External nasal morphology and respiratory function

Anthropometric analysis of the nose in young Turkish men and women

PURPOSE

The aim of the study was to describe and compare values for nasal anthropometric measurements using the landmark-based geometric morphometric technique in young healthy Turkish men and women.

MATERIALS AND METHODS

A total of 115 young adults (56 men and 59 women) whose ages ranged from 18 to 30 years (mean age 21.22 years) were included in the analysis.

RESULTS

For men the mean nasal bridge length, total length, width and root width were 52.95, 54.38; 35.24 and 17.83 mm, respectively, and in women they were 47.81 and 50.90; 31.59 and 17.36 mm, respectively. The columella length and width were 12.76 and 5.77 mm, respectively, for men, and for women they were 11.88 and 5.60 mm, respectively.

CONCLUSION

Data collected in the present research could serve as a database for the quantitative description of nasal morphology in young Turkish adults. It may also be used in sex based data banks for the Turkish population.

Nasal region dimensions in children: a CT study and clinical implications

Atresias of nasal cavity, especially in young children, pose an essential problem in children's otolaryngology. Only a few morphometric studies of nasal cavity concerning healthy neonates and young infants without nasal stenosis are available. Multislice computed tomography is a perfect tool enabling a precise evaluation of anatomic structures. The aim of this study was a complex morphometric evaluation of clinically important bone and mucosal structures of nasal cavity and examination of their dependence on age and sex in children up to 3 years of age. 180 children, age range 0–3 years, were divided into 5 age groups, and measurements of 18 distances between skeletal structures and between mucosal structures of nasal cavity were performed on their CT scans. A correlation between the widths of selected bone structures was examined. There were no statistically significant differences in analyzed morphometric parameters between adjacent age groups. The differences were statistically significant only between extreme age groups. There was a correlation between evaluated structures and age. Our results are a valuable supplement of nasal cavity morphometric data of young children. They may be useful in setting reference values of evaluated parameters in children and in diagnosis and planning of surgical treatment in children's otolaryngology.

Active anterior rhinomanometry in paediatrics. Normality criteria

BACKGROUND

Active anterior rhinomanometry with a face mask was used to establish the lower age limit for application of the technique, define normality reference standards, and determine the most appropriate pressure for referencing the nasal resistance values.

MATERIAL AND METHODS

A total of 409 children of both sexes and aged 5-14 years were studied. The subjects were selected from among healthy children in two primary care centres and one school. The Rhinospir 164 rhinomanometer was used for the tests. Rhinomanometry was performed according to the guidelines of the International Committee on Standardization of Rhinomanometry. The SPSS (Statistical Package for the Social Sciences) was used for the analysis of the results.

RESULTS

The study sample was divided into five age groups involving intervals of two years from 5 to 14 years of age, and four body surface groups. The dependent variables studied (resistances and flows at pressure differences of 75 and 100) showed significantly different mean values according to age and body surface. All the mean ratios were over 1.4 units, i.e., the measures of each variable on one side and the other differed between 40% and 44%.

CONCLUSIONS

1.- The lower age limit for rhinomanometry is five years. 2.- The most appropriate pressures for referencing the resistance and flow values are 75 and 100. 3.- The reference standards are established with respect to total resistance and according to subject age and body surface.

Three-dimensional morphologic nasal surface characteristics that predict the extremes of esthetics in patients with repaired cleft lip and palate

OBJECTIVE

The purposes of this study were (1) to develop imaging methods and objective numeric parameters to describe nose morphology, and (2) to correlate those parameters with nasal esthetics for patients with clefts.

METHODS

A total of 28 patients with repaired complete unilateral cleft lip and palate (CUCLP) and 20 age- and gender-matched individuals without clefts were identified. A panel of orthodontists rated and ranked nasal esthetics from nose casts for the cleft group. Best and worst esthetic cleft groups were established from the cast assessments. Three-dimensional surface coordinates of the casts were digitally mapped with an electromagnetic tracking device. Digitized nasal images were oriented, voxelated, sliced, and mathematically curve-fitted. Maximum difference, percent area difference, and maximum and minimum derivative differences between cleft and noncleft and between right and left nose sides were calculated. Differences in parameters between groups were assessed with the use of analysis of variance (ANOVA) and t tests, and correlations with esthetics were assessed with the Spearman rank correlation test.

