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Surg Radiol AnatDOI 10.1007/s00276-013-1215-0

ORIgInAl ARtIcle

External nasal parameters in Egyptians: an in‑depth nasal photogrammatic analysis

Mona Hassan Mohammed Ali

Received: 29 December 2012 / Accepted: 10 October 2013 © Springer-Verlag France 2013

Conclusion Data collected in the present investigation could serve as a database for the quantitative description of the egyptian nasal morphology.

Keywords Anthropometry · Digital photograph · external nasal parameters · egyptians

Introduction

Anthropometry of the face has always been an interesting subject for artists and plastic surgeons and when evaluat-ing the face, one of the things that often call for attention is the set of three facial prominences that characterize the pro-file: the lips, the nose and the chin [25]. the importance and applications of knowing the nasal forms and their differences in different races is evident not only for technical purposes, but also for the esthetic appreciations that are influenced by the culture [6, 17]. Moreover, as the nose is one of the main components of the facial esthetics, the study of its form is of great importance in plastic surgery [9]. Uzun et al. [28] added that as the human nose differs in anatomy and mor-phology between racial groups, it has become readily appar-ent to practitioners that most of the patients place great importance on maintaining their core ethnic features while achieving cosmetic enhancement. Furthermore, the morpho-logical variations of the nasal measurements can be used in forensic medicine and forensic dentistry because its knowl-edge may be applied to the sexual and ethnic differentiation [18]. In addition to the aforementioned implications, there are characteristic differences among races in the shape and the size of the nose, which can provide useful insights for the fields of otolaryngology and anthropology [18].

In addition, the racial and ethnic features of each patient’s nose are dependent on the underlying bony and

Abstract Purpose As ethnic influences can result in different appearances of the nose, the purpose of this study was to provide a set of standard values of the external form of the nose with special emphasis on the influence of age and sex on these values to establish norms for the egyptians.Methods Several soft-tissue landmarks on the external nose were obtained by a non-invasive, photogrammet-ric analysis in 1,000 healthy egyptians aged 20–70 years. From these landmarks, ten linear distances and six nasal angles were measured and six nasal indices were calculated.Results A significant sexual dimorphism was found for nasal external volume and area and most linear distances where males presented with higher values than those in females of the corresponding age except for alar length where females showed higher values. Moreover, age sig-nificantly influenced nasal volume, area and distances as they showed statistically significant increase till old age. concerning angles, nasofrontal, nasofacial, nasomental and nasolabial angles were wider in females while men-tocervical angle was wider in males. Moreover, nasofron-tal, mentocervical and alar slope angles showed significant increase with advancing age while nasofacial, nasomental and nasolabial showed significant decrease. Regarding nasal indices, sexual dimorphism was recognized for ana-tomic nasal index, nasal tip protrusion, nasal height ratio and nasal tip protrusion-nasal width indices. Moreover, results also showed that the egyptians have a Mesorrhine type of nose.

M. H. Mohammed Ali (*) Department of Human Anatomy and embryology, Faculty of Medicine, Suez canal University, Ismailia, egypte-mail: hararh2002@yahoo.com

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cartilaginous skeletal frameworks together with the skin and the soft tissue envelopes [2]. these features have genetic basis but are also influenced by environmental fac-tors such as climate, trauma, aging, nutrition and surgery. therefore, a detailed knowledge of the dimensions and relative positions of facial structures in the different age and ethnic groups, as well as in the two sexes, is prefer-able [27]. However, there are few studies of the extent of the nose measurements [3].

For years, the use of direct anthropometry was the prin-cipal method to describe the different anatomical struc-tures, whereas the most widely used method is the indirect anthropometry [11, 12]. Moreover, digital photographic views provide an accurate and reliable set of measurements [7].

the purpose of this study was to provide a set of stand-ard values of the external form of the nose with special emphasis of the influence of age and sex on theses meas-urements to establish norms for the egyptians to be a guide data base in the fields of forensic medicine, physi-cal anthropometry, rhinoplasty and nasal reconstruction of egyptians.

