OBJECTIVE: A group of established aesthetic physicians sought to develop treatment guidelines for assessing Asian face morphologies that reflect accurate and current beauty standards across Asia. DESIGN: Physicians completed surveys, debated, and voted on their clinical strategies and developed an alternative simplified visual tool of assessment (SVAT) that discerns between country variations in genetic and ideal morphotypes. SETTING: Electronic and paper surveys were followed by consensus debates and voting. PARTICIPANTS: Established aesthetic physicians practicing regularly on Asian patients. MEAUSUREMENTS: A clinically applicable SVAT was developed, which considered facial index, mid-face projection, upper and lower face shape, submalar contour, nose length and dorsal height, eye shape and brow shape, proportion of lips-to-lower face and ratio of upper-to-lower lip, and chin shape. RESULTS: For facial shape change, physicians always assessed the horizontal thirds, facial symmetry, and lip-chin complex profile, and also analyzed overall face shapes and Ogee curves. Criteria for creating oval-shaped faces was also defined and included treating indications, such as loss of angularity and bilateral masseter muscle hypertrophy, narrow jawlines, and longer and wider foreheads. Critical differences and similarities in country-specific aesthetic preferences, treatment requests, and considerations or strategies were uncovered, including the inadequacy of assessing overall peripheral facial shapes. CONCLUSION: This consensus establishes the assessment and treatment criteria for achieving ideal shapes for Asian patients. Specific descriptors are affected by variations; therefore, we present the visual criteria for Asian facial morphotypes. We hope that physicians new to treating Asian patients can use this clinical information to improve their practice.
In cosmetic surgery, knowledge of the average dimensions of periorbital features based on gender and ethnicity is essential to improve the patient appearance and maintain the ethnicity. The aim the study was to establish gender-specific periorbital anthropometric and anthroposcopic data for Indian Americans (IA) and to assess the statistically ethnic differences by comparing with published data of Malaysian Indians (MI). Evaluation of periorbital features was done on the standardized frontal photographs of 400 IA, aged 18 to 26 years. The measured values were evaluated by an independent t-test. Sexual dimorphism was found in all 15 measurements. The eyebrow height, combined height of the orbit and eyebrow, eyebrow apex inclination, apex to lateral canthus distance, medial end of brow to medial canthus distance, lateral end of brow to lateral canthus distance; pretarsal skin height, palpebral fissure height, palpebral fissure inclination (PFI), and medial canthus tilt were significantly greater in female than the males. In males, eyebrow apex hairline distance, apex to lateral limbus distance, eyebrow apex angle (EAA), lower eyelid height, and interpupillary distance was significantly greater than the females. Significant ethnic difference was found between IA and MI for eyebrow height, apex to lateral limbus distance, EAA, palpebral fissure height, and PFI in male group. In female group, EAA, medial canthus tilt, and PFI were significantly greater in MI. Four types of epicanthus were observed and the brow apex between lateral limbus and lateral canthus was the most common position. The generated normative data may be useful during diagnosis and treatment planning.
The Hiding Heidi low-contrast 'face' test is a new paediatric contrast test to evaluate the ability to detect objects with low contrast. The purpose of the present study was to compare the Hiding Heidi low-contrast 'face' test (HH) with the Pelli-Robson contrast sensitivity test (PR) and the functional acuity contrast test (FACT) in the low-contrast assessment.
The aim of this retrospective study was to study the clinical patterns of oro-facial infections presented and their management (or trends of management) at the Department of Oral and Maxillofacial Surgery, Dental Faculty, University of Malaya. These included the predisposing factors, presentations and management. This study reviewed the oro-facial infection cases over 15 years. The data was obtained from case note reviews of patients using specially designed proforma. A total number of 409 samples were included in this study. Majority of the patients were generally healthy with about 6.6% having diabetes mellitus. The common presentations were pain (47.4%), pus discharges (16.9%) and limitation of mouth opening (12.5%). The major site was in the submandibular region (18.9%) followed by cheek (13.2%). Most of the infections were from odontogenic source (63.2%). Other sources includes cysts (15.4%) and tumours (6.7%). Incision and drainage were the treatment of choice performed on 57.55% of patients. Monoantimicrobial therapy was the treatment instituted in 20.8% of cases.
Male proboscis monkeys have uniquely enlarged noses that are prominent adornments, which may have evolved through their sexually competitive harem group social system. Nevertheless, the ecological roles of the signals encoded by enlarged noses remain unclear. We found significant correlations among nose, body, and testis sizes and a clear link between nose size and number of harem females. Therefore, there is evidence supporting both male-male competition and female choice as causal factors in the evolution of enlarged male noses. We also observed that nasal enlargement systematically modifies the resonance properties of male vocalizations, which probably encode male quality. Our results indicate that the audiovisual contributions of enlarged male noses serve as advertisements to females in their mate selection. This is the first primate research to evaluate the evolutionary processes involved in linking morphology, acoustics, and socioecology with unique masculine characteristics.
