Analysis of nasal bone characteristics in turkish people with multi-slice computed tomography



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ANALYSIS OF NASAL BONE CHARACTERISTICS IN TURKISH PEOPLE WITH MULTI-SLICE COMPUTED TOMOGRAPHY

ABSTRACT

The thickness, length and the shape of the nasal bone show variations between different ethnic groups. Further, there are differences between men and women within the same ethnic groups. In our study, to determine the morphological characteristics of the nasal bone in Turkish people, 1050 people (524 male, 526 female) from all over the country who had undergone maxillofacial CT in 7 different centers between January 2012 and May 2014 were retrospectively reviewed. Nasal trauma, nasal surgery and maxillofacial surgery patients were excluded from the study. Nasofrontal angle, thickness of the nasal bone, nasal bone length and angle of the nasal pyramid were evaluated. Nasofrontal angle was 122.4 ° ± 11.4 ° in men and 127.8 ° ± 10.6 ° in women; upper nasal bone thickness was 0.71 ± 0.21 cm in men and 0.69 ± 0:20 cm in women; intermediate level nasal bone thickness was 0.32 ± 0.1 cm in men and 0.34 ± 0.1 cm in women; lower border nasal bone thickness was 0.25 ± 0.15 cm in men and 0.21 ± 0.15 cm in women; nasal bone length was 2.32 ± 0.6 cm in men and 2.18 ± 0.5 cm in women; upper border nasal pyramidal angle was 90.7 ° ± 17 ° in men and 91.7 ° ± 16 ° in women; intermediate level nasal pyramidal angle was 64.6 ° ± 19 ° in men and 69.3 ° ± 19 ° in women; lower border nasal pyramidal angle was 57.9 ° ± 22 ° in men and 59.6 ° ± 22 ° in women. Overall, nasofrontal angle, intermediate level nasal bone thickness, and intermediate level nasal pyramid angle were significantly higher in women than men whereas the nasal bone length was significantly higher in men.



INTRODUCTION

Nose is a pyramidal structure that contains bone, cartilage and the membranous structures. The nasal pyramid includes 2 nasal bones that make joints with frontal bone at the top, maxillary ascending process at the lateral, and upper lateral cartilage at the inferior. Upper border articulating the frontal bone is narrow and thick while lower border articulating upper lateral cartilage is wide and thin(1, 2). The thickness, length and the shape of the nasal bone show variations between different ethnic groups as well as between men and women within the same ethnic groups. In maxillofacial surgery (especially in rhinoplasty), nasal bone thickness should be taken into consideration in order to perform an optimal nasal osteotomy. For this, knowledge of the morphological characteristics of the nasal bone and choosing the appropriate osteotomy is important. In our study, samples were taken from 7 different geographic regions to represent the Turkish people, and differences of nasal bones between men and women were identified via multi-slice computed tomography.



MATERIALS AND METHODS

We have designed a retrospective study and received local ethics committee approval. 1050 people (524 male, 526 female) from all over the country who had undergone maxillofacial CT in 7 different centers between January 2012 and May 2014 were retrospectively reviewed. Turkey consists of 7 geographical regions and does not have a homogeneous structure. Ethnic groups vary between regions). Among 1050 patient, 524 men (mean age 35.7, between 18-61 years) and 526 women (average age 36.2, between 18- 62 years) were identified.

Nasofrontal angle, thickness of the nasal bone, nasal bone length and angle of the nasal pyramid was evaluated as follows.

1 - nasofrontal angle: The angle between the most significant glabellar point, the nasion and distal point of the nasal bone was measured in the mid-sagittal section (Figure 1).

2- nasal bone thickness: measurement was done from 3 points at mid- sagittal section; nasofrontal junction, middle part of the nasal bone and the distal portion of the nasal bone (Figure 2).

3- nasal bone lenght: distance between the nasofrontal junction and distal nasal bone(rhinion) was measured at mid-saggital section(Figure3).

