Abdullah Etöz

Facial asymmetry in young healthy subjects evaluated by statistical shape analysis

Statistical shape analysis, a relatively a new method for biological research, compares body forms by using specific landmarks determined by anatomical prominences. In this study, we aimed to identify normal facial asymmetry between the right and the left sides of the face. Facial landmark data were collected from two‐dimensional digital images of 321 young healthy subjects (150 males and 171 females). These data were analysed using Euclidean distance matrix analysis. The number of significantly asymmetric linear distances between the two halves of the face was greater in females than in males. We found that the left side of the face was most commonly dominant in both males and females. Such data may be useful in establishing a database for future similar studies.

Nasal shapes and related differences in nostril forms: a morphometric analysis in young adults.

Being aware of the morphologic differences in the nasal anatomy between men and women during the cosmetic rhinoplasty is essential because feminization of a male nose is not a very rare complication. Although there is no difference in the techniques of male and female rhinoplasty, the anthropometric differences have to be considered. This morphometric study evaluated the nasal shapes in both sexes and the related differences in the nostril forms. The nostril forms were separated into 4 main groups such as teardrop, heart shaped, round, and triangular. In this landmark-based morphometric study, significant relations of nostril forms to the nasal shape, frontonasal, and nasolabial angles were found. The results of this study should make us think about these relations of nostril forms to the nasal shapes and should be a basement for further clinical studies enhancing the plans of the corrective surgery.

Statistical Shape Analysis of Nose in Turkish Young Adults

There are several anthropometric studies regarding the nose, however none of them involves data about a statistical shape analysis. In this study, a landmark-based geometric morphometric technique was used to analyze the nasal shapes in a young Turkish adult population. A population of 75 female and 75 male volunteer Turkish young adults whose ages ranged 18-39 years (24.82 ± 5.64 year) was examined. The stratified sampling method was used to determine the subjects according to the seven main geographic regions of Turkey. All data was obtained from standardized digital photographic images taken from anterior, lateral and inferior aspects by using standard anthropometric measurement methods. Euclidean Distance Matrix Analysis (EDMA) is used to calculate all possible linear distances among landmarks by creating matrixes for each subject. Today, the anthropometric methods and surgical practice intersected at a point to treat the congenital or post-traumatic facial disfigurements in various racial or ethnic groups. Rhinoplasty surgeons require access to facial databases based on accurate anthropometric measurements to perform optimum correction in both sexes. There should be some points brought to mind during the cosmetic nasal surgery for men because of different expectations, which is not technically different from the one for women. This study is a way to clarify these important points and a basis for further clinical studies enhancing the plans of the corrective surgery.

Isolated lower lip fistulas in Van der Woude syndrome.

Van der Woude syndrome (VWS) is a dominantly inherited disease of orofacial region. Characteristic features of this syndrome are bilateral lower lip sinuses along with cleft lip or palate deformity. However, isolated lower lip pits in VWS without any cleft syndrome is uncommon. Lip pits in VWS are usually asymptomatic; however, patients may complain of watery drainage and/or infection. In this report, asymptomatic isolated lower lip sinuses without any cleft syndrome in a patient and his father are presented.

Anthropometric Analysis of the Nose

Anthropometric evaluation begins with the identification of specific locations, called landmark points, defined in terms of visible or palpable features on the subject. Data from facial landmarks have traditionally been obtained by the direct measurement technique using standard instruments such as callipers, measuring tapes, compasses, protractors and angle finders. However, this requires physical contact by the examiner, which could lead to errors during measurement as many areas on the face are very sensitive to touch. The latest reports on craniofacial anthropometry, therefore, include laser scanning and photogrammetric techniques. The nose is a person’s most defining feature as it is at the centre of the face. The shape of the nose is a signature indicating ethnicity, race, age and sex. Anthropometric methods and surgical practice have now merged to treat congenital or post-traumatic facial disfigurements in various racial or ethnic groups successfully. Nasoplasty surgeons require access to facial data based on accurate anthropometric measurements to perform optimum correction. The photogrammetric anthropometric method will be summarized in this chapter. Anthropometry is said to be the most suitable nasal evaluation method to demonstrate the sharp nasal profile contours and eliminate differences between direct and indirect nasal measurements.

A giant neuroglial heterotopia.

