Braz. j. . vol.80 número5

Brazilian

Journal

of

OTORHINOLARYNGOLOGY

www.bjorl.org

ORIGINAL

ARTICLE

Morphometric

analysis

of

nasal

shapes

and

angles

in

young

adults

夽

Ahmet

Uzun

_,

_Fikri

_Ozdemir

DepartmentofAnatomy,FacultyofMedicine,OndokuzMayisUniversity,Samsun,Turkey

Received18March2014;accepted2June2014 Availableonline22July2014

KEYWORDS

Female; Male;

Anthropometry; Nose

Abstract

Introduction:Thesize,angle,shapeandtypeofnoseareasignatureindicatingrace,ageand sex.

Objective: Describeandcomparenasalangles,nosetypes,nostrilmodels,andnasalprofilesin youngTurkishmalesandfemales.

Methods:The study groupconsistedofuniversitystudents,56 malesand59females. Nasal measurementswereobtainedfromallsubjects,usinganthropometricmethods.

Results:The nose types of females and males were 78% and 70% narrow nose, respec-tively. Themeansoffemales’ nasofrontal,nasaltip, nasolabial,andalarslopeangleswere 133.16◦_±8.88◦_;77.91◦_±9.80◦_;98.91◦_±10.01◦_,and80.89◦_±8.33◦_{,respectively.Themeans} of males’ nasofrontal, nasal tip, nasolabial, and alar slope angles were 123.85◦_±13.23◦_; 82.16◦_±9.98◦_;97.91◦_±8.78◦_and85.98◦_±8.72◦_{,respectively.}

Conclusion: Theaveragevaluesofthenoseinthispopulationmaybeusedasaguidetoplan correctiveesthetic---cosmeticsurgeryandforburnscarsofthenose.

© 2014Associac¸ãoBrasileira de Otorrinolaringologiae CirurgiaCérvico-Facial. Publishedby ElsevierEditoraLtda.Allrightsreserved.

PALAVRAS-CHAVE

Feminino; Masculino; Antropometria; Nariz

Morfométricaanálisedenasaisformaseângulosemadultosjovens

Resumo

Introduc¸ão: Otamanho,osângulos,aformaeotipodonarizhumanosãoumaassinaturaque indicarac¸a,idadeesexo.

Objetivo: Descreverecompararosângulosnasais,tiposdenariz,modelosdenarinaeperfis nasaisemhomensemulheresjovensturcos.

夽

Pleasecitethisarticleas:UzunA,OzdemirF.Morphometricanalysisofnasalshapesandanglesinyoungadults.BrazJOtorhinolaryngol. 2014;80:397---402.

∗_{Correspondingauthor.}

E-mail:auzun@omu.edu.tr(A.Uzun).

http://dx.doi.org/10.1016/j.bjorl.2014.07.010

Métodos: Grupodeestudoconsistiude56jovensdosexomasculinoe59dosexofeminino,que eramestudantesnaUniversidade.Medidasnasaisforamobtidasdetodasasdisciplinas,através demétodosantropométricos.

Resultados: Tiposde nariz de fêmeas e machos foram encontrados na maior parte 78% e 70% nariz estreito, respectivamente. Os meios de nasofrontal das fêmeas, ponta nasal, nasolabial e ângulos de inclinac¸ão alar foram 133,16±8,88; 77,91±9,80; 98,91±10,01 e 80,89±8,33◦_{,respectivamente.Osmeiosdenasofrontaldosmachos,apontanasal,nasolabial} eângulosdeinclinac¸ãoalarforam123,85±13,23;82,16±9,98;97,91±8,78e85,98±8,72◦_, respectivamente.

Conclusão:Osvaloresmédiosdonariznestapopulac¸ãopodemserusadoscomoummarcode orientac¸ãoparaplanejaracirurgiacorretivanosaestheticcosmetics,cicatrizesdequeimadura donariz.