RESULTS

Differences were seen between cleft and noncleft and best and worst esthetic groups for all four parameters (p < .05). The best esthetic cleft group had (1) lower percent area difference (p < .0001), (2) lower maximum difference (p < .001), and (3) smaller differences in slope of the nose in the coronal plane (p < .0001) than the worst esthetic cleft group.

CONCLUSIONS

Maximum difference and maximum derivative difference and, to a lesser degree, percent area difference can be used to identify differences between cleft and noncleft nasal morphology and to assess levels of nasal esthetics for patients with CUCLP.

Effect of alveolar bone grafting on nasal morphology, symmetry, and nostril shape of patients with unilateral cleft lip and palate

OBJECTIVE

To evaluate nasal morphology, symmetry, and nostril shape in patients with unilateral cleft lip and palate following mixed-dentition alveolar bone grafting.

DESIGN

Prospective stereophotogrammetric study.

SETTING

Hospital-based.

PATIENTS

Thirty-nine patients with a history of repaired unilateral cleft lip and palate who received an iliac crest alveolar bone graft were recruited prospectively to participate in the study. Each patient served as his/her own control.

INTERVENTIONS

Partial facial impressions of all patients were acquired before and a minimum of 6 months after the alveolar bone grafting procedure. Image acquisition and analysis of the casts constructed from these models were carried out using three-dimensional stereophotogrammetry.

MAIN OUTCOME MEASURES

Surface-based registrations and linear measurements were performed to assess nasal morphology and nostril shape. A modified Procrustes technique was used to determine the change in nasal symmetry. A two-tailed, paired t test and an analysis of covariance were used to assess statistical significance.

RESULTS

Significant side-to-side asymmetry exists in the nasal region of patients with unilateral cleft lip and palate, both before and after alveolar bone grafting. No significant changes were observed between pre-alveolar bone graft and post-alveolar bone graft images based on linear measurements, asymmetry scores, and registrations. Gender and surgeon were not significant factors.

CONCLUSION

Under the conditions of this study, mixed-dentition alveolar bone grafting appears to have no significant long-term effect on nasal morphology, symmetry, or nostril shape.

Correlation between facial morphology and esthetics in patients with repaired complete unilateral cleft lip and palate

OBJECTIVE

The purpose of this study was to determine if there were correlations between anthropometric nasolabial measurements and subjective assessments of nasal esthetics in individuals with repaired complete unilateral cleft lip and palate (CUCLP).

PARTICIPANTS

The sample consisted of 28 individuals with repaired CUCLP and 20 age- and gender-matched individuals without clefts.

OUTCOME MEASURES

Nasolabial morphology was assessed using 2D and 3D measurements made on frontal photographs, lateral cephalometric radiographs, and plaster nose casts. A panel of orthodontists rated nasal esthetics from frontal, lateral, three-quarter, and basal view photographs and plaster nose casts using visual analog scales, and they also order ranked the nose casts. Based on the nasal esthetics ratings and rankings, two groups that had the best and the worst esthetics representing the extremes of nasolabial esthetics were statistically identified. Measurements were compared between the cleft and noncleft and the best and worst groups using t tests and analysis of variance.

RESULTS

Differences in anthropometric measurements between the groups were identified. The columellar width and nose base and nasolabial angles significantly differed between the best and worst groups (p < .05). Differences in panel ratings of nasolabial esthetics between the best and worst groups were statistically detected using lateral and three-quarter view photographs (p < .05).

CONCLUSIONS

Although morphologic differences between the cleft and noncleft and between the best and worst groups were identified, the slight morphologic differences noted were not sufficient to explain the subjective esthetic evaluation by the panel.

The average values of the nasal anthropometric measurements in 108 young Turkish males

OBJECTIVE

The aim of the study was to describe the average values of the nasal anthropometric measurements in young Turkish male population.

METHODS

Study group consisted of 108 volunteer young Turkish males whose age were 18-30 years (mean age 22.31 year). All subjects were students in Yasar Dogu School of Physical Education and Sport of University of Ondokuz Mayis.

