|Year : 2020 | Volume
| Issue : 3 | Page : 115-120
Assessment of nasal morphological parameters in Maharashtrian population
Pushkar Andhare1, Sanjeev Datana1, Shiv Shankar Agarwal1, SK Bhandari2
1 Department of Orthodontics and Dentofacial Orthopedics, Armed Forces Medical College, Pune, Maharashtra, India
2 Department of Oral and Maxillofcial Surgery, Armed Forces Medical College, Pune, Maharashtra, India
|Date of Submission||21-Apr-2020|
|Date of Decision||11-May-2020|
|Date of Acceptance||19-May-2020|
|Date of Web Publication||08-Oct-2020|
Shiv Shankar Agarwal
Department of Orthodontics and Dentofacial Orthopedics, Armed Forces Medical College, Pune, Maharashtra
Source of Support: None, Conflict of Interest: None
Introduction: Human nose influences facial aesthetics and soft tissue harmony. Owing to uniqueness of nasal morphological characteristics, due consideration to it during treatment plan is essential. Present study aims at assessing nasal index in the Maharashtrian population and its correlation with age, gender and type of malocclusion. Materials and Methods: A sample of 410 patients was selected out of patients undergoing orthodontic treatment at the department to assess various nasal parameters. Data thus obtained was divided in groups depending on age, gender and type of malocclusion and subjected to suitable statistical analyses. Results: Mean nasal index in males was 79.08 ± 8.21 while in females was 76.65 ± 9.87 which did not differ significantly with respect to gender and age (P > 0.05). Mean nasal index differ in respect to type of malocclusion in sagittal plane and was found to be highest in patients' records pertaining to skeletal Class III malocclusion, which was statistically significant (P < 0.05). Nasal index did not show significant correlation with facial index and dorsum base ratio (P > 0.05 for both). Conclusions: Mean nasal index in Maharashtrian male is 79.08 ± 8.21 and in females is 76.65 ± 9.87 (mesorrhine nasal type). The mean nasal index was found to be reduced in Class II malocclusion cases as compared to Class I and Class III malocclusion. The facial index, nasal index and dorsum base ratio also did not show statistically significant correlation.
Keywords: Maharashtrian population, nasal index, type of malocclusion
|How to cite this article:|
Andhare P, Datana S, Agarwal SS, Bhandari S K. Assessment of nasal morphological parameters in Maharashtrian population. J Dent Res Rev 2020;7:115-20
|How to cite this URL:|
Andhare P, Datana S, Agarwal SS, Bhandari S K. Assessment of nasal morphological parameters in Maharashtrian population. J Dent Res Rev [serial online] 2020 [cited 2021 Jan 15];7:115-20. Available from: https://www.jdrr.org/text.asp?2020/7/3/115/297518
| Introduction|| |
Human nose, because of its anatomical position forms an epicentre for facial aesthetics and soft tissue harmony. In today's soft tissue paradigm where achieving ideal soft tissue relationship is the primary goal, it is empirical for the clinician to understand the normal soft tissue proportions and its adaptation in response to the dental and skeletal changes that are anticipated following orthodontic treatment. During sixth century BC, Susruta Samhita came into existence and various rhinoplasty procedures which are still prevalent and practiced were introduced. The importance of nose in aesthetics has been accepted worldwide, which is evident from the extensive historical, philosophical and scientific publications that are referred to, in every hour of need to attain the aesthetic facial balance. Moreover, it is the soft tissues that form the anatomical boundary for various dental and skeletal changes that are incorporated in the treatment planning of an orthodontic treatment.
Various attempts have been made in the literature to identify the ideal proportions of face, nose, lips and other soft tissue of the face, so that definitive guidelines can be made for clinician to maintain/achieve the same. Because of the central location of the nose on the face, it has impact on both the lips and the chin to develop a peculiar characteristic facial appearance of an individual. Facial characters are found to be influenced by factors such as: race, ethnicity, age, sex, culture and environmental factors such as geographic location of the individual and climatic variations. Owing to this uniqueness of nasal characteristics, it has been included in victim identification protocol of the investigation and forensic authorities by various countries.,,,,, The anthropometric and medicine literature yields a plethora of parameters to assess the nasal and facial morphological features such as facial height, facial width, facial index, nasal height, nasal length, nasal width, nasal index, dorsum-base ratio and so on. However, these parameters and their peculiarities in Maharashtrian population have not yet been explored.
