morphometric study of human auricle in the age group of 18-24...

GLOBALJOURNALOFMEDICINEANDPUBLICHEALTH

1 www.gjmedph.comVol.5,No.62016ISSN#-2277-9604

Morphometricstudyofhumanauricleintheagegroupof18-24yearsinNorthWestpartofIndiaLArora1*,VSingh2ABSTRACTIntroductionWiththelatestinventionintissueengineeringofcartilage,thereconstructivesurgeriesofhumanauriclecanbeabetteroptionforgettingtissue for 3D structures which cause minimal donor site morbidity. Butdimensions of auricle vary in various races and age groups. Therefore wehaveconfinedourstudyinnorthwestpartofIndiaandinagegroupof18-24years.MaterialandMethodsDifferentparameterofauriclethatislengthandwidthof auricle, lobular length and width, conchal length and width weremeasuredwiththehelpofverniercallipers.Protrusionofearatsuperauraleandtragallevelweremeasuredwiththehelpofgeometricsetofsquares.ResultTheresultshowedmeanvaluesoflengthofauricle,widthofauricle,lobular length, lobularwidth, conchal length, conchalwidth, protrusion atsuperaurale level and protrusion at tragal level respectively as61.57+3.55,31.04+2.69,18.3+1.97,18.77+2.13,27.75+2.09,19.83+2.24,16.5+0.25, 25.7+0.25 for the right earand61.61+3.41,31.41+2.97,17.82+2.23,18.68+2.16,28.16+2.24,20.01+2.64,1.75+0.25,2.55+0.25fortheleftear in males. However the values in females were respectively, 56.74+3.75, 29.40+2.50, 17+1.96,16.03+2.78, 24.88+3.13, 17.20+1.90, 15.5+0.27, 22.3+0.34 for the right ear and 56.48+3.65, 29.40+2.52,17.03+1.88,16.06+2.78,24.91+3.01,17.28+1.96,1.56+0.25,2.17+0.35fortheleftear.ConclusionThusourstudyaimstofindthemeanvaluesofdifferentmorphometricmeasurementsofrightandleftearinthepresentstudypopulation.Keywords:morphometry,humanauricleINTRODUCTIONTheauriclehasasignificantroleinthediagnosisofcongenital deformities. Any deformation in shape,size and spatial position of auricle can help indiagnosis of anomaly. Therefore knowledge ofnormal ear dimensions and ear growth patternhelps indiagnosisofvariouscongenitalanomalies.The auricle develops from series of elevations atdorsalendof firstpharyngealarchcalled ‘auricularhillocks’.Threeelevationsappeararoundeachsideof external meatus which are seen at 6 weeks ofgestationalperiod.Thesehillocksaretransitoryandlater fuse to form definitive auricle1. As fusion of

auricular hillock is complicated, developmentalanomalies of auricle are common. Initially auriclesareventrolaterallyplacedinlowerneckregion,butat end of embryonic period they assumedorsolateralpositionandascendtosideofneckatlevel of eyes. Malformations of the ear may berelatedtosizeofauricle,shapeofearandpositionofear.Marfan’ssyndromeandFragileXsyndrome,for example are reported to havemacrotia that islarge ears. Trisomy 13-15 and anencephaly caseshave dysplastic ears. Mean ear length andmeasured expected ear length ratios aresignificantly lower in 75%of foetuseswith trisomy

GJMEDPH2016;Vol.5,issue61AssociateProfessorAnatomyDepartmentSantoshMedicalCollegeandHospital2ProfessorandHeadof

DepartmentAnatomyDepartmentSantoshMedicalCollegeandHospital*CorrespondingAuthorLatikaAroraD-34Sector-12,NoidaUttarPradesh,India-201301Tel:[email protected]—noneFunding—none


