic rhinitis, and adenoid disease, play a role in the susceptibility of a child to infection. The susceptibility to infection depends on the pediatric age structure (infant, young child) and has yet to be well defined. The acute rhinosinusitis in children develops after a viral infection of the upper airways, also referred to as the "common cold" in the literature. It usually spontaneously heals within ten days without any medical therapy. Antibiotic therapy is prudent in complicated episodes of ARS. The antibiotic therapy is reserved for children with complications or associated disease, such as bronchial asthma and/or chronic bronchitis. A chronic rhinosinusitis is defined as the inflammatory change in the nasal mucosa and nasal sinus mucosa, in which the corresponding symptoms persist for over 12 weeks. The indication for CT-imaging of the nasal sinuses is reserved for cases of chronic rhinosinusitis that have been successfully treated with medication. A staged therapeutic concept is followed in CRS based on conservative and surgical methods. Nasal sinus surgery is considered nowadays as effective and safe in children. Based on the assumption that adenoids are a reservoir for bacteria, from which recurrent infections of the nose and nasal sinus originate, the adenoidectomy is still defined as a cleansing procedure in rhinosinusitis. 69.3% of the children had benefit from adenoidectomy. Comorbidities, such as pediatric bronchial asthma, presently play an even more important role in the therapy of rhinosinusitis; therefore, it is often wise to have the support of pediatricians. In western European countries 40% of children presently suffer from allergic rhinitis, in which pronounced nasal obstruction can cause disturbed growth in facial bones. An early therapy with SIT may prevent the development of bronchial asthma and secondary sensitization to other allergens. Therefore, SIT is recommended in treatment of allergic rhinitis whenever, if possible. The assessment of diagnostic tools is for the examiner not often possible due to the lack of evidence. Rhinosurgical approaches are often described in study reports; however, they lack the standard prospective randomized long-term study design required nowadays and can only be evaluated with caution in the literature.

Three-dimensional facial distances of Northern Sudanese persons from childhood to young adulthood

No current age- and gender-related normative data exist for the dimensions of facial structures in Northern Sudanese subjects. In the current study information about normal sex- and age-related linear distances is provided. The three-dimensional coordinates of 14 landmarks on the facial soft tissues were obtained using a hand-held laser scanner in 653 healthy Northern Sudanese subjects (326 males and 327 females) aged 4-30 years. From the landmarks, 13 linear distances were calculated, and averaged for age and sex. Comparisons were performed by factorial analysis of variance. All analyzed linear soft tissue facial dimensions were significantly larger in men than in women (p < 0.01), except mouth width (ch-ch), upper facial height (n-sn), mandibular body length (pg-go) and width (go-go). All measurements underwent significant modifications as a function of age (p < 0.01), with significant age × sex interactions (p < 0.01) for all linear dimensions except lower face height (sn-pg). Overall, when compared to literature data for African and Caucasoid subjects, several differences were found, pointing to the necessity of ethnic-specific data. Data collected in the present investigation could serve as a database for the quantitative description of human facial morphology during normal growth and development.

External nasal parameters in Egyptians: an in-depth nasal photogrammatic analysis

PURPOSE

As ethnic influences can result in different appearances of the nose, the purpose of this study was to provide a set of standard values of the external form of the nose with special emphasis on the influence of age and sex on these values to establish norms for the Egyptians.

METHODS

Several soft-tissue landmarks on the external nose were obtained by a non-invasive, photogrammetric analysis in 1,000 healthy Egyptians aged 20-70 years. From these landmarks, ten linear distances and six nasal angles were measured and six nasal indices were calculated.

RESULTS

A significant sexual dimorphism was found for nasal external volume and area and most linear distances where males presented with higher values than those in females of the corresponding age except for alar length where females showed higher values. Moreover, age significantly influenced nasal volume, area and distances as they showed statistically significant increase till old age. Concerning angles, nasofrontal, nasofacial, nasomental and nasolabial angles were wider in females while mentocervical angle was wider in males. Moreover, nasofrontal, mentocervical and alar slope angles showed significant increase with advancing age while nasofacial, nasomental and nasolabial showed significant decrease. Regarding nasal indices, sexual dimorphism was recognized for anatomic nasal index, nasal tip protrusion, nasal height ratio and nasal tip protrusion-nasal width indices. Moreover, results also showed that the Egyptians have a Mesorrhine type of nose.

CONCLUSION

Data collected in the present investigation could serve as a database for the quantitative description of the Egyptian nasal morphology.

