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1.  A cross-sectional study of soft tissue facial morphometry in children of West Bengal 
Facial analysis is the first step in the evaluation of patients with orthodontic, cosmetic, or reconstructive procedures of the face, and one of the most important components of orthodontic diagnosis and treatment planning. It is a well-established fact that human faces differ from one another on the basis of race and ethnicity. The study will provide the aesthetic guidelines to assess the facial discrepancy in Bengali children to develop a proper treatment plan.
To find out the mean values for selective linear measurements on the facial soft tissue of Bengali children, to demonstrate gender differences in the measurements.
Materials and Methods:
A cross-sectional study was done on 250 Bengali children of 6-14 years age, by measuring certain identified facial landmarks using a digital caliper.
Statistical Analysis Used:
Analytical statistical method with the help of student's t-test was used to determine mean values, standard deviation, and gender differences in the measurements using SPSS version 11.0.
In 6-8 years age group, male's average inter-endocanthion distance was significantly higher than that of females (P < 0.05), whereas in 12-14 years age group, the same parameter for females was significantly higher than that of males (P < 0.001). In 9-11 years age group, the average distance of exocanthion to exocanthion was higher for males compared to females, but the difference was not significant at 5% level (P > 0.05), though for 87% of cases, it was significant (P = 0.13). Total facial height for male subject was significantly high compared to that of females (P < 0.001) in 12-14 years age group.
The study will provide the aesthetic guidelines to assess the facial discrepancy in Bengali children and provide a proper treatment plan through a simple and economically reasonable soft tissue analysis method.
PMCID: PMC3703693  PMID: 23853451
Anthropometry; face; facial analysis; soft tissue
2.  Agreement between cranial and facial classification through clinical observation and anthropometric measurement among envigado school children 
BMC Oral Health  2014;14:50.
To evaluate the agreement between cranial and facial classification obtained by clinical observation and anthropometric measurements among school children from the municipality of Envigado, Colombia.
This cross-sectional study was carried out among 8-15-year-old children. Initially, an indirect clinical observation was made to determine the skull pattern (dolichocephalic, mesocephalic or brachycephalic), based on visual equivalence of right eurion- left eurion and glabella-opisthocranion anthropometric points, as well as the facial type (leptoprosopic, mesoprosopic and euryprosopic), according to the left and right zygomatic, nasion and gnation points. Following, a direct measurement was conducted with an anthropometer using the same landmarks for cranial width and length, as well as for facial width and height. Subsequently, both the facial index [euryprosopic (≤80.9%), mesoprosopic (between 81% - 93%) and leptoprosopic (≥93.1%)] and the cranial index [dolichocephalic (index ≤ 75.9%), mesocephalic (between 76% - 81%), and brachycephalic (≥81.1%)] were determined. Concordance between the indices obtained was calculated by direct and indirect measurement using the Kappa statistic.
A total of 313 students were enrolled; 172 (55%) were female and 141 (45%) male. The agreement between the direct and indirect facial index measurements was 0.189 (95% CI 0.117-0261), and the cranial index was 0.388 (95% CI 0.304-0.473), indicating poor concordance.
No agreement was observed between direct measurements conducted with an anthropometer and indirect measurements via visual evaluation. Therefore, the indirect visual classification method is not appropriate to calculate the cranial and facial indices.
PMCID: PMC4018620  PMID: 24886038
Anthropometry; Craniofacial type; Face anatomy; Head anatomy
3.  A population-based cross-sectional study of the association between facial morphology and cardiometabolic risk factors in adolescence 
BMJ Open  2013;3(5):e002910.
To determine whether facial morphology is associated with fasting insulin, glucose and lipids independent of body mass index (BMI) in adolescents.
Population-based cross-sectional study.
Avon Longitudinal Study of Parents and Children (ALSPAC), South West of England.
From the ALSPAC database of 4747 three-dimensional facial laser scans, collected during a follow-up clinic at the age of 15, 2348 white British adolescents (1127 males and 1221 females) were selected on the basis of complete data on cardiometabolic parameters, BMI and Tanner's pubertal stage.
Main outcome measures
Fasting insulin, glucose and lipids (triglycerides, high-density lipoprotein cholesterol (HDLc) and low-density lipoprotein cholesterol (LDLc)).
On the basis of the collection of 63 x, y and z coordinates of 21 anthropometric landmarks, 14 facial principal components (PCs) were identified. These components explained 82% of the variation in facial morphology and were used as exposure variables. With adjustment for age, gender and pubertal stage, seven PCs were associated with fasting insulin, none with glucose, three with triglycerides, three with HDLc and four with LDLc. After additional adjustment for BMI, four PCs remained associated with fasting insulin, one with triglycerides and two with LDLc. None of these associations withstood adjustment for multiple comparisons.
These initial hypotheses generating analyses provide no evidence that facial morphology is importantly related to cardiometabolic outcomes. Further examination might be warranted. Facial morphology assessment may have value in identifying other areas of disease risk.
PMCID: PMC3657674  PMID: 23793675
Epidemiology; Preventive Medicine; Statistics & Research Methods
4.  Overcoming cross-gender differences and challenges in Le Fort-based, craniomaxillofacial transplantation with enhanced computer-assisted technology 
Annals of plastic surgery  2013;71(4):421-428.