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212. Several studies have been reported on auricleinvolving various syndromes and anomalies3. TherelevanceofthesestudiesistoidentifyoptimalageforsurgicalcorrectionofcongenitalmalformedearsThe human ear is defining feature of face. Anydefect in disproportionate size of auricle or itsmissingpartcanbecorrectedbycosmeticsurgery.Researchershavedemonstratedthatwithcurrentlyavailabletechniques,biomaterialandbiomoleculesthe neocartilage can be constituted inpredetermined stage and complex 3D structure ofear can be regenerated which will help in tissuereconstructive surgeries4. For these surgeriescosmetic surgeonneedsdataaboutnormalauricledimension, auricle’s bilateral position and generalconformation. But these data varies in differentraces. Studies have been conducted in differentpopulation of world. Bozkir MG et al5 studiedhumanauricleinTurkishpopulationandAzariaRetal6studiedtheJewishpopulation.BruckerMJetal7studied theageandsex relatedchanges inhumanauricleinAmericanpopulation.Indiaisamultiracialcountry and measurements in population of oneregion may not match with that of other region.Sharma A et al8 studied the morphometry of earlobule in males of northwest region of India andPurkaitRetal9investigatedthemalepopulationincentral India.Only fewstudieshavebeenreportedfrom India and data available is frugal. Thus wehaveattemptedtoprovideanthropometricdataofnomalmaleandfemaleinthesubjectofage18-20yearsfromUPstateofIndia.The studies of the ear are important for surgicaltechniques for the treatment of congenitaldeformities and reconstruction of traumaticallyinjuredears10.Lobularparametersareimportantforplasticsurgeonswhoaimtoachieveproperbalancebetween right and left ear lobes in reconstructionsurgeries. These parameters also give informationon age and sex and play valuable role in forensicinvestigations.Metric analysis requires the choice of anappropriate standard because there is evidencethat populations aremetrically distinct.Brucker et

al7studiedtheearmorphometryinagefrom20-80years. According to Brucker et al7 significant agechangeswereobservedonlyinthelengthoflobule,whilewidthoflobuledecreasedreciprocally.SforzaC et al11 studied age and sex related changes inItalian population and Barut et al12 measured theauricle of Turkish population On reviewingliteraturewe found that very few auricular studieshavebeen reported from India.Frugaldataon theauriclehavebeenpresentedbyLakshmiarayanaetal13 in their report on the facial growth of SouthIndian. Hence current study was attempted toprovideanthropometricdataonnormaladultmaleandfemaleauriclesfromnorthwestpartofIndiaMATERIALSANDMETHODSLinear measurement of human auricle was takenwith the help of vernier callipers of 50undergraduatestudentsbothmaleandfemale.Thestudent sat uprightwithhis\ her head in Frankfurthorizontal plane. Measurements were takenfollowingPurkaitR 20079method. Students signedon the consent form; the copy of consent form isattached with the paper. Following parametersweremeasured(seefigurespage3):1. Lengthofauricle (ab) (fig.1)2. Widthofauricle (cd) (fig.1)3. Lobularlength (ij) (fig.2)4. Lobularwidth (kl) (fig.2)5. Conchallength (ef) (fig.2)6. Conchalwidth (gh) (fig.2)7. Protrusionatsuperauralelevel8. ProtrusionattragallevelFor readings of auricular protrusion at superauraleand tragal level a geometric set square was usedwith its base resting onmastoid area. From thesemeasurementsmean and standard deviationwerecalculated for each parameter. Statistical analysisusing t-test was undertaken to study the bilateralvariation.RESULTSReadingsofdifferentmeasurementsofbothearsof50malesandfemalesisshowninTable1andTable2(seepage4)


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Figure1Landmarksofauricleformeasuringlengthandwidthofauricle

Figure2Landmarksofauricleformeasuringlengthandwidthofconcha,andlengthandwidthoflobule


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Table1Differentauriculardimensionsinmalestudents,n=50 RightEar LeftEar

Measurements(mm)

MeanStandarddeviation


Correlationbetween

readingsofrightandleftside

Significance

Lengthofauricle 61.57 3.55 61.61 3.41 .921 .000Widthofauricle 31.04 2.69 31.41 2.97 .931 .000

