ANATOMICAL STUDY
Craniofacial Morphologic Parameters in a Persian Population: An Anthropometric Study Fariborz Amini, DDS, MS,* Ziba Mashayekhi, DDS, MS, Hajir Rahimi, DDS, MS,* and Golnaz Morad, DDS† Abstract: Limited data are available regarding the reference ranges of facial proportions of the Persian population in Iran. This study aimed to establish the reference range of craniofacial anthropometric measurements in an adult Iranian population. On 100 individuals (men = women), aged 18 to 30 years with normal faces and occlusions, 34 linear and 7 angular measurements as well as 24 indices were calculated. The difference of measurements between men and women were evaluated by paired t-test. The data were compared with the norms of North American whites using 1-sample t-test. The subjects belonged to 5 ethnic groups (57% from Fars, 14% from Kord, 11% from Azari, 10% from Gilaki-Mazani, and 2% from Lor). All head measurements were greater in men except for the head index and the head height. The subjects had leptoprosopic faces. The intercanthal width was almost one third of the biocular width and greater than the eye fissure length. Although the nose width of women was significantly smaller, both sexes had leptorrhine noses. The chin height and lower chin height were greater in men. In comparison with North American whites, considerable differences were found regarding head height and width, biocular width, nose height, face height, mouth width, and upper chin height. In conclusion, the reference range of craniofacial anthropometric measurements established for the Iranian population might be efficiently used for esthetic treatments. Key Words: Anthropometry, craniofacial proportions, soft tissue analysis (J Craniofac Surg 2014;25: 1874–1881)
E
valuation of soft tissue proportions and parameters is a critical point in diagnosis and treatment planning in patients with maxillofacial deformities or esthetic problems. The standards of esthetics considerably vary according to race/ethnicity, sex, and age. Determination of anthropometric measurements and reference ranges of each ethnic group is therefore essential for indicating the degree of deviations from normal.1–4 From the *Department of Orthodontics, Dental Branch, Islamic Azad University, Tehran, Iran; and †Research Institute of Dental Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Received June 9, 2013. Accepted for publication February 10, 2014. Address correspondence and reprint requests to Hajir Rahimi, DDS, MS, Department of Orthodontics, Islamic Azad University, 10th Neyestan St, Pasdaran, Tehran, Iran; E-mail: [email protected] Ziba Mashayekhi is in private practice in Tehran, Iran. The authors report no conflicts of interest. Copyright © 2014 by Mutaz B. Habal, MD ISSN: 1049-2275 DOI: 10.1097/SCS.0000000000000902
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At present, very limited data are available regarding the reference ranges of facial proportions and anthropometric measurements of the Persian population in Iran. Aiming to establish normal measurements for different ethnicities, Farkas et al2 collected anthropometric data of 1470 individuals from 25 European, Middle Eastern, Asian, and African countries including Iran. Other studies have also evaluated the Iranian population for facial/craniofacial proportions.4–7 The reported data, however, are confined to certain ethnic groups in Iran and cannot be generalized to all the Iranian population.2,4–7 In addition, only particular anatomic regions are included in these data, whereas many essential parameters for diagnosis and treatment planning are left unevaluated.2,7,8 Furthermore, there are some inconsistencies between the results of these studies.2,4 It is for these reasons that measurements reported in other populations, particularly North American whites (NAWs),9 are commonly considered in the current treatment guidelines for Iranian patients. Apparently, these measurements may not be compatible with the specific anthropometric characteristics of Iranian people. This study aimed to establish the reference range of craniofacial anthropometric measurements in the adult Iranian population.
MATERIALS AND METHODS Subjects This cross-sectional study was conducted on dental students of the Azad University, Tehran, Iran, in 2011 to 2012. After clinical examination and interview of 1000 students, 100 individuals (50 men, 50 women) aged between 18 to 30 years old were enrolled. Criteria of inclusion were as follows: (1) no history of orthodontic treatment; (2) no history of trauma to the craniofacial region; (3) no history of plastic surgery in the orofacial region; (4) having Iranian parents and grandparents; and (5) normal face and occlusion, which was defined by symmetric face and occlusion, normal facial height, straight profile, Cl-I molar relationship, normal overjet and overbite, no posterior cross-bite, no dentoalveolar protrusion or retrusion, no considerable spacing or crowding, no missing or extraction of the teeth anterior to the first molar, and/or no supernumerary teeth anterior to the first molar. The study was approved by the ethical committee of the university, and informed consent for reviewing the data of patients was obtained at enrollment.
Measurements Clinical examinations, interviews, and measurements were performed separately by 2 orthodontic residents (Z.M. and H.R.). To assess the raters’ reliability, all the measurements were initially taken in 10 women and 10 men, for 3 times with 7-day intervals, and the intraclass correlation coefficient was calculated. As demonstrated in Figures 1 and 2, 27 anatomic on the patients’ face and head were considered for measurements and, if possible, were marked by a black erasable pen. These points are standard anatomic landmarks used in previous studies.9 Using the
The Journal of Craniofacial Surgery • Volume 25, Number 5, September 2014
Copyright © 2014 Mutaz B. Habal, MD. Unauthorized reproduction of this article is prohibited.
The Journal of Craniofacial Surgery • Volume 25, Number 5, September 2014
Parameters in Persian Population
belonged to 5 ethnic groups (57% from Fars, 14% from Kord, 11% from Azari, 10% from Gilaki-Mazani, and 2% from Lor). Intraclass correlation test results are shown in Table 1. All the measurement except for the glabella-subnasale (g-sn) inclination had perfect ICCs. The nose width (alare-alare [al-al]), head height (vertex-nasion [v-n]), and sn-pogonion (pg) inclination had moderate ICCs. The craniofacial measurements of the 5 ethnic groups, the comparison between sexes, and their relationship to the NAWs’ reference range are presented later.
Head
FIGURE 1. Anatomic points: tr, g, n, pronasale (prn), sn, labiale superius (ls), stomion (sto), ch, labiale inferius (li), sublabiale (sl), pg, gn, cervical point (c), orbitale (or), en, ex, and zy.
Farkas9 method, 34 linear and 7 angular measurements were taken. Measurement devices included digital sliding calipers with long jaws, digital sliding calipers, digital hook depth gauge, and digital protractor and level (Insize, Austria). Given the importance of golden ratio in treatment planning, 9 additional indices were also taken.10 The Frankfort line was considered as the reference line.11
Statistical Analysis Data were analyzed by the Statistical Package for the Social Sciences (version 18; SPSS Inc, Chicago). Mean of the measurements taken by the 2 raters was considered for analyses. ShapiroWilk test confirmed the normal distribution of data. A P < 0.01 was considered statistically significant. The difference of measurements between men and women was evaluated by paired t-test. Moreover, the data were compared with the norms of NAWs previously reported by Farkas9 using 1-sample t-test.
RESULTS The 100 participants enrolled in this study were aged between 18 to 30 years old (mean, 23.7; SD, 3.4). The subjects
All measurements were greater in men than men except for the head index and head height (v-n). The head circumference in men and head height in women showed the greatest variations. In comparison with NAWs, Iranians had wider and shorter heads. Head width in 30% of the women was greater than the reference range of NAW women. Head index measurements showed that, whereas NAWs have a mesocephalic head form, subjects of the current study were brachycephalic (Table 2).
Ear The ear dimensions were greater in men than women. However, the ear index was similar in both sexes. Comparing with the NAWs, only the ear length was significantly greater in the Iranian men (Table 3).
Orbits The biocular width (exocanthion-exocanthion [ex-ex]) was greater in men. However, other measurements were similar in men and women. The eye index revealed that the intercanthal width (endocanthion-endocanthion [en-en]) was almost one third of the biocular width and slightly greater than the eye fissure length (en-ex). Significantly greater biocular width (and therefore, smaller eye index) was seen in the subjects in comparison with NAWs (P < 0.0001). Other measurements were comparable with NAWs (Table 4).
Nose The nose index was significantly different between men and women. Although the nose width (al-al) of women was significantly TABLE 1. Correlations Between the Three Records of Each Anthropometric Measurement Measurement
ICC*
Measurement
ICC
Measurement
ICC
g-op
0.95 0.99 0.99 0.95 0.97 0.92 0.99 0.74 0.99 0.97 0.96 0.95 0.93 0.98
al-al sn-prn ch-ch sn-sto sn-ls ls-sto sto-sl li-sl sto-li sto-gn sl-pg pg-gn sl-gn pra-pa
0.69 0.84 0.93 0.99 0.98 0.92 0.94 0.91 0.73 0.98 0.82 0.95 0.97 0.95
sa-sba en-en ex-ex en-ex gn-c v-n g-sn inclination sn-pg inclination bridge inclination sn-ls inclination sl-li inclination mentocervical angle nasolabial angle
0.99 0.94 0.96 0.71 0.95 0.67 0.42 0.62 0.96 0.97 0.97 0.98 0.98
eu-eu g-op zy-zy go-go tr-gn n-gn n-sto tr-g g-sn sn-gn t-sn t-gn n-sn FIGURE 2. Anatomic points: v, n, ex, orbitale (or), al, pronasale (prn), sn, stomion (sto), sublabiale (sl), pg, zy, tragion (t), superaurale (sa), subaurale (sba), postaurale (pa), preaurale (pra), go, and opisthocranion (op).
*Poor, 0–0.2; fair, 0.3–0.4; moderate, 0.5–0.6; strong, 0.7–0.8; and perfect, >0.8. ICC, intra class correlation.