Subjects and methods

Subjects

In this study, 1,000 egyptian volunteers participated, comprising of 500 males and 500 females, between the age of 20 and 70 years by random sampling through a prospective cross-sectional study. the study protocol was approved by the local ethic committee of Faculty of Medicine, Suez canal University. Participants had been recruited on a volunteer basis. they were informed about all the adopted procedures and provided their writ-ten consent to the investigation. Participants were divided equally into five non-overlapping age groups with 10-year spans. the participants were chosen to represent equally both sexes in the different age groups. All participants declared to have at least three generations of egyptian ancestry. Prior to the study, all the volunteers were exam-ined for scars or facial deformities, those with history of surgery, facial trauma or with noticeable nose anomalies and present disease that could affect the morphometry of the nose were excluded from the study. the data collec-tion procedure used in the current study was noninvasive, not potentially harmful, did not provoke pain and did not use any instrument or energy currently considered to be potentially dangerous to the present or future health of the participants or of her/his offspring. Additionally, great care was taken to use procedures provoking the minimal disturbance to the subject.

Data collection

Measurements were done using a digital camera cyber-shot Sony 7.2 megapixel; photographs of the frontal, profile (left lateral) and the nasal base plane were taken. For the fron-tal and profile photographs, the participants were seated in such a way that the head aligns parallel to the floor, with respect to the Frankfort plane, which could be verified by means of a rectangular square, located in the latter part of the participant; the photographic center was located at 70 cm of the pronasal point and a ruler was included in each image for calibration [17].

to obtain a vision of the nasal base, the participant was positioned with the neck in extension so that the pronasal and glabella points were in the same plane, verified with the square, with the objective of the camera located at 45 cm from the nasal apex [17]. All the photographs were taken on a blue background and digitized in JPeg format. later, the images were processed using the program corel Draw graphics Suite X3 that could reproduce the image in real-size or life-size dimensions, on which the points were identified and marked, which helped in making the meas-urements [17]. All measurements were obtained by the same investigator.

Angle measurements were obtained by taking a com-plete nasal photographic series (frontal, left lateral and basal views) and measuring the angle using Mirror Image software. From the data accrued, several nasal indices were examined.

In the present study, the following soft tissue landmarks were considered (Fig. 1):

Fig. 1 Digitized soft-tissue nasal landmarks used in the current study: midline landmarks: g glabella, n nasion, prn pronasale, sn subnasale, p pogonion, m menton, nd nasal dorsum, col columella. Paired landmarks: alr, all alare; acr, acl, nasal alar crest; itnr, itnl inferior point of the nostril axis; stnr, stnl superior point of the nostril axis

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Midline landmarks [12, 27].

1. nasion, n: the point on the root of the nose where the mid-sagittal plane cuts the nasofrontal suture.

2. Pronasale, prn: the most prominent anterior point on the nasal tip.

3. Subnasale, sn: the point at which the nasal septum merges with the upper cutaneous lip in the midsagittal plane.

4. glabella, g: most prominent point in the midline of frontal bone.

5. columella, col: the vertical soft tissue column in between the nostrils that helps provide support to the nasal tip.

6. Pogonion, p: the most anterior point on the contour of the chin located midway between pogonion and menton.

7. Menton (m): the lowest point on the symphysis of the mandible.

8. nasal dorsum, nd.

Paired landmarks (right and left side noted r and l) [12, 27].

1. Alare, alr, all: most posterior point of the radiographic curve of the nasal notch.

2. nasal alar crest, acr, acl: the most lateral point in the curved base line of each ala.

3. Inferior point of the nostril axis, itnr, intl: the lowest point of the nostril axis.

4. Superior point of the nostril axis, stnr, sntl: the highest point of the nostril axis.

the landmarks obtained on each subject were used to calculate the following measurements:

A—volume (unit: mm3) nasal volume, approximated from the volumes of two tetrahedra: the first tetrahedron had the plane acr, acl, prn as its base and vertex in n, the second had the same base and vertex in sn [27].

B—area (unit: mm2) external nasal surface, computed as the sum of the areas of the triangles n–prn–acr, n– prn–acl, prn–sn–acr and prn–sn–acl [27].