Gender-specific anthropometrics, skin texture/adnexae mismatch, and social apprehension have prevented cross-gender facial transplantation from evolving. However, the scarce donor pool and extreme waitlist times are currently suboptimal. Our objective was to: 1) perform and assess cadaveric facial transplantation for each gender-mismatch scenario employing virtual panning with cutting guide fabrication and 2) review the advantages/disadvantages of cross-gender facial transplantation.
Cross-gender facial transplantation feasibility was evaluated through two mock, double-jaw, Le Fort-based cadaveric allotransplants, including female donor-to-male recipient (T1-FM) and male donor-to-female recipient (T2-MF). Hybrid facial-skeletal relationships were investigated using cephalometric measurements, including sellion-nasion-A point (SNA) and sellion-nasion-B point (SNB) angles, and lower-anterior-facial-height to total-anterior-facial-height ratio (LAFH/TAFH). Donor and recipient cutting guides were designed with virtual planning based on our team’s experience in swine dissections and used to optimize the results.
Skeletal proportions and facial-aesthetic harmony of the transplants [n=2] were found to be equivalent to all reported experimental/clinical gender-matched cases by using custom guides and Mimics technology. Cephalometric measurements are shown in Table 1 relative to Eastman Normal Values.
Based on our results, we believe that cross-gender facial transplantation can offer equivalent, anatomical skeletal outcomes to those of gender-matched pairs using pre-operative planning and custom guides for execution. Lack of literature discussion of cross-gender facial transplantation highlights the general stigmata encompassing the subject. We hypothesize that concerns over gender-specific anthropometrics, skin texture/adnexae disparity, and increased immunological resistance have prevented full acceptance thus far. Advantages include an increased donor pool with expedited reconstruction, as well as size-matched donors.
PMCID: PMC3775652  PMID: 24025655
Face Transplant; Craniomaxillofacial; Vascularized Composite Allotransplantation (VCA); Gender; Cross-gender; Intraoperative Cutting Guide
5.  Photogrammetric Analysis of Palpebral Fissure Dimensions and its Position in Malaysian South Indian Ethnic Adults by Gender 
Anthropometric data describing the palpebral fissure and its position is available for various populations. Unfortunately there is no data available for Malaysian South Indian.
The present study was undertaken to determine the normative values for Malaysian South Indian according to gender.
Materials and Methods:
Anthropometric measurement was done on standardized photographs taken from 300 MSI aged 18-26 years. The parameters were measured using computerized software.
Significant sexual difference was observed in all parameters except canthal index, which includes palpebral fissure width (male, 30.9 mm; female, 29.62 mm), palpebral fissure height (male, 11.06 mm; female, 11.48 mm), palpebral fissure inclination (male, 4.72°; female, 7.04°), outercanthal distance (male, 97.15 mm; female, 91.78 mm), interpupillary distance (male, 68.09 mm; female, 63.6 mm), intercanthal distance (male, 34.1 mm; female, 32.77 mm), and canthal index (male, 35.22 mm; female, 35.86±4.44 mm).
Sexual dimorphism was found in all parameters. Comparison of our results with other studies revealed the variation and similarities in key parameters. Establishing normative values and understanding the facial morphology of different ethnic groups is important in designing the treatment planning for an aesthetic oculoplastic procedure.
PMCID: PMC3482776  PMID: 23112966
Anthropometry; Averageness; Palpebral fissure; Sexual dimorphism; Variation
6.  Anterior Face Height Values in a Nigerian Population 
Withan increasing demand in the number of patients seeking orthodontictreatment at the Orthodontic unit of University of Benin teaching hospital it becomes imperative to provide normative values for anterior face heights. These values will then form a basis for clinical diagnosis, treatment planning and evaluation of facial proportions following orthodontic treatments.
The aim of this study was to measure anterior face height proportions of school children in Benin City.
Subjects and Methods:
One hundred Lateral cephalometric radiographs of 12-15 years old school children, in Benin City were taken to establish anterior face height values. Manual tracings of the cephalograms were carried out and the linear measurements were recorded, summarized, and statistically analyzed using the Microsoft Excel Programme 2000. The comparative test was conducted using the Student's t-test to demonstrate any statistically significant difference between the values for the males and females, at 95% confidence level P < 0.05, was regarded as significant.
Out of the 100 subjects who participated in the study, there were 40 males 40% (40/100) and 60 females 60% (60/100), with a mean age of 12.2 years. Following a combined data analysis for both males and females, the mean biological values obtained for the parameters investigated are; Anterior Lower Face Height (ALFH) 60.9 (5) mm, Anterior Upper Face Height 47.7 (4) mm, Anterior Total Face Height (ATFH) 108.5 (5) mm, ratio of ALFH to ATFH ALFH: ATFH 56 (4)%.
This study provides anterior face height measurements, which will be of great significance in evaluating facial proportions andesthetics in orthodontics, orthognathic surgery, and prosthetic dentistry.
PMCID: PMC3868128  PMID: 24380013
Anterior face heights; Asia facial esthetics; Facial proportions
7.  Is there a correlation between right bronchus length and diameter with age? 
Journal of Thoracic Disease  2013;5(3):306-309.