©2014Associac¸ãoBrasileira deOtorrinolaringologiaeCirurgiaCérvico-Facial.Publicadopor ElsevierEditoraLtda.Todososdireitosreservados.

Introduction

Thenosehasanumberofvitalfunctions. Itfilters,heats, and moistens inhaled air; it is the first line of defense against inhaled allergens; it acts as a sensory olfactory organandaffectsresonance in speechproduction. Condi-tions such asdeviated septum and turbinate hypertrophy affectnasalgeometryandmayimpairnasalpatencyandthe physiologyofthenose,duetoreductionsintheinner dimen-sionsofthenasalcavityandincreasesintheresistanceto airflow.1_{Forcenturies,anthropologistsandclinicianshave} attemptedtoobjectivelycomprehendtheconceptoffacial beauty.2_{Renaissanceartistsemphasizedthatfacialbeautyis} rootedinsymmetricandbalancedproportions.Their quanti-tativedescriptionspersistedasneoclassicalcannons,which arecurrentlyusedinreconstructivefacialoperations.3_The shapeof the nose is a signatureindicating the ethnicity, race,age,andsex.4_{Anthropometricparametersvarywith} age,sex,andethnicbackground,andseveralauthorshave attemptedtodocumentnormativevalueswhichmayserve asreferences.5_{Thesize,shapeandproportionsofthenose} providebeautyorhandsomeness,becauseitisatthe cen-teroftheface.6_{Knowledgeoftheuniqueshape,anatomy,} anddimensionsofthehumannoseisessentialforsurgeons undertakingestheticrepairandreconstructionofnoses.7

Determining nose types, nostril models, nasal profiles, andanglesofthenoseprovidesnormsforthestudyof abnor-malitiesortheeffectsofaginganddisease;orchangesdue tobodygrowth,andethnicandracialdifferences.8 _Racial andethnicmorphometricdifferenceshave beenthe focus ofinvestigations.9,10

This study aimed to describe the differences in nasal angles,nosetypes,nostrilmodelsandnoseprofilesinyoung Turkishmalesandfemalesandcomparethemwiththe stud-iesfoundintheliterature.

Materials

and

methods

The present study recorded nasal types, nostril models, andanglesofuniversitystudentsofphysicaleducationand

sports,whowere18---30(mean21.22)yearsofage,selected by a random sampling method, totaling 115 healthy stu-dents(59femalesand56males).Theseindividualshadno noticeablenasalorfacialdisfigurement,norpreviousnasal or facialsurgery.5 _{This study was approved by the Ethics} CommitteeofUniversityClinicalResearch(Ethics Commit-tee Number: 569). All objects were previously described; which from the point of nasal measurements by using anthropometricinstrumentsandweresignedinformed con-sent form.Body weightwas measured using a Secascale (Seca, Mod 220,withprecision of 0.1kg--- Hamburg, Ger-many), without shoes, barefoot, and withas few clothes as possible. Body height was measured in anatomic posi-tionusingaportablestadiometer(Seca,Mod220,Hamburg Germany),withprecisionof0.5cm.5_{Meanbodyweightand} heightofthemalesubjectswere77.34kg(53.40---112.20kg) and177.02cm(163.00---194.00cm),respectively.Meanbody weight and height of the female subjects were 59.32kg (38.40---86.00kg)and164.83cm(150---182cm),respectively. Anthropometricmeasurements were obtained from all includedsubjects,usingstandardanthropometricmethods andinstrumentsdescribedinliterature.5_{Themeasurements} of angles were calculated in degrees (◦_{), and were}

A

n _nfa

nta

nla

al

asa

prn

al

ls sn

prn

B

Figure1 Facialandnasalsofttissuelandmarks.(A)Facialsoft tissuelandmarks of glabella(g), nasion (n), pronasale (prn), subnasale(sn), labialesuperius(ls) andanglesofnasofrontal (nfa),nasaltip(nta),andnasolabial(nla)weredemonstrated onlateralview.(B)Facialsofttissuelandmarksofalare(al), pronasale(prn)andalarslopeangle(asa)weredemonstrated onbasalview.