C—linear distances (unit: mm):

1. Anatomic length of the nasal bridge (ln): the dis-tance from (n) to (prn) [14].

2. Anatomic nasal height (nH): the distance from (n) to (sn) [14].

3. Anatomic width of the nose (Wn): the distance at right angle to the nasal height from Rt ala (alr) to lt ala (all) [14].

4. Superior nostril width (SnW): the distance from (stnr) to (stnl) [27].

5. Inferior nostril width (InW): the distance from (itnr) to (itnl) [27].

6. Width of the columella (Wc): the distance between right and left borders of (sn) [7].

7. length of columella (lc): the distance from (sn) to top of the (col) [7].

8. nasal tip protrusion (ntP): the distance from (prn) to (sn) [20].

9. Alar width (AW): the distance spanning between its borders [7].

10. Alar length (Al): the distance spanning from the pos-terior extent of the nasal ala to the nasal tip [7].

D—angles (unit: degrees):

1. nasofrontal angle: formed by drawing a line tangent to the (g) through the (n) that intersect a line drawn tan-gent to (nd) [22] Fig. 2a.

2. nasofacial angle: formed by drawing a vertical line tangent to the forehead at the (g) and tangent to the chin at (p) so that a line drawn along the (nd) intersects it [22] Fig. 2b.

3. nasomental angle: formed by a line drawn through the (nd) intersecting a line drawn from the nasal tip to soft tissue chin (p) [22] Fig. 2c.

4. Mentocervical angle: A vertical line tangent to the fore-head passing through the (g) and (p) and second line intersecting tangent to the chin of the (m) [22] Fig. 2d.

5. nasolabial: corresponds to the angle, whose vertex is the (sn), lying in a tangent line to the nasal tip and another tangent line to the upper lip [7] Fig. 2e.

6. nasal alar slope angle or inter-alar angle: corresponds to the angle between lines drawn from Rt and lt (al) and passing through the (prn) [27] Fig. 2f.

E—nasal indices (unit: percentage):

1. 1-Anatomic nasal index: the ratio of Wn to nH × 100 [14].

2. nasal tip protrusion-nose height (ntP-nH) index: the ratio of ntP to nH × 100 [7].

3. nasal tip protrusion-nasal width (ntP-nW) index: the ratio of ntP to nW × 100 [7].

4. Alar length- nasal height (Al-nH) index: the ratio of Al to nH × 100 [7].

5. length of columella—nasal tip protrusion (lc-ntP) index: the ratio of lc to ntP × 100 [7].

6. Anatomic width of the nose -alar length (Wn-Al) index: the ratio of Wn to Al × 100 [7].

Statistical analysis

All measurements were made by the same investigator to ensure uniformity of measurement. each parameter was measured three times and the mean was recorded. the data

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were analyzed using SPSS versions 16.0 software pro-gram. Descriptive statistics (mean and standard deviation) for each measurement were computed within sex and age group. Statistics of the angular measurements were com-puted using the rectangular components of each angle. Mean values between sexes and age groups were compared using two-way factorial analyses of variance (AnOVA). Significance was set at p < 0.05, with two-tail statisti-cal tests used in all analyses [27]. the data obtained were compared with the measurements of other population in literature.

Results

Simple descriptive statistical data for the measured param-eters in the different age groups in both sexes are repre-sented in tables 1, 2, 3.

table 1 represents mean values for nasal volumes, nasal areas and linear distances in both sexes in the differ-ent age group. A significant sexual dimorphism was found for nasal external volume and area (two-way AnOVA, 1; 837 degrees of freedom, p < 0.001). Age modification was evident and gradual in both sexes for both nasal vol-umes and areas. In 51- to 60-year-olds, external nasal vol-ume reached 129 % for males and 114 % for females of the relevant mean value in the 20- to 30-year-old subjects