Extra nodal nasal NK/T cell lymphoma is relatively a rare type of non-Hodgkin lymphoma. Variable clinical presentation with rapidly progressive necrosis of the cartilaginous and bony wall of the nose and upper respiratory passages leads to delayed diagnosis and treatment. A 43-years-old patient presented with right nasal pain and furuncle-like swelling. The swelling progressed rapidly to cellulitis to the face up to the right eye. Within 2 months, it had advanced to necrosis of the lateral vestibular cartilage, medial maxillary wall, turbinate and nasal septal cartilage. Biopsy reported as non-Hodgkin diffuse T cell (angiocentric T cell) lymphoma.
A 26-year-old female presented to the paediatric clinic at 11 years of age with poor growth. The detection of delayed puberty, anosmia, coloboma and hearing impairment led to a diagnosis of CHARGE syndrome. This was confirmed by a heterogenous de novo pathogenic variant c.6955C >T:p.(Arg2319Cys) detected in the CHD7 gene. Detailed assessment, including olfaction, ophthalmic and auditory examination should be part of the evaluation framework in children with delayed growth and puberty.
There is a general consensus that individuals with conspicuous strabismus are perceived more negatively with respect to physical appearance, personality and capability. Such social biases can potentially lead to social alienation and negative psychosocial development, particularly when experienced at a young age. This study aims to explore young children's perception of peers with noticeable exotropia.
A hot water burn is a thermal injury that results in cell death. Thermal eye injury triggers inflammatory processes, including inflammatory cell influx and/or the activation of various inflammatory cells, which result in the rapid accumulation of extravascular fluid in the ocular tissue. The ocular effect depends on the temperature of the water, and the final visual outcome depends on the severity of the damage to the intraocular structures. We report a 23-year-old woman who experienced a facial hot water burn that resulted in blindness. The patient presented late to the hospital after the unsuccessful use of traditional medication. Facial burns are a known cause of blindness. Public health education on prompt hospital presentation, and resistance to the use of potentially harmful traditional medicine in facial burns is suggested.
The aim of this study was to compare the skeletal and soft tissue patterns between obstructive sleep apnoea (OSA) patients and control group of non-OSA patients. Fifty Malays (32 males and 18 females) aged 18-65 years divided into two equal groups 25 (17 males and 8 females) with OSA and a control group 25 subjects (15 males and 10 females). Both groups were diagnosed using polysomnography. Nineteen variables related to craniofacial skeletal and soft tissue morphology were measured on lateral cephalometric films. Analysis of covariance was used to compare the means between the two groups. The results showed that OSA subjects had a significant increase in body mass index (BMI) and neck circumference than the control group. The soft palate and tongue were longer and thicker in OSA patients. In addition, upper, middle, and lower posterior airway spaces were narrower, the hyoid bone was more inferior and posterior, and the cranial base flexure angle was significantly acute when compared with the control group. The findings indicate that craniofacial abnormalities play significant roles in the pathogenesis of OSA in Malay patients.
OBJECTIVE: This study was done to establish the craniofacial anthropometric norms of the young adult (18- 25 years) Malaysian Indian.
MATERIALS AND METHODS: The study group consisted of convenient samples of 100 healthy volunteers, with equal number of female and male subjects who had no history of mixed racial-parentage. Twenty-two linear measurements were taken twice from 28 landmarks over six craniofacial regions. The methodology and evaluation of indices of the craniofacial region was adapted from Hajnis et al.
RESULTS: The minimum measurements are always contributed by the female Indian except for the nose height (n-sn), (left) eye fissure length (ex-en), upper vermillion height (ls-sto), and lower vermillion height (sto-li). There is a gender difference in all the measurements except the (left) eye fissure height (independent t-test; P < 0.05). The Malaysian Indians exhibit some North American White Caucasian (NAWC) features in all regions. The cephalic index indicates a brachycephalic or relatively short wide head with a tendency towards mesocephaly. From the low nasal index, the Malaysian Indian female have a nose that is narrow or leptorrhin similar to the NAWCs. The lower value of the upper lip height to mouth width index in the Indian female indicates a relatively shorter upper lip height compared to the mouth width, also similar to the NAWC.
CONCLUSION: This study establishes the craniofacial anthropometric norms of the Malaysian Indian over 22 parameters. Male in general has a significantly higher measurement than female. The Malaysian Indians do exhibit some NAWC features.
Facial soft tissues are a major determinant of treatment choice. When Class I and Class II malocclusions were compared using finite-element analysis, morphologic differences were localized and quantified. This study highlights the importance of determining the timing, magnitude and direction offacial growth prior to treatment to achieve stable results.
We report the first case of an immunocompromised adult patient presenting with cervicofacial lymphadenitis due to Mycobacterium haemophilum, confirmed using hsp65 gene sequencing and line-probe assays. In resource-limited settings, especially in developing countries, appropriate culture methods and rapid molecular diagnostic tools such as hsp65 gene sequencing for identification of this organism may not be readily available. This may cause M. haemophilum infections to go unrecognised or lead to delays in diagnosis. Lack of heightened awareness about the potential for this mycobacterial species to cause infections may also contribute to possible underestimation of M. haemophilum cases in the developing world.