Right main bronchial anatomy knowledge is essential to guide endoscopic stent placement in modern era. The aim is to describe right bronchial anatomy, cross-area and its relation with the right pulmonary artery and patient’s age.
One hundred thirty four cadaveric specimens were studied after approval by the Research and Ethics Committee at the University of São Paulo Medical School and Medical Forensic Institute of São Paulo. All necropsies were performed in natura after 24 hours of death and patients with previous pulmonary disease were excluded. Landmarks to start measurement were the first tracheal ring, vertex of carina, first right bronchial ring, and right pulmonary artery area over the right main bronchus. After mobilization, the specimens were measured using a caliper and measurement of distances was recorded in centimeters at landmarks points. All the measures (distances, cross sectional area and planes) were performed by three independent observers and recorded as mean, standard error and ranges. Student t test was used to compare means and linear regression was applied to correlate the measurements.
From 134 specimens studied, 34 were excluded (10 with previous history of pulmonary diseases, surgery or deformities and 24 of female gender). Linear regression showed proportionality between tracheal length and right bronchus length; with the area at first tracheal ring and carina and also between the cross sectional area at these points. Linear regression analysis between tracheal length and age (R=0.593 P<0.005), right bronchus length and age (R=0.523, P<0.005), area of contact between right bronchus and right pulmonary artery and age (R=0.35, P<0.005).
We can conclude that large airways grow progressively with increasing age in male gender. There was a direct correlation between age and tracheal length; as has age and right bronchus length. There was a direct correlation between age and the area of the right bronchus covered by the right pulmonary artery.
PMCID: PMC3698291  PMID: 23825764
Anatomy; right bronchus; trachea; gender; age; human
8.  Detecting Genetic Association of Common Human Facial Morphological Variation Using High Density 3D Image Registration 
PLoS Computational Biology  2013;9(12):e1003375.
Human facial morphology is a combination of many complex traits. Little is known about the genetic basis of common facial morphological variation. Existing association studies have largely used simple landmark-distances as surrogates for the complex morphological phenotypes of the face. However, this can result in decreased statistical power and unclear inference of shape changes. In this study, we applied a new image registration approach that automatically identified the salient landmarks and aligned the sample faces using high density pixel points. Based on this high density registration, three different phenotype data schemes were used to test the association between the common facial morphological variation and 10 candidate SNPs, and their performances were compared. The first scheme used traditional landmark-distances; the second relied on the geometric analysis of 15 landmarks and the third used geometric analysis of a dense registration of ∼30,000 3D points. We found that the two geometric approaches were highly consistent in their detection of morphological changes. The geometric method using dense registration further demonstrated superiority in the fine inference of shape changes and 3D face modeling. Several candidate SNPs showed potential associations with different facial features. In particular, one SNP, a known risk factor of non-syndromic cleft lips/palates, rs642961 in the IRF6 gene, was validated to strongly predict normal lip shape variation in female Han Chinese. This study further demonstrated that dense face registration may substantially improve the detection and characterization of genetic association in common facial variation.
Author Summary
Heritability of human facial appearance is an intriguing question to the general public and researchers. Although it is known that some facial features are highly heritable, the exact genetic basis is unknown. Previous studies used simple linear measurements such as landmark distances, to evaluate the facial shape variation. Such approaches, although easy to carry out, may lack statistical power and miss complex morphological changes. In this study, we utilized a new 3D face registration method that enables subtle differences to be detected at high resolution 3D images. Based on this, we tried to test and characterize the associations of 10 candidate genetic variants to common facial morphological variations. Different types of phenotype data were extracted and compared in the association tests. Our results show that geometry based data performed better than simple distance based data. Furthermore, high density geometric data outstood the others in capturing small shape changes and modeling the 3D face visualization. Interestingly, a genetic variant from IRF6 gene, which is also a well-known risk factor of non-syndrome cleft lip, was found to strongly predispose the mouth shape in Han Chinese females.
PMCID: PMC3854494  PMID: 24339768
9.  An anthropometric analysis of facial height, arch length, and palatal rugae in the Indian and Nepalese population 
A country such as India abounds with diverse population groups with distinct anthropometric characteristics. Among these, numerous Nepalese population groups are present in different states of India comprising one of the most common immigrant races. The aim of the study is to compare two distinct races, Indians and Nepalese on the basis of facial height proportions, arch length and palatal rugae patterns and assess their significance in racial identification.
Materials and Methods:
A total of 120 subjects comprising of 60 Indians and 60 Nepalese were selected, with each group including 30 males and 30 females. Facial heights were measured using sliding digital calipers, arch lengths with the help of a brass wire and rugae patterns were traced on dental casts obtained with alginate impressions.
Facial height measurements did not give significant results for racial or gender identification of given races. Differences between arch length parameters were found to be significant between the two population groups. Secondary and fragmentary palatal rugae forms were found to be more common in Nepalese than Indians.
The Indian and Nepalese have similar anthropometric characteristics with regard to facial height. However, arch length and palatal rugae characteristics vary between the two races.