and in 61- to 70-year-olds, it reached 103 % for males and 107 % of the relevant mean value of the 20- to 30-year-old subjects. Similar age-related variations were observed for external nasal area: in 51- to 60-year-olds, nasal area reached 107 % for both males and females of the relevant mean value of the 20- to 30-year-old subjects and in 61- to 70-year-olds, it reached 104 % for both genders of the rele-vant mean value of the 20- to 30-year-old subjects. Regard-ing the linear distances, all parameters showed statistically significant sexual dimorphism in the different age groups (two-way AnOVA, 10; 837 degrees of freedom, p < 0.001 for all measurements) and all measurements were larger in males than in females of the corresponding age except Al where females presented with higher values than in males. Overall, in most occasions male increments in nasal lin-ear distances were larger than those observed in females. Moreover, age significantly influenced all analyzed linear distances (AnOVA, 10; 837 degrees of freedom, p < 0.001 for all measurements) as most linear distances showed sta-tistically significant increase till old age. In the 51–60 years age group, Wn showed increments up to 107 % (males) and 106 % (females) of corresponding sex in 20–30 years age group and 109 % for males and 111 % for females in 61–70 years age group of corresponding sex in 20–30 years age group.

table 2 represents mean values for angles in both sexes in the different ages. the nasofrontal, nasofacial,

Fig. 2 Analyzed angles measured in the current study: a nasofrontal, b nasofacial, c nasomental, d mentocervical, e nasolabial, f alar slope

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nasomental and nasolabial angles were wider in females than in males while mentocervical angle was wider in males. the greatest variability was found for the naso-frontal angle, which had the highest standard deviation. no consistent sex-related pattern was found for the alar

slope angle. Age had significant modification in the nasal angles. nasofrontal, mentocervical and alar slope angles showed significant increase with advancing age while nasofacial, nasomental and nasolabial showed significant decrease.

Table 1 Mean values for linear distance measurements expressed in millimeters in the different age group

* Denotes significant difference in the corresponding measurements between males and females at p < 0.05

Parameter (mm) Mean ± SD 20–30 31–40 41–50 51–60 61–70 total mean

nasal volume (mm3)

Male 4.58 ± 3.57 4.97 ± 3.71 5.68 ± 4.05 5.90 ± 3.51 4.73 ± 2.32 5.17 ± 2.37

Female 4.02 ± 2.93* 4.48 ± 3.17* 4.81 ± 3.11* 4.60 ± 2.63* 4.33 ± 2.41* 4.45 ± 2.11*

nasal area (mm2) Male 1767 ± 162.07 1839 ± 176.00 1891 ± 183.04 1858 ± 172.04 1852 ± 167.40 1841.40 ± 157.22

Female 1558 ± 170.09* 1673 ± 161.87* 1693 ± 163.70* 1671 ± 172.09* 1621 ± 152.37* 1643.20 ± 143.77*

nH Male 54.65 ± 2.45 53.48 ± 2.10 54.27 ± 2.89 54.28 ± 3.12 52.46 ± 3.86 53.83 ± 3.10

Female 52.60 ± 2.11* 52.93 ± 2.04* 53.01 ± 3.56* 53.17 ± 3.40* 52.01 ± 3.48* 52.74 ± 3.42*

Wn Male 39.41 ± 2.68 40.10 ± 2.11 41.55 ± 2.95 42.30 ± 3.05 43.21 ± 2.59 41.31 ± 2.40

Female 37.40 ± 2.50* 38.27 ± 3.47* 39.21 ± 3.24* 39.90 ± 3.69* 41.77 ± 3.21* 39.31 ± 2.47*

nl Male 50.03 ± 3.212 50.93 ± 2.60 51.57 ± 3.21 51.62 ± 3.10 49.38 ± 3.11 50.71 ± 2.81

Female 48.46 ± 3.33* 49.00 ± 3.87* 49.42 ± 2.77* 48.34 ± 3.60* 48.68 ± 2.60* 48.78 ± 2.45*

ntP Male 16.53 ± 1.24 17.10 ± 1.32 18.50 ± 1.03 19.20 ± 1.09 19.10 ± 1.36 18.1 ± 1.49

Female 14.06 ± 1.62* 15.64 ± 1.04* 17.03 ± 1.44* 17.92 ± 1.28* 18.07 ± 1.28* 16.54 ± 1.08*

SnW Male 10.92 ± 1.65 11.31 ± 1.38 11.71 ± 1.84 10.48 ± 1.54 11.41 ± 1.38 11.17 ± 1.59

