Davide G. Tommasi

Age- and sex-related changes in the normal human ear.

The objective of this study was to supply information about: (1) normal sex-related dimensions of ears (linear distances and ratios, area); (2) left-right symmetry; and (3) growth changes between childhood and old age. The three-dimensional coordinates of several soft-tissue landmarks on the ears and face were obtained by a non-invasive, computerized electromagnetic digitizer in 497 male and 346 female healthy subjects aged 4-73 years. From the landmarks, paired ear width and length, the relevant ratios, ear areas and angles relative to the facial midline, as well as indices of left-right symmetry, were calculated, and averaged for age and sex. Comparisons were performed by factorial analysis of variance. All ear dimensions were significantly larger in men than in women (p<0.001). A significant effect of age was found (p<0.001), with larger values in older individuals. The ear width-to-length ratio and the sagittal angle of the auricle significantly decreased as a function of age (p<0.001) but without sex-related differences. On average, the three-dimensional position of ears was symmetric, with symmetry coefficients ranging between 92% and 96%. Asymmetry was found in the sagittal angle of the auricle (both sexes), in the ear width-to-length ratio and ear width (men only). Data collected in the present investigation could serve as a data base for the quantitative description of human ear morphology and position during normal growth, development and aging. Forensic applications (evaluations of traumas, craniofacial alterations, teratogenic-induced conditions, facial reconstruction, aging of living and dead persons, personal identification) may also benefit from age- and sex-based data banks.

Age- and sex-related changes in the soft tissues of the orbital region

The orbital region plays a predominant role in the evaluation of the craniofacial complex. In the current study information about normal sex-related dimensions of the orbital region, and growth, development and aging, were provided. The three-dimensional coordinates of several soft-tissue landmarks on the orbits and face were obtained by a non-invasive, computerized electromagnetic digitizer in 531 male and 357 female healthy subjects aged 4-73 years. From the landmarks, biocular and intercanthal widths, paired height and inclination of the orbit relative to both the true horizontal (head in natural head position) and Frankfurt plane, length and inclination of the eye fissure, the relevant ratios, soft-tissue orbital area, were calculated, and averaged for age and sex. Comparisons were performed by factorial analysis of variance. Biocular and intercanthal widths, length of the eye fissure, soft-tissue orbital area, and the inclination of the orbit relative to the true horizontal, were significantly larger in men than in women (p<0.01), with a significant effect of age (p<0.001), and significant agexsex interactions (p<0.001). Orbital height, and the height-to-width ratio increased as a function of age (p<0.001), but without gender-related differences. The inclination of the orbit relative to Frankfurt plane, and the inclination of the eye fissure did not differ between men and women, but modified as a function of age (p<0.001), with different sex-related patterns (sexxage interaction, p<0.001). On average, the paired measurements were symmetric, with similar values within each sex and age group. Overall, when compared to literature data, some differences were found due to both ethnicity, and different instruments. Nevertheless, during childhood, adolescence, and young adulthood, the age-related trends for linear dimensions were similar to those found in previous studies, while no previous data exist for older adults. During aging an increment in soft-tissue orbital area was found, with a progressive downward shift of landmark orbitale. Data collected in the present investigation could serve as a data base for the quantitative description of human orbital morphology during normal growth, development and aging. Forensic applications (evaluations of traumas, craniofacial alterations, teratogenic-induced conditions, facial reconstruction, aging of living and dead persons, personal identification) may also benefit from age- and sex-based data banks.

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

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

Three-dimensional assessment of nose and lip morphology in North Sudanese subjects with Down syndrome

OBJECTIVE To detail the nasolabial morphologic characteristics of North Sudanese subjects with Down syndrome (DS). MATERIALS AND METHODS Nasolabial morphology was assessed three-dimensionally in 64 North Sudanese subjects with DS aged 4 to 34 years and in 682 sex- and age-matched controls. Three-dimensional facial coordinates were collected using a laser scan, and selected distances, angles, areas, and volumes were computed. Subject and reference data were compared by computing z-scores and Students t-tests. RESULTS The nose was significantly smaller (area) in subjects with DS than in reference subjects, and it had a different shape (more flat angle of alar slope, more acute nasal tip angle). The vertical (nasal bridge length, nose height) and anteroposterior (nasal tip protrusion) dimensions were reduced, while the horizontal dimensions (alar base width, inferior widths of the nostrils) were increased. The nasolabial angle was increased. The cutaneous lip volume was significantly smaller, while the vermilion lip area was larger in the subjects with DS. The mouth and philtrum widths were significantly reduced, while the vermilion height was significantly increased. CONCLUSION Analyzed subjects with DS had a hypoplastic nose and different upper and lower lips than did reference, normal subjects.