© 2014 Mutaz B. Habal, MD
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TABLE 2. Head Measurements in the Study Population and Their Comparison With Those of NAWs Persian Versus NAW Measurements/Indices
Sex
Width of the head
eu-eu (mm)
Length of the head
g-op (mm)
Height of the head
v-n (mm) on-op (mm)
Head circumference Head index
eu−eu g−op
100
Mean (SD)
Men Women Men Women Men Women Men Women Men Women
158.7 151.8 194.4 186.7 106.4 104.2 573.1 551.9 81.7 81.4
(5.4) (3.9) (6.2) (5.5) (5.3) (6.1) (13.1) (13.8) (3.5) (2.9)
Min
Max
NAWs, Mean (SD)
P Value
148 141.4 178 172.9 93.4 89.4 545 490 74.2 74.7
169.3 163.4 211 198.1 115.3 115.7 606 578 91.3 88.6
153.3 (5.9) 144.4 (4.6) 193.7 (7.6) 184.9 (7) 117.7 (8) 112.7 (7.1) 568.6 (16.1) 544.4 (14.8) 79.2 (4.6) 78.2 (4.2)
≤0.0001* ≤0.0001* ≤0.62 ≤0.15 ≤0.0001* ≤0.0001* ≤0.13 ≤0.0098* ≤0.003* ≤0.0001*
*Statistically significant. Min, minimum measured amount; Max, maximum measured amount.
smaller than men (P < 0.0001), the nose form of both sexes was leptorrhine. Similar to neoclassic canons, the nose width in women was almost equal to the eye fissure length. Nose width was approximately one fourth of the facial width in subjects. Nasal bridge inclination and nose height had the greatest and smallest variations, respectively. Nose height (n-sn) in both sexes (34% of men and 66% of women) was significantly greater than those of the reference range in NAW (P < 0.0001). Therefore, the nose index was also affected. Both populations had leptorrhine noses. However, female subjects had smaller nasal width than NAW women (P < 0.0001). The nasolabial angle of Iranian women was also smaller than of NAWs. In contrast to NAWs in which the nasolabial angle is significantly greater in women, the men and women in the current study were identical (Table 5).
Face Men had bigger faces in 3 dimensions than women. However, because these differences were proportionate, the indexes were comparable in men and women. Regarding the face index, the subjects had leptoprosopic (long) faces. The mandible width (goniongonion [go-go]) was three fourths of the face width (zygion-zygion [zy-zy]), and the depth of maxilla was 43% of the mandible depth. Among facial indices, face width in women and forehead height in men had the smallest and greatest variations. A slight convexity was observed in the profiles of both sexes. Moreover, the results showed that the 3 vertical thirds were not equal in the subjects (forehead, 30%; middle third, 35%; lower third, 35%). The facial height and upper facial height were significantly greater in NAWs (P < 0.0001). Mandible width, mandibular depth,
and maxillary depth were greater in female subjects than in NAW women (P < 0.0001). Regarding the facial index, although the facial form of the NAW women is mesoprosopic, the female subjects were dominantly leptoprosopic. However, both Iranian and NAW men had leptoprosopic faces, and there was no significant difference among them (Table 6).
Labio-Oral Region Mouth width, upper and lower lip height, and cutaneous upper and lower lip height were greater in men than women. In both sexes, the mouth width is almost one third of the bizygomatic width, the upper lip height is 30% of the lower facial height, and the lower lip height is 26% of the lower facial height. Upper vermilion height of the men and mouth width-facial width index in women had the most and least variations, respectively. The mouth width, upper vermilion height, and cutaneous lower lip height were smaller than NAW in both sexes (P < 0.0001 and P < 0.002). Lower vermilion height is smaller in male subjects than in NAWs; however, the women of both races were the same. Despite the lower lip inclination, which was similar to NAWs, upper lip inclination was greater in the male and female subjects (P < 0.0001 and P < 0.006) (Table 7).
Chin and Neck The chin height and lower chin height were greater in men. On average, the chin height is 43% of the lower facial height. Upper and lower chin height is 45% and 64% of the chin height, respectively. The throat length was approximately 42 mm, and no significant difference was observed between men and women. Upper chin
TABLE 3. Ear Measurements in the Study Population and Their Comparison With Those of NAWs Persian Versus NAW Measurements/Indices Ear width
pra-pa (mm)
Ear length
sa-sba (mm)
Ear index
pra−pa sa−sba
100
Sex
Mean (SD)
Min
Max
NAW, Mean (SD)
Men Women Men Women Men Women
37.4 (2.4) 34 (2.8) 63.3 (4.8) 59.5 (3.5) 59.2 (4.8) 57.2 (4)
28.1 27.1 53.7 51 40.3 48.6
41.3 41.6 83.8 65.4 68 64.8
35.9 (2.2) 34.1 (2.6) 62.4 (3.7) 59 (3.6) 58.1 (3.9) 57.4 (3.8)
P Value ≤0.002* ≤0.85 ≤0.29 ≤0.48 ≤0.21 ≤0.79
*Statistically significant. Min, minimum measured amount; max, maximum measured amount.
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The Journal of Craniofacial Surgery • Volume 25, Number 5, September 2014
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TABLE 4. Eye Measurements in the Study Population and Their Comparison With Those of NAWs Persian Versus NAW Sex
Mean (SD)
Min
Max
NAW, Mean (SD)
P Value
Men Women Men Women Men Women Men Women
32.8 (2.9) 32.2 (2.7) 94.7 (4.2) 92.3 (3.6) 31.6 (1.9) 31 (1.7) 34.6 (2.4) 34.9 (2.3)
26.7 25.5 85.8 84.6 27.7 27.9 29.1 30.2
38.6 40 103.7 27.9 36.1 35.4 40.3 42.6
32.9 (2.7) 32.5 (2.1) 90.7 (3.8) 87.6 (4) 31.2 (1.4) 30.7 (1.8) 37.4 (2.2) 37.2 (2.4)
≤0.86 ≤0.53 ≤0.0001* ≤0.0001* ≤0.24 ≤0.39 ≤0.0001* ≤0.0001*
Measurements/Indices Intercanthal width
en-en (mm)
Biocular width
ex-ex (mm)
Eye fissure length (left)
en-ex (mm)
Eye index
en−en ex−ex
100
*Statistically significant. Min, minimum measured amount; max, maximum measured amount.
height and the chin height-lower facial height in men had the most and least variations, respectively. The upper chin was smaller than NAWs in both sexes (P < 000.1) (Table 8).
DISCUSSION This study investigated the craniofacial anthropometric measurements of an adult Iranian population in 2011 to 2012. Different methods are available for the assessment of facial dimensions.6,12,13 However, the reliability of direct clinical measurement is considerably more than photography and cephalometry.14,15 We selected 34 linear and 7 angular measurements based on the Farkas9 method and calculated 24 indices from a sample of 50 men and 50 women. A few anthropometric studies have been previously performed on certain ethnic/racial groups in Iran.2,4,5,7,8 In this study, the sample group was chosen from Tehran, the capital of Iran, which is a multiracial city and can be a proper sample of the Iranian population.16 Farkas et al2 evaluated 30 men and 30 women in Iran in their international evaluation. Their findings regarding the eye fissure
length were in contrast to the current study where no significant difference was observed between sexes (30.7 in women and 31.2 in men). With respect to ear height and mouth width, the findings of these 2 studies were compatible. However, we observed that the nasal bridge inclination in both sexes and nose height in men were greater than those of the Iranian sample in the study of Farkas et al.2 This dissimilarity in results can be justified by the different sampling methods of the 2 studies. In the study of Farkas et al, the samples were randomly selected. On the contrary, the subjects of the current study were chosen based on a healthy population of normal and proportionate faces and occlusions in all 3 dimensions. The findings of Farkas et al might probably be confounded by not strictly adhering to the proportionate face criterion for the inclusion of samples as well as the small sample size. Observations of Fariaby and associates4 who studied a group of Iranian adults in Kerman, Iran, are well matched to the findings of this study regarding the measurements of orbit, mouth width, upper and lower lip height in both sexes, and nasolabial angle in men. However, they reported a greater nasolabial angle in women comparing with this study. Furthermore, shorter and wider noses and
TABLE 5. Nose Measurements in the Study Population and Their Comparison With Those of NAWs Persian Versus NAW Measurements/Indices Nose width
al-al (mm)
Nose height
n-sn (mm) sn-prn (mm)
Protrusion of the tip of nose Nose index Protrusion of nose-nose width index Nose height-morphologic height of face index Nose width-facial width index
al−al n−sn
100
sn−prn al−al
100
n−sn n−gn
100
al−al zy−zy
100
Nasal bridge inclination, degrees
—
Nasolabial angle, degrees
—
Sex
Mean (SD)
Min
Max
NAW, Mean (SD)
Men Women Men Women Men Women Men Women Men Women Men Women Men Women Men Women Men Women
36.7 (2.5) 32.8 (2.2) 58.4 (3.7) 56.8 (3.4) 20 (2.6) 19.3 (2.2) 63.1 (7) 57.9 (5.1) 54.7 (7.2) 58.9 (7.1) 45.8 (2.5) 47.3 (2.2) 26 (1.9) 24.9 (1.5) 33.7 (6.3) 31.2 (5.4) 97 (8.9) 94.6 (10.5)
31.4 28.4 50.8 49.4 13 14.5 48.3 48.1 35.8 44.1 40.6 42 21.5 21.9 14.2 15 73.1 79.7
42.1 38.5 66.3 65.3 26.2 23.8 82.5 70.7 68.7 77.6 51.2 51.7 30.5 29 43.9 42.1 119.2 130.1
34.8 (2.7) 31.9 (1.9) 53.2 (3.3) 49.2 (2.9) 20.6 (2.2) 19.4 (1.7) 65.8 (6.8) 65.1 (5.8) 59.8 (7.9) 61.7 (6) — — — — 31.6 (4.6) 30 (5.3) 99.8 (11.8) 104.2 (9.8)
P Value ≤0.09 ≤0.03* ≤0.0001* ≤0.0001* ≤0.21 ≤0.8 ≤0.05* ≤0.0001* ≤0.001* ≤0.03* — — — — ≤0.06 ≤0.26 ≤0.14 ≤0.0001*
*Statistically significant. Min, minimum measured amount; max, maximum measured amount.