Female 9.31 ± 1.77* 10.70 ± 1.85* 10.82 ± 1.66* 9.42 ± 1.37* 9.89 ± 1.49* 10.03 ± 1.99*

InW Male 30.47 ± 2.05 32.14 ± 2.51 33.36 ± 2.30 34.02 ± 2.41 34.62 ± 2.38 32.92 ± 2.18

Female 28.54 ± 2.18* 29.36 ± 2.35* 31.05 ± 2.98* 31.91 ± 2.71* 32.81 ± 2.10* 30.73 ± 2.38*

Wc Male 8.11 ± 1.40 8.63 ± 1.10 9.01 ± 1.39 7.86 ± 1.21 7.23 ± 1.18 8.17 ± 1.18

Female 7.06 ± 1.79* 6.74 ± 1.20* 8.04 ± 1.10* 7.20 ± 1.94* 6.81 ± 1.91* 7.17 ± 1.33*

lc Male 11.56 ± 1.13 13.48 ± 1.17 12.09 ± 1.14 11.21 ± 1.05 10.34 ± 1.88 11.74 ± 1.00

Female 10.03 ± 1.99* 11.31 ± 1.05* 11.37 ± 1.11* 10.10 ± 1.48* 9.76 ± 1.71* 10.51 ± 1.69*

AW Male 6.40 ± 1.13 6.81 ± 1.35 7.32 ± 1.84 7.94 ± 1.41 8.45 ± 1.33 7.38 ± 1.26

Female 5.70 ± 1.83* 6.11 ± 1.29* 6.84 ± 1.58* 7.00 ± 1.27* 7.70 ± 1.18* 6.67 ± 1.38*

Al Male 23.83 ± 1.32 26.49 ± 1.20 27.00 ± 1.28 24.33 ± 1.26 23.04 ± 1.21 24.94 ± 1.28

Female 25.93 ± 1.04* 27.50 ± 1.49* 28.03 ± 1.99* 26.40 ± 1.94* 23.21 ± 1.36* 26.21 ± 1.55*

Table 2 Mean values for angular measurements expressed in degrees in the different age group

* Denotes significant difference in the corresponding measurements between males and females at p < 0.05

Angle (º) Mean ± SD 20–30 31–40 41–50 51–60 61–70 total mean

nasofrontal Male 134.97 ± 9.12 136.43 ± 9.08 137.00 ± 9.33 140.76 ± 9.11 141.32 ± 9.15 138.10 ± 9.28

Female 139.50 ± 9.20* 140.08 ± 9.49* 142.22 ± 9.81* 144.69 ± 9.04* 146.07 ± 9.70* 142.51 ± 9.50*

nasofacial Male 39.94 ± 6.85 41.33± 40.83 ± 7.03 38.42 ± 6.27 37.01 ± 7.39 39.51 ± 6.26

Female 38.79 ± 6.22* 40.47 ± * 39.76 ± 7.20* 37.02 ± 6.26* 36.31 ± 6.89* 38.47 ± 6.44*

nasomental Male 113.33 ± 7.20 114.00 ± 7.17 113.74 ± 7.10 110.20 ± 6.66 110.25 ± 6.36 112.30 ± 7.19

Female 117.99 ± 6.94* 117.50 ± 7.35* 116.04 ± 7.50* 112.48 ± 7.15* 111.64 ± 6.48* 115.13 ± 7.40*

Mentocervical Male 92.13 ± 3.20 93.01 ± 4.33 92.13 ± 3.56 94.80 ± 3.88 94.99 ± 3.20 93.41 ± 3.50

Female 91.04 ± 4.13* 91.62 ± 4.07* 91.33 ± 3.27* 93.50 ± 3.87* 94.00 ± 3.28* 92.30 ± 3.70*

nasolabial Male 100.61 ± 4.25 102.09 ± 4.12 102.12 ± 4.44 99.38 ± 3.66 99.06 ± 4.16 100.65 ± 3.16