PMCID: PMC3190438  PMID: 22022137
Anthropometry; arch length; facial height; Indian; Nepalese; palatal rugae
10.  Photographic facial soft tissue analysis of healthy Iranian young adults: anthropometric and angular measurements 
Background: Soft tissue profile can be widely different in various populations. Furthermore, this profile can be also continues to change throughout life. However, there are few studies that quantitatively evaluate the soft tissue profile in Iranian population. In order to determine normal reference values of facial parts in our populations, we aimed to measure standards for facial soft tissue parameters in Iranian young population.
Methods: The study samples included 155 medical students at the Firouzgar hospital in winter 2011. The soft tissue facial profiles were digitally analyzed using linear measurements and angles made with standardized photographic records, taken in a natural head position, to determine the average soft tissue facial profile for males and females.
Results: There was a statistically significant difference between males and females in 21 of our 26 measurements. The most prominent differences between the genders were observed in the measurements taken from the face region. Minimum frontal breadth and supraorbital breadth were larger in males than in females. Except for middle face height measurement, other horizontal and vertical measurements for the face were larger in males than in females, indicating wider and higher faces in men than in women. Some measurements of facial angles are discrepant between the two genders.
Conclusion: Due to the specific features of Iranian facial soft tissue values and also observable differences in facial measurements and angles between men and women, the Iranian standard values on facial measurements and angles should be given more attention, especially by plastic and cosmetic surgeons.
PMCID: PMC4219889  PMID: 25405115
Anthropometry; Measurements; Face; Analysis; Iranian
11.  Normative Findings for Periocular Anthropometric Measurements among Chinese Young Adults in Hong Kong 
BioMed Research International  2013;2013:821428.
Measurement of periocular structures is of value in several clinical specialties including ophthalmology, optometry, medical and clinical genetics, oculoplastic surgery, and traumatology. Therefore we aimed to determine the periocular anthropometric norms for Chinese young adults using a noninvasive 3D stereophotography system. Craniofacial images using the 3dMDface system were acquired for 103 Chinese subjects (51 males and 52 females) between the ages of 18 and 35 years. Anthropometric landmarks were identified on these digital images according to standard definitions, and linear distances between these landmarks were calculated. It was found that ocular measurements were significantly larger in Chinese males than females for intercanthal width, biocular width, and eye fissure lengths. No gender differences were found in the eye fissure height and the canthal index which ranged between 43 and 44. Both right and left eye fissure height-length ratios were significantly larger in females. This is the first study to employ 3D stereophotogrammetry to create a database of anthropometric normative data for periocular measurements. These data would be useful for clinical interpretation of periocular pathology and serve as reference values when planning aesthetic and posttraumatic surgical interventions.
PMCID: PMC3730197  PMID: 23957005
12.  Active commuting to school: How far is too far? 
Walking and cycling to school provide a convenient opportunity to incorporate physical activity into an adolescent's daily routine. School proximity to residential homes has been identified as an important determinant of active commuting among children. The purpose of this study is to identify if distance is a barrier to active commuting among adolescents, and if there is a criterion distance above which adolescents choose not to walk or cycle.
Data was collected in 2003–05 from a cross-sectional cohort of 15–17 yr old adolescents in 61 post primary schools in Ireland. Participants self-reported distance, mode of transport to school and barriers to active commuting. Trained researchers took physical measurements of height and weight. The relation between mode of transport, gender and population density was examined. Distance was entered into a bivariate logistic regression model to predict mode choice, controlling for gender, population density socio-economic status and school clusters.
Of the 4013 adolescents who participated (48.1% female, mean age 16.02 ± 0.661), one third walked or cycled to school. A higher proportion of males than females commuted actively (41.0 vs. 33.8%, χ2 (1) = 22.21, p < 0.001, r = -0.074). Adolescents living in more densely populated areas had greater odds of active commuting than those in the most sparsely populated areas (χ2 (df = 3) = 839.64, p < 0.001). In each density category, active commuters travelled shorter distances to school. After controlling for gender and population density, a 1-mile increase in distance decreased the odds of active commuting by 71% (χ2 (df = 1) = 2591.86, p < 0.001). The majority of walkers lived within 1.5 miles and cyclists within 2.5 miles. Over 90% of adolescents who perceived distance as a barrier to active commuting lived further than 2.5 miles from school.
Distance is an important perceived barrier to active commuting and a predictor of mode choice among adolescents. Distances within 2.5 miles are achievable for adolescent walkers and cyclists. Alternative strategies for increasing physical activity are required for individuals living outside of this criterion.
PMCID: PMC2268942  PMID: 18182102
13.  Photographic measurement of upper-body sitting posture of high school students: A reliability and validity study 
All the reported measures of sitting posture, as well as photographs, have one flaw, as these measures are external to the body. These measures use calculations from external bony landmarks to estimate spinal posture, on the understanding that what is being measured externally reflects the shape, health and performance of structures of the underlying spine. Without a comparative measure of the relative position of the structures of the spine, the validity of any external spinal posture measure cannot be established. This paper reports on a study which tests the validity of photographs to measure adolescent sitting posture.