© 2014 Mutaz B. Habal, MD
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TABLE 6. Face Measurements in the Study Population and Their Comparison With Those of NAWs Persian Versus NAW Measurements/Indices Face width
zy-zy (mm)
Mandible width Morphologic height of face
go-go (mm) n-gn (mm)
Face width Mandible width Morphologic height of face
n-sto (mm) sto-gn (mm)
Mandible height Facial index Mandible width-morphologic height of face index Lower face-morphologic height of face index Mandible index Mandible width-face width index
n−gn zy−zy
100
go−go n−gn
100
sn−gn n−gn
100
sto−gn go−go
100
go−go zy−zy
100
Maxillary depth
t-sn (mm)
Mandibular depth
t-gn (mm)
Maxilla-mandible depth index
t−sn t−gn
100
tr-gn (mm)
Physiognomic height of face Forehead height
tr-g (mm)
g-sn distance
g-sn (mm) sn-gn (mm)
Lower facial height Forehead height-physiognomic height of face index g-sn distance-physiognomic height of face index Lower facial height-physiognomic height of face index
tr−g tr−gn
100
g−sn tr−gn
100
sn−gn tr−gn
100
Upper profile inclination
g-sn inclination, degrees
Lower profile inclination
sn-pg inclination, degrees
Sex
Mean (SD)
Min
Men Women Men Women Men Women Men Women Men Women Men Women Men Women Men Women Men Women Men Women Men Women Men Women Men Women Men Women Men Women Men Women Men Women Men Women Men Women Men Women Men Women Men Women
141.2 (5.4) 131.5 (4.3) 107.9 (6.3) 101 (5.3) 127.4 (4.8) 120.1 (5.5) 79.2 (3.9) 76.1 (4.1) 51 (3.8) 46.4 (2.9) 90.3 (4.4) 91.4 (5) 84.8 (5.5) 84.3 (5.3) 55.9 (2.3) 54.8 (2.4) 47.3 (3.9) 46 (3.3) 76.4 (3.6) 76.8 (3.8) 132.6 (5.6) 123.2 (4.8) 150.4 (6.5) 138.4 (5.4) 43.4 (5.4) 43.3 (4.4) 191.9 (9.7) 180.1 (9.7) 59.2 (9.4) 53.9 (7.3) 67.1 (4.2) 64.9 (4.5) 71.3 (4.2) 65.8 (4.2) 30.7 (3.8) 29.8 (3) 35.1 (2.6) 36.1 (2.6) 37.2 (2.1) 36.6 (2) 3.5 (3.6) 1.6 (3.2) −8.9 (7.8) −11.7 (6.7)
127.7 121.4 97.8 86 117.1 108.2 69 68.3 43.8 39.2 80.6 78.4 75 74.3 49.8 49.1 39.2 39.2 70.1 67.3 121.2 114.5 135.9 129.8 80.5 77.1 175.1 154.2 41.1 35.6 56.5 52.8 62.7 57.6 23.4 23.1 27.1 30.6 33 31.4 −7.4 −5.7 −23.4 −24.5
Max
NAWs, Mean (SD)
P Value
151.7 143 121.5 111 138.4 130.8 88.3 85 63.3 52 98.6 101.4 102.8 99.2 61.7 59.7 55.1 53.3 83.7 84.5 145.1 137.1 166.6 157 92.5 94.4 216.4 198.1 79.7 69.2 75 74.5 79.6 72.8 38.4 36.9 42.1 41 42.2 40.8 13.8 7.1 18.3 11.5s
139.1 (6.3) 131.1 (5.3) 105.6 (6.7) 94.5 (5) 121.3 (6.8) 112 (4.7) 74 (4.2) 68.9 (3.9 48.8 (4) 44.8 (3.4) 88.5 (5.1) 86.2 (4.6) — — 59.2 (2.7) 58.6 (2.9) — — — — 131.8 (4.3) 119.3 (4) 148.2 (5.2) 133.9 (5.1) — — 187.2 (12.1) 173.3 (7.8) 57 (7.4) 52.7 (6) 67.2 (4.9) 63.1 (4.4) 72.6 (4.5) 64.3 (4) — — — — — — 1.3 (3.5) 1.6 (2.5) −10.6 (5.3) −13.3 (4.5)
≤0.08 ≤0.68 ≤0.04* ≤0.0001* ≤0.0001* ≤0.0001* ≤0.0001* ≤0.0001* ≤0.006* ≤0.013* ≤0.06 ≤0.0001* — — ≤0.0001* ≤0.0001* — — — — ≤0.32 ≤0.0001* ≤0.02* ≤0.0001* — — ≤0.02* ≤0.0001* ≤0.11 ≤0.23 ≤0.9 ≤0.01* ≤0.09 ≤0.02* — — — — — — ≤0.004* ≤1.0 ≤0.12 ≤0.04*
*Statistically significant. Min, minimum measured amount; max, maximum measured amount.
greater binocular width were reported for the evaluated population. In addition to racial differences between the people from Tehran and Kerman, using photographs instead of direct clinical measurement may account for the inconsistencies between the 2 studies. Photographs have been proved to be generally less reliable than direct measurement for anthropometric studies. However, the reliability of photographs in the assessment of labio-oral and angular measurements were shown to be greater than the alternatives.14 The similarity of labio-oral measurements between the 2 studies fortifies the assumption that the abovementioned variations may be the result of distortions in photographs. Moreover, the n point
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considered in the current study was lower than that in the study of Fariabi et al. This might be the reason for the differences in nose height between the 2 studies. Heidari and coworkers7 assessed the nasal and facial form of Sistani and Baloch women from southeast Iran. The leptorrhine nose and leptoprosopic face were reported as the dominant forms in both study groups, which is in accordance with the current study. On the other hand, based on their observations, the nose height of Sistani and Baloch women were 53 and 49.5, and the nose width were 32.3 and 31.4, respectively. They reported that the nose index of Sistani women (69.7) is greater than of Baloch © 2014 Mutaz B. Habal, MD
Copyright © 2014 Mutaz B. Habal, MD. Unauthorized reproduction of this article is prohibited.
The Journal of Craniofacial Surgery • Volume 25, Number 5, September 2014
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TABLE 7. Labio-Oral Measurements in the Study Population and Their Comparison With Those of NAWs Persian Versus NAW Measurements/Indices Mouth width
ch-ch (mm)
Upper lip height
sn-sto (mm)
Cutaneous upper lip height
sn-ls (mm)
Upper vermilion height
ls-sto (mm)
Mouth width-facial width index Upper lip-lower facial height index Cutaneous upper lip height-upper lip height index
ch−ch zy−zy
100
sn−sto sn−gn
100
sn−ls sn−sto
100
sn-ls inclination, degrees
Upper lip inclination
sto-sl (mm)
Lower lip height
li-sl (mm)
Cutaneous lower lip height
sto-li (mm)
Lower vermilion height Lower lip-lower facial height index Cutaneous lower lip height-lower lip height index
sto−sl sn−gn
100
sl−li sto−sl
100
sl-li inclination, degrees
Lower lip inclination
Sex
Mean (SD)
Min
Max
NAW, Mean (SD)
P Value
Men Women Men Women Men Women Men Women Men Women Men Women Men Women Men Women Men Women Men Women Men Women Men Women Men Women Men Women
50.5 (3.5) 47 (3.1) 22.1 (2.6) 20.1 (2.2) 15.3 (2.8) 12.9 (2.3) 7 (1.7) 7.6 (1.5) 35.8 (2.6) 35.8 (2.1) 30.9 (2.9) 30.5 (2.5) 69.2 (8.5) 64.4 (8.8) 5.6 (8.6) 8.9 (9.3) 18.7 (2.1) 17.4 (2) 10.1 (2) 8.6 (1.7) 9.9 (1.6) 10 (1.5) 26.3 (2.9) 26.5 (2.3) 54.4 (9.1) 49.3 (8.1) 47.2 (8.2) 50.5 (9.5)
43.5 40.2 17.4 15.2 10.6 7.14 2.2 4.4 30.5 31.3 24.7 25.5 52.2 44.8 −12.5 −17.2 14.8 13.4 5.6 5.2 4.9 6.4 20.1 22.8 28.3 32.1 25.4 27.7
57.7 54.3 26.8 24.3 23.2 17.8 10.5 10.7 43.6 40 36.9 36.4 89 84.2 31.3 30 23.6 22.3 14.3 11.9 13.3 13.8 34 32.3 75.5 69.1 66.1 74
53.5 (3.6) 49.8 (3.2) 21.8 (2.2) 20.1 (2.3) 14.8 (2.6) 13.5 (2.2) 9.5 (1.5) 8.6 (1.6) — — 32.4 (3.1) 31.1 (2.6) 67.3 (5.1) 69.4 (6.3) 1.5 (8.7) 0.8 (7.5) 18.8 (2.5) 16.7 (2.3) 11.9 (2.2) 9.9 (2.4) 11 (2.2) 10 (1.5) 26.8 (3.0) 26.5 (2.2) 63 (9.1) 61.1 (16.7) 46.6 (17.8) 48.6 (14.1)
≤0.0001* ≤0.0001* ≤0.53 ≤1.0 ≤0.56 ≤0.42 ≤0.0001* ≤0.002* — — ≤0.01* ≤0.24 ≤0.40 ≤0.07 ≤0.006* ≤0.0001* ≤0.83 ≤0.11 ≤0.0001* ≤0.002* ≤0.005* ≤1 ≤0.40 ≤1 ≤0.0001* ≤0.0001* ≤0.82 ≤0.37
*Statistically significant. Min, minimum measured amount; max, maximum measured amount.
TABLE 8. Chin and Neck Measurements in the Study Population and Their Comparison With Those of NAWs Persian Versus NAW Measurements/Indices Upper chin height
sl-pg (mm)
Lower chin height
pg-gn (mm)
Chin height
sl-gn (mm)
Throat length
gn-c (mm)
Chin height to lower facial height Upper chin height-chin height index Lower chin height-chin height index
sl−gn sn−gn
100
sl−pg sl−gn
100
pg−gn sl−gn
100
—
Mentocervical angle, degrees
Sex
Mean (SD)
Min
Max
NAW, Mean (SD)
P Value
Men Women Men Women Men Women Men Women Men Women Men Women Men Women Men Women
13.9 (3.6) 13.1 (2.9) 20.6 (4) 18 (3.4) 30.8 (2.9) 28.3 (2.9) 41.9 (6.7) 42.4 (6.1) 43.3 (3.6) 43.1 (4.6) 45.3 (12.1) 46.8 (11.1) 66.8 (11.2) 63.6 (10.4) 86.3 (15.2) 79 (12.3)
9 8.5 10.1 9.4 23.7 20.9 21.6 26.1 34.2 35.3 28.8 30.1 37.4 37.4 53.4 55.3
31.7 23.4 28.4 24.8 38.2 35 56.8 57.6 52.2 60.3 108.7 78.5 89.4 79 113.8 105
16.9 (3.6) 17.3 (2.3) 20.4 (3.7) 17.6 (2.2) 30.1 (3.3) 28.2 (2.6) — — 42.9 (4.7) 44.4 (3.2) — — — — 78.3 (7.9) 83.9 (9.3)
≤0.0001* ≤0.0001* ≤0.79 ≤0.49 ≤0.26 ≤0.86 — — ≤0.63 ≤0.10 — — — — ≤0.003* ≤0.04*
* Statistically significant. Min, minimum measured amount; max, maximum measured amount.
