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The movements required for piano playing usually involve low impact loads that do not exceed physiologic limits of human body, but their repetition may provoke microtrauma leading to overuse injuries. Experience may allow a pianist to modify the motor patterns used for a performance, allowing the highest accuracy with minimum effort. In the present study, hand and finger movement patterns were analyzed in 19 pianists (8 concert players, 11 students and teachers) while they played 16 measures of a minuet. The three-dimensional coordinates of their right hand and fingers were obtained by a motion analyzer. Three-dimensional finger velocity was determined, unitary kinetic energy was computed, and movements were divided into useful (for sound production) and erratic (extraneous movements not used for sound production). The number of key presses for each pianist was counted, and single finger unitary kinetic energy computed. On average, the concert players used more total unitary kinetic energy than the students and teachers (p < 0.05, Wilcoxon test), while the useful unitary kinetic energy was similar. The number of key presses for each finger did not differ (p > 0.05, chi-squared test). The useful unitary kinetic energy per single key press differed between groups (p = 0.035, with concert players greater than students and teachers, analysis of variance) and among the five fingers (p = 0.008, with second and first fingers larger). In conclusion, the same piano exercise was performed with different movement patterns depending on the pianist¿s experience. The patterns of extraneous hand and finger movements during playing could be investigated to assess their relationship to overuse injuries. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To supply quantitative information about the facial soft tissues of patients with hypohidrotic ectodermal dysplasia. DESIGN: Prospective assessment. SETTING: National meetings of hypohidrotic ectodermal dysplasia patients and families. PATIENTS AND MAIN OUTCOME MEASURES: Facial and mandibular corpus convexities in the horizontal plane; facial convexity in the sagittal plane; interlabial, naso-labial, nasal convexity, and left and right soft tissue gonial angles were calculated from the three-dimensional coordinates of 11 soft tissue facial landmarks obtained in 18 male and 17 female hypohidrotic ectodermal dysplasia patients aged 3 to 41 years and in 504 reference healthy individuals. In addition, z-scores were computed and the patients were grouped by cluster analysis. RESULTS: Male and female z-scores did not differ. In the pooled group, facial convexities in the horizontal and sagittal planes were significantly (Student's t, p < .01) increased (flatter) in hypohidrotic ectodermal dysplasia patients, compared with normal controls. The naso-labial angle was significantly reduced (more acute). Upper and lower facial convexity and mandibular corpus convexity in the horizontal plane deviated less from the norm with increasing age. Facial convexity in the horizontal and sagittal planes, soft tissue gonial angles, and naso-labial and interlabial angles deviated less from the norm with increasing number of teeth present in the mouth. Cluster analysis identified three homogeneous groups, all characterized by a peculiar facial phenotype. Modifications in facial convexity and gonial and interlabial angles differentiated each cluster. CONCLUSIONS: Patients with hypohidrotic ectodermal dysplasia had flatter faces in the horizontal and sagittal planes than normal controls had. Cluster analysis revealed patterned differences in facial phenotype. [ABSTRACT FROM AUTHOR]

Sport performance during the execution of closed skills combines specific body and limb movements into codified patterns where stability and consistency may be more important than variability. Repeated sport movements can be investigated to assess the consistency of body trajectories. More consistent trajectories will result in more repeatable movements. The present study quantified the short-term consistency of body trajectories during the performance of the backward flic-flac, a technique of floor gymnastics. Nine experienced gymnasts (six men, three women), all of national level, performed 10 repetitions of backward flic-flac. An optoelectronic instrument was used for the detection of the three-dimensional movement of 13 body landmarks. The spatiotemporal consistency of repeated landmark trajectories was measured by the standard deviation between standardized trajectories. The results showed smaller standard deviation (larger consistency between landmark trajectories) in female than in male gymnasts. The analysis of the consistency of landmark trajectories could help gymnasts indicating which parts of the body do not repeat a selected movement with sufficient accuracy. [ABSTRACT FROM AUTHOR]

In this study, the neck and head relative to the ground were more flexed, while the head relative to the neck was more extended, in the subjects who were blind than in the sighted subjects. The introduction of external (sound) or proprioceptive (mandibular position, look ahead) inputs modified craniocervical posture and relationships (extension) in both groups. [ABSTRACT FROM AUTHOR]

Pre-treatment lateral cephalograms of 41 skeletal Class I girls aged 11 to 15 were divided according to MP-SN angle: lower than 28 degrees (hypodivergent, 10 girls), between 31 and 34 degrees (normodivergent, 18 girls), or larger than 37 degrees (hyperdivergent, 13 girls). The mandibular outlines were traced and digitized, and differences in shape were quantified using the elliptic Fourier series. Size differences were measured from the areas enclosed by the mandibular outlines. Shape differences were assessed by calculating a morphological distance (MD) between the size-independent mean mathematical reconstructions of the mandibular outlines of the three divergency classes. Mandibular shape was different in the three classes: large variations were found in hyperdivergent girls versus normodivergent girls (MD = 4.61), while smaller differences were observed in hypodivergent girls (MD versus normodivergent 2.91). Mean size-independent mandibular shapes were superimposed on an axis passing through the centres of gravity of the condyle and of the chin. Normodivergent and hyperdivergent mandibles differed mostly at gonion, the coronoid process, sigmoid notch, alveolar process, posterior border of the ramus, and along the mandibular plane. A significant size effect was also found, with smaller mandibles in the hyperdivergent girls. [ABSTRACT FROM AUTHOR]