(n),thepointinthemidlineofboththenasalrootandthe nasofrontalsuture.Subnasale(sn),themidpointofthe col-umellabase.Pronasale(prn),themostprominentpointon thenasaltip.Glabella(g),themid-pointbetweenthe eye-brows.Labialesuperius,themidpointoftheuppervermilion line,andthealare(al),thepointwherethenasalblade(ala nasi)extendsfarthest,12_{areshowninFig.1AandB.}

In the present study, the following parame-ters were measured and noted: nasofrontal angle; glabella---nasion---pronasale (g---n---prn), nasal tip angle; nasion---pronasale---subnasale (n---prn---sn), nasolabial angle; pronasale---subnasale---labialesuperius (prn---sn---ls) andalar slope angle; alare---pronasale---alare (al---prn---al), width of the nose; alare---alare (al---al), total nose length; and nasion---subnasale(n---sn).5,12_{TheseareshowninFig.1Aand} B.

NasalIndex= widthofthenose(al-al)×100

totalnoselength(n-sn)

According to the index,the nose is divided into seven types(Olivierclassification).13

These are:overly narrow nose (X---39.99), very narrow nose (40.00---54.99), narrow nose (55.00---69.99), medium

Table2 Numberandpercentageofindividualsamong var-iousnosetypesofyoungTurkishfemalesandmales.

Nosetypes Females Males Total

Verynarrownose 6(10%) 2(3%) 8(7%) Narrownose(55---69.9) 46(78%) 39(70%) 85(74%) Mediumnose(70---84.9) 7(12%) 14(25%) 21(18%) Broadnose(85---99.9) 0 1(2%) 1(1%)

According to gender, nose type variability was determined (2=4.61;p=0.11).

nose(70.00---84.99),broad nose(85.00---99.99), verybroad nose(100.00---114.99),andoverlybroadnose(115.00---X).14

Results

Themeans of females’nasofrontal angle, nasaltipangle; nasolabialangleandalarslopeanglewere133.16◦_±8.88◦_;

77.91◦_±9.80◦_;98.91◦_±10.01◦ _and80.89◦_±8.33◦_,

respec-tively. The means of males’ nasofrontal angle, nasal tip angle; nasolabial angle, and alar slope angle were 123.85◦_±13.23◦_{; 82.16}◦_±9.98◦_{; 97.91}◦_±8.78◦ _and

85.98◦_±8.72◦_{, respectively (Table 1). There were}

statis-ticallysignificant differencesbetween themeanvaluesof thenasofrontalangle, nasaltipangleandalarslope angle (p<0.05).

Nosetypeswerecalculatedbasedonthenumberand per-centageof nosetypes bygender.Forfemales, therewere six(10%)withverynarrownose,46(78%)withnarrownose, seven(12%)withmediumnose.Formales,thereweretwo (3%) with very narrow nose, 39 (70%) with narrow nose, 14(25%)withmediumnoseandone(2%)withbroadnose. Accordingtogender, nosetypevariabilitywasdetermined (2=4.61,p=0.11).

Forallindividuals(malesandfemales),therewereeight (7%) with very narrow nose, 85 (74%) with narrow nose, 21(18%)withmedium noseand one(1%)withbroad nose (Table2).

Measurement and evaluation of the wings of the nose typologicalfindings asa resultof the waythe nostrils,in bothmalesandfemalesasaresultofseparatereviewshave identifiedfivedifferentnostrilmodels.

Nostrilmodelsoffemales:

I Wide blunt nasal base, parallelto theala of the nose, narrowovalnostril.

Table1 Studentt-testforequalityofmeansamongnasalanglesinyoungTurkishfemalesandmales.