The study was conducted in a laboratory at the Department of Human Biology, University of Cape Town. A random sample of 40 adolescents were recruited from the Cape metropolitan schools, to detect differences of three degrees or more between the repeated measures of upright, normal or slouched posture (photographs) and between the posture photographs and LODOX measures. Eligible participants were healthy male and female subjects aged 15 or 16 years old, in Grade 10, and who were undertaking Computer or Computype studies at their schools. Two posture measurement tools were used in the study, namely: Photographs were taken using the Photographic Posture Analysis Method (PPAM) and Radiographs were taken using the LODOX (LODOX (Pty) Ltd) system. Subjects' posture was assessed in simulated computer workstations. The following angles were measured: the sagittal head angle, cervical angle, protraction/retraction angle, arm angle and the thoracic angle.
Data from 39 subjects (19 males, 20 females) was used for analysis (17 15-year-olds (7 boys and 10 girls), 22 16-year-olds (12 boys and 10 girls)). All but one photographic angle showed moderate to good correlation with the LODOX angles (Pearson r values 0.67–0.95) with the exception being the shoulder protraction/retraction angle Pearson r values. Bland Altman limits of agreement illustrated a slight bias for all angles. The reliability study findings from repeated photographs demonstrated moderate to good correlation of all angles (ICC values 0.78–0.99).
The findings of this study suggest that photographs provide valid and reliable indicators of the position of the underlying spine in sitting. Clinically it is important to know whether a patient is showing true progression in relation to a postural intervention. Based on the results of this study, the PPAM can be used in practice as a valid measure of sitting posture.
PMCID: PMC2542508  PMID: 18713477
14.  Automated Analysis of Craniofacial Morphology Using Magnetic Resonance Images 
PLoS ONE  2011;6(5):e20241.
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.
PMCID: PMC3105012  PMID: 21655288
15.  Abnormal anthropometric measurements and growth pattern in male adolescent idiopathic scoliosis 
European Spine Journal  2011;21(1):77-83.
The progression of adolescent idiopathic scoliosis is closely correlated with longitudinal growth during puberty. A decreased incidence of curve progression has been found in male patients with adolescent idiopathic scoliosis compared with female patients with the condition. This finding implies that there might be a sexual dimorphism in the pubertal growth patterns of adolescent idiopathic scoliosis patients. Abnormal pubertal growth in female adolescent idiopathic scoliosis patients has been well characterized; however, the pubertal growth patterns of male adolescent idiopathic scoliosis patients have not been reported. We conducted a cross-sectional study of anthropometric measurements to compare the growth patterns of male patients with adolescent idiopathic scoliosis with those of healthy boys during puberty and explore the difference in the pubertal growth patterns of female and male patients with adolescent idiopathic scoliosis.
A total of 688 subjects were involved in the study, including 332 male adolescent idiopathic scoliosis patients and 356 age-matched healthy boys. The subjects were categorized according to their chronological ages. Their body weights, heights and arm spans were obtained using standard methods; the corrected body heights of the adolescent idiopathic scoliosis boys were determined using Bjour’s equation. The inter-group differences in the anthropometric parameters were analyzed. Multivariate regression analysis was carried out in the adolescent idiopathic scoliosis patients to identify the anthropometric parameters that influence curve severity.
The corrected standing heights and arm spans of male adolescent idiopathic scoliosis patients were similar to those of the matched controls during puberty. However, the body weights of the adolescent idiopathic scoliosis patients who were more than 14 years old were significantly less than those of the control group. The body mass index of the adolescent idiopathic scoliosis patients between the ages of 15 and 17 were also significantly less than those of the control subjects. Moreover, a significantly higher incidence of underweight was found in adolescent idiopathic scoliosis patients (8.6%) than in the controls (3.4%). Upon multivariate regression analysis, body weight and chronological age were identified as independent predictors of curve magnitude in male adolescent idiopathic scoliosis patients. The male adolescent idiopathic scoliosis patients with variable curve patterns exhibited no significant differences in their anthropometric parameters.
The results showed abnormal pubertal growth in the male adolescent idiopathic scoliosis patients compared with their age- and gender-matched normal controls. Despite similar longitudinal growth, the male patients with adolescent idiopathic scoliosis exhibited significantly lower body weights and a higher incidence of underweight during the later stage of puberty compared with their normal controls. These abnormalities in the pubertal growth of male patients were different from those observed in female patients with adolescent idiopathic scoliosis. Body weight could be an important parameter for further longitudinal studies on the prognostication of curve progression in adolescent idiopathic scoliosis.
PMCID: PMC3252435  PMID: 21826498
Adolescent idiopathic scoliosis; Male; Anthropometric measurement; Underweight; Pubertal growth
16.  A three-dimensional analysis of the effect of atopy on face shape 
Three-dimensional (3D) imaging technology has been widely used to analyse facial morphology and has revealed an influence of some medical conditions on craniofacial growth and morphology.
The aim of the study is to investigate whether craniofacial morphology is different in atopic Caucasian children compared with controls.
Study design included observational longitudinal cohort study. Atopy was diagnosed via skin-prick tests performed at 7.5 years of age. The cohort was followed to 15 years of age as part of the Avon Longitudinal Study of Parents and Children (ALSPAC). A total of 734 atopic and 2829 controls were identified. 3D laser surface facial scans were obtained at 15 years of age. Twenty-one reproducible facial landmarks (x, y, z co-ordinates) were identified on each facial scan. Inter-landmark distances and average facial shells for atopic and non-atopic children were compared with explore differences in face shape between the groups.