Female 102.06 ± 4.04* 104.66 ± 4.40* 104.81 ± 4.17* 102.99 ± 4.07* 100.95 ± 4.00* 103.09 ± 3.50*

nasal alar slope angle Male 75.43 ± 5.25 73.65 ± 6.39 74.63 ± 5.19 73.08 ± 6.77 81.11 ± 6.77 75.58 ± 6.60

Female 74.45 ± 6.10* 73.82 ± 6.28* 79.75 ± 6.22* 77.50 ± 6.90* 79.98 ± 6.36* 77.10 ± 6.28*

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nasal indices in both sexes in the different ages are summarized in table 3. Sexual dimorphism was recog-nized for anatomic nasal index where males were found to be having significantly higher values than females in the corresponding age groups. Male values ranged from 72.11 ± 6.06 to 82.37 ± 7.20 and those for females ranged from 71.11 ± 6.18 to 80.31 ± 7.34 indicating Mesorrhine type of nose in both sexes in all the studied age groups.

Statistically significant gender differences were also found for both ntP to nH ratio and ntP to Wn indices (table 3).

In all indices, males and females had different age-related patterns, with significant sex by age interactions (AnOVA, 10; 837 degrees of freedom, p < 0.001 for all measurements).

Discussion

the nose is one of the best anatomical markers to racial origin and can give a clue to sexual dimorphism in the stud-ied populations. therefore, each population should have its own values [23].

Zankl et al. [29] reported that reference data for anthro-pometric characteristics of normal, healthy individuals should be provided in age ranges as wide as possible. In the present study, the ages of the participants ranged from 20 to 70 years. the choice of the study population was deliber-ate since the age of 18 years is the age of physical matura-tion and maturity [1] while the age of 69 years is the end of middle-age as stated by cohen et al. [8]. therefore, the set of data offered by the present study probably covers the largest age range with a considerable number of subjects in each sex and age group.

In the current study, photogrammetry was used to deter-mine the size of the nasal dimensions. In his research, Farkas et al. [11] conducted a validation study of photo-grammetry, determining that the frontal, left lateral and basal projections were necessary for analyzing the nasal morphotype.

In the present study, nasal dimensions and shape have been shown to be dimorphic between two sexes with modification between adulthood and old age. these find-ings are in accordance with those reported by Oladipo et al. [23] who reported higher value of all nasal param-eters in nigerian males than in females and Sforza et al. [27] who reported sexual dimorphism in the nasal dimen-sions and shape in Italians. On the contrary and surpris-ingly, garandawa et al. [15] found no sex differences in most of the nasal measurements carried out in his study on adult nigerian. Moreover, in the present study, males had larger noses than females in most of the nasal dimensions, a finding in accord with Zanki et al. [29]. Furthermore, in the current study, growth in the nasal soft tissues was larger and earlier in males than in females of the same age. these findings are different from trends reported for white American caucasoid [13] and for white caucasoid of cen-tral european descent [29]. However, these findings cannot be considered contrary to the present findings since these authors studied the growth patterns in younger ages than those reported in the current study.

Furthermore, the results obtained in the current study revealed that increments in nasal dimensions continued after 20 years of age, a finding in accordance with previ-ous cross-sectional anthropometric studies [13, 29]. Farkas et al. [13] and Zanki et al. [29] explained that human facial soft tissues continue to modify well beyond the attain-ment of skeletal maturity. Additionally, most of the meas-ured parameters here also showed age modification. these

Table 3 Mean values for nasal indices expressed in percentage in the different age group

* Denotes significant difference in the corresponding measurements between males and females at p < 0.05a

nasal index (%) Mean ± SD 20–30 31–40 41–50 51–60 61–70 total mean

Anatomic nasal index Male 72.11 ± 6.06 74.98 ± 6.20 76.56 ± 7.32 77.93 ± 6.47 82.37 ± 7.20 76.79 ± 6.38

Female 71.11 ± 6.18* 72.30 ± 6.96* 73.97 ± 6.29* 75.04 ± 7.01* 80.31 ± 7.34* 74.55 ± 6.06*

ntP-nH index Male 30.25 ± 5.21 31.97 ± 3.46 34.09 ± 3.60 35.37 ± 3.50 36.41 ± 3.58 33.62 ± 3.28