Improvements in computed tomography and in functional endoscopic sinus surgery have recently increased interest toward paranasal sinus anatomy and anatomic variations that can be observed in patients affected by sinusitis. Isolated sphenoid sinusitis is a relatively rare pathology, often related to nonspecific symptoms, therefore making diagnosis difficult. The correlation between this type of sinusitis and anatomical variants remains unclear.The authors' aim was to retrospectively revise paranasal sinuses computed tomography scans of patients affected by sphenoid sinusitis, compared with a control group, analyzing the types of sphenoid sinus and the presence of aberrant pneumatization, and performing a segmentation of the sphenoid sinuses to calculate the volumes.Sphenoid sinuses of 60 patients affected by sinus opacification, compared with a control group, were segmented. Type of sinus (sellar, presellar, postsellar) and presence of aberrant pneumatization were assessed as well. Possible statistically significant differences in volumes according to sex and group were assessed through 2-way ANOVA test (P < 0.05). Post-hoc test was assessed through Student t test. χ test was applied in order to verify the statistically significance of differences in frequency of different types of sinus pneumatization variants (P < 0.05).Average volume of sphenoid sinuses in males was of 7.672 cm and of 7.751 cm in females within the group of patients; statistically significant differences in volume were found according to sex (P: 0.342), but not between the patients and control group (P: 0.0929). Post-hoc test verified that males affected by sinus opacification showed smaller volumes in comparison with the control males (P < 0.05). In addition, patients by affected sinus opacification showed more frequently the postsellar type and were less affected by pneumatization variants of the sphenoid bone than the control group (P < 0.05).This study first suggests the possible protective role of variants of pneumatization in the development of sphenoid sinus opacification.

Swallowing is a muscular activity that occurs both after mastication and spontaneously as a result of saliva accumulation. Spontaneous saliva swallowing occurs about every 2 minutes. Comprehension of its functional mechanisms is relevant to assess their modification in clinical situations. A standardised surface electromyographical (ssEMG) protocol for the evaluation of this muscle activity is lacking. Aims of the present study are: (i) to determine the reproducibility of a ssEMG protocol for the evaluation of the oral phase of saliva swallowing and (ii) to evaluate the activity of masseter (MM), anterior temporalis (TA), submental muscles (SM) to draw a reference model of swallowing. Standardised surface electromyographical activity of MM, TA and SM during swallowing of saliva spontaneously accumulated was recorded in 20 healthy participants. Functional indexes including symmetry (POC), recruitment (Impact), duration of activation of each couple of muscles and of the whole exercise, position, intensity of the spike were computed. Inter- and intra-appointment reliabilities were assessed and method errors calculated. Descriptive statistics, sex- and muscles-related comparisons were carried out. Standardised surface electromyographical assessment of MM, TA and SM muscles was reliable. A high inter-individual variability was found. Percentage overlapping coefficient (POC) values were close to 80% for TA and SM, higher than for MM (P < .001). Impact values ranged between 16.4% and 30.7%, and differences were found between muscles (P < .001). The global muscle activity during swallowing lasted between 1.5 and 1.8 seconds. For each couple of muscles, the duration of activation ranged between 0.7 and 1.6 seconds and muscles-related differences were found (P < .001). The spike of activation for each couple of muscle ranged between 35.7% and 44.2% of the duration. The protocol was reliable and intra-participants repeatable measures can be carried out. Due to the high inter-participants variability, further analyses are needed to draw a model of muscular activity., (© 2018 John Wiley & Sons Ltd.)

Palatal rugae are known in literature as individualizing anatomical structures with a strong potential for personal identification. However, a 3D assessment of their uniqueness has not yet been performed. The present study aims at verifying the uniqueness of 3D models of the palate. Twenty-six subjects were recruited among the orthodontic patients of a private dental office; from every patient, at least two dental casts were taken in different time periods, for a total of 62 casts. Dental casts were digitized by a 3D laser scanner (iSeries, Dental Wings©, Montreal, Canada). The palatal area was identified, and a series of 250 superimpositions was then performed automatically through VAM©software in order to reach the minimum point-to point distance between two models. In 36 matches the models belonged to the same individual, whereas in 214 mismatches they came from different subjects. The RMS (root mean square) of point-to-point distances was then calculated by 3D software. Possible statistically significant differences were assessed through Mann-Whitney test (p < 0.05). Results showed a statistically significant difference in RMS mean point-to-point distance between matches (mean 0.26 mm; SD 0.12) and mismatches (mean 1.30; SD 0.44) (p < 0.0001).All matches reached an RMS value below 0.50 mm. This study first provided an assessment of uniqueness of palatal rugae, based on their anatomical 3D conformations, with consequent applications to personal identification.

Uniqueness of ear morphology has been a widely debated issue in cephaloscopy, but past studies used only two-dimensional approaches. In the current investigation, the right and left ears of 10 healthy adults were imaged twice by stereophotogrammetry at the interval of a few seconds. The ear images obtained from the two acquisitions were superimposed both within subject (group of matches) and among subjects (group of mismatches). A point-to-point root mean square distance was calculated between the two three-dimensional models. Differences according to side and group were assessed by two-way analysis of variance. In total, 200 superimpositions were performed. On average, the point-to-point root mean square distance was 0.31 mm in cases of matches and 1.43 mm in cases of mismatches: differences were statistically significant (p < 0.01). Results provided quantitative data for the assessment of uniqueness of ear morphology, highlighting differences based on their three-dimensional morphology.