Therefore, a study was planned with an aim to assess the nasal index in Maharashtrian population of India. The study also attempts to co-relate the nasal index with facial index of the individual and also with respect to gender, age and malocclusion in sagittal and vertical plane.
| Materials and Methods|| |
This observational study was conceived and executed at department of orthodontics and dentofacial orthopaedics of a tertiary care government teaching institute in Maharashtra. After taking necessary ethical clearance, the study sample was selected using the following criteria:
Patients undergoing orthodontic treatment at the department with age ranging from 12 to 30 years and providing consent for the study; patients with Maharashtrian ethnicity, irrespective of caste or subcaste (confirmed with both the parents), were included in the study.
Patients with history of trauma to nasal structures, history of nasal surgery, syndromic condition that affect the nasal structures such as cleft lip and palate, facial asymmetry, etc., were excluded from the study. After application of inclusion and exclusion criteria, 410 patients were selected for the study.
Pretreatment records of patients undergoing orthodontic treatment at the department along with anthropometric measurement were assessed. The various variables assessed during the present study include nasal height, nasal length, nasal width, facial height, facial width, age, gender and malocclusion in sagittal and vertical plane. Anthropometric measurements were done using digital calliper sensitive up to first decimal point. The parameters assessed were as follows: Nasal height-distance measured from soft tissue nasion to subnasale; Nasal length-measured from soft tissue nasion to pronasale; nasal width-distance measured between most convex point of ala on both sides (inter alar width); nasal index-determined by mathematical formula = nasal width/nasal height ×100; Dorsum base ratio (nasal width to nasal length ratio)-determined by mathematical formula = nasal width/nasal length; facial height-measured as distance from soft tissue nasion to soft tissue menton; facial width-measured as distance between most lateral point on the soft tissue overlying the zygomatic arch (inter zygion width); and facial index-determined by mathematical formula = facial height/facial width ×100 [Figure 1]. For assessing the malocclusion in sagittal plane-Pretreatment lateral cephalogram was used to determine the ANB angle. Skeletal Class I = ANB of 0° to 4°. Skeletal Class II = ANB of more than 4°. Skeletal Class III = ANB of <0°. For assessing the malocclusion in vertical plane-pretreatment lateral cephalogram was used to determine the Frankfort mandibular plane angle (FMA) (normodivergent = FMA 22°–25°; hypodivergent = FMA <22°; and hyperdivergent = FMA more than 25°).
|Figure 1: Anthropometric measurements of facial and nasal parameters (a) digital callipers, (b) nasal height, (c) nasal width, (d) nasal length, (e) facial height, (f) facial width|
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In order to overcome the possible inter and intra examiner bias, randomly selected 150 patients were reassessed by principal investigator (PA) and also reviewed by a senior orthodontist (SD) at interval of 1 week.
The data on categorical variables is shown as n (% of cases) and the data on continuous variables is presented as mean and standard deviation. The statistical comparison of distribution of categorical variables was tested using Chi-square test. The statistical comparison of distribution of means of continuous variables was tested using independent sample t-test for two groups and using analysis of variance (ANOVA) for more than two groups. Correlation analysis was done using Pearson's technique. Scatter diagram along with line of regression is shown to depict the linear relationship between the study variables. The underlying assumption of normality was tested before subjecting the study variables to t-test, ANOVA and Pearson's correlation analysis. In the entire study, the P < 0.05 were considered to be statistically significant. All the hypotheses were formulated using two tailed alternatives against each null hypothesis (hypothesis of no difference). The entire data was statistically analyzed using Statistical Package for Social Sciences (SPSS) (SPSS version 22.0, IBM Corporation, Armonk, New York, USA) for MS Windows.,,
| Results|| |
The inter-examiner recordings did not show any significant difference (κ =0.8). On complete evaluation of the study sample, it was observed that out of 410 patients, 180 (43.9%) patients were males and 230 (56.1%) females. One hundred and thirty (31.7%) patients were of age below 16 years while 280 (62.3%) were above 16 years of age. Amongst the type of malocclusion; in sagittal plane, it was observed that 115 (28%) patients exhibited skeletal Class I malocclusion, 245 (59.7%) exhibited skeletal Class II malocclusion and 50 (12.3%) exhibited skeletal Class III malocclusion, whereas in vertical plane, it was observed that 145 (35.4%) patient showed normodivergent facial type, 215 (52.3%) hypodivergent facial type and 50 (12.3%) hyperdivergent facial type.