Female 26.73 ± 4.33* 29.55 ± 3.21* 31.53 ± 3.09* 33.70 ± 3.54* 34.74 ± 3.39* 31.25 ± 3.17*

ntP-nW index Male 41.94 ± 3.40 42.64 ± 3.61 44.52 ± 3.70 45.39 ± 3.17 44.20 ± 3.06 43.74 ± 3.24

Female 37.59 ± 3.27* 40.87 ± 3.18* 43.43 ± 3.48* 44.91 ± 3.10* 43.26 ± 3.90* 42.01 ± 3.50*

Al- nH index Male 43.60 ± 1.12 49.53 ± 1.33 49.75 ± 1.11 44.82 ± 1.36 43.92 ± 1.30 46.33 ± 1.67

Female 49.30 ± 2.16* 51.96 ± 1.20* 52.88 ± 1.36* 49.65 ± 1.71* 44.63 ± 1.04* 49.70 ± 1.79*

lc- ntP index Male 69.93 ± 2.35 78.83 ± 2.50 65.35 ± 2.00 58.39 ± 1.99 54.14 ± 2.35 64.86 ± 2.00

Female 71.34 ± 2.33* 72.31 ± 2.72* 66.76 ± 2.05* 56.36 ± 2.46* 54.01 ± 2.05* 63.54 ± 1.49*

Wn-Al index Male 165.38 ± 3.49 151.38 ± 3.58 153.89 ± 2.36 173.86 ± 2.48 187.54 ± 2.52 165.64 ± 2.43

Female 144.23 ± 3.40* 139.16 ± 3.57* 139.89 ± 2.09* 151.14 ± 2.41* 179.97 ± 2.44* 149.98 ± 2.45*

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findings counter genecov et al. [16] who concluded that most soft tissue growth was completed at the age of 12 for girls and 17 for boys. On the other hand, Zankl and Moli-nari [30] demonstrated that the nose did not reach a pla-teau and nose growth was continuous throughout life. Janis and Rohrich [19] have explained that nose has three com-ponents: external tissue, framework and supporting tissue and the nasal skin is less elastic due to excessive amount of sebaceous glands and subcutaneous fat. they added that when people get older, the nasal skin would become thinner and so the cartilage framework leading to changes in the nasal dimensions. Sforza et al. [27] added that with aging, modifications of the microscopic structure of facial soft tis-sues, with alterations of cartilages, muscles, skin elastic-ity and resilience may explain the macroscopic increments in nasal dimensions, especially in those more determined by muscles and cartilages (Wn, ntP), observed after the attainment of skeletal maturity.

Moreover, aging differences were larger in males than in females as shown by the significant age by sex interactions found in the current and in previous investigations on other facial soft tissues [27].

All over the world, nasal dimensions have been inves-tigated in several ethnic groups with ethnical variations in actual nasal dimensions and proportions [6, 21, 28].

the nasal height for egyptians reported in this study was nearer to those reported for turkish by Ozdemir et al. [24] who conducted their research through a photographic assessment while our results are different to those reported also for turkish by Uzun et al. [28] that was carried through a direct anthropometric study. Indeed Sforza et al. [27] explained that when comparing measurements obtained in different studies; the effect of the measurement protocols should always be considered: for instance, optical instru-ments (stereophotogrammetric digitizers, laser scans) do not compress facial skin during landmark collection, while this may occur with calipers and contact digitizers. Further-more, intra- and inter-observer errors may also be possible sources of measurement variability. these errors may be of larger importance in direct anthropometry, where each measurement is taken individually, thus possibly increment-ing their variability (landmark identification, caliper posi-tioning, measurement reading and recording). In contrast, the use of computerized digitizers reduces the method error to landmark identification and digitization. these are sup-ported by the very interesting findings that the reported nH in this study was higher than those reported for nigerian [5], but very near to those reported by Jimoh et al. [20] also, for nigerian.It should be mentioned that Antibor et al. [5] used direct anthropometric measurements while Jimoh et al. [20] used the same method used in the current study. However, the results reported here concerning nH and Wn were very near to those reported for north American caucasoid [13].