RESULTS

The means total length and nasal bridge length of the nose were 56.92 and 55.26 mm, respectively. The means of the nasal bridge width and morphologic nose width were 29.74 and 33.63 mm, respectively. The mean width of the anatomic nose was 23.14 mm. The mean width of the nostril floor was 11.00 mm. The means length and width of the ala were 19.93 and 4.81 mm, respectively. The means of length and width of the columella were 9.34 and 5.34 mm, respectively. The mean frontonasal angle was 134.96 degrees and the mean nasolabial angle was 90.32 degrees.

CONCLUSION

The nose was the dominant feature in the facial region. Anthropometric measurements related with the nose measured were compared with the available literature. Average values of the nose in this population may be used as a landmark for guidance to plan corrective surgery of the nose.

[Functional and aesthetic outcome of nasal surgery in cleft lip palate patients]

Between June 1996 and November 2000 60 patients suffering from severe nasal dysplasia due to cleft lip and palate (CLP) underwent corrective nasal surgery. Diagnoses included 37 cases of unilateral CLP and 23 cases of bilateral CLP. Age ranged from 7 to 50 years. To assess functional outcome three different methods were used pre- and postoperatively with and without nasal decongestion: active anterior rhinomanometry, rhinoresistometry, and acoustic rhinometry. For the measurement of esthetic changes frontal, lateral, and caudal photographs were analyzed. Compared to a non-cleft population esthetic and functional impairment was evident preoperatively. Postoperatively a statistically significant improvement in nasal projection and configuration was seen. Concerning nasal respiration an improvement in nasal flow and hydraulic diameter was noted in the unilateral CLP group only, whereas a statistically nonsignificant average deterioration was found in the bilateral CLP group. No correlation existed between external nasal form or the change in nasal appearance and nasal function. Whereas the esthetic outcome of nasal surgery is covered by way of photo-analysis in many centers, a distinct lack of measuring the effects on nasal function can be stated. Without using objective methods, however, no data for improving surgical procedures and for internal quality control are at hand.

Midsagittal facial soft-tissue growth of French Canadian adolescents

This study examines changes in 12 midline soft-tissue thicknesses from the forehead, nose, lip, and chin regions in girls and boys from 10 to 16 years of age. The soft-tissue changes are compared to changes in two hard-tissue distances (sella-nasion and nasion-menton). The subjects are from a mixed-longitudinal sample studied at the Montreal Human Growth Research Center in the 1960s and 1970s. Total sample size is 242 (from lateral cephalographs of 124 males and 118 females), with numbers varying by age and measurement. For hard-tissues, boys show clearly defined adolescent spurts, while girls display small velocity increases indicative of only very minor spurts. Forehead tissue thicknesses for both sexes change little and show no demonstrable growth spurts. For the nose and philtrum region, which have the greatest absolute soft-tissue growth changes, both boys and girls show adolescent spurts. Peak velocities are attained between 13 and 14 years in boys and between 11.9 and 12.5 years in girls. Boys appear to have small adolescent spurts for upper (13.7 years) and perhaps lower lip thicknesses. Neither sex displays clear evidence for adolescent spurts in the chin region.

Nasal morphology and shape parameters as predictors of nasal esthetics in individuals with complete unilateral cleft lip and palate

OBJECTIVE

The purpose of this study was to assess the ability of shape parameters of nasal morphology to predict esthetics in individuals with complete unilateral cleft lip and palate (CUCLP).

METHODS

This retrospective study involved 28 patients with repaired CUCLP. Nostril morphology was analyzed using nose casts and a video-imaging technique. Calculated shape parameters included area, perimeter, centroid, angle of the principal axis, major and minor moments of area, anisometry, bulkiness, lateral offset, and three-dimensional internostril angles. Esthetics was assessed using a panel of six orthodontists who rated nasal esthetics from frontal, lateral, basal, and three-quarters view slides and from nose casts. Correlations between esthetics and the shape parameters were completed using the entire group as well as using two statistically determined subsets: those with the best and those with the worst esthetics.

RESULTS

Nasal esthetics was related to only the perimeter and bulkiness parameter ratios. Symmetry of the perimeters between the right and left nostrils positively correlated with better esthetics using the entire sample group while symmetry of bulkiness between the right and left nostrils positively correlated with better esthetics using both the entire sample group and the best and worst subsets.