Morphometry of the soft tissues of the orbital region in Northern Sudanese persons

The orbital region plays a predominant role in the evaluation of the craniofacial complex. No current normative data exist for Northern Sudanese subjects. In the current study information about normal sex- and age-related dimensions of the orbital region was provided. The three-dimensional coordinates of ten landmarks on the orbital soft tissues were obtained using a hand-held laser scanner in 654 healthy Northern Sudanese subjects aged 4-30 years. From the landmarks, biocular and intercanthal widths, paired height and inclination of the orbit relative to both the true horizontal (head in natural head position) and Frankfurt plane, length and inclination of the eye fissure, the relevant ratios, were calculated, and averaged for age and sex. Comparisons were performed by factorial analysis of variance. All analysed linear soft-tissue orbital dimensions, except intercanthal width and left orbital height, were significantly larger in men than in women (p<0.01). A significant sexual dimorphism was found also for the height-to-width ratios (larger in women in most age groups), the orbital inclinations vs. the true horizontal and Frankfurt plane (both measurements were almost always larger in men than in women), and the right side inclination of the eye fissure vs. the true horizontal (larger in women than in men), while no sex-related differences were observed for the left side inclination of the eye fissure vs. the true horizontal. All measurements but the right side inclination of the eye fissure vs. the true horizontal underwent significant modifications as a function of age, with several significant age×sex interactions. Biocular and intercanthal widths, orbital height, length of the eye fissure, all increased from childhood to young adulthood; in the second decade of life all age-related increments were larger in men than in women. Overall, when compared to literature data for African and Caucasoid subjects, several differences were found, pointing to the necessity of ethnic-specific data. Data collected in the present investigation could serve as a database for the quantitative description of human orbital morphology during normal growth and development. Forensic applications (evaluations of traumas, craniofacial alterations, teratogenic-induced conditions, facial reconstruction, ageing of living and dead people, personal identification) may also benefit from age- and sex-based data banks.

Ear and nose reconstruction in children

Auricular and nasal deformities can have significant social ramifications; therefore, proper repair of these deformities is critically important to a child's well-being. Moreover, the benefits of reconstruction in the pediatric population must be weighed against added concerns about potential growth restriction on the ear and the nose with any manipulation. This article reviews various methods of auricular and nasal reconstruction and discusses some of the technical pearls for improved outcome. A complete discourse on treatment of total ear and nasal reconstruction is beyond the scope of this article. Attention is focused primarily on partial to subtotal defects.

Normal nasal patency: problems in obtaining standard reference values for the surgeon

This review examines why there is no normal range of nasal patency available to the surgeon when assessing nasal obstruction, and discusses the factors that influence nasal patency. Current normal ranges are examined and criticised because of the variability of normal values and the poor sampling methods used. Instability of physiological nasal patency is related to factors such as the nasal cycle and the nose's direct exposure to the external environment. Decongestion of the nose is proposed as a way of stabilising anatomical nasal patency, and measurements of patency in this state may be more useful to the surgeon. Population studies are needed to establish a normal range, but these studies must control for factors such as age, height, sex, and nasal shape and size related to climatic adaptation. Rather than classify populations according to unscientific categories such as race, anthropometric measures such as the nasal index are proposed.

Automated analysis of craniofacial morphology using magnetic resonance images

Quantitative analysis of craniofacial morphology is of interest to scholars working in a wide variety of disciplines, such as anthropology, developmental biology, and medicine. T1-weighted (anatomical) magnetic resonance images (MRI) provide excellent contrast between soft tissues. Given its three-dimensional nature, MRI represents an ideal imaging modality for the analysis of craniofacial structure in living individuals. Here we describe how T1-weighted MR images, acquired to examine brain anatomy, can also be used to analyze facial features. Using a sample of typically developing adolescents from the Saguenay Youth Study (N = 597; 292 male, 305 female, ages: 12 to 18 years), we quantified inter-individual variations in craniofacial structure in two ways. First, we adapted existing nonlinear registration-based morphological techniques to generate iteratively a group-wise population average of craniofacial features. The nonlinear transformations were used to map the craniofacial structure of each individual to the population average. Using voxel-wise measures of expansion and contraction, we then examined the effects of sex and age on inter-individual variations in facial features. Second, we employed a landmark-based approach to quantify variations in face surfaces. This approach involves: (a) placing 56 landmarks (forehead, nose, lips, jaw-line, cheekbones, and eyes) on a surface representation of the MRI-based group average; (b) warping the landmarks to the individual faces using the inverse nonlinear transformation estimated for each person; and (3) using a principal components analysis (PCA) of the warped landmarks to identify facial features (i.e. clusters of landmarks) that vary in our sample in a correlated fashion. As with the voxel-wise analysis of the deformation fields, we examined the effects of sex and age on the PCA-derived spatial relationships between facial features. Both methods demonstrated significant sexual dimorphism in craniofacial structure in areas such as the chin, mandible, lips, and nose.