The mean nasal index in males was found to be 79.08 ± 8.21 while that in females it was 76.65 ± 9.87 which makes the nasal type of Maharashtrian males and females as Mesorrhine according to the Lang et al. classification. This distribution of mean nasal index did not differ significantly between group of male and female patients studied in the study group (P > 0.05) [Table 1] and [Figure 2].
The mean nasal index in group of patients with age below 16 years and above 16 did not differ significantly in the study sample (P > 0.05) [Table 1] and [Figure 2].
The mean nasal index was found to be increased in group of patients with skeletal Class III malocclusion as compared to skeletal Class I and Class II malocclusion (P < 0.05) [Table 2] and [Figure 3].
|Table 2: Distribution of nasal index according to type of skeletal malocclusion in sagittal plane|
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|Figure 3: Distribution of nasal index according to type of skeletal malocclusion|
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The mean nasal index in group of patients with normodivergent, hypodivergent and hyperdivergent facial type did not differ significantly in the study sample (P > 0.05) [Table 3] and [Figure 3].
|Table 3: Distribution of nasal index according to type of skeletal malocclusion in vertical plane|
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On assessing the correlation of nasal index with facial index and dorsum base ratio, it was observed that nasal index did not show statistically significant correlation with facial index and dorsum base ratio (P > 0.05 for both). Also on assessment of correlation analysis of facial index with dorsum base ratio it was found that the facial index did not show statistically significant correlation with dorsum base ratio (P > 0.05) [Table 4] and [Figure 4], [Figure 5], [Figure 6].
|Table 4: Correlation analysis between nasal index, facial index and dorsum base ratio|
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|Figure 4: Scatter diagram showing correlation analysis between nasal index and facial index. Line of regression depicting the extent of linear relationship along with R2 value is also shown in the figure|
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|Figure 5: Scatter diagram showing correlation analysis between nasal index and dorsum base ratio. Line of regression depicting the extent of linear relationship along with R2 value is also shown in the figure|
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|Figure 6: Scatter diagram showing correlation analysis between facial index and dorsum base ratio. Line of regression depicting the extent of linear relationship along with R2 value is also shown in the figure|
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| Discussion|| |
The strategic anatomic position of nose has made it essential for both clinicians and patients to understand the effect of morphological variations of nasal features on facial aesthetics. In this regards plethora of research has been conducted in all fields of science; predominantly in anthropometry, cosmetic surgery, ear nose throat, orthodontics, etc., so as to identify and quantify the morphological features of nose and its relation to other facial structures which will enable the clinician to plan and attain balanced, aesthetic treatment results. Rotimiet al. examined Bini children of southern Nigeria and found the mean nasal index for male as 90.25 ± 1.33 which was significantly higher than that for female 88.65 ± 1.50, making the nasal type of Bini children as Platyrrhine. In Indian scenario, Ray et al. found that the mean nasal index of western Uttar Pradesh population was 73.98 ± 1.9 which fall in Mesorrhine nasal type category; with males having a higher nasal index than females. Choudhary and Chowdhary studied the nasal index in two ethnic groups of Rajasthan and came to the conclusion that the Jats have nasal index of 68.09 (leptorrhine nasal type) and Sindhis with nasal index 70.72 (mesorrhine nasal type). In the Himachali ethnic population, Thakuret al. observed that Himachali males having longer protrusive nose and females with a shorter and lesser protrusive nose. In present study which pertains to Maharashtrian population, the mean nasal index of 79.08 ± 8.21 in males and that of 76.65 ± 9.87 in females was observed and falls in Mesorrhine nasal type as per Lang et al. classification which is in accordance with previously conducted studies in Indian population except in case of Rajasthani Jat who predominantly had leptorrhine nasal type. Even though the result obtained did not differ statistically in terms of gender, higher value of nasal index was observed in males as compared to females which is in accordance with previously conducted studies. The study sample showed unequal distribution in terms of age and type of malocclusion in sagittal and vertical plane, resulting in less promising outcomes. Even though, the study sample provides some information regarding the nasal index of the study population and the influence of factors such as age and malocclusion on it, the study sample appear to be deficient to yield a statistically as well as clinically significant outcome.