Lobularlength 18.3 1.97 17.82 2.23 .937 .000

Lobularwidth 18.77 2.13 18.68 2.16 .891 .000

Conchallength 27.75 2.09 28.16 2.24 .878 .000

Conchalwidth 19.83 2.24 20.01 2.64 .909 .000

Protrusionatsuperauralelevel

16.5 .25 1.75 .25 .862 .000

Protrusionattragallevel

25.7 .27 2.55 .25 .795 .000

Table2Differentauriculardimensionsinfemalestudents,n=50 RightEar LeftEar

Measurements(mm)



Correlationbetween

readingsofrightandleftside

Significance

Lengthofauricle 56.74 3.75 56.48 3.65 .932 .000

Widthofauricle 29.40 2.50 29.40 2.52 .993 .000

Lobularlength 17.00 1.96 17.03 1.88 .971 .000

Lobularwidth 16.03 2.78 16.06 2.78 .996 .000

Conchallength 24.88 3.13 24.91 3.01 .997 .000

Conchalwidth 17.20 1.90 17.28 1.96 .979 .000

Protrusionatsuperauralelevel

15.5 .27 1.56 .25 .858 .000

Protrusionattragallevel

22.3 .34 2.17 .35 .937 .000

Statisticalanalysisshowednosignificantdifferencebetween the readings of left and right side and apositive correlation between the readings of rightand left side. Theparametermost useful formasssurveyisauricularlengthandwidth.16DISCUSSIONANDCONCLUSIONThe most prominent feature of face is ear whichmakes human face aesthetically and naturallyappealing.Formanyyearsreconstructivesurgeriesof auricles were challenging to the surgeons. Buttissue engineering of cartilage for reconstructive

surgeries has proven to be a promising option14.Therefore the study of exact morphometry ofhumanearhasbecomeallthemoreimportant.Thedimensions are different in various ethnic groupswhicharenecessaryforthesurgeontoworkonthedataspecifictoethnicgroup.The sizeofhumanauricle increaseswithageevenafter it`s complete development11. The increase isattributed to elastic fibres in auricular cartilage. Asignificanceofagewas foundwith largervalues inolder individuals.Thereforeour study is toprovide


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data in males and females in age group of 18-24yearsfromnorthwestpartofIndia.Total height of ear is important in diagnosis ofcongenital anomalies2. In North American whitestotalheightofearauriclehasbeen reported tobe62.4mm inmales and 58.5mm in females ( Asai Y1990)15andinJapanesepopulationtheearheightis70.1mm16.Bozkir et al5 reported the height of earauricle in Turkish population to be 62.9mm infemalesand63.1mminmales.Ourresultsaremoresimilar to North American and Turkish populationthanwithJapanesepopulation.Duetorecentdevelopmentintissuereconstructivesurgeries, we have reported the width of auricle.Widthoftheauriclehasnotbeenreportedbymanyauthors except Bozkir et al5 in Turkish populationwhichisquitesimilartoourstudy.The dimensions of ear lobule reported in differentstudies6,7 varies from 13mm to 25 mm. But in ourstudy lengthandwidthof ear lobulewas found tobearound18mminmalesand17mmfemales.The conchal length and width has not beenextensively reported in literature except for9 inCentral India population. They reported conchal

lengthtobearound26mmandwidtharound18mmwhichwasquitesimilartoourstudyThe knowledge of measurement of auricularprotrusion is useful in designing of hearing aidinstrument. The hearing aid is either fitted behindtheearorsurgicallyanchoredtomastoid.AscitedbyPukraitRetal9inIndiansprotrusionofauricleatsuperauralelevelisaround10.5mmto16.1mmandattragallevelrangesbetween18.8mmto24.8mm.Ourreadingsalmostfallinthisrange.In our measurements no difference was foundbetween the readings of right and left side butdifference between paired structures of right andleftpartsofhumanfacehasbeenreportedbyotherauthors17.Thusweconducted this study togenerate interestand further research on the knowledge of eardimensions, especially in the north west part ofIndia,wheredata is limited.Thedataprovidedwillhelp in diagnosing of congenital and acquireddeformityandwillalsoprovideguidelinestoplasticsurgeons to correct deformity. Moreover the dataprovided will help in recent developments ofmedicines, such as, tissue engineering of earcartilageforreconstructivesurgeries.

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morphometric study of human auricle in the age group of 18-24...

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