© 2014 Mutaz B. Habal, MD
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women (59.2). Given the definition of nose index as nose widthheight ratio, the accuracy of their findings should be considered with skepticism. Jahanshahi and associates8 studied a population from Gorgan, Iran, consisting of 2 races of Fars and Turkman. In both races, the dominant facial form was euryprosopic in women and mesoprosopic in men. There are 4 possible explanations for this difference between the reported results and the current study. The first is the racial difference in the 2 samples. Second, the n point was considered lower in their study, which led to a smaller face index. Third, a Martin spreading caliper with the millimeter gauge was used in their study, whereas in the current investigation, the long-jaw sliding caliper with the accuracy of 0.01 was used. Finally, Jahanshahi et al determined the facial forms based on the Banister classification, which is different from the classification considered in this study as well as the study of Farkas et al.2 Pezeshki Rad et al5 investigated anthropometric linear measurements of a group of normal adults in Mashhad, Iran, with a method similar to this study. The measurements of orbits, ears, and noses and the mouth width in their report were similar to the present findings. However, although the 2 studies documented similar measurements of the head length in both sexes and the head width in women, the head width in men was smaller than our observations. Overall, the findings of the 2 studies were almost completely comparable. The present study also compared the data collected from the Iranian population with those reported for the NAWs. Because both NAWs and most of the current study population were whites, more similarities were anticipated. However, considerable differences were found between the 2 populations with respect to their head height and width, biocular width, nose height, face height, mouth width, and upper chin height. Farkas et al2 observed that, compared with NAWs, Iranian women had longer faces than NAW women, which was the only difference between the 2 groups with regard to the facial height and width. These findings were generally corroborated in our study. However, the face height of Iranian men was approximately 10 mm greater than the facial height of Iranian men in the study of Farkas et al.2 Moreover, Farkas et al reported that, in Iranians, the eye fissure length and intercanthal width were extremely significantly smaller than NAWs in both sexes, whereas the biocular width (ex-ex) in men and women was significantly greater and smaller, respectively. There is a lack of conformity between these findings and those of the current study. According to this investigation, the biocular width of Iranian women was 92.3, whereas Farkas et al found it to be 79.8. Comparing the measurements in men and women, the current study revealed that both sexes have a brachycephalic head form with a slight tendency to mesocephalic form, and the mean head index was 81.5. On the contrary, the NAWs have a mesocephalic head form. The eye fissure length and, therefore, the eye index in both sexes were smaller than NAWs.9 The nose form in both sexes was leptorrhine, similar to NAWs. However, the nose index was significantly smaller in Iranian women.9 The facial form was mostly leptoprosopic. The 3 vertical thirds were not equal, and the upper third was smaller. Whereas the NAWs men have leptoprospic faces, the women have mesoprosopic faces. The mouth width and upper vermilion height were smaller than NAWs.9,17 As expected, most of the linear measurements were greater in men. However, because the differences were proportionate, it had not affected the indices.18–20 Similarly, Farkas et al19 showed no significant difference between sexes with regard to the neoclassic canon proportions. In our study, the nose index of women reveals that they have longer noses with smaller width compared with men. The study performed by Ngeow and Aljunid supports this observation.21 Moreover, we found that cutaneous upper and lower lip height in men is a greater percentage
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of the total lip height, which is in accordance with the findings of Ngeow and Aljunid22 and Farkas et al.17 In comparison of the findings of this study with those reported for neoclassic canons,23 trichion (tr)-g, g-sn, and sn-gnathion (gn) were not equal, and the forehead height (30% of the face height) was smaller than the other thirds, which are equal to each other. The ear height was also greater than the nose height in the studied subjects. The upper lip, lower lip, and chin have been suggested as the equal thirds of lower facial height. Other views claim that the upper lip and the lower lip are one fourth of the lower facial height, whereas the chin constitutes the remaining half of the lower facial height.17,23,24 However, none of these proportions were seen in the subjects of the current study (lower lip, 26%; upper lip, 30%; chin, 44%). Our results confirmed the equivalence between en-en and en-ex. However, whereas the nose width was equal to the intercanthal width in women, it was wider in men. The equation of zy-zy = 4 al-al was observed in women but not in men (because of their wider noses). Moreover, the equation of cheilion-cheilion (ch-ch) = 1.5 al-al was not obtained in the subjects.25–27 Accordingly, the neoclassic canons are not quite comparable with the Iranian population evaluated in this study. Similar to the study of Farkas et al,19 this inconsistency is more prominent in the vertical proportions. On the whole, the findings of the current study showed that, despite that the Iranian population mostly consists of whites, considerable differences with regard to the measurements of head, orbits, nose, ears, face, labio-oral, and chin regions exist between them and the NAWs. These differences were clinically significant. Because the facial anatomic proportions are of utmost importance in determining the beauty and attractiveness of the face, the reference ranges of each measurement might be used as references to treat the disproportions in patients and improve their appearance. The differences found between the values measured in the current study and those reported in textbooks underscore that reference ranges of other populations cannot be generalized to Iranian races. The present study tried to establish the reference range of craniofacial anthropometric measurements in an adult Iranian population. These measurements might be efficiently used as references for esthetic treatments.
CONCLUSIONS According to the findings of this study, most linear measurements were greater in men than in women, although the differences did not affect the indices. It was also shown that both sexes of normal adult Iranian population have brachycephalic heads, leptoprosopic faces, and leptorrhine noses. In comparison with NAWs, considerable differences were observed in the head, face, orbits, labio-oral, nose, and chin regions. These differences were more prominent in the head region of both sexes as well as the face and nose regions in women. Whereas Iranian women were found to have leptoprosopic faces, NAWs women have mesoprosopic faces. The least differences between the 2 populations were related to the ear region.
REFERENCES 1. Fernandez-Riveiro P, Smyth-Chamosa E, Suarez-Quintanilla D, et al. Angular photogrammetric analysis of the soft tissue facial profile. Eur J Orthod 2003;25:393–399 2. Farkas LG, Katic MJ, Forrest CR, et al. International anthropometric study of facial morphology in various ethnic groups/races. J Craniofac Surg 2005;16:615–646 3. Farkas LG, Katic MJ, Forrest CR. Comparison of craniofacial measurements of young adult African American and North American white males and females. Ann Plast Surg 2007;59:692–698
© 2014 Mutaz B. Habal, MD
Copyright © 2014 Mutaz B. Habal, MD. Unauthorized reproduction of this article is prohibited.