Subtelny was the first to document the downward and forward growth of the nose with maturity. He observed that the vertical dimension of the nose shows more growth than its sagittal projection in growing male and female patients. A spurt in nasal growth was observed in male from 10 to 16 years of age with a peak around 13–14 years of age. However, females did not show any such nasal growth spurt but exhibited a steady increase in nasal growth. According to William et al., the growth of nasal bone is completed by about 10 years of age and the remaining growth is a result of growth of nasal cartilage and soft tissue, which expresses maximum growth during the adolescent growth spurt of the individual. Behrents, in his longitudinal study found that the changes in the nasal dorsum are mostly because of angulation changes of the lower dorsum of nose, particularly during adolescence. Accordingly the data in the present study was divided in to two groups depending upon age; above 16 years and below 16 years of age. However, the result shows no significant difference in nasal index in these two study groups.
Chaconas found that Class I subjects have more forward growth of the nasal tip than Class II subjects, with Class II subjects predominantly showing a elevation on the dorsum of nose and Class III subjects predominantly showing a concave dorsum of nose. Jafarpour et al. in their study recorded angular measurements of nose and showed variation with respect to malocclusion in sagittal plane. Nehra and Sharma in their study correlated nasal parameters with malocclusion in vertical plane and found the inter-relation between nasal parameters and vertical maxillary discrepancies. Robisonet al. found the correlation of facial profile and nasal shape which states that patients with straight profiles tended to have straight noses; convex profiles with convex nasal shapes; and concave profiles were found to have concave nasal shapes. In the present study a significant difference in nasal index was found in patient with different malocclusion in sagittal plane, highest among patients with skeletal Class III malocclusion, which was statistically significant (P < 0.05). However, in terms of malocclusion in vertical plane, no significant difference was observed, probably owing to the uneven distribution of cases with different type of malocclusion in the study group.
The current literature fails to yield any study that has attempted for establishing correlation between facial index, nasal index and dorsum base ratio; hence results of the present study cannot be compared with literature. The present study could not find any statistically significant correlation between facial index, nasal index and dorsum base ratio. Hence, further multicentric studies with larger sample size are recommended so that results so obtained can be used in clinics for correlating these indices and ratios for better planning of facial aesthetics.
| Conclusions|| |
The mean nasal index in Maharashtrian male was observed to be 79.08 ± 8.21 and that in females was found to be 76.65 ± 9.87(Mesorrhine nasal type). Even though, mean nasal index did not differ significantly with respect to gender and age, its clinical significance in terms of changes owing to variation in growth in males and females of different age groups and also anticipated soft tissue changes because of orthodontic treatment needs to be taken into consideration during treatment planning. The mean nasal index was found to be reduced in Class II malocclusion cases as compared to Class I and Class III malocclusion cases. Therefore, planning of lip prominence/support achieved at end of the treatment should consider these important nasal features, in order to obtain an aesthetic outcome. The facial index, nasal index and dorsum base ratio also did not show statistically significant correlation. Further studies with larger sample size and equal distribution with different type of malocclusion is recommended to obtain a more significant result, which will definitely prove to be beneficial for orthodontic diagnosis and treatment planning.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]
[Table 1], [Table 2], [Table 3], [Table 4]