To the Editor: Herein, a rare case of a giant heterotopic brain tissue of the left temporal area in a 2-month-old girl with a bony depression is described. A 2-month-old female infant presented with a left temporal soft-tissue mass measuring 15 18 cm. The mass was present at birth and was rapidly increasing in size. At birth, the patient also exhibited an asymmetrical face. Over the 2-month period, the mass became wider and flatter and was now protruding from the temporal region of the scalp. The mass over the patient’s left ear and lateral aspect of the left eye had expanded superiorly. On physical examination, there was a large, firm, regular, mobile, and nontender mass involving the superior part of the left ear. There were no pigmentation abnormalities of the overlying skin, and there were no hair abnormalities (Fig. 1). The patient was otherwise healthy with normal achievement of developmental milestones. The clinical differential diagnosis included lymphangioma. Laboratory evaluation included serum amino acids, urine organic acids, very long-chain fatty acids, lactate and pyruvate levels that were all within normal limits, and normal thyroid-stimulating hormone and thyroxin levels. MRI with contrast demonstrated a structurally normal brain with a 7 6 7.5 cm left temporal soft-tissue lesion located beneath the subcutaneous fat with substantial peripheral enhancement and no intracranial extension. On this admission, the MRI of the head and neck revealed a thin-walled cystic lesion in the left temporal region and extending inferiorly to the left infratentorial space. There were no solid components, but internal septation was observed within the cyst. The mass caused a soft tissue and bone deformity as well as aplasia of the left zygomatic bone. The MRI scan also showed that there was no intracranial extension and no intracranial communication (Fig. 2A). A CT scan showed a large (5 7.5 8 cm) hypodense globular lobular lesion in the left inferior temporal region. The mass had a thin enhancing wall (Fig. 2B). There was no chromosomal anomaly. Ophthalmologic examination revealed impaired adduction of the left eye. The cyst fluid was eviscerated by needle puncture and histologic examination of the fluid revealed cerebrospinal fluid. Twomonths after the needle puncturing, the cyst was reproduced. The patient underwent a cystectomy with removal of the lateral temporal scalp under general anesthesia. The excised specimen measured 9.5 7.5 3.5 cm on gross examination (Fig. 3). The histopathological examination revealed well-differentiated glial cells along with fibrous and muscle tissue. Neuroglial cells and scattered microcalcifications were also entrapped within the fibrous tissue. A diagnosis of heterotopic brain tissue was made. After the excision, the patient made an uneventful recovery. There was no recurrence or neurological deficits over a 4-year follow-up period (Fig. 4). The filing with a free tissue transfer of the depressed area in the temporal region was planned. Heterotopic brain tissue is a rare congenital condition in which mature brain tissue is located outside the cranial cavity or spinal cord. Displaced neuroglial tissue is the result of abnormal closure of the neural tube. There is no malignant potential. They are generally present at birth or manifest within the first few years of life, but they can be observed in any age group. Heterotopic brain tissue is defined as a mass-like lesion. Many cases involve localization to the soft tissues of the head and neck region. Heterotopic brain tissue usually occurs in the brain and extracranial midline structures, including the nose, nasopharynx, oropharynx, soft palate, lip, and tongue. The most common location for these heterotopias is around the nasal cavity, which accounts for approximately 40% of the cases. Rarely, heterotopic brain tissue has been reported to occur in the extracranial nonmidline locations, such as the scalp, orbit, eye, lung, diaphragm, peritoneum, skin, temporal bone, uterine cervix, and endometrium. These lesions, which are disconnected from the central nervous system, most likely represent true heterotopias of brain tissue. In the present case, a glial heterotopia was present in the left temporal region with a bony deformity. The temporal and zygomatic bones exhibited aplasia. Clinically, these lesionsmust be differentiated from encephaloceles. Thorough imaging of any lesion in the medial portion of the temporal cavity should be performed before surgery to rule out contiguity with the central nervous system. These patients may have other craniofacial anomalies including cleft palate, micrognathia, glossoptosis, pectus excavatum, polydactyly, anencephaly, cardiovascular anomalies, and bronchopulmonary dysplasia. A detailed systemic evaluation did not reveal any other morphological associations in the present case. This lesion was initially diagnosed as a lymphangioma. However, the rapid growth of the mass and the fluid aspect on MR with no connection to the central nervous system did not support this diagnosis. The discovery of cerebrospinal fluid upon needle puncture was the most helpful feature for narrowing the differential diagnoses. The site of heterotopic brain tissue in the scalp varies. Twelve lesions have been adequately described in the literature; 7 of these were located in the occipital region, 4 were located in the parietal region, and 1 was located in the temporal region. Although 6 of these were located in the midline, the rest were located on either side of the midline. Four of the lesions were found to have some form of