Purpose: To compare a new normalization technique (wax pad, WAX) with the currently utilized cotton roll (COT) method in surface electromyography (sEMG) of the masticatory muscles., Methods: sEMG of the masseter and anterior temporalis muscles of 23 subjects was recorded while performing two repetitions of 5s maximum voluntary clenches (MVC) on COT and WAX. For each task, the mean value of sEMG amplitude and its coefficient of variation were calculated, and the differences between the two repetitions computed. The standard error of measurement (SEM) was calculated. For each subject and muscle, the COT-to-WAX maximum activity increment was computed. Participant preference between tasks was also recorded., Results: WAX MVC tasks had larger maximum EMG amplitude than COT MVC tasks (P<0.001), with COT-to-WAX maximum amplitude increments of 61% (temporalis) and 94% (masseter) (P=0.006). WAX MVC had better test-retest repeatability than COT. For both MVC modalities, the mean amplitude (P>0.391) and its coefficient of variation were unchanged (P>0.180). The WAX task was the more comfortable for 18/23 subjects (P=0.007)., Conclusion: WAX normalization ensures the same stability level of maximum EMG amplitude as COT normalization, but it is more repeatable, elicits larger maximum muscular contraction, and is felt to be more comfortable by subjects., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Information about age-related and sex-related normative measurements of the nasolabial region in native Northern Sudanese subjects is scanty. We have therefore used a hand-held laser scanner to measure nasolabial angles and distances, and collected the 3-dimensional coordinates of seven landmarks on the facial soft tissues from 654 healthy native Northern Sudanese subjects (327 male and 327 female, aged 4-30 years). From these we calculated five angles and two linear distances and took the mean (SD) for age and sex, and compared them using factorial analysis of variance. All measurements analysed were significantly modified by age in both sexes (p < 0.01) except for the distance from the lower lip to Ricketts' E-line. Sex had a significant effect on the mentolabial and maxillary prominence angles and both distances (p < 0.005). Nasal convexity and the interlabial angle became more obtuse with growth, while the nasolabial and mentolabial angles reduced progressively with female subjects having significantly more obtuse mentolabial angles (p < 0.001). The maxillary prominence angle progressively decreased during childhood, and increased after adolescence, with larger values in male subjects. The upper and lower lip distances from Ricketts' E-line were also significantly larger in male subjects (p < 0.003), but the difference reduced with age. Overall, there were several differences when we compared our data with published data for African and white subjects, which points to the need for ethnic-specific data. Measurements collected in the current study could be used for the quantitative description of facial morphology in native Northern Sudanese children, adolescents, and young adults., (Copyright © 2015 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

Objective: To identify esthetic characteristics of the orbital soft tissues of attractive Italian adult women and men., Materials and Methods: Three-dimensional computerized digitizers were used to collect the coordinates of facial landmarks in 199 healthy, normal subjects aged 18 to 30 years (71 women, 128 men; mean age, 22 years) and in 126 coetaneous attractive subjects (92 women, 34 men; mean age, 20 years) selected during beauty competitions. From the landmarks, six linear distances, two ratios, six angles, and two areas were calculated. Attractive subjects were compared with normal ones by computing z-scores., Results: Intercanthal width was reduced while eye fissure lengths were increased in both genders. Orbital heights (os-or) were increased only in attractive women, with a significant gender-related difference. The inclinations of the eye fissure were increased in attractive subjects, while the inclinations of the orbit were reduced. For several of the analyzed measurements, similar patterns of z-scores were observed for attractive men and women (r  =  .883)., Conclusion: Attractive women and men had several specific esthetic characteristics in their orbital soft tissues; esthetic reference values can be used to determine optimal goals in surgical treatment.

Background: With increasing age, the smile becomes elongated and less appealing. Currently, several methods are proposed for analysis of lip morphology including lateral cephalograms, profile and frontal photographs, video images, and three-dimensional systems. Despite several descriptions of morphologic and histologic age-related changes in the literature, no scientific well-supported model of the labial aging process is reported., Methods: For this study, 33 healthy volunteers were selected and divided into two groups according to age: a youthful group (ages 21-34 years) and an aged group (ages 45-65 years). Their dental and labial stone casts were obtained, digitized, and virtually reproduced using a computerized electromechanical digitizer and applying nonuniform rational B-spline geometry. To obtain a synthetic parameter describing local surface deformation, average curvature and curvature variability indexes were computed and compared., Results: No significant age- or sex-related differences in the average curvature were detected. In contrast, the curvature variability was significantly greater in the young than in the aged subjects., Conclusions: The labial arch surface remains macroscopically constant between the third and the sixth decades of life, but with local modifications that influence the standard deviation of its curvature. A high standard deviation described the protruding labial appearance of the young subjects, whereas a reduced one described the flat lips of the aged subjects., Level of Evidence Iv: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Objective: To investigate dimensions and ratios of soft-tissue facial volumes of adult Northern Sudanese subjects with Down syndrome by using computerized anthropometric measurements., Design, Setting, and Patients: The 3D coordinates of soft-tissue facial landmarks were obtained by a computerized digitizer in 26 Northern Sudanese adult subjects with Down syndrome (18 men, 8 women, aged 17-34 years), and in 99 healthy Northern Sudanese controls (48 women, 51 men) of the same age range. From the landmarks, several facial volumes and volume ratios were calculated. Data were compared to those collected in healthy individuals by computing z-scores., Results: In subjects with Down syndrome, facial volumes were significantly smaller than in control subjects (Student's t, p < 0.05). The patterns of deviation from the norm were similar in men and women. When compared to controls, subjects with Down syndrome had no differences in nose volume as a fraction of total facial volume and a larger total lip volume as a fraction of total facial volume; within the facial middle third, they had relatively larger upper lip volumes and relatively smaller nose volumes., Conclusions: The facial soft-tissue structures of subjects with Down syndrome differed from those of normal controls of the same age, sex and ethnic group: a reduced facial size was coupled with specific variations in the nasal and labial regions.