Angle Females Males p

X_±SD(◦_{) Med(}◦_{)(min---max) X±SD(}◦_{) Med(}◦_)(min---max)

Nasofrontalangle 133.16±8.88 133.00(114---148) 123.85±13.23 122.50(83---150) 0.001a

Nasalipangle 77.91±9.80 77.50(60---105) 82.16±9.98 81.25(66---113) 0.02a

Nasolabialangle 98.91±10.01 100(75---126) 97.91±8.78 97.50(80---124) 0.57b

Alarslopeangle 80.89±8.33 80(62.50---112.50) 85.98±8.72 87.50(64---102.50) 0.001a

I

II

III

IV

V

Figure2 NostrilmodelsinyoungTurkishfemales.

II Narrowbluntnasalbase,paralleltothealaofthenose, triangularnostril.

III Widesharpnasalbase,roundnostril.

IV Widebluntnasalbase,paralleltothealaofthenose,long andlargenostril.

V Widesharpnasalbase,paralleltothenasolabialgroove, wideovalnostril(Fig.2).

Nostrilmodelswerecalculatedbasedonthenumberand percentageoffemalesnostrilmodels:17(28.81%)modelI, 17(28.81%)modelII,eight(13.55%)modelIII,ten(16.94%) modelIVandseven(11.86%)modelV.

Nostrilmodelsofmales:

I Middlesharpnasalbase,paralleltothealaofthenose, narrowovalnostril.

II Wide sharpnasalbase, parallel tothe ala ofthe nose, wideovalnostril.

III Widebluntnasalbase,roundnostril.

IV Wide blunt nasal base, parallel tothe alaof the nose, narrowovalnostril.

V Middlebluntnasalbase,paralleltothenasolabialgroove, narrowovalnostril(Fig.3).

The nostril models of males found were: 12 (21.42%) model I, 21 (37.50%) model II, five (8.92%) model III, 15 (26.78%)modelIV,andthree(5.35%)modelV.

Researchersshouldobservetheshapeofthedorsumof thenose,whichcanbestraight,concave,convex,orcurved. Inaddition,theshapeofthetipofthenose,nosewingshape andheight shouldbe examined carefully. Noseprofiles of measuredsubjectswereasfollows.

Femalenoseprofiles:

I Longnasaldorsum,highnasalroot,forwardslopingnasal tip,andhorizontalnasalbase.

II Longnasaldorsum,deepnasalroot,upwardslopingnasal tip,andupwardslopingnasalbase.

III Short nasal dorsum, middle nasal root, upward sloping nasaltip,andupwardslopingnasalbase.

IV Middlenasaldorsum,middlenasalroot,upwardsloping nasaltip,andhorizontalnasalbase.

V Middlenasaldorsum,middlenasalroot,upwardsloping nasaltip,andupwardslopingnasalbase(Fig.3).

I

II

III

IV

V

Figure3 NostrilmodelsinyoungTurkishfemales.

I

II

III

IV

V

Figure4 NasalprofilesinyoungTurkishfemales.

The femalenose profiles found were: 16(27.11%) pro-file I,ten(16.94%) profileII, seven(11.86%) profileIII, 16 (27.11%)profileIVandten(16.94%)profileV.

Malenoseprofiles:

I Shortnasaldorsum,deepnasalroot,upwardslopingnasal tip,andforward/upwardslopingnasalbase.

II Long nasal dorsum, high nasal root, downward sloping nasaltip,andforward/upwardslopingnasalbase. III Longnasaldorsum,middlenasalroot,forward/downward

slopingnasaltip,andhorizontalnasalbase.

IV Middle nasal dorsum, deep nasal root, upward sloping nasaltip,andforward/upwardslopingnasalbase. V Long nasal dorsum, deep nasal root, forward/upward

slopingnasaltip,andforward/upwardslopingnasalbase (Fig.4).

Thenoseprofilesofmalesfoundwere:12(21.42%)profile I,eight(14.28%)profileII,six(10.71%)profileIII,20(35.71%) profileIVandten(17.85%)profileV(Fig.5).