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4. Fariaby J, Hossini A, Saffari E. Photographic analysis of faces of 20-year-old students in Iran. Br J Oral Maxillofac Surg 2006;44:393–396 5. Pezeshki Rad H, Jahanbin A, et al. An investigation on facial and cranial anthropometric measurements among 20–35 year old individuals in the city of Mashhad. J Mashhad Dent Sch 2008;31:261–268 6. Mojtahedzadeh F, Alizadeh S. Comparison of anthropometric measurements as substitutes for McNamara’s cephalometric maxillomandibular unit measurements. J Dent Med 2011;24:87–93 7. Heidari Z, Mahmoudzadeh-Sagheb H, Khammar T, et al. Anthropometric measurements of the external nose in 18-25-year-old Sistani and Baluch aborigine women in the southeast of Iran. Folia Morphol (Warsz) 2009;68:88–92 8. Jahanshahi M, Golalipour MJ, Heidari K. The effect of ethnicity on facial anthropometry in Northern Iran. Singapore Med J 2008;49:940–943 9. Farkas LG. Anthropometry of the head and face. New York: Raven Press, 1994 10. Ricketts RM. The golden divider. J Clin Orthod 1981;15:752–759 11. Proffit WR, Fields HW Jr, Sarver DM. Contemporary orthodontics. Canada: Mosby Elsevier 2007 12. Nechala P, Mahoney J, Farkas LG. Digital two-dimensional photogrammetry: a comparison of three techniques of obtaining digital photographs. Plast Reconstr Surg 1999;103:1819–1825 13. Lundstrom A, Forsberg CM, Peck S, et al. A proportional analysis of the soft tissue facial profile in young adults with normal occlusion. Angle Orthod 1992;62:127–133; discussion 33–34 14. Farkas LG, Bryson W, Klotz J. Is photogrammetry of the face reliable? Plast Reconstr Surg 1980;66:346–355 15. Farkas LG, Tompson BD, Katic MJ, et al. Differences between direct (anthropometric) and indirect (cephalometric) measurements of the skull. J Craniofac Surg 2002;13:105–108; discussion 9–10
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16. Madanipour A. Tehran: the making of a metropolis. World cities series. New York: John Wiley, 1998 17. Farkas LG, Katic MJ, Hreczko TA, et al. Anthropometric proportions in the upper lip-lower lip-chin area of the lower face in young white adults. Am J Orthod 1984;86:52–60 18. Fang F, Clapham PJ, Chung KC. A systematic review of interethnic variability in facial dimensions. Plast Reconstr Surg 2011;127:874–881 19. Farkas LG, Hreczko TA, Kolar JC, et al. Vertical and horizontal proportions of the face in young adult North American Caucasians: revision of neoclassical canons. Plast Reconstr Surg 1985;75:328–338 20. Zhuang Z, Landsittel D, Benson S, et al. Facial anthropometric differences among gender, ethnicity, and age groups. Ann Occup Hyg 2010;54:391–402 21. Ngeow WC, Aljunid ST. Craniofacial anthropometric norms of Malaysian Indians. Indian J Dent Res. 2009;20:313–319 22. Ngeow WC, Aljunid ST. Craniofacial anthropometric norms of Malays. Singapore Med J 2009;50:525–528 23. Wang D, Qian G, Zhang M, et al. Differences in horizontal, neoclassical facial canons in Chinese (Han) and North American Caucasian populations. Aesthetic Plast Surg 1997;21:265–269 24. Naini FB. Facial aesthetics: concepts and clinical diagnosis. New Dehli: Wiley-Blackwell, 2011 25. Le TT, Farkas LG, Ngim RC, et al. Proportionality in Asian and North American Caucasian faces using neoclassical facial canons as criteria. Aesthetic Plast Surg 2002;26:64–69 26. Byrd HS, Hobar PC. Rhinoplasty: a practical guide for surgical planning. Plast Reconstr Surg 1993;91:642–654; discussion 55–56 27. Choe KS, Sclafani AP, Litner JA, et al. The Korean American woman’s face: anthropometric measurements and quantitative analysis of facial aesthetics. Arch Facial Plast Surg 2004;6:244–252
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Craniofacial Morphologic Parameters in a Persian Population: An Anthropometric Study Fariborz Amini, DDS, MS,* Ziba Mashayekhi, DDS, MS, Hajir Rahimi, DDS, MS,* and Golnaz Morad, DDS† Abstract: Limited data are available regarding the reference ranges of facial proportions of the Persian population in Iran. This study aimed to establish the reference range of craniofacial anthropometric measurements in an adult Iranian population. On 100 individuals (men = women), aged 18 to 30 years with normal faces and occlusions, 34 linear and 7 angular measurements as well as 24 indices were calculated. The difference of measurements between men and women were evaluated by paired t-test. The data were compared with the norms of North American whites using 1-sample t-test. The subjects belonged to 5 ethnic groups (57% from Fars, 14% from Kord, 11% from Azari, 10% from Gilaki-Mazani, and 2% from Lor). All head measurements were greater in men except for the head index and the head height. The subjects had leptoprosopic faces. The intercanthal width was almost one third of the biocular width and greater than the eye fissure length. Although the nose width of women was significantly smaller, both sexes had leptorrhine noses. The chin height and lower chin height were greater in men. In comparison with North American whites, considerable differences were found regarding head height and width, biocular width, nose height, face height, mouth width, and upper chin height. In conclusion, the reference range of craniofacial anthropometric measurements established for the Iranian population might be efficiently used for esthetic treatments. Key Words: Anthropometry, craniofacial proportions, soft tissue analysis (J Craniofac Surg 2014;25: 1874–1881)
E
valuation of soft tissue proportions and parameters is a critical point in diagnosis and treatment planning in patients with maxillofacial deformities or esthetic problems. The standards of esthetics considerably vary according to race/ethnicity, sex, and age. Determination of anthropometric measurements and reference ranges of each ethnic group is therefore essential for indicating the degree of deviations from normal.1–4 From the *Department of Orthodontics, Dental Branch, Islamic Azad University, Tehran, Iran; and †Research Institute of Dental Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Received June 9, 2013. Accepted for publication February 10, 2014. Address correspondence and reprint requests to Hajir Rahimi, DDS, MS, Department of Orthodontics, Islamic Azad University, 10th Neyestan St, Pasdaran, Tehran, Iran; E-mail: [email protected] Ziba Mashayekhi is in private practice in Tehran, Iran. The authors report no conflicts of interest. Copyright © 2014 by Mutaz B. Habal, MD ISSN: 1049-2275 DOI: 10.1097/SCS.0000000000000902
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At present, very limited data are available regarding the reference ranges of facial proportions and anthropometric measurements of the Persian population in Iran. Aiming to establish normal measurements for different ethnicities, Farkas et al2 collected anthropometric data of 1470 individuals from 25 European, Middle Eastern, Asian, and African countries including Iran. Other studies have also evaluated the Iranian population for facial/craniofacial proportions.4–7 The reported data, however, are confined to certain ethnic groups in Iran and cannot be generalized to all the Iranian population.2,4–7 In addition, only particular anatomic regions are included in these data, whereas many essential parameters for diagnosis and treatment planning are left unevaluated.2,7,8 Furthermore, there are some inconsistencies between the results of these studies.2,4 It is for these reasons that measurements reported in other populations, particularly North American whites (NAWs),9 are commonly considered in the current treatment guidelines for Iranian patients. Apparently, these measurements may not be compatible with the specific anthropometric characteristics of Iranian people. This study aimed to establish the reference range of craniofacial anthropometric measurements in the adult Iranian population.
MATERIALS AND METHODS Subjects This cross-sectional study was conducted on dental students of the Azad University, Tehran, Iran, in 2011 to 2012. After clinical examination and interview of 1000 students, 100 individuals (50 men, 50 women) aged between 18 to 30 years old were enrolled. Criteria of inclusion were as follows: (1) no history of orthodontic treatment; (2) no history of trauma to the craniofacial region; (3) no history of plastic surgery in the orofacial region; (4) having Iranian parents and grandparents; and (5) normal face and occlusion, which was defined by symmetric face and occlusion, normal facial height, straight profile, Cl-I molar relationship, normal overjet and overbite, no posterior cross-bite, no dentoalveolar protrusion or retrusion, no considerable spacing or crowding, no missing or extraction of the teeth anterior to the first molar, and/or no supernumerary teeth anterior to the first molar. The study was approved by the ethical committee of the university, and informed consent for reviewing the data of patients was obtained at enrollment.
Measurements Clinical examinations, interviews, and measurements were performed separately by 2 orthodontic residents (Z.M. and H.R.). To assess the raters’ reliability, all the measurements were initially taken in 10 women and 10 men, for 3 times with 7-day intervals, and the intraclass correlation coefficient was calculated. As demonstrated in Figures 1 and 2, 27 anatomic on the patients’ face and head were considered for measurements and, if possible, were marked by a black erasable pen. These points are standard anatomic landmarks used in previous studies.9 Using the
The Journal of Craniofacial Surgery • Volume 25, Number 5, September 2014
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belonged to 5 ethnic groups (57% from Fars, 14% from Kord, 11% from Azari, 10% from Gilaki-Mazani, and 2% from Lor). Intraclass correlation test results are shown in Table 1. All the measurement except for the glabella-subnasale (g-sn) inclination had perfect ICCs. The nose width (alare-alare [al-al]), head height (vertex-nasion [v-n]), and sn-pogonion (pg) inclination had moderate ICCs. The craniofacial measurements of the 5 ethnic groups, the comparison between sexes, and their relationship to the NAWs’ reference range are presented later.
Head
FIGURE 1. Anatomic points: tr, g, n, pronasale (prn), sn, labiale superius (ls), stomion (sto), ch, labiale inferius (li), sublabiale (sl), pg, gn, cervical point (c), orbitale (or), en, ex, and zy.
Farkas9 method, 34 linear and 7 angular measurements were taken. Measurement devices included digital sliding calipers with long jaws, digital sliding calipers, digital hook depth gauge, and digital protractor and level (Insize, Austria). Given the importance of golden ratio in treatment planning, 9 additional indices were also taken.10 The Frankfort line was considered as the reference line.11
Statistical Analysis Data were analyzed by the Statistical Package for the Social Sciences (version 18; SPSS Inc, Chicago). Mean of the measurements taken by the 2 raters was considered for analyses. ShapiroWilk test confirmed the normal distribution of data. A P < 0.01 was considered statistically significant. The difference of measurements between men and women was evaluated by paired t-test. Moreover, the data were compared with the norms of NAWs previously reported by Farkas9 using 1-sample t-test.
RESULTS The 100 participants enrolled in this study were aged between 18 to 30 years old (mean, 23.7; SD, 3.4). The subjects
All measurements were greater in men than men except for the head index and head height (v-n). The head circumference in men and head height in women showed the greatest variations. In comparison with NAWs, Iranians had wider and shorter heads. Head width in 30% of the women was greater than the reference range of NAW women. Head index measurements showed that, whereas NAWs have a mesocephalic head form, subjects of the current study were brachycephalic (Table 2).
Ear The ear dimensions were greater in men than women. However, the ear index was similar in both sexes. Comparing with the NAWs, only the ear length was significantly greater in the Iranian men (Table 3).
Orbits The biocular width (exocanthion-exocanthion [ex-ex]) was greater in men. However, other measurements were similar in men and women. The eye index revealed that the intercanthal width (endocanthion-endocanthion [en-en]) was almost one third of the biocular width and slightly greater than the eye fissure length (en-ex). Significantly greater biocular width (and therefore, smaller eye index) was seen in the subjects in comparison with NAWs (P < 0.0001). Other measurements were comparable with NAWs (Table 4).
Nose The nose index was significantly different between men and women. Although the nose width (al-al) of women was significantly TABLE 1. Correlations Between the Three Records of Each Anthropometric Measurement Measurement
ICC*
Measurement
ICC
Measurement
ICC
g-op
0.95 0.99 0.99 0.95 0.97 0.92 0.99 0.74 0.99 0.97 0.96 0.95 0.93 0.98
al-al sn-prn ch-ch sn-sto sn-ls ls-sto sto-sl li-sl sto-li sto-gn sl-pg pg-gn sl-gn pra-pa
0.69 0.84 0.93 0.99 0.98 0.92 0.94 0.91 0.73 0.98 0.82 0.95 0.97 0.95
sa-sba en-en ex-ex en-ex gn-c v-n g-sn inclination sn-pg inclination bridge inclination sn-ls inclination sl-li inclination mentocervical angle nasolabial angle
0.99 0.94 0.96 0.71 0.95 0.67 0.42 0.62 0.96 0.97 0.97 0.98 0.98
eu-eu g-op zy-zy go-go tr-gn n-gn n-sto tr-g g-sn sn-gn t-sn t-gn n-sn FIGURE 2. Anatomic points: v, n, ex, orbitale (or), al, pronasale (prn), sn, stomion (sto), sublabiale (sl), pg, zy, tragion (t), superaurale (sa), subaurale (sba), postaurale (pa), preaurale (pra), go, and opisthocranion (op).