Objective: To demonstrate if one or more golden relationships between different measurements of the human face exist., Materials and Methods: To make our measurements, we used three-dimensional (3D) stereophotogrammetry, which has proved to be the "gold standard" in the field of facial anthropometry. We obtained 3D stereophotogrammetric facial acquisitions of 400 healthy young adult subjects, then had them scored by an Evaluation Jury. Each subject received an esthetic evaluation ranging from 0 to 40. Individuals with a score larger than 28 were considered very attractive (VA), and individuals with a score lower than 12 were considered not attractive (NA). Fifteen subjects per group were chosen by chance, with a final total group of 60 subjects: 15 VA males, 15 NA males, 15 VA females, and 15 NA females. For each subject, a set of facial distances was obtained from the stereophotogrammetric facial reconstruction, and 10 ratios were computed. The effects of sex and attractiveness were tested by analysis of variance. Additionally, Student's t-tests verified if the ratios were statistically different from the golden ratio., Results: For nine ratios, no significant effects of sex or attractiveness were found. Only the eye-mouth distance/height of the mandible ratio was significantly influenced by sex (P = .035) and attractiveness (P = .032). Seven out of 10 ratios were statistically different from the hypothetical value of 1.618, and only three of them were similar to the golden ratio., Conclusions: Ratios between 3D facial distances were not related to attractiveness. Most of the facial ratios were different from the golden ratio.

The orbital region plays a predominant role in the evaluation of the craniofacial complex. No current normative data exist for Northern Sudanese subjects. In the current study information about normal sex- and age-related dimensions of the orbital region was provided. The three-dimensional coordinates of ten landmarks on the orbital soft tissues were obtained using a hand-held laser scanner in 654 healthy Northern Sudanese subjects aged 4-30 years. From the landmarks, biocular and intercanthal widths, paired height and inclination of the orbit relative to both the true horizontal (head in natural head position) and Frankfurt plane, length and inclination of the eye fissure, the relevant ratios, were calculated, and averaged for age and sex. Comparisons were performed by factorial analysis of variance. All analysed linear soft-tissue orbital dimensions, except intercanthal width and left orbital height, were significantly larger in men than in women (p<0.01). A significant sexual dimorphism was found also for the height-to-width ratios (larger in women in most age groups), the orbital inclinations vs. the true horizontal and Frankfurt plane (both measurements were almost always larger in men than in women), and the right side inclination of the eye fissure vs. the true horizontal (larger in women than in men), while no sex-related differences were observed for the left side inclination of the eye fissure vs. the true horizontal. All measurements but the right side inclination of the eye fissure vs. the true horizontal underwent significant modifications as a function of age, with several significant age×sex interactions. Biocular and intercanthal widths, orbital height, length of the eye fissure, all increased from childhood to young adulthood; in the second decade of life all age-related increments were larger in men than in women. Overall, when compared to literature data for African and Caucasoid subjects, several differences were found, pointing to the necessity of ethnic-specific data. Data collected in the present investigation could serve as a database for the quantitative description of human orbital morphology during normal growth and development. Forensic applications (evaluations of traumas, craniofacial alterations, teratogenic-induced conditions, facial reconstruction, ageing of living and dead people, personal identification) may also benefit from age- and sex-based data banks., (Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.)

This study evaluated the electromyographic (EMG) characteristics of masticatory muscles in patients with fixed implant-supported prostheses according to All-on-Four(®) principles and in control healthy dentate subjects. Twenty-six subjects aged 50-74 years were examined. Eighteen were edentulous and had been successfully rehabilitated with (i) mandibular All-on-Four(®) implant-supported fixed prostheses and maxillary complete dentures (10 patients) and (ii) mandibular and maxillary All-on-Four(®) implant-supported fixed prostheses (eight patients). Eight reference subjects had natural dentition. Surface EMG recordings of the masseter and temporalis muscles were performed during maximum voluntary teeth clenching and during unilateral gum chewing. All values were standardised as percentage of a maximum clenching on cotton rolls. During clenching, a good global neuromuscular equilibrium was found in all participants. During chewing, all groups had similar values of working-side muscle activities and of chewing frequency. No significant differences in the analysed EMG parameters were found between the patients with mandibular and maxillary All-on-Four(®) implant-supported prostheses and the reference subjects. In contrast, standardised pooled muscle activities and standardised muscular activities per cycle were larger in patients with a maxillary removable prosthesis than in control subjects (Kruskal-Wallis test, P < 0·01). Also, patients wearing a complete maxillary denture showed a poor neuromuscular coordination with altered muscular pattern and lower values of the index of masticatory symmetry than dentate control subjects (P < 0·01). EMG outcomes suggest that All-on-Four(®) implant-supported prostheses may be considered a functionally efficient treatment option for the rehabilitation of edentulous patients with reduced residual bone volume., (© 2012 Blackwell Publishing Ltd.)