Both total anterior face height (pg–g, pg–men) and mid-face height (Is–men, sn–men, n–sn) were longer (0.6 and 0.4mm respectively) in atopic children when compared with non-atopic children. No facial differences were detected in the transverse and antero-posterior relationships.
Small but statistically significant differences were detected in the total and mid-face height between atopic and non-atopic children. No differences were detected in the transverse and antero-posterior relationships.
PMCID: PMC4174908  PMID: 25257926
17.  Anthropometerical Association of the Craniofacial Dysmorphology with Schizophrenia 
Dysmorphology is more concentrated in the craniofacial region of Schizophrenic Patients. So, an early anthropometric assessment of the physical dimensions of the cranium and the face may indicate a potential clue of Schizophrenia.
To study the craniofacial dysmorphology in schizophrenic patients and in healthy controls of the Agra region and to find out whether its evaluation could be used as a tool in the early diagnosis of schizophrenia.
Setting and Design
This was a case-control, cross-sectional study.
Subjects and Methods
Schizophrenic Patients well diagnosed by consultant psychiatrists on the basis of the DSM IV criteria of the S.N. Medical College Agra and the Institute of Mental health, Agra and healthy controls of Agra were selected for the study. The total facial height (trichion to gnathion), the upper facial height (trichion to subnasale) and the lower facial height (subnasale to gnathion) were measured among the various groups of patients and the controls. The mean data were statistically correlated by using the t test for the independent variables.
The total facial height (trichion to gnathion) was elongated in the Schizophrenic male patients as compared to the controls. When we compared the schizophrenic patients on the basis of the family history of schizophrenia, it was found that there was an elongation of the total facial height in the patients with a positive family history of schizophrenia as compared to the patients without a family history of schizophrenia. There was also a significant elongation of the upper facial height (trichion to subnasale ) in the schizophrenic male and female patients.
There was total facial elongation and upper facial region elongation in the schizophrenia patients as compared to the controls.
PMCID: PMC3552189  PMID: 23373013
Craniofacial dysmorphology; Anthropometry; Psychiatry; Schizophrenia
18.  The relationship of maxillary canines to the facial anatomical landmarks in a group of Thai people 
The objective was to evaluate canine positions, intercanine tip width (ICTW) and width of distal surface of canine (WDC), related to facial landmarks including interalar width (IAW), intercommissural width (ICoW), and distance between left and right projection lines drawn from inner canthus of eyes to alae of the nose (DPICa) in a group of Thai.
One hundred Thai subjects aged 18-35 years were selected. IAW and ICoW were measured on subject's face using digital vernier caliper. Irreversible hydrocolloid impression of the upper arch was taken, and a cast was poured with dental stone. Silicone impression material was used to take imprint of the incisal edge of upper six anterior teeth. DPICa was obtained from the subject's face using custom-made measuring equipment and marked on the silicone incisal imprint. The marks were then transferred from the imprint to the stone cast and measured with digital caliper. The ICTW and WDC were also measured on the stone cast. Pearson's correlation was used to determine the correlation.
The results revealed that the correlation between ICTW-ICoW was 0.429 and ICTW-DPICa was 0.573. The correlation between WDC-ICoW was 0.426 and WDC-DPICa was 0.547. However, IAW did not show any correlation with ICTW or WDC (P>.05).
The correlation between canine position and facial landmarks was found. ICTW and WDC had relationship with ICoW and DPICa. DPICa showed stronger correlation with the position of maxillary canine than that of ICoW.
PMCID: PMC3865189  PMID: 24353872
Complete denture; Canine; Canthus; Alae
19.  Detection of Propensity for Aggression based on Facial Structure Irrespective of Face Race 
The human face provides a wealth of information pertaining to the internal state and life-stage history of an individual. Facial width-to-height ratio is a size-independent sexually dimorphic trait, and estimates of aggression made by untrained adults judging own-race faces were positively associated with both facial width-to-height ratio and actual aggressive behavior. Given the significant adaptive value of accurately detecting aggressiveness based on facial appearance, we hypothesized that aggression estimates made by adults and 8-year-olds would be highly correlated with male facial width-to-height ratio even for a face category with which they had minimal experience—other-race faces. For each of the four race and age groups, estimates of aggression were positively correlated with facial width-to-height ratio irrespective of rating own-or other-race faces. Overall, the correlations between facial width-to-height ratio and ratings of aggression were stronger for adults than for children. Sensitivity to facial width-to-height ratio appears to be part of an evolved mechanism designed to detect threats in the external environment. This mechanism is likely broadly tuned and functions independently of experience.
PMCID: PMC3352668  PMID: 22611331
20.  Facial morphometrics of children with NON-syndromic orofacial clefts in Tanzania 
BMC Oral Health  2014;14:93.
Orofacial clefts (cleft lip/palate; CL/P) are among the most common congenital anomalies, with prevalence that varies among different ethnic groups. Craniofacial shape differences between individuals with CL/P and healthy controls have been widely reported in non-African populations. Knowledge of craniofacial shape among individuals with non-syndromic CL/P in African populations will provide further understanding of the ethnic and phenotypic variation present in non-syndromic orofacial clefts.