*Poor, 0–0.2; fair, 0.3–0.4; moderate, 0.5–0.6; strong, 0.7–0.8; and perfect, >0.8. ICC, intra class correlation.
© 2014 Mutaz B. Habal, MD
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TABLE 2. Head Measurements in the Study Population and Their Comparison With Those of NAWs Persian Versus NAW Measurements/Indices
Sex
Width of the head
eu-eu (mm)
Length of the head
g-op (mm)
Height of the head
v-n (mm) on-op (mm)
Head circumference Head index
eu−eu g−op
100
Mean (SD)
Men Women Men Women Men Women Men Women Men Women
158.7 151.8 194.4 186.7 106.4 104.2 573.1 551.9 81.7 81.4
(5.4) (3.9) (6.2) (5.5) (5.3) (6.1) (13.1) (13.8) (3.5) (2.9)
Min
Max
NAWs, Mean (SD)
P Value
148 141.4 178 172.9 93.4 89.4 545 490 74.2 74.7
169.3 163.4 211 198.1 115.3 115.7 606 578 91.3 88.6
153.3 (5.9) 144.4 (4.6) 193.7 (7.6) 184.9 (7) 117.7 (8) 112.7 (7.1) 568.6 (16.1) 544.4 (14.8) 79.2 (4.6) 78.2 (4.2)
≤0.0001* ≤0.0001* ≤0.62 ≤0.15 ≤0.0001* ≤0.0001* ≤0.13 ≤0.0098* ≤0.003* ≤0.0001*
*Statistically significant. Min, minimum measured amount; Max, maximum measured amount.
smaller than men (P < 0.0001), the nose form of both sexes was leptorrhine. Similar to neoclassic canons, the nose width in women was almost equal to the eye fissure length. Nose width was approximately one fourth of the facial width in subjects. Nasal bridge inclination and nose height had the greatest and smallest variations, respectively. Nose height (n-sn) in both sexes (34% of men and 66% of women) was significantly greater than those of the reference range in NAW (P < 0.0001). Therefore, the nose index was also affected. Both populations had leptorrhine noses. However, female subjects had smaller nasal width than NAW women (P < 0.0001). The nasolabial angle of Iranian women was also smaller than of NAWs. In contrast to NAWs in which the nasolabial angle is significantly greater in women, the men and women in the current study were identical (Table 5).
Face Men had bigger faces in 3 dimensions than women. However, because these differences were proportionate, the indexes were comparable in men and women. Regarding the face index, the subjects had leptoprosopic (long) faces. The mandible width (goniongonion [go-go]) was three fourths of the face width (zygion-zygion [zy-zy]), and the depth of maxilla was 43% of the mandible depth. Among facial indices, face width in women and forehead height in men had the smallest and greatest variations. A slight convexity was observed in the profiles of both sexes. Moreover, the results showed that the 3 vertical thirds were not equal in the subjects (forehead, 30%; middle third, 35%; lower third, 35%). The facial height and upper facial height were significantly greater in NAWs (P < 0.0001). Mandible width, mandibular depth,
and maxillary depth were greater in female subjects than in NAW women (P < 0.0001). Regarding the facial index, although the facial form of the NAW women is mesoprosopic, the female subjects were dominantly leptoprosopic. However, both Iranian and NAW men had leptoprosopic faces, and there was no significant difference among them (Table 6).
Labio-Oral Region Mouth width, upper and lower lip height, and cutaneous upper and lower lip height were greater in men than women. In both sexes, the mouth width is almost one third of the bizygomatic width, the upper lip height is 30% of the lower facial height, and the lower lip height is 26% of the lower facial height. Upper vermilion height of the men and mouth width-facial width index in women had the most and least variations, respectively. The mouth width, upper vermilion height, and cutaneous lower lip height were smaller than NAW in both sexes (P < 0.0001 and P < 0.002). Lower vermilion height is smaller in male subjects than in NAWs; however, the women of both races were the same. Despite the lower lip inclination, which was similar to NAWs, upper lip inclination was greater in the male and female subjects (P < 0.0001 and P < 0.006) (Table 7).
Chin and Neck The chin height and lower chin height were greater in men. On average, the chin height is 43% of the lower facial height. Upper and lower chin height is 45% and 64% of the chin height, respectively. The throat length was approximately 42 mm, and no significant difference was observed between men and women. Upper chin
TABLE 3. Ear Measurements in the Study Population and Their Comparison With Those of NAWs Persian Versus NAW Measurements/Indices Ear width
pra-pa (mm)
Ear length
sa-sba (mm)
Ear index
pra−pa sa−sba
100
Sex
Mean (SD)
Min
Max
NAW, Mean (SD)
Men Women Men Women Men Women
37.4 (2.4) 34 (2.8) 63.3 (4.8) 59.5 (3.5) 59.2 (4.8) 57.2 (4)
28.1 27.1 53.7 51 40.3 48.6
41.3 41.6 83.8 65.4 68 64.8
35.9 (2.2) 34.1 (2.6) 62.4 (3.7) 59 (3.6) 58.1 (3.9) 57.4 (3.8)
P Value ≤0.002* ≤0.85 ≤0.29 ≤0.48 ≤0.21 ≤0.79
*Statistically significant. Min, minimum measured amount; max, maximum measured amount.
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TABLE 4. Eye Measurements in the Study Population and Their Comparison With Those of NAWs Persian Versus NAW Sex
Mean (SD)
Min
Max
NAW, Mean (SD)
P Value
Men Women Men Women Men Women Men Women
32.8 (2.9) 32.2 (2.7) 94.7 (4.2) 92.3 (3.6) 31.6 (1.9) 31 (1.7) 34.6 (2.4) 34.9 (2.3)
26.7 25.5 85.8 84.6 27.7 27.9 29.1 30.2
38.6 40 103.7 27.9 36.1 35.4 40.3 42.6
32.9 (2.7) 32.5 (2.1) 90.7 (3.8) 87.6 (4) 31.2 (1.4) 30.7 (1.8) 37.4 (2.2) 37.2 (2.4)
≤0.86 ≤0.53 ≤0.0001* ≤0.0001* ≤0.24 ≤0.39 ≤0.0001* ≤0.0001*
Measurements/Indices Intercanthal width
en-en (mm)
Biocular width
ex-ex (mm)
Eye fissure length (left)
en-ex (mm)
Eye index
en−en ex−ex
100
*Statistically significant. Min, minimum measured amount; max, maximum measured amount.
height and the chin height-lower facial height in men had the most and least variations, respectively. The upper chin was smaller than NAWs in both sexes (P < 000.1) (Table 8).
DISCUSSION This study investigated the craniofacial anthropometric measurements of an adult Iranian population in 2011 to 2012. Different methods are available for the assessment of facial dimensions.6,12,13 However, the reliability of direct clinical measurement is considerably more than photography and cephalometry.14,15 We selected 34 linear and 7 angular measurements based on the Farkas9 method and calculated 24 indices from a sample of 50 men and 50 women. A few anthropometric studies have been previously performed on certain ethnic/racial groups in Iran.2,4,5,7,8 In this study, the sample group was chosen from Tehran, the capital of Iran, which is a multiracial city and can be a proper sample of the Iranian population.16 Farkas et al2 evaluated 30 men and 30 women in Iran in their international evaluation. Their findings regarding the eye fissure
length were in contrast to the current study where no significant difference was observed between sexes (30.7 in women and 31.2 in men). With respect to ear height and mouth width, the findings of these 2 studies were compatible. However, we observed that the nasal bridge inclination in both sexes and nose height in men were greater than those of the Iranian sample in the study of Farkas et al.2 This dissimilarity in results can be justified by the different sampling methods of the 2 studies. In the study of Farkas et al, the samples were randomly selected. On the contrary, the subjects of the current study were chosen based on a healthy population of normal and proportionate faces and occlusions in all 3 dimensions. The findings of Farkas et al might probably be confounded by not strictly adhering to the proportionate face criterion for the inclusion of samples as well as the small sample size. Observations of Fariaby and associates4 who studied a group of Iranian adults in Kerman, Iran, are well matched to the findings of this study regarding the measurements of orbit, mouth width, upper and lower lip height in both sexes, and nasolabial angle in men. However, they reported a greater nasolabial angle in women comparing with this study. Furthermore, shorter and wider noses and
TABLE 5. Nose Measurements in the Study Population and Their Comparison With Those of NAWs Persian Versus NAW Measurements/Indices Nose width
al-al (mm)
Nose height
n-sn (mm) sn-prn (mm)
Protrusion of the tip of nose Nose index Protrusion of nose-nose width index Nose height-morphologic height of face index Nose width-facial width index
al−al n−sn
100
sn−prn al−al
100
n−sn n−gn
100
al−al zy−zy
100
Nasal bridge inclination, degrees
—
Nasolabial angle, degrees
—
Sex
Mean (SD)
Min
Max
NAW, Mean (SD)
Men Women Men Women Men Women Men Women Men Women Men Women Men Women Men Women Men Women
36.7 (2.5) 32.8 (2.2) 58.4 (3.7) 56.8 (3.4) 20 (2.6) 19.3 (2.2) 63.1 (7) 57.9 (5.1) 54.7 (7.2) 58.9 (7.1) 45.8 (2.5) 47.3 (2.2) 26 (1.9) 24.9 (1.5) 33.7 (6.3) 31.2 (5.4) 97 (8.9) 94.6 (10.5)
31.4 28.4 50.8 49.4 13 14.5 48.3 48.1 35.8 44.1 40.6 42 21.5 21.9 14.2 15 73.1 79.7
42.1 38.5 66.3 65.3 26.2 23.8 82.5 70.7 68.7 77.6 51.2 51.7 30.5 29 43.9 42.1 119.2 130.1
34.8 (2.7) 31.9 (1.9) 53.2 (3.3) 49.2 (2.9) 20.6 (2.2) 19.4 (1.7) 65.8 (6.8) 65.1 (5.8) 59.8 (7.9) 61.7 (6) — — — — 31.6 (4.6) 30 (5.3) 99.8 (11.8) 104.2 (9.8)
P Value ≤0.09 ≤0.03* ≤0.0001* ≤0.0001* ≤0.21 ≤0.8 ≤0.05* ≤0.0001* ≤0.001* ≤0.03* — — — — ≤0.06 ≤0.26 ≤0.14 ≤0.0001*
*Statistically significant. Min, minimum measured amount; max, maximum measured amount.