Craniofacial growth in ectodermal dysplasia. An 8 year longitudinal evaluation of Italian subjects.

OBJECTIVE To identify the main directions of growth of facial structures in subjects with hypohidrotic ectodermal dysplasia (HED). MATERIALS AND METHODS The 3D noninvasive facial measurements were collected in 12 subjects (6 boys, 6 girls) with HED during four assessments (at 8, 11, 12, and 15 years) using an electromagnetic digitizer. The modifications of linear distances in the upper, middle, and lower third of the face were analyzed and compared with cross-sectional data obtained in normal healthy coetaneous. For each distance, differential values between the last and the initial data were calculated individually, separately for a first (8-11 years) and a second growth period (12-15 years). RESULTS In the first time span, the growth of all facial measurements was reduced in HED subjects compared with control subjects. During this interval, most of the HED children underwent a functional and/or prosthetic treatment. During adolescence, the width and height of the lower and upper facial thirds showed a larger growth in HED subjects than in control subjects, while all facial depths and all distances in the middle facial third maintained a reduced growth. CONCLUSIONS The deviation from normal facial growth of HED subjects tends to lessen with age. Functional and prosthetic appliances may have enhanced facial growth.

Active head and cervical range of motion: effect of age in healthy females.

Study Design. A study on active cervical range of motion (RoM) in healthy females of different ages. Objective. Perform a three-dimensional quantitative analysis of active head-cervical RoM in healthy females to assess the relationship with age. Summary of Background Data. Age-related variations in active cervical RoM are still partially unknown: some investigations demonstrated that age has no effect whatsoever on the primary movements, whereas other studies found an inverse proportionality between age and cervical RoM. Methods. Three groups of females were compared: 22 aged 15 to 18 years (adolescents), 25 aged 20 to 30 years (young adults), and 16 aged 35 to 45 years (mid-aged women). Active flexion and extension, lateral bending and axial rotation were recorded via an optoelectronic system. After the mathematical exclusion of thoracic movements, cervical RoM was referred to head local reference system and calculated using the tilt/twist method. Data were compared using analysis of variance. Results. Flexion and extension were larger in the adolescents (137°) than in the young adults (128°) and mid-aged women (127°). Lateral bending had similar ranges in the 3 groups: 103° for adolescents, 101° for young adults, and 100° for mid-aged women. Axial rotation had similar ranges in the adolescents and in the mid-aged women (143°) and a slightly larger range in the young adults (151°). Primary movements were always associated with out-of-plane components. Conclusion. In healthy females, between 15 and 45 years old, cervical RoMs in the principal planes decrease (except for rotation), but these variations are not statistically significant (P > 0.05).

Anthropometric Indices of Facial Features in Down’s Syndrome Subjects

Down’s Syndrome (DS) is the most frequent live-born autosomal aneuploidy in humans, and it is characterized by a distinctive craniofacial phenotype. Qualitative reports and quantitative investigations comparing subjects with DS to normal subjects found modifications in head size (overall reduction) and shape (brachycephaly with a flattened occipital bone). The faces of subjects with DS are narrower, less deep, and shorter than normal faces, with a global anomalous relationship between individual measurements. In the upper part of the face, the interorbital width is decreased, the palpebral fissures are reduced with slanted eyelids, and the forehead is prominent with a depressed nasal bridge. The middle part of the face (maxillary region) is hypoplasic, with reduced vertical, lateral, and anteroposterior dimensions. Overall, the nose is significantly smaller; its vertical and anteroposterior dimensions are reduced, but its horizontal dimensions are increased. In DS subjects the nose is shorter and less protruding, but with larger nostrils, a flatter angle of alar slope, and a more acute nasal tip angle. The mandible is small, with more acute gonial angles, and a more prominent position. Overall, there is a tendency toward a skeletal Class III pattern; the prominent forehead and mandible, associated with midfacial hypoplasia, may result in a concave sagittal plane facial profile. In the horizontal plane, the face is less prominent. Mouth width is reduced, with a smaller lower lip and a larger upper lip, with increased vermilion area and height. The lips are prominent, with reduced nasolabial, interlabial (soft tissues), and interincisal (teeth) angles. There are alterations in ear dimensions (global reduction), position and shape, with a significant larger asymmetry than in normal subjects. The ears are usually more prominent from head surface in DS subjects than in normal subjects. Persons with DS also possess several alterations in the hard- and soft-tissue structures of the oral cavity (teeth and dental arches, palate, tongue, oral mucosa), with reduced hard tissue palatal dimensions. In conclusion, the facial soft-tissue of subjects with Down’ syndrome can be successfully measured and monitored with noninvasive computerized anthropometry. A global, three-dimensional, quantitative assessment of the craniofacial characteristics may help in clinical diagnosis.