Our results concerning ln were similar to those reported for Italians [14, 27] but differ from those reported for chinese [6] and those for central european [29].

Regarding ntP, SnW, InW, Wc, lc, Al and AW, the current results are nearer to those reported for chinese [6] and for Malaysian [21], but differ from those reported for central european [29]. It has been mentioned that the fac-tors responsible for the variations in the size, shape and length of the nose could include genetic factors, race, tribe and environmental climatic conditions with narrower noses being favored in cold and dry climates and broader noses in warm and moist environment as a consequence of natural selection in human evolution [12].

extensive evaluation of angular relationship is essential in soft tissue profiling as not all facial traits directly follow the underlying dento-skeletal profile [22]. the nasofrontal angle showed statistically significant age and sexual dimor-phism in our study. Sexual dimorphism observed in this study agrees with the findings of Anic-Milosevic et al. [4]. It, however, contradicts that of epker [10]. Degenerative changes in the underlying structures leading to decreasing in prominence of glabella could be the underlying cause.

the current values of nasofrontal angle are near to those reported for caucasian [4]. However, our results show higher values than those reported for other caucasian sam-ples [10] and for nigerians [22]. ethnic and genetic factors could be the underlying cause.

the relationship of the nose with the facial plane is a facial parameter of esthetic importance [22]. An average of 35º and 33.26º for nasofacial angle has been reported for north American caucasians and Himachali population, respectively [29]. this is low when compared with the means of nasofacial angle reported in this study. the findings in this study are near to those reported by Oghenemavwe et al. [22] for Urhobos nigerian. Higher nasofacial angle suggests that the projection of the nose in the egyptians is more than those of the Himachalis and north American population [29] and near to those of Urhobos nigerian [22].

Regarding nasomental angle, the mean value reported in the current study is lower than those reported for Urhobos nigerian [22]. Bigger lower face that correlates well with high nasomental angle could explain this difference [22].

the mean values of mentocervical angle reported here for the egyptians are near to that of Urhobos nigerian [22], higher than that of north America population and lesser than that of the Himachalis [29]. less prominent glabella results in higher mentocervical and nasofrontal angles. the values of alar slope angle reported in the current study are very similar to those reported for white Italians [27] but very low when compared with values of north American caucasoids [13].

the anatomic nasal index is very useful in anthropology as it is one of the clinical anthropometric parameters recognized

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in nasal surgery and medical management [29]. Anatomic nasal index is related to regional and climatic differences [12]. Most caucasians are leptorrrhine having long and nar-row nose with nasal index of 69.9 or less. the Bantu-speak-ing negroids and Australiods have a nasal index of 85.0 and above (Platyrrhine), while that of the caucasoid of the early Indo-Aryan was Mesorrhine [26]. In a similar study, Oladipo et al. [23] reported that the mean values for nigerian Igbos were 95.9 and 90.8 for males and females, respectively. Ris-ley [26] reported that the nasal index for Africans is basically platyrrhine; this does not agree with the findings of our pre-sent study which showed that the subjects in this study have Mesorrhine type of nose. A report by Oladipo et al. [23] has also shown that nigerian Andoni ethnic group has Mesor-rhine type of nose which agrees with the findings of the pre-vious report [26] that not all Africans are Platyrrhines. the results of the present work agree with these reports as egyp-tian participants showed Mesorrhine nose type. As morpho-metric parameters are dependent on age, race and sex, Mes-orrhine nose could be typical of the egyptians though this suggestion warrants further supportive studies.

Conclusion

In conclusion, racial and ethnic differences in the facial structure are a well accepted fact. Hence it is imperative that effort should be made to establish general norms for different races and ethnic groups with consideration for certain individual characteristic features. In the present investigation, detailed information about the normal sex and age-related nasal dimensions in healthy egyptians were provided. Data collected in the present investigation could serve as a database for the quantitative description of egyptian nasal morphology in the different ages, also con-sidering sex- and ethnic-related variations.

Acknowledgments the author would like to express her gratitude to those who participated in the research.

Conflict of interest the author declares no conflict of interest.

Ethical standards the author declares that this research complies with the current laws of egypt.

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