© 2014 Mutaz B. Habal, MD
Copyright © 2014 Mutaz B. Habal, MD. Unauthorized reproduction of this article is prohibited.
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TABLE 6. Face Measurements in the Study Population and Their Comparison With Those of NAWs Persian Versus NAW Measurements/Indices Face width
zy-zy (mm)
Mandible width Morphologic height of face
go-go (mm) n-gn (mm)
Face width Mandible width Morphologic height of face
n-sto (mm) sto-gn (mm)
Mandible height Facial index Mandible width-morphologic height of face index Lower face-morphologic height of face index Mandible index Mandible width-face width index
n−gn zy−zy
100
go−go n−gn
100
sn−gn n−gn
100
sto−gn go−go
100
go−go zy−zy
100
Maxillary depth
t-sn (mm)
Mandibular depth
t-gn (mm)
Maxilla-mandible depth index
t−sn t−gn
100
tr-gn (mm)
Physiognomic height of face Forehead height
tr-g (mm)
g-sn distance
g-sn (mm) sn-gn (mm)
Lower facial height Forehead height-physiognomic height of face index g-sn distance-physiognomic height of face index Lower facial height-physiognomic height of face index
tr−g tr−gn
100
g−sn tr−gn
100
sn−gn tr−gn
100
Upper profile inclination
g-sn inclination, degrees
Lower profile inclination
sn-pg inclination, degrees
Sex
Mean (SD)
Min
Men Women Men Women Men Women Men Women Men Women Men Women Men Women Men Women Men Women Men Women Men Women Men Women Men Women Men Women Men Women Men Women Men Women Men Women Men Women Men Women Men Women Men Women
141.2 (5.4) 131.5 (4.3) 107.9 (6.3) 101 (5.3) 127.4 (4.8) 120.1 (5.5) 79.2 (3.9) 76.1 (4.1) 51 (3.8) 46.4 (2.9) 90.3 (4.4) 91.4 (5) 84.8 (5.5) 84.3 (5.3) 55.9 (2.3) 54.8 (2.4) 47.3 (3.9) 46 (3.3) 76.4 (3.6) 76.8 (3.8) 132.6 (5.6) 123.2 (4.8) 150.4 (6.5) 138.4 (5.4) 43.4 (5.4) 43.3 (4.4) 191.9 (9.7) 180.1 (9.7) 59.2 (9.4) 53.9 (7.3) 67.1 (4.2) 64.9 (4.5) 71.3 (4.2) 65.8 (4.2) 30.7 (3.8) 29.8 (3) 35.1 (2.6) 36.1 (2.6) 37.2 (2.1) 36.6 (2) 3.5 (3.6) 1.6 (3.2) −8.9 (7.8) −11.7 (6.7)
127.7 121.4 97.8 86 117.1 108.2 69 68.3 43.8 39.2 80.6 78.4 75 74.3 49.8 49.1 39.2 39.2 70.1 67.3 121.2 114.5 135.9 129.8 80.5 77.1 175.1 154.2 41.1 35.6 56.5 52.8 62.7 57.6 23.4 23.1 27.1 30.6 33 31.4 −7.4 −5.7 −23.4 −24.5
Max
NAWs, Mean (SD)
P Value
151.7 143 121.5 111 138.4 130.8 88.3 85 63.3 52 98.6 101.4 102.8 99.2 61.7 59.7 55.1 53.3 83.7 84.5 145.1 137.1 166.6 157 92.5 94.4 216.4 198.1 79.7 69.2 75 74.5 79.6 72.8 38.4 36.9 42.1 41 42.2 40.8 13.8 7.1 18.3 11.5s
139.1 (6.3) 131.1 (5.3) 105.6 (6.7) 94.5 (5) 121.3 (6.8) 112 (4.7) 74 (4.2) 68.9 (3.9 48.8 (4) 44.8 (3.4) 88.5 (5.1) 86.2 (4.6) — — 59.2 (2.7) 58.6 (2.9) — — — — 131.8 (4.3) 119.3 (4) 148.2 (5.2) 133.9 (5.1) — — 187.2 (12.1) 173.3 (7.8) 57 (7.4) 52.7 (6) 67.2 (4.9) 63.1 (4.4) 72.6 (4.5) 64.3 (4) — — — — — — 1.3 (3.5) 1.6 (2.5) −10.6 (5.3) −13.3 (4.5)
≤0.08 ≤0.68 ≤0.04* ≤0.0001* ≤0.0001* ≤0.0001* ≤0.0001* ≤0.0001* ≤0.006* ≤0.013* ≤0.06 ≤0.0001* — — ≤0.0001* ≤0.0001* — — — — ≤0.32 ≤0.0001* ≤0.02* ≤0.0001* — — ≤0.02* ≤0.0001* ≤0.11 ≤0.23 ≤0.9 ≤0.01* ≤0.09 ≤0.02* — — — — — — ≤0.004* ≤1.0 ≤0.12 ≤0.04*
*Statistically significant. Min, minimum measured amount; max, maximum measured amount.
greater binocular width were reported for the evaluated population. In addition to racial differences between the people from Tehran and Kerman, using photographs instead of direct clinical measurement may account for the inconsistencies between the 2 studies. Photographs have been proved to be generally less reliable than direct measurement for anthropometric studies. However, the reliability of photographs in the assessment of labio-oral and angular measurements were shown to be greater than the alternatives.14 The similarity of labio-oral measurements between the 2 studies fortifies the assumption that the abovementioned variations may be the result of distortions in photographs. Moreover, the n point
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considered in the current study was lower than that in the study of Fariabi et al. This might be the reason for the differences in nose height between the 2 studies. Heidari and coworkers7 assessed the nasal and facial form of Sistani and Baloch women from southeast Iran. The leptorrhine nose and leptoprosopic face were reported as the dominant forms in both study groups, which is in accordance with the current study. On the other hand, based on their observations, the nose height of Sistani and Baloch women were 53 and 49.5, and the nose width were 32.3 and 31.4, respectively. They reported that the nose index of Sistani women (69.7) is greater than of Baloch © 2014 Mutaz B. Habal, MD
Copyright © 2014 Mutaz B. Habal, MD. Unauthorized reproduction of this article is prohibited.
The Journal of Craniofacial Surgery • Volume 25, Number 5, September 2014
Parameters in Persian Population
TABLE 7. Labio-Oral Measurements in the Study Population and Their Comparison With Those of NAWs Persian Versus NAW Measurements/Indices Mouth width
ch-ch (mm)
Upper lip height
sn-sto (mm)
Cutaneous upper lip height
sn-ls (mm)
Upper vermilion height
ls-sto (mm)
Mouth width-facial width index Upper lip-lower facial height index Cutaneous upper lip height-upper lip height index
ch−ch zy−zy
100
sn−sto sn−gn
100
sn−ls sn−sto
100
sn-ls inclination, degrees
Upper lip inclination
sto-sl (mm)
Lower lip height
li-sl (mm)
Cutaneous lower lip height
sto-li (mm)
Lower vermilion height Lower lip-lower facial height index Cutaneous lower lip height-lower lip height index
sto−sl sn−gn
100
sl−li sto−sl
100
sl-li inclination, degrees
Lower lip inclination
Sex
Mean (SD)
Min
Max
NAW, Mean (SD)
P Value
Men Women Men Women Men Women Men Women Men Women Men Women Men Women Men Women Men Women Men Women Men Women Men Women Men Women Men Women
50.5 (3.5) 47 (3.1) 22.1 (2.6) 20.1 (2.2) 15.3 (2.8) 12.9 (2.3) 7 (1.7) 7.6 (1.5) 35.8 (2.6) 35.8 (2.1) 30.9 (2.9) 30.5 (2.5) 69.2 (8.5) 64.4 (8.8) 5.6 (8.6) 8.9 (9.3) 18.7 (2.1) 17.4 (2) 10.1 (2) 8.6 (1.7) 9.9 (1.6) 10 (1.5) 26.3 (2.9) 26.5 (2.3) 54.4 (9.1) 49.3 (8.1) 47.2 (8.2) 50.5 (9.5)
43.5 40.2 17.4 15.2 10.6 7.14 2.2 4.4 30.5 31.3 24.7 25.5 52.2 44.8 −12.5 −17.2 14.8 13.4 5.6 5.2 4.9 6.4 20.1 22.8 28.3 32.1 25.4 27.7
57.7 54.3 26.8 24.3 23.2 17.8 10.5 10.7 43.6 40 36.9 36.4 89 84.2 31.3 30 23.6 22.3 14.3 11.9 13.3 13.8 34 32.3 75.5 69.1 66.1 74
53.5 (3.6) 49.8 (3.2) 21.8 (2.2) 20.1 (2.3) 14.8 (2.6) 13.5 (2.2) 9.5 (1.5) 8.6 (1.6) — — 32.4 (3.1) 31.1 (2.6) 67.3 (5.1) 69.4 (6.3) 1.5 (8.7) 0.8 (7.5) 18.8 (2.5) 16.7 (2.3) 11.9 (2.2) 9.9 (2.4) 11 (2.2) 10 (1.5) 26.8 (3.0) 26.5 (2.2) 63 (9.1) 61.1 (16.7) 46.6 (17.8) 48.6 (14.1)
≤0.0001* ≤0.0001* ≤0.53 ≤1.0 ≤0.56 ≤0.42 ≤0.0001* ≤0.002* — — ≤0.01* ≤0.24 ≤0.40 ≤0.07 ≤0.006* ≤0.0001* ≤0.83 ≤0.11 ≤0.0001* ≤0.002* ≤0.005* ≤1 ≤0.40 ≤1 ≤0.0001* ≤0.0001* ≤0.82 ≤0.37
*Statistically significant. Min, minimum measured amount; max, maximum measured amount.