A descriptive cross-sectional study was carried out at Bugando Medical Centre, Tanzania, comparing individuals with unrepaired non-syndromic CL/P and normal individuals without orofacial clefts. Three-dimensional (3D) facial surfaces were captured using a non-invasive 3D camera. The corresponding 3D coordinates for 26 soft tissue landmarks were used to characterize facial shape. Facial shape variation within and between groups, based on Procrustes superimposed data, was studied using geometric morphometric methods.
Facial shape of children with cleft lip differed significantly from the control group, beyond the cleft itself. The CL/P group exhibited increased nasal and mouth width, increased interorbital distance, and more prognathic premaxillary region. Within the CL/P group, PCA showed that facial shape variation is associated with facial height, nasal cavity width, interorbital distance and midfacial prognathism. The isolated cleft lip (CL) and combined cleft lip and palate (CLP) groups did not differ significantly from one another (Procrustes distance = 0.0416, p = 0.50). Procrustes distance permutation tests within the CL/P group showed a significant shape difference between unilateral clefts and bilateral clefts (Procrustes distance = 0.0728, p = 0.0001). Our findings indicate the morphological variation is similar to those of studies of CL/P patients and their unaffected close relatives in non-African populations.
The mean facial shape in African children with non-syndromic CL/P differs significantly from children without orofacial clefts. The main differences involve interorbital width, facial width and midface prognathism. The axes of facial shape differences we observed are similar to the patterns seen in Caucasian populations, despite apparent differences in cleft prevalence and cleft type distribution. Similar facial morphology in individuals with CL/P in African and Caucasian populations suggests a similar aetiology.
PMCID: PMC4118654  PMID: 25070002
21.  A Systematic Review of Inter-ethnic Variability in Facial Dimensions 
Plastic and reconstructive surgery  2011;127(2):874-881.
The earliest recorded facial proportional analysis is in the Greek neoclassical canons (c. 450 B.C.). In contemporary times, there has not yet been a study that describes the relative differences in facial proportions among the world’s different ethnic groups. The specific aim of this project is to perform a systematic review of data from the existing literature in order to evaluate the degree of variability in the facial dimensions among various ethnic groups.
A PubMed database review identified primary articles containing measurements of facial proportions from various ethnic groups. Data extracted from these articles were the actual means and standard deviations of recorded facial measurements. These facial measurements included the heights and widths of the upper, middle, and lower face which are the features originally described by the neoclassical canons. Coefficients of variation (CV) were calculated to derive a unit-free comparison of the degree of variability among different ethnic groups in each of the neoclassically-measured facial dimensions.
Our literature search identified 239 potential articles. After screening for the inclusion and exclusion criteria, seven relevant articles were selected. These articles contained data on 11 linear facial measurements from 2359 male and female individuals from 27 different ethnic groups. 95% confidence intervals of the CVs of the measurements indicated that the features that demonstrated the largest differences between the different ethnic populations are the forehead height, interocular distance, and nasal width. The least amount of variability is found in the ear height and upper, middle, and lower facial widths.
The greatest inter-ethnic variability in facial proportions exists in the height of the forehead. More pronounced difference among the ethnic groups is also present in the measurements of the eyes, nose, and mouth. There is no significant difference between sexes in the neoclassical facial proportions.
PMCID: PMC3074358  PMID: 21285791
Systematic Review; inter-ethnic variability; facial dimensions
22.  Facial phenotypes in subgroups of prepubertal boys with autism spectrum disorders are correlated with clinical phenotypes 
Molecular Autism  2011;2:15.
The brain develops in concert and in coordination with the developing facial tissues, with each influencing the development of the other and sharing genetic signaling pathways. Autism spectrum disorders (ASDs) result from alterations in the embryological brain, suggesting that the development of the faces of children with ASD may result in subtle facial differences compared to typically developing children. In this study, we tested two hypotheses. First, we asked whether children with ASD display a subtle but distinct facial phenotype compared to typically developing children. Second, we sought to determine whether there are subgroups of facial phenotypes within the population of children with ASD that denote biologically discrete subgroups.
The 3dMD cranial System was used to acquire three-dimensional stereophotogrammetric images for our study sample of 8- to 12-year-old boys diagnosed with essential ASD (n = 65) and typically developing boys (n = 41) following approved Institutional Review Board protocols. Three-dimensional coordinates were recorded for 17 facial anthropometric landmarks using the 3dMD Patient software. Statistical comparisons of facial phenotypes were completed using Euclidean Distance Matrix Analysis and Principal Coordinates Analysis. Data representing clinical and behavioral traits were statistically compared among groups by using χ2 tests, Fisher's exact tests, Kolmogorov-Smirnov tests and Student's t-tests where appropriate.
First, we found that there are significant differences in facial morphology in boys with ASD compared to typically developing boys. Second, we also found two subgroups of boys with ASD with facial morphology that differed from the majority of the boys with ASD and the typically developing boys. Furthermore, membership in each of these distinct subgroups was correlated with particular clinical and behavioral traits.
Boys with ASD display a facial phenotype distinct from that of typically developing boys, which may reflect alterations in the prenatal development of the brain. Subgroups of boys with ASD defined by distinct facial morphologies correlated with clinical and behavioral traits, suggesting potentially different etiologies and genetic differences compared to the larger group of boys with ASD. Further investigations into genes involved in neurodevelopment and craniofacial development of these subgroups will help to elucidate the causes and significance of these subtle facial differences.