The objective of the current study was to assess a low-cost, noninvasive facial morphometric digitizer to assist the practitioner in three-dimensional soft-tissue changes before and after oral rehabilitation. Twenty-two patients aged 45 to 82 years, all with edentulous maxilla and mandible, were assessed both before and after receiving their definitive complete implant-supported prostheses (each received 4-11 implants in each dental arch; full-arch fixed prostheses were made). The three-dimensional coordinates of 50 soft-tissue facial landmarks were collected with a noninvasive digitizer; labial and facial areas, volumes, angles, and distances were compared without and with the prostheses. Dental prostheses induced significant reductions in the nasolabial, mentolabial, and interlabial angles, with increased labial prominence (P < 0.05, Wilcoxon test). Lip vermilion area and volume significantly increased; significant increments were found in the vertical and anteroposterior labial dimensions. The presence of the dental prostheses significantly (P < 0.001) modified the three-dimensional positions of several soft-tissue facial landmarks. In conclusion, the current approach enabled quantitative evaluation of the final soft-tissue results of oral rehabilitation with implant-supported prostheses, without submitting the patients to invasive procedures. The method could assess the three-dimensional appearance of the facial soft tissues of the patient while planning the provisional prosthetic restoration, providing quantitative information to prepare the best definitive prosthesis.

Morphological changes in three-dimensional (3D) dentolabial relationships during ageing were assessed in healthy individuals. 38 subjects with healthy dentition were analysed. They were divided into a youthful group (21-34 years, mean 26 years, SD 4) and an older group (45-65 years, mean 53 years, SD 5). Stone labial and dental models were made, digitized and 3D virtual reproductions of dentolabial morphology were obtained. From the digital reconstructions, the relative positions of the labial commissure and of the maxillary dental clinical crowns in the vertical direction were obtained. Sex and age effects were compared using two-way analysis of variance. Lip position relative to the teeth was significantly different in youthful and older subjects (P<0.01). No statistically significant effects of sex in dentolabial relationship were demonstrated, but a sex×age effect was found in the anterior labial segments (P<0.05). The perioral soft tissues drop down in older subjects and the soft tissue descends on the entire labial arch. These differences may help the clinician when estimating, planning and evaluating surgical, orthodontic and prosthetic treatments., (Copyright © 2012 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

Facial nerve paralysis is one of several possible complications following conservative parotidectomy. To assess three-dimensional facial movements non-invasively in patients with unilateral facial palsy following parotidectomy for benign tumours, the three-dimensional coordinates of 21 soft-tissue facial landmarks were recorded in 32 patients (21 HB I, 5 HB II, 6 HB III-IV; 3 months post-surgery follow-up), and 40 control subjects, during the performance of facial movements (smile, 'surprise', eye closure, single eye closure). For all symmetric animations, control subjects had larger total mobility than patients; mobility progressively decreased in patients with larger clinical grades. For asymmetric eye closures, HB I patients and control subjects had similar total movements, while HB II patients had smaller movements, especially for the paretic side eye closure; smaller total movements were found in HB III-IV patients. The method allowed the quantitative detection of alterations in facial movements. Significant differences between patients and control subjects in the magnitude and asymmetry of movements were found., (Copyright © 2012 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

To quantify the effects of facial palsy reanimation, 14 patients aged 17-66 years were analysed. All patients had unilateral facial paralysis, and were candidates for surgical masseteric to facial nerve anastomosis. Two patient groups were measured: seven patients were waiting for surgery, the other seven patients had already been submitted to surgery, and had regained facial mimicry. Each patient performed three facial animations: brow raise; free smile; lip purse. These were recorded using an optoelectronic motion analyser. The three-dimensional coordinates of facial landmarks were obtained, their movements were computed, and asymmetry indices calculated (differential movements between the two hemi-faces: healthy and paretic/rehabilitated). Before surgery, mobility was larger in the healthy than in the paretic side; after surgery, the differences were reduced (brow raise and lip purse), or even reversed (smile). Before surgery, lip purse was performed with significant labial asymmetry (p=0.042; larger healthy side movement). After surgery, asymmetry indices reduced. Total labial asymmetry during smiling was significantly different from 0 before surgery (p=0.018, larger healthy side movement). After surgery, all asymmetry indices became non-significant. Before surgery the lateral displacements of all labial landmarks were towards the healthy side, while they normalized after surgery., (Copyright © 2011 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

The repeatability of a non-invasive digital protocol proposed to evaluate the three-dimensional (3D) position of the occlusal plane in the face is assessed. Dental virtual models and soft tissue facial morphology of 20 adult subjects were digitally integrated using a 3D stereophotogrammetric imaging system. The digital 3D coordinates of facial and dental landmarks were obtained by two different operators. Camper's (facial) and occlusal (dental) planes were individuated, and their 3D relationships were measured. The repeatability of the protocol was investigated and showed no significant differences in repeated digitizations. The angle between occlusal and Camper's planes was smaller than 2° in the frontal and horizontal projections. In the sagittal projection, the angle was observed to be, on average, 4.9°. The determined occlusal plane pitch, roll and yaw values show good agreement with previously published data obtained by different protocols. The current non-invasive method was repeatable, without inter-operator differences and can facilitate assessment of healthy subjects.