TABLE 8. Chin and Neck Measurements in the Study Population and Their Comparison With Those of NAWs Persian Versus NAW Measurements/Indices Upper chin height
sl-pg (mm)
Lower chin height
pg-gn (mm)
Chin height
sl-gn (mm)
Throat length
gn-c (mm)
Chin height to lower facial height Upper chin height-chin height index Lower chin height-chin height index
sl−gn sn−gn
100
sl−pg sl−gn
100
pg−gn sl−gn
100
—
Mentocervical angle, degrees
Sex
Mean (SD)
Min
Max
NAW, Mean (SD)
P Value
Men Women Men Women Men Women Men Women Men Women Men Women Men Women Men Women
13.9 (3.6) 13.1 (2.9) 20.6 (4) 18 (3.4) 30.8 (2.9) 28.3 (2.9) 41.9 (6.7) 42.4 (6.1) 43.3 (3.6) 43.1 (4.6) 45.3 (12.1) 46.8 (11.1) 66.8 (11.2) 63.6 (10.4) 86.3 (15.2) 79 (12.3)
9 8.5 10.1 9.4 23.7 20.9 21.6 26.1 34.2 35.3 28.8 30.1 37.4 37.4 53.4 55.3
31.7 23.4 28.4 24.8 38.2 35 56.8 57.6 52.2 60.3 108.7 78.5 89.4 79 113.8 105
16.9 (3.6) 17.3 (2.3) 20.4 (3.7) 17.6 (2.2) 30.1 (3.3) 28.2 (2.6) — — 42.9 (4.7) 44.4 (3.2) — — — — 78.3 (7.9) 83.9 (9.3)
≤0.0001* ≤0.0001* ≤0.79 ≤0.49 ≤0.26 ≤0.86 — — ≤0.63 ≤0.10 — — — — ≤0.003* ≤0.04*
* Statistically significant. Min, minimum measured amount; max, maximum measured amount.
© 2014 Mutaz B. Habal, MD
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women (59.2). Given the definition of nose index as nose widthheight ratio, the accuracy of their findings should be considered with skepticism. Jahanshahi and associates8 studied a population from Gorgan, Iran, consisting of 2 races of Fars and Turkman. In both races, the dominant facial form was euryprosopic in women and mesoprosopic in men. There are 4 possible explanations for this difference between the reported results and the current study. The first is the racial difference in the 2 samples. Second, the n point was considered lower in their study, which led to a smaller face index. Third, a Martin spreading caliper with the millimeter gauge was used in their study, whereas in the current investigation, the long-jaw sliding caliper with the accuracy of 0.01 was used. Finally, Jahanshahi et al determined the facial forms based on the Banister classification, which is different from the classification considered in this study as well as the study of Farkas et al.2 Pezeshki Rad et al5 investigated anthropometric linear measurements of a group of normal adults in Mashhad, Iran, with a method similar to this study. The measurements of orbits, ears, and noses and the mouth width in their report were similar to the present findings. However, although the 2 studies documented similar measurements of the head length in both sexes and the head width in women, the head width in men was smaller than our observations. Overall, the findings of the 2 studies were almost completely comparable. The present study also compared the data collected from the Iranian population with those reported for the NAWs. Because both NAWs and most of the current study population were whites, more similarities were anticipated. However, considerable differences were found between the 2 populations with respect to their head height and width, biocular width, nose height, face height, mouth width, and upper chin height. Farkas et al2 observed that, compared with NAWs, Iranian women had longer faces than NAW women, which was the only difference between the 2 groups with regard to the facial height and width. These findings were generally corroborated in our study. However, the face height of Iranian men was approximately 10 mm greater than the facial height of Iranian men in the study of Farkas et al.2 Moreover, Farkas et al reported that, in Iranians, the eye fissure length and intercanthal width were extremely significantly smaller than NAWs in both sexes, whereas the biocular width (ex-ex) in men and women was significantly greater and smaller, respectively. There is a lack of conformity between these findings and those of the current study. According to this investigation, the biocular width of Iranian women was 92.3, whereas Farkas et al found it to be 79.8. Comparing the measurements in men and women, the current study revealed that both sexes have a brachycephalic head form with a slight tendency to mesocephalic form, and the mean head index was 81.5. On the contrary, the NAWs have a mesocephalic head form. The eye fissure length and, therefore, the eye index in both sexes were smaller than NAWs.9 The nose form in both sexes was leptorrhine, similar to NAWs. However, the nose index was significantly smaller in Iranian women.9 The facial form was mostly leptoprosopic. The 3 vertical thirds were not equal, and the upper third was smaller. Whereas the NAWs men have leptoprospic faces, the women have mesoprosopic faces. The mouth width and upper vermilion height were smaller than NAWs.9,17 As expected, most of the linear measurements were greater in men. However, because the differences were proportionate, it had not affected the indices.18–20 Similarly, Farkas et al19 showed no significant difference between sexes with regard to the neoclassic canon proportions. In our study, the nose index of women reveals that they have longer noses with smaller width compared with men. The study performed by Ngeow and Aljunid supports this observation.21 Moreover, we found that cutaneous upper and lower lip height in men is a greater percentage
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of the total lip height, which is in accordance with the findings of Ngeow and Aljunid22 and Farkas et al.17 In comparison of the findings of this study with those reported for neoclassic canons,23 trichion (tr)-g, g-sn, and sn-gnathion (gn) were not equal, and the forehead height (30% of the face height) was smaller than the other thirds, which are equal to each other. The ear height was also greater than the nose height in the studied subjects. The upper lip, lower lip, and chin have been suggested as the equal thirds of lower facial height. Other views claim that the upper lip and the lower lip are one fourth of the lower facial height, whereas the chin constitutes the remaining half of the lower facial height.17,23,24 However, none of these proportions were seen in the subjects of the current study (lower lip, 26%; upper lip, 30%; chin, 44%). Our results confirmed the equivalence between en-en and en-ex. However, whereas the nose width was equal to the intercanthal width in women, it was wider in men. The equation of zy-zy = 4 al-al was observed in women but not in men (because of their wider noses). Moreover, the equation of cheilion-cheilion (ch-ch) = 1.5 al-al was not obtained in the subjects.25–27 Accordingly, the neoclassic canons are not quite comparable with the Iranian population evaluated in this study. Similar to the study of Farkas et al,19 this inconsistency is more prominent in the vertical proportions. On the whole, the findings of the current study showed that, despite that the Iranian population mostly consists of whites, considerable differences with regard to the measurements of head, orbits, nose, ears, face, labio-oral, and chin regions exist between them and the NAWs. These differences were clinically significant. Because the facial anatomic proportions are of utmost importance in determining the beauty and attractiveness of the face, the reference ranges of each measurement might be used as references to treat the disproportions in patients and improve their appearance. The differences found between the values measured in the current study and those reported in textbooks underscore that reference ranges of other populations cannot be generalized to Iranian races. The present study tried to establish the reference range of craniofacial anthropometric measurements in an adult Iranian population. These measurements might be efficiently used as references for esthetic treatments.
CONCLUSIONS According to the findings of this study, most linear measurements were greater in men than in women, although the differences did not affect the indices. It was also shown that both sexes of normal adult Iranian population have brachycephalic heads, leptoprosopic faces, and leptorrhine noses. In comparison with NAWs, considerable differences were observed in the head, face, orbits, labio-oral, nose, and chin regions. These differences were more prominent in the head region of both sexes as well as the face and nose regions in women. Whereas Iranian women were found to have leptoprosopic faces, NAWs women have mesoprosopic faces. The least differences between the 2 populations were related to the ear region.
REFERENCES 1. Fernandez-Riveiro P, Smyth-Chamosa E, Suarez-Quintanilla D, et al. Angular photogrammetric analysis of the soft tissue facial profile. Eur J Orthod 2003;25:393–399 2. Farkas LG, Katic MJ, Forrest CR, et al. International anthropometric study of facial morphology in various ethnic groups/races. J Craniofac Surg 2005;16:615–646 3. Farkas LG, Katic MJ, Forrest CR. Comparison of craniofacial measurements of young adult African American and North American white males and females. Ann Plast Surg 2007;59:692–698
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Copyright © 2014 Mutaz B. Habal, MD. Unauthorized reproduction of this article is prohibited.
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4. Fariaby J, Hossini A, Saffari E. Photographic analysis of faces of 20-year-old students in Iran. Br J Oral Maxillofac Surg 2006;44:393–396 5. Pezeshki Rad H, Jahanbin A, et al. An investigation on facial and cranial anthropometric measurements among 20–35 year old individuals in the city of Mashhad. J Mashhad Dent Sch 2008;31:261–268 6. Mojtahedzadeh F, Alizadeh S. Comparison of anthropometric measurements as substitutes for McNamara’s cephalometric maxillomandibular unit measurements. J Dent Med 2011;24:87–93 7. Heidari Z, Mahmoudzadeh-Sagheb H, Khammar T, et al. Anthropometric measurements of the external nose in 18-25-year-old Sistani and Baluch aborigine women in the southeast of Iran. Folia Morphol (Warsz) 2009;68:88–92 8. Jahanshahi M, Golalipour MJ, Heidari K. The effect of ethnicity on facial anthropometry in Northern Iran. Singapore Med J 2008;49:940–943 9. Farkas LG. Anthropometry of the head and face. New York: Raven Press, 1994 10. Ricketts RM. The golden divider. J Clin Orthod 1981;15:752–759 11. Proffit WR, Fields HW Jr, Sarver DM. Contemporary orthodontics. Canada: Mosby Elsevier 2007 12. Nechala P, Mahoney J, Farkas LG. Digital two-dimensional photogrammetry: a comparison of three techniques of obtaining digital photographs. Plast Reconstr Surg 1999;103:1819–1825 13. Lundstrom A, Forsberg CM, Peck S, et al. A proportional analysis of the soft tissue facial profile in young adults with normal occlusion. Angle Orthod 1992;62:127–133; discussion 33–34 14. Farkas LG, Bryson W, Klotz J. Is photogrammetry of the face reliable? Plast Reconstr Surg 1980;66:346–355 15. Farkas LG, Tompson BD, Katic MJ, et al. Differences between direct (anthropometric) and indirect (cephalometric) measurements of the skull. J Craniofac Surg 2002;13:105–108; discussion 9–10
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