PMCID: PMC3212884  PMID: 21999758
autism; neurodevelopment; anthropometry; facial phenotype; biomarker; craniofacial genetics
23.  Cephalometric Pattern and Nasal Patency in Children with Primary Snoring: The Evidence of a Direct Correlation 
PLoS ONE  2014;9(10):e111675.
Sleep disordered breathing (SDB) might affect craniofacial growth and children with obstructive sleep apnea syndrome present an increase in total and lower anterior heights of the face and a more anterior and inferior position of the hyoid bone when compared to nasal breathers.
To investigate the correlation between rhinomanometric and cephalometric parameters in children with primary snoring (PS), without apnea or gas exchange abnormalities.
Materials and Methods
Thirty children with habitual snoring (16 females and 14 males) aged 4–8 years (mean age 6.85±1.51 years) were selected by a SDB validate questionnaire. All subjects underwent lateral cephalometric, panoramic radiographies.
In our sample 10 children (33%) had snoring 3 nights/week, 11 (37%) 4–6 nights/week and 9 (30%) every night/week. Overall 7 patients (23.3%) were affected by adenoid hypertrophy (AH), 4 (13.3%) by tonsillar hypertrophy (TH) and 13 (43.3%) by AH and TH. We found a more vertical position of the hyoid bone to the mandibular plane (H⊥VT) in patients with a higher frequency (7.3±2.7 vs 7.6±3.7 vs 10.9±2.5 in children snoring 3 nights/week, 4–6 nights/week and every night/week respectively; p = 0.032). Concerning nasal patency significant correlations were found with ANB (maxillary and jaw position with respect to the cranial base), NS∧Ar (growth predictor), sumangle, FMA (total divergence), SnaSnp∧GoMe (inferior divergence), BaN∧PtGn (facial growth pattern), Phw1_PsP (posterosuperior airway space), AHC3H (the horizontal distance between the most anterosuperior point of the hyoid bone and the third cervical vertebra).
The present study supports the relationship between nasal obstruction and specific craniofacial characteristics in children with primary snoring and lead us to hypothesize that nasal obstruction might explain the indirect link between snoring and cephalometric alterations.
PMCID: PMC4216138  PMID: 25360610
24.  Prevalence of overweight and obesity on the island of Ireland: results from the North South Survey of Children's Height, Weight and Body Mass Index, 2002 
BMC Public Health  2007;7:187.
Childhood obesity is emerging as a major public health problem in developed and developing countries worldwide. The aim of this survey was to establish baseline data on the prevalence and correlates of overweight and obesity among children and adolescents in the Republic of Ireland (RoI) and Northern Ireland (NI).
The heights and weights of 19,617 school-going children and adolescents aged between 4 and 16 years in NI and RoI were measured using standardised and calibrated scales and measures. The participants were a representative cross-sectional sample of children randomly selected on the basis of age, gender and geographical location of the school attended. Overweight and obesity were classified according to standard IOTF criteria.
Males were taller than females, children in RoI were taller than those in NI and the more affluent were taller than the less well off. The overall prevalence of overweight and obesity was higher among females than males in both jurisdictions. Overall, almost one in four boys (23% RoI and NI) and over one in four girls (28% RoI, 25% NI) were either overweight or obese. In RoI, the highest prevalence of overweight was among 13 year old girls (32%) and obesity among 7 year old girls (11%). In NI the highest prevalence of overweight and obesity were found among 11 and 8 year old girls respectively (33% and 13%).
These figures confirm the emergence of the obesity epidemic among children in Ireland, a wealthy country with the European Union. The results serve to underpin the urgency of implementing broad intersectoral measures to reduce calorie intake and increase levels of physical activity, particularly among children.
PMCID: PMC1950090  PMID: 17672893
25.  Residual bone height measured by panoramic radiography in older edentulous Korean patients 
The aim of this study was to obtain statistical data on the residual bone height at different natural tooth positions by panoramic radiography in edentulous Korean patients aged 60-90 years.
The study included the diagnostic panoramic radiographs of 180 randomly selected edentulous patients without systemic diseases affecting bone. The radiographic selection criteria included absence of obvious facial asymmetry, clearly visible anatomic structures, and no surgical and fracture history. The panoramic radiographs of 79 patients met these criteria and were used in the analysis. The same researcher processed all the radiographs by using a standardized method. The height of the residual bone was measured at 18 predetermined sites (7 in the maxilla and 11 in the mandible) on digitized and printed radiographs by using a Digimatic caliper, triangle, and ruler. Gender- and age-related differences were statistically analyzed by using the t-test and rank-sum test (α=0.05).
The maxillary residual bone height did not show significant gender-related differences, but male patients had significantly higher residual bone in the mandible(P<.05). No significant height differences at the measured sites were noted among the 60s, 70s, and 80s age groups.
Dentists should pay greater attention to older female edentulous patients because they are more prone to rapid residual bone resorption. Residual bone resorption may not be affected by age.
PMCID: PMC3942528  PMID: 24605207
Radiography; Panoramic; Alveolar bone loss; Denture, Complete; Dental implants; Maxilla; Mandible

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