4- nasal pyramid angle : measurement was done from 3 points at mid- sagittal section; upper border angle, intermediate level angle and lower border angle (Figure 4,5,6).

RESULTS


Nasofrontal angle

Overall, average nasofrontal angle was 125.1 ± 11.2 °. It was 122.4 ° ± 11.4 ° in men and 127.8 ° ± 10.6 ° in women. Among men, the angle was 123.4 ° ± 11.3 ° between the 18-30 years of age, 122.3 ° ± 11.3° between the 30-50 years, and 119.8 ° ± 10.4 ° above the 50 years. In women, the angle was 129.1 ° ± 10.1 ° between 18-30 years of age, 127.5 ° ± 10.7 ° between the 30-50 years, and 126.2 ° ± 11.4 ° above the 50 years. Nasofrontal angle was found significantly higher in women for all age groups (P <0.001) (Table 1).

Nasal bone thickness

a- upper border thickness:

Mean upper border thickness of nasal bone was 0.70 cm ± 0.21 for entire population, 0.71 cm ± 0.21 in men, and 0:20 ± 0.69 cm in women. Among men, it was 0.71 ± 0.23 cm between the 18-30 years of age, 0.73 cm ± 0.22 between the 30-50 years and it was 0.61 ± 0.26 cm above the age of 50. In women, it was 0.71±0.22 cm between the 18-30 years of age, 0.71±0.20 cm between the 30-50 years, 0.66±0.21 cm above the age of 50. No statistically significant difference was found between men and women (P> 0.05) (Table 2).

b- intermediate level thickness:

Overall, average nasal bone intermediate level thickness was 0.33 ± 0.10 cm. It was 0.32±0.10 cm in men and 0.34±0.10 cm in women. Among men, it was 0.33±0.09 cm between the 18-30 years of age, 0.32±0.09 cm between the 30-50 years and it was 0.31±0.09 cm above the age of 50. In women, it was 0.32±0.10 cm between the 18-30 years of age, 0.37±0.10 cm between the 30-50 years, 0.31±0.10 cm above the age of 50. Intermediate level thickness was found significantly higher in women (P <0.05) (Table 3).

c- Lower border thickness:

Overall, average nasal bone lower level thickness was 0.23 ± 0.10 cm. It was 0.25± 0.15 cm in men and 0.21±0.15 cm in women. Among men, it was 0.24±0.12 cm between the 18-30 years of age, 0.24±0.10 cm between the 30-50 years and it was 0.32±0.12 cm above the age of 50. In women, it was 0.22±0.17 cm between the 18-30 years of age, 0.18±0.14 cm between the 30-50 years, 0.22±0.20 cm above the age of 50. No statistically significant difference was found between men and women (P> 0.05)(Table 4).

Nasal bone length

Overall, average length of nasal bone was 2.25±0.50 cm. It was 2.32±0.60 cm in men and 2.18±0.50 cm in women. Among men, it was 2.33±0.50 cm between the 18-30 years of age, 2.35±0.63 cm between the 30-50 years and it was 2.25±0.72 cm above the age of 50. In women, it was 2.1±0.50 cm between the 18-30 years of age 2.2±0.4 cm between the 30-50 years, 2.11±0.50 cm above the age of 50. Length of nasal bone was found significantly higher in men than women for all age groups (P <0.001) (Table 5).



Nasal pyramid angle

a - upper border angle:

Overall, average upper border nasal pyramidal angle was 91.2°±16°. It was 90.7°±17° in men and 91.7°±16° in women. Among men, it was 90.7°±17.8° between the 18-30 years of age, 90.8°±16.1° between the 30-50 years and it was 90.5°±17.1° above the age of 50. In women, it was 91.1°±17.4° between the 18-30 years of age 91.6°±16.1° between the 30-50 years, 93.8°±14.6° above the age of 50. No statistically significant difference was found between men and women (P> 0.05)(Table 6).

b- intermediate level angle:

Overall, intermediate level nasal pyramidal angle was 67.2°±19°. It was 64.6°±19° in men and 69.3°±19° in women. Among men, it was 64.5°±20.1° between the 18-30 years of age, 65.3°±18.8° between the 30-50 years and it was 62.9°±21.1° above the age of 50. In women, it was 68.7°±19.1° between the 18-30 years of age 71.1°±19.6° between the 30-50 years, 68.8°±18.5° above the age of 50. Intermediate level angle was found significantly higher in women (P<0.05)(Table 7).

c- lower border angle:

Overall, lower border nasal pyramidal angle was 58.7°±22°. It was 57.9°±22° in men and 59.6°±22° in women. Among men, it was 58.8°±23.7° between the 18-30 years of age, 57.6°±21.2° between the 30-50 years and it was 55.9°±21.1° above the age of 50. In women, it was 58.8°±20.7° between the 18-30 years of age 60.4°±25.1° between the 30-50 years, 58.6°±17.3° above the age of 50. No statistically significant difference was found between men and women (P> 0.05)(Table 8).



DISCUSSION

Various anthropometric maxillofacial soft tissue analyses have been published in the literature, but to our knowledge, no tomography assisted analysis of the nasal bone that represents Turkish people was available.

The thickness, length and the shape of the nasal bone show variations between different ethnic groups as well as within the same ethnic groups depending on the age and gender. Accordingly, maxillofacial surgery characteristics also differ (especially osteotoni in rhinoplasty surgery) (1).

Nasal osteotomies are the controlled incisions of the nasal bone with osteotomy or amplified instruments, and they constitute an important part of rhinoplasty surgery. The medial osteotomy is the incisions made in the nasal bone separating the septum and nasal bone and nasal bone thickness is particularly important in the medial osteotomy(3, 4) (figure 7).

Nasal bone thickness can directly affect the outcome of the osteotomy in rhinoplasty. In cases with very thick nasal bone, osteotomy gets more challenging whereas in cases with very thin nasal bones, uncontrolled fracture may occur unless an appropriate osteotomy is used. Nasal bone thickness is increased starting from caudal border towards radix on the mid line. In a cadaveric study by Harshbarger RJ et al. (5), nasal bone thickness was found 1.93 mm at cauda, and 5.87 mm at radiks. In our study, the average thickness was 7.10 mm at radiks, 2.30 mm at the cauda.

Morphological analysis of the nasal bone is important in appropriate osteotomy selection for rhinoplasty surgery as well as determining the gender and ethnicity in forensics (6). The length of the nasal bone demonstrates regional differences in relation to climate. In cold and dry regions, nasal bone length was found to be greater (7). In a study with Anatolian people, Karadağ et al. found the nasal bone length 30.61 ± 1.26 in men and 29.01 ± 1.12 in women(1). Hwang TS et al. (8) measured the nasal bone length in Korean men as 25.9 ± 3.8 mm and 24.5 ± 3.7 mm in women. In a cadaveric study, Ofodile FA reported the nasal bone length as 3.02 cm in Austrians, 2.79 cm in black American people, 2.18 cm in African people and 3.0 cm in Indian people(9). In a study with 40 Indian originated skulls, Asghar et al. measured the nasal bone length as 17:58 mm (10). In a study conducted with 64 Korean people, Kim NG et al. found the nasal bone length as 20.6 mm (11). In our study, the average nasal bone length was 23.2 mm in men and 21.8 mm in women.



Nasal anthropometry studies show the nasofrontal angle is greater in women than men. In a study with 100 participants, Moon KIM et al. showed the nasofrontal angle as 131.14 in men and 140.7 in women (12). In our series, the average nasofrontal angle was found 122.4 ° ± 11.4 ° in men and 127.8 ° ± 10.6 ° in women.

Last of all, the nasal bone morphology shows variations between different ethnic groups as well as between men and women within the same ethnic group. According to the nasal anthropometric measurements in our study; nasofrontal angle, intermediate level nasal bone thickness and Intermediate level nasal pyramid angle were significantly higher in women while the nasal bone length was significantly higher in men.

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