I

II

III

IV

V

Table3 Comparisonofnasalanglesoffemalesandmalesinthepresentstudyandotherraces.

Author Race Sex n NFA(◦_{) NTA(}◦_{) NLA(}◦_{) ASA(}◦₎

Rhee,2004 Korean F 22 103.43

Japan F 15 99.87

Chinese F 16 113.51

Western F 18 106.52

Husein,2010 IndianAmerican F 102 138.20 97.20

NAW F 200 134.30 67.40 104.20 59.40

ChoesKS,2006 KoreanAmerican F 72 136.80 78.50 92.10 81.90

AungSC,2000 Chinese F 45 139.09 83.87 97.91 90.89

DongY,2011 Chinese(Han) F 143 144.04 96.16 103.42

MilosevicAS,2008 Croatian F 58 139.11 84.12 109.39

SforzaC,2011 Italian F 66 93.84 75.43

Presentstudy Turkish F 59 133.16 77.91 98.91 80.89

Porter,2004 AfricanAmerican M 109 126.90 83.10

NguyenandTurley,1998 Caucasian M 116 137.30 80.60

AungSC,2000 Chinese M 45 137.43 82.55 99.91 89.07

DongY,2011 Chinese(Han) M 146 138.19 94.16 104.30

SforzaC,2011 Italian M 126 94.99 74.45

Presentstudy Turkish M 56 123.85 82.16 97.91 85.98

n,number;NFA,nasofrontalangle;NTA,nasaltipangle;NLA,nasolabialangle;ASA,alarslopeangle;NAW,NorthAmericanwhite;F, female;M,male.

Discussion

The midline areaof the face is of crucial importancefor thejudgmentofattractiveness.15_{Lyinginthemiddleofthe} face,thenasalpyramidplaysanoticeablecosmeticrolein theappearanceofthewholeface;itprovidesharmonyand balancetotheface.The appreciationoffacial attractive-ness,especiallyofthenose,dependsonvariousfactorssuch asgenderandtheindividualobserver.16

Detailedinformationwasnotfoundintheliteratureon thecomparisonofnasalangles,nosetypes,nostrilmodels, andnasalprofileinyoungTurkishfemalesandmales. Stan-dards for analysis of the Turkish male and female nasal shapes and angle measurements are lacking, especially considering that the concept of facial attractiveness is a complex assimilation of innate perceptions and cultural stereotypes.

Aswithotherpartsofthebody,theexternalnoseangles, noseshape,thehead,andfacedevelopmentrapidlyduring adolescence. It is very important to know the pattern of developmentandtimingofmaturitytodeterminethebest time for the reconstruction nasal deformities.17 _Farkas18 reportedthattheanglesofthenoseessentiallystopgrowing attheageof12inwomenandatage14or15inmen,and thesizeandshapeoftheexternalnoseislesslikelychange after maturity. Thus, the present study selected healthy youngTurkish malesandfemalesagedbetween18and 30 yearsoldandperformedananthropometricstudytoprovide reliablereferencedataduringreconstructionofsecondary nasaldeformityaftercheiloplasty,nasalreconstruction,and repairofnasaldefectsandrhinoplastyinTurkishadults.This study’s results of angles were compared withthe studies availableinliterature.

Themeanresultofthenasofrontalangleinthepresent study for females (133.16◦_{) was smaller than Indian}

American2 _(138.20◦_{), North American White}2 _(134.30◦_),

Korean American12 _(136.80◦_{), Chinese}13 _{(Han) (144.04}◦_),

Croatian19 _(139.11◦_),andChinese20 _{females(139.09}◦_).The

Turkish female mean nasal tip angle value (77.91◦_{) was}

greaterthanNorthAmericanWhite2_(67.40◦_),andsmaller

thanKoreanAmerican12_(78.50◦_{),Chinese(Han)}13 _(96.16◦_),

Croatian19 _(84.12◦_{), and Chinese}20 _{females (83.87}◦_{). The}

meanresultofTurkishfemalenasolabialangle(98.91◦_)was

narrowerthan NorthAmericanWhite2 _(104.20◦_{), Korean}10 (103.43◦_{), Japanese}10 _(99.87◦_{), Chinese}10 _(113.51◦_),