The orbital region of subjects with Down syndrome (DS) has been scanty described so far. We wanted to detail the morphologic characteristics of the soft tissue orbital region in Italian and North Sudanese subjects with DS. The three-dimensional coordinates of 10 landmarks on the orbital soft tissues were obtained using computerized anthropometry in 53 Italian and 64 North Sudanese subjects with DS aged 4 to 52 years, and in 461 (Italian) and 682 (North Sudanese) sex- and age-matched controls. From the landmarks, linear distances, ratios, areas, and angles were calculated, z scores computed, and compared by t-tests and analyses of covariance. In North Sudanese DS subjects, intercanthal width and height-to-length ratio were increased; biorbital width, eye height, length, and area were reduced. Eye fissure and orbital inclinations relative to Frankfort plane were reduced, whereas orbital inclinations versus the true horizontal were increased. In Italian DS men, orbital height and height-to-length ratio were increased, eye length was decreased; orbital inclination versus the true horizontal was increased. For almost all measurements, a significant effect of age was found. No effects of sex were found. Ethnic group influenced orbital height, area, and orbital inclination versus Frankfort plane. All paired measurements had similar discrepancies on both sides. The orbital soft tissues of North Sudanese DS subjects differed from those of their reference subjects, but this was only partially true for Italian subjects. The 2 ethnic groups had different alterations in their soft tissue orbital regions that were influenced by age, but not by sex.

The objective of this study was to measure: (1) normal sex-related dimensions of external nose (linear distances, ratios, angles, volume and surface area); and (2) growth changes between childhood and old age. The three-dimensional coordinates of several soft-tissue landmarks on the external nose were obtained by a non-invasive, computerized digitizer in 519 male and 340 female healthy subjects aged 4-73 years. The subjects were divided into 11 non-overlapping age groups: for children and preadolescent subjects, 2-year spans were used, while larger intervals were used for adolescent and adult subjects. From the landmarks, nasal volume and external surface area; nasal and alar base widths, nasal height, nasal bridge length, philtrum length, nasal tip protrusion, right and left nostril lengths, superior and inferior nostril widths; nasal tip protrusion-to-nasal height, and nasal width-to-nasal height ratios; nasal convexity, alar slope, and nasal tip angles were calculated, and averaged for age and sex. Comparisons were performed by factorial analysis of variance. On average, men had larger nasal external volume and area, linear distances and nasal width-to-height ratio than women (p<0.01); no sex differences were found for the angles and the nasal tip protrusion-to-nasal height ratio. Age significantly influenced all analyzed measurements (p<0.001): nasal volume, area, linear distances increased from childhood to old age, while the nasal tip angle decreased as a function of age. No consistent age related patterns were found for the ratios and the nasal convexity and alar slope angles. Men and women had different age related patterns, with significant sex by age interactions (p<0.001). Overall, in most occasions male increments in nasal dimensions were larger than female ones. Data collected in the present investigation could serve as a database for the quantitative description of human nasal morphology during normal growth, development and aging. Forensic applications (evaluations of traumas, craniofacial alterations, teratogenic-induced conditions, facial reconstruction, aging of living and dead persons, personal identification) may also benefit from age and sex based data banks., (Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.)

Objective: To detail the nasolabial morphologic characteristics of North Sudanese subjects with Down syndrome (DS)., Materials and Methods: Nasolabial morphology was assessed three-dimensionally in 64 North Sudanese subjects with DS aged 4 to 34 years and in 682 sex- and age-matched controls. Three-dimensional facial coordinates were collected using a laser scan, and selected distances, angles, areas, and volumes were computed. Subject and reference data were compared by computing z-scores and Student's t-tests., Results: The nose was significantly smaller (area) in subjects with DS than in reference subjects, and it had a different shape (more flat angle of alar slope, more acute nasal tip angle). The vertical (nasal bridge length, nose height) and anteroposterior (nasal tip protrusion) dimensions were reduced, while the horizontal dimensions (alar base width, inferior widths of the nostrils) were increased. The nasolabial angle was increased. The cutaneous lip volume was significantly smaller, while the vermilion lip area was larger in the subjects with DS. The mouth and philtrum widths were significantly reduced, while the vermilion height was significantly increased., Conclusion: Analyzed subjects with DS had a hypoplastic nose and different upper and lower lips than did reference, normal subjects.

Down syndrome (DS) is the most frequent live-born autosomal aneuploidy in humans. Scanty data on the craniofacial phenotype of African subjects with DS have been published so far. We wanted to detail the morphologic characteristics of the ears in north Sudanese subjects with DS. The three-dimensional coordinates of 13 soft-tissue landmarks on the ears were obtained using a laser scanner in 64 north Sudanese subjects with DS aged 4 to 34 years and in 682 sex- and age-matched control subjects. From the landmarks, left and right linear distances (ear width and length), ratios (ear width-to-ear length), areas (ear area), angles (angle of the auricle vs the facial midplane), and the three-dimensional symmetry index were calculated. Distances, angles, areas, and ratios were computed. Subject and reference data were compared by computing z scores and calculating Student t tests. Ear width, length, and area were significantly (Student t test, P < 0.001) smaller in the subjects with DS than in the reference subjects. On the right side of the face, the subjects with DS had larger ear width-to-ear length ratios and larger angles of the auricle versus the facial midplane than the reference subjects. The three-dimensional symmetry index was significantly larger in the reference subjects. In conclusion, ear dimensions, position, and shape significantly differed in subjects with DS when compared with sex-, age-, and ethnic group-matched control subjects.