Registration of dental arch models in 3D facial volumes: an alternative to CBCT acquisitions

Digital 3D models of dental arches and facial soft tissues may constitute an important support for clinicians and maxillofacial surgeons. They can be obtained using a noninvasive and harmless method1 starting from acquisitions made with a dental scanner and a stereophotogrammetric device. The aim of the study was to compare measures taken on the 3D dental and facial models with the ones obtained through a Cone Beam Computed Tomography (CBCT) device in order to evaluate the reliability of the proposed method and its repeatability. Dental and facial data about a population of seven healthy subjects just undergone CBCT have been acquired and registered twice by three operators following a protocol devised for previous works published by this same laboratory2,3. Five craniofacial and six dental landmarks have been taken into account and their linear distances have been calculated. The errors between the corresponding distances in the alternative method and in the CBCT volume have been normalized on the corresponding distance measured on the CBCT model. Statistically significant differences between repetitions and operators were found in the distances between the orbitalis and dental landmarks. We assume that these differences might have been caused by the difficulty in the positioning of the craniofacial soft-tissue landmarks on the CBCT scans. Also the delicate steps for registering the models of the dental arches could have generated errors as it has been suggested by the significant difference between experienced and inexperienced operators. It is advisable to continue the study on more patients in order to obtain a larger data set. It might also be good to consider soft tissue landmarks that are closer to the respective bone tissue ones.

Facial anthropometry in Northern Sudanese persons from childhood to young adulthood

A deep knowledge of the dimensions and relative positions of facial structures in the different age, gender and ethnic groups, is necessary for a complete anatomical description as well as for a correct reconstruction of the global facial appearance, both for surgical and forensic purposes. No current normative data exist for Northern Sudanese subjects. Sudan is the second largest country in Africa, and it has a multiethnic population, with four major ethnic groups: those of Arab descent in the North, Nilotic tribes in the South, West African tribes in the region of Darfur and Eastern Tribes [1]. In the current study information about normal sex- and age-related linear distances was provided. The three-dimensional coordinates of 14 landmarks on the facial soft tissues were obtained using a hand-held laser scanner in 653 healthy Northern Sudanese subjects (326 males and 327 females) aged 4 to 30 years. From the landmarks, 13 linear distances were calculated, and averaged for age and sex. Comparisons were performed by factorial analysis of variance. All analyzed linear soft-tissue facial dimensions were significantly larger in men than in women (p < 0.05), except mouth width (ch-ch), upper facial height (n-sn) and mandibular corpus length (pg-go). All measurements underwent significant modifications as a function of age (p < 0.01), with significant age x sex interactions (p < 0.01) for all linear dimensions except lower face height (sn-pg). Overall, when compared to literature data for African and Caucasoid subjects, several differences were found, pointing to the necessity of ethnic-specific data [2]. Data collected in the present investigation could serve as a database for the quantitative description of human facial morphology during normal growth and development.

Three-dimensional facial morphometry in patients rehabilitated with implant-supported prostheses

The aim of the present study was to assess a low-cost, non-invasive facial morphometric digitizer to assist the practitioner in three-dimensional soft-tissue changes before and after oral rehabilitation. The method should provide quantitative data to support an objective assessment of the facial esthetic outcome [1]. Twenty-two patients aged 45-82 years, all with edentulous maxilla and mandible, were assessed both before and after receiving their definitive complete implant-supported prostheses (each received 4-11 implants in each dental arch; full-arch fixed prostheses were made). The three-dimensional coordinates of 50 soft-tissue facial landmarks were collected with a non-invasive digitizer; labial and facial areas, volumes, angles and distances were compared without/ with the prostheses [2]. Dental prostheses induced significant reductions in the nasolabial, mentolabial and interlabial angles, with increased labial prominence (p<0.05, Wilcoxon test). Lip vermilion area and volume significantly increased; significant increments were found in the vertical and anteroposterior labial dimensions. The presence of the dental prostheses significantly (p<0.001) modified the three-dimensional positions of several soft-tissue facial landmarks. The current approach enabled quantitative evaluation of the final soft-tissue results of oral rehabilitation with implant-supported prostheses, without submitting the patients to invasive procedures. The method could assess the three-dimensional appearance of the facial soft tissues of the patient while planning the provisional prosthetic restoration, providing quantitative information to prepare the best definitive prosthesis. Dote ricerca: FSE, Regione Lombardia