Western10 _(106.52◦_{), Chinese}13 _{(Han) (103.42}◦_{), and}

Croatian19 _{females (109.39}◦_{); and wider than Indian}

American2 _(97.20◦_{), Korean American}12 _(92.10◦_{), and}

Chinese20 _{females (97.71}◦_{). The Turkish female alar slope}

angle(80.89◦_{)wassmallerthanKoreanAmerican}12_(81.90◦₎

and Chinese20 _{females (90.89}◦_{), and greater than North}

AmericanWhite2_{females(59.40}◦_).

Themeanresultofthenasofrontalangleinthepresent study for males (123.85◦_{) was smaller than Caucasians}7 (137.30◦_{), African American}9 _(126.90◦_{), Chinese}13 _(Han) (138.19◦_{),andChinesemales}20 _(137.43◦_{).TheTurkishmale}

mean nasal tip angle value (82.16◦_{) was greater than}

Caucasian7 _(80.60◦_{) and Croatian males}19 _(79.85◦_{); and}

smaller than Chinese13 _{(Han) females (96.16}◦_{), Chinese}20 (82.55◦_{), and Italian}21 _(93.84◦_{). The Turkish male mean}

nasolabial angle (97.91◦_{) was narrower than Chinese}13 (Han)(104.30◦_),Croatian19 _males(105.42◦_),andChinese20 (99.91◦_{);andwiderthanAfricanAmerican}9_males(83.10◦_).

TheTurkishfemalealarslopeanglevalue(80.89◦_)waswider

thanItalianfemales(74.45◦_).21_{ThemeanoftheTurkishmale} alarslopeangle(85.98◦_{)wassmallerthanChinese}20 _males (89.07◦_{),andlargerthanItalian}21_males(75.43◦_)(Table3).

differences.20_{Springeretal.}16_{reportedthattherewere} gen-derrelatedeffectswithrespecttotheassessmentofnasal shapeinwomenascomparedtomen,whoaremorecritical inassessingtheappearanceoftheirownnoseasopposedto thenosesofotherpeople.Farkasetal.23_{indicatedthatthe} neoclassicalestheticstandard developed during the Euro-peanRenaissance isnotcompletely suitableforAsianand Africanethnicgroups.Similarly,therearestillsome differ-encesbetween the esthetics of the peopleof Turkey and othercountries. Whitesgenerallyhave narrowor medium noses,Asiansusuallyhavemediumnoses,andBlacksoften have wide nose. Blacks living in the Congo and Guinea14 have especially wide noses, with nose indexes over 100. Inthepresentstudy,narrownosespredominated:46(78%) females,39(70%)males,and85(74%)amongallsubjects. Facialanalysis,usinganthropometricproportionsasaguide, isparamountforplanningcosmeticandreconstructivefacial surgery.

Conclusion

Thepresentstudyshowsthatstatisticallysignificant differ-encesbetween themean valuesof thenasofrontal angle, nasaltipangle,andalarslopeangleinyoungTurkishmales andfemales,whohadmostlynarrownoses,amongfive dif-ferentnostrilmodelsandnoseprofiles.TheTurkishfemales hadmostlynasalprofileIandnostrilmodelI,andtheTurkish maleshadmostlynasalprofileIVandnostrilmodelII. Aver-agevaluesofthenasalangles,nose types,nostrilmodels, andnasalprofilesinthispopulationmaybeusedasaguide toplancorrective esthetic---cosmeticsurgery andfor burn scarsofthenose.

Funding

ThisstudywassupportedbytheProjectManagementOffice (Referencenumber:PYO.033).

Conflicts

of

interest

Theauthorsdeclarenoconflictsofinterest.

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