To assess sex- and age-related characteristics in standardized facial movements, 40 healthy adults (20 men, 20 women; aged 20-50 years) performed seven standardized facial movements (maximum smile; free smile; "surprise" with closed mouth; "surprise" with open mouth; eye closure; right- and left-side eye closures). The three-dimensional coordinates of 21 soft tissue facial landmarks were recorded by a motion analyser, their movements computed, and asymmetry indices calculated. Within each movement, total facial mobility was independent from sex and age (analysis of variance, p>0.05). Asymmetry indices of the eyes and mouth were similar in both sexes (p>0.05). Age significantly influenced eye and mouth asymmetries of the right-side eye closure, and eye asymmetry of the surprise movement. On average, the asymmetry indices of the symmetric movements were always lower than 8%, and most did not deviate from the expected value of 0 (Student's t). Larger asymmetries were found for the asymmetric eye closures (eyes, up to 50%, p<0.05; mouth, up to 30%, p<0.05 only in the 20-30-year-old subjects). In conclusion, sex and age had a limited influence on total facial motion and asymmetry in normal adult men and women., (Copyright © 2010 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

To assess sex-related characteristics in facial movements, and to define a set of reference normal values, 20 healthy young adults (10 men, 10 women) performed six standardized facial movements (maximum smile; free smile; "surprise" with closed mouth; "surprise" with open mouth; right- and left-side eye closures). The three-dimensional coordinates of 21 soft-tissue facial landmarks were recorded by an optoelectronic motion analyzer, their movements computed, and standardized for facial dimensions. Asymmetry indices were calculated. The mouth area had the largest movements. Sex-related differences were found only for the superciliare landmark (men had larger movements than women, p<0.001). Asymmetries in the eyes, mouth and nose were similar in both sexes (p>0.01), with a significant effect of movement (p<0.001): eye and mouth asymmetry was larger during the asymmetric eye closures than during the symmetric movements. The right-side asymmetric movements were somewhat larger than the left-side ones. The total facial movement did not differ between sexes; the "surprise with mouth open" movement had the largest landmark displacements (p<0.001). In conclusion, normal young adult men and women had similar standardized facial movements, except in the forehead. Some individual asymmetry was found in symmetric facial animations; some synkinesis was found even in normal adults., (Copyright 2009 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

Purpose: To test the accuracy and reproducibility of a 3-dimensional (3D) stereophotogrammetric imaging system for measuring the facial soft tissues of healthy subjects., Materials and Methods: Three-dimensional soft tissue facial landmarks were obtained from the faces of 10 adult subjects, by use of a 3D stereophotogrammetric imaging system (Vectra; Canfield Scientific, Fairfield, NJ). Sixteen linear measurements were computed. Systematic and random errors between operators, calibration steps, and acquisitions were calculated., Results: No systematic errors were found for all performed tests (P > .05, paired t test). The method was repeatable, and random errors were always lower than 1 mm, except for the distance from cheilion to cheilion. Repeated sets of acquisition showed random errors up to 0.91 mm, without systematic biases., Conclusion: The 3D stereophotogrammetric imaging system can assess the coordinates of facial landmarks with good precision and reproducibility. The method is fast and can obtain facial measurements with few errors., (Copyright 2010 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

The objective of this study was to supply information about: (1) normal sex-related dimensions of mouth and lips (linear distances, ratios, angles, area, volume); and (2) growth changes between childhood and old age. The three-dimensional coordinates of several soft-tissue landmarks on the lips and face were obtained by a non-invasive, computerized electromagnetic digitizer in 532 male and 386 female healthy subjects aged 4-73 years. From the landmarks, linear distances (mouth width, width of the philtrum, vermilion heights of the upper, lower and total lips, total lip height), the vermilion height-to-mouth width ratio, areas (vermilion of the upper, lower and total lip) and volumes (upper, lower, and total lip volume) were calculated and averaged for age and sex. Comparisons were performed by factorial analysis of variance. Mouth width, width of the philtrum, total lip height, and lip volumes were significantly larger in men than in women (p<0.01), increased with age (p<0.001), and had age x sex interactions (p<0.001). Vermilion areas and heights of the lower and total lips progressively increased with age until late adolescence, and then decreased with aging (p<0.001). The vermilion height-to-mouth width ratio was larger in women than in men (p<0.001), and decreased with age (p<0.001). Data collected in the present investigation could serve as a database for the quantitative description of human lip morphology during normal growth, development and aging. Forensic applications (evaluations of traumas, craniofacial alterations, teratogenic-induced conditions, facial reconstruction, aging of living and dead persons, personal identification) may also benefit from age- and sex-based data banks., ((c) 2010 Elsevier Ireland Ltd. All rights reserved.)

Introduction: Several noninvasive methods are used for 3-dimensional (3D) morphologic facial and dental analysis to aid practitioners during diagnosis and treatment planning. Integrating dental and facial noninvasive 3D reproduction could improve the efficacy of treatment management., Methods: Dental virtual model and soft-tissue facial morphology were digitally integrated from 11 adults with a 3D stereophotogrammetric imaging system (Vectra, Canfield Scientific, Fairfield, NJ). The digital 3D coordinates of 3 facial landmarks (N, nasion; Ftr, frontotemporale right; Ftl, frontotemporale left) and 3 dental landmarks (I, interincisor; Pr, PI, tips of the mesiovestibular cusps of the right and left first permanent premolars) were then obtained by using Vectra's software. Additionally, the coordinates of the same 6 landmarks were digitized directly on each subject by using a 3D computerized electromagnetic digitizer (in vivo). Seven linear measurements were made between the occlusal plane (Pr-I-Pl) and the facial landmarks (Ftr-N-Ftl). The accuracy and reliability of the reconstruction were tested by in-vivo measurements and repeated acquisitions., Results: The greatest mean relative error of measurements was smaller than 1.2%. No significant differences in repeatable reproductions were found., Conclusions: Integration of facial stereophotogrammetry acquisition and dental laser scan reproduction is possible with marginal error., (Copyright (c) 2010 American Association of Orthodontists. Published by Mosby, Inc. All rights reserved.)