CONCLUSIONS

Only perimeter and bulkiness showed positive correlations with nasal esthetics. The group of parameters used to assess nostril morphology had neither significant correlation with-nor predictive power for-esthetics. Thus, an assessment of the entire nasal surface topography in three dimensions needs to be completed and assessed with respect to predictability of nasal esthetics.

Video-imaging assessment of nasal morphology in individuals with complete unilateral cleft lip and palate

OBJECTIVE

The purpose of this study was to develop a video-imaging mathematical method to assess nostril morphology.

DESIGN

This retrospective study involved two age-matched groups: 28 subjects with complete unilateral cleft lip and palate (CUCLP) and 19 noncleft controls. Nose casts were reproducibly oriented in a jig such that the casts could be rotated about the coronal axis. Video images of the nostrils were captured and then analyzed for area, perimeter, centroid, principal axis, moments about the major and minor axes (I11, I22), anisometry, bulkiness, lateral offset, internostril angle, and rotational angle.

RESULTS

All parameters identified nostril asymmetry in both groups. The results of the analyses using anisometry, I11, and I22 showed that, in both groups, one nostril was rounder and one was more elliptical. This asymmetry, however, differed between the two groups, and the difference was primarily based on the degree of ellipticity of the nostrils. Maximum dimension, perimeter, lateral offset, I11, and I22 were more asymmetric in the cleft group. In the control group, the right nostril was more elliptical and had a greater perimeter, and the left-side nostril had a greater bulkiness (enfolding).

CONCLUSIONS

The method developed was validated for assessment of nasal morphology in cleft and noncleft samples. Nostril morphology was asymmetric in both groups but more asymmetric in the cleft group than the control group. The dominant influence of the cleft resulted in more elliptical noncleft nostrils and greater nostril shape asymmetry in the cleft group. The validated video-imaging method can now be used to assess the efficacy of treatment on nasal morphology.

Three-dimensional study of growth and development of the nose

OBJECTIVE

The aim of this study was to describe normal nasal growth in a large sample of boys and girls from 6 to 14 years of age, to compare nasal development at 14 years of age with its adult dimensions, and to evaluate differences in growth patterns between males and females.

DESIGN

Growth and development of the nose were analyzed through the three-dimensional facial morphometry method. One thousand thirteen examinations were performed on 402 children between 6 and 14 years of age and on 101 adults. Three-dimensional coordinates of five nasal landmarks were collected. Eleven parameters including nasal volume and external surface were calculated and averaged for age and sex.

RESULTS

Volume, surface, and linear distances were larger in males than in females, with the exception of the 11-to-12 age group, where a sharp female growth spurt was present. In males, the growth spurt was broader, and continued to 13 years of age at a nearly steady rate. Statistically significant gender differences could be found both in the adult group and before the adolescent growth spurt.

CONCLUSIONS

Our findings are in general agreement with previous reports on craniofacial growth, which suggested a strong tendency in males for growth to continue for several years beyond that seen in females.

The burden of proof: a critical review of orthodontic claims made by some general practitioners

The increased demand for orthodontic treatment in the developed countries has led to a recent proliferation of "motel courses" that are specifically designed for general practitioners. Most of the techniques presented are only those that have long been available for selection by discerning orthodontists. However, when they are applied exclusively and indiscriminately by inexperienced clinicians, this may result in either prolonged, unnecessary treatment or failure through instability. Therefore some of the claims that are made will be examined and discussed with a review of the literature.

Lip and nose morphology in patients with unilateral cleft lip and palate from four Scandinavian centres

Sixty patients with unilateral cleft lip and palate were compared for lip and nose appearance. All patients were photographed from an anteroposterior and a basal view at 7-10 years of age. The photographic registration method was tested for validity and accuracy. Although the four groups of 15 patients each were treated according to different protocols, many similarities were found with shorter lip heights at the cleft side and inclination of the rima oris. Asymmetry of nose and retropositioning at the cleft side naris were generally seen. Significantly straighter noses were demonstrated in the group treated with a two-stage lip nose operation combined with nose plugs, and the two groups where vomer flaps were used showed the greatest deviation of the nose.