A cephalometric study using Downs' analysis was undertaken with lateral cephalometric radiographs for a mixed sample of 50 child, adolescent and young adult Indonesians who presented with Angle Class I occlusions. Significant differences between this study group and the published results from comparative racial types were found for Downs' angle of convexity, Y-axis and incisor inclinations, indicating that Indonesians can be differentiated from other races with similar occlusions by using Downs' analysis.
Coffin-Siris syndrome (CSS, MIM#135900) is a congenital disorder characterized by coarse facial features, intellectual disability, and hypoplasia of the fifth digit and nails. Pathogenic variants for CSS have been found in genes encoding proteins in the BAF (BRG1-associated factor) chromatin-remodeling complex. To date, more than 150 CSS patients with pathogenic variants in nine BAF-related genes have been reported. We previously reported 71 patients of whom 39 had pathogenic variants. Since then, we have recruited an additional 182 CSS-suspected patients. We performed comprehensive genetic analysis on these 182 patients and on the previously unresolved 32 patients, targeting pathogenic single nucleotide variants, short insertions/deletions and copy number variations (CNVs). We confirmed 78 pathogenic variations in 78 patients. Pathogenic variations in ARID1B, SMARCB1, SMARCA4, ARID1A, SOX11, SMARCE1, and PHF6 were identified in 48, 8, 7, 6, 4, 1, and 1 patients, respectively. In addition, we found three CNVs including SMARCA2. Of particular note, we found a partial deletion of SMARCB1 in one CSS patient and we thoroughly investigated the resulting abnormal transcripts.
Noonan syndrome (NS) is a common genetic syndrome associated with gain of function variants in genes in the Ras/MAPK pathway. The phenotype of NS has been well characterized in populations of European descent with less attention given to other groups. In this study, individuals from diverse populations with NS were evaluated clinically and by facial analysis technology. Clinical data and images from 125 individuals with NS were obtained from 20 countries with an average age of 8 years and female composition of 46%. Individuals were grouped into categories of African descent (African), Asian, Latin American, and additional/other. Across these different population groups, NS was phenotypically similar with only 2 of 21 clinical elements showing a statistically significant difference. The most common clinical characteristics found in all population groups included widely spaced eyes and low-set ears in 80% or greater of participants, short stature in more than 70%, and pulmonary stenosis in roughly half of study individuals. Using facial analysis technology, we compared 161 Caucasian, African, Asian, and Latin American individuals with NS with 161 gender and age matched controls and found that sensitivity was equal to or greater than 94% for all groups, and specificity was equal to or greater than 90%. In summary, we present consistent clinical findings from global populations with NS and additionally demonstrate how facial analysis technology can support clinicians in making accurate NS diagnoses. This work will assist in earlier detection and in increasing recognition of NS throughout the world.
Turner syndrome (TS) is a common multiple congenital anomaly syndrome resulting from complete or partial absence of the second X chromosome. In this study, we explore the phenotype of TS in diverse populations using clinical examination and facial analysis technology. Clinical data from 78 individuals and images from 108 individuals with TS from 19 different countries were analyzed. Individuals were grouped into categories of African descent (African), Asian, Latin American, Caucasian (European descent), and Middle Eastern. The most common phenotype features across all population groups were short stature (86%), cubitus valgus (76%), and low posterior hairline 70%. Two facial analysis technology experiments were conducted: TS versus general population and TS versus Noonan syndrome. Across all ethnicities, facial analysis was accurate in diagnosing TS from frontal facial images as measured by the area under the curve (AUC). An AUC of 0.903 (p < .001) was found for TS versus general population controls and 0.925 (p < .001) for TS versus individuals with Noonan syndrome. In summary, we present consistent clinical findings from global populations with TS and additionally demonstrate that facial analysis technology can accurately distinguish TS from the general population and Noonan syndrome.
The aims of this study were to assess the quantitative values of measurements using proportion indices in the craniofacial region in patients with repaired, non-syndromic, complete unilateral cleft lip and palate (UCLP), and compare them with a control group who did not have clefts using the non-invasive systems of 3-dimensional technology. Three-dimensional measurements of the facial surfaces of 15 Malay patients who had UCLP repaired and 100 Malay control patients aged 18-25 years were analysed. The 3-dimensional images of the respondents' faces were captured using the VECTRA-3D Stereophotogrammetry System. Eleven craniofacial proportions were assessed using a combination of 18 linear measurements obtained from 21 anthropometric soft tissue landmarks. These measurements were used to produce proportion indices to find the differences in the morphological features between the groups, and assessed using the independent sample t test and z scores. There were significant differences between the groups in 7 out of 11 craniofacial proportion indices (p=0.001-0.044). Z scores of 2 indices were disproportionate. They were nasal index (which was severely supernormal) and upper lip index (which was moderately supernormal). Patients with UCLP had higher mean z scores, indicating that patients with UCLP tended to have larger faces than the control group. There were clinically important differences mainly in the nasolabial area, where the nose and the upper lip were wider, larger, or flatter in patients with UCLP.