Objective: To identify the main directions of growth of facial structures in subjects with hypohidrotic ectodermal dysplasia (HED)., Materials and Methods: The 3D noninvasive facial measurements were collected in 12 subjects (6 boys, 6 girls) with HED during four assessments (at 8, 11, 12, and 15 years) using an electromagnetic digitizer. The modifications of linear distances in the upper, middle, and lower third of the face were analyzed and compared with cross-sectional data obtained in normal healthy coetaneous. For each distance, differential values between the last and the initial data were calculated individually, separately for a first (8-11 years) and a second growth period (12-15 years)., Results: In the first time span, the growth of all facial measurements was reduced in HED subjects compared with control subjects. During this interval, most of the HED children underwent a functional and/or prosthetic treatment. During adolescence, the width and height of the lower and upper facial thirds showed a larger growth in HED subjects than in control subjects, while all facial depths and all distances in the middle facial third maintained a reduced growth., Conclusions: The deviation from normal facial growth of HED subjects tends to lessen with age. Functional and prosthetic appliances may have enhanced facial growth.

Soft tissue analysis plays an increasing, strategic role in the recognition of facial alterations, but there are scanty three-dimensional reference data during normal growth, development and aging. In the current study, 532 male and 386 female healthy subjects aged 4 to 73 years were analyzed using a non-invasive, computerized electromagnetic digitizer, and normal dimensions of mouth and lips were obtained in the three-dimensional space. Labial thickness and curvature were also assessed in a selected group of 40 men and women, equally divided into young (age 21-30 yr, mean 25 yr) and old persons (age 45-65 yr, mean 55 yr). Lip vermilion area to volume, and vermilion height to cutaneous lip height ratios decreased with age in both sexes. On average, the lips were thicker in men and in young persons than in women and in old persons. Mean labial curvature was larger in young men than in the other groups, and it was more variable in young than in old persons. Data collected in the present investigation can be used as a data base for the quantitative description of human lip morphology during normal growth, development and aging.

Moebius syndrome is a congenital facial palsy associated with the impairment of ocular abduction. The three-dimensional characteristics of the facial soft tissues of 12 male and 14 female subjects [3-52 yr of age (mean age + standard deviation: 17 + 14 yr)] were measured using a non-invasive, computerized system; facial volumes, areas, angles, and distances were computed and compared with those obtained in reference subjects of the same age and gender. When compared with reference subjects, patients with Moebius syndrome had a more prominent and hyperdivergent face in the sagittal plane, a smaller and more prominent upper facial third; a smaller middle facial width; a smaller nose; smaller mandibular volume, depth, corpus length, and ramus height; and a more posterior positioned mandible, with a less prominent chin. In conclusion, patients with Moebius syndrome had a tendency towards a skeletal Class II pattern. These morphological variations may be the combined effect of a general alteration of the motor and sensitive facial nerves, including the trigeminal nerve, and of a maldevelopment of the brainstem.

Objective: To assess rotation and translation movements of the mandible at maximum mouth opening in a group of patients successfully rehabilitated after condylar fractures., Materials and Methods: Using a three-dimensional motion analyser, free movements of mouth opening were recorded in nine patients, and divided into their rotation and gliding components. Surface electromyography (EMG) of the masticatory and sternocleidomastoid (SCM) muscles was performed during maximum voluntary teeth clenching (MVC). Data were compared with those collected in healthy adults., Results: At maximum mouth opening, the total displacement of the mandibular interincisor point was 86% of reference value (p>0.05, Student's t test), with a reduced vertical displacement (84% of reference value, p=0.012). Percentage mandibular rotation was significantly larger in patients (82%) than in reference subjects (77%, p=0.005). During MVC, patients had more asymmetric EMG potentials (p=0.018), with greater mandibular torque (p<0.001), and reduced co-contraction of SCM (p=0.003). EMG indices were used to formulate an overall performance score that was related to the characteristics of mouth opening (r=0.557)., Conclusion: Notwithstanding a good recovery in the total mandibular movement, the rotation/translation components of mouth opening were modified. The overall EMG performance score could be used to predict the characteristics of mandibular motion.

Purpose: To develop a noninvasive 3-dimensional method to evaluate labial morphology and to assess gender-related differences in healthy young adults., Materials and Methods: Dental and lip impressions of 11 men and 10 women aged 21 to 34 years, with sound, full, permanent dentition were obtained. The models were digitized and 3-dimensional virtual reproductions obtained. The labial thickness, vermilion area, and volume of the upper and lower lips were measured from the digital reconstructions. The male and female data were compared using Student's t test., Results: The mean lip thickness was significantly larger (P = .02) in men (14.3 mm) than in women (12.3 mm). The lower lip was thicker than the upper lip. The vermilion width was larger in men (75 mm) than in women (70 mm), and no differences were found for vermilion height (10 mm). In the upper lip, the height/width ratio was significantly larger in women (14.1%) than in men (12.3%). The vermilion surface area was slightly larger in men than in women (upper lip area: women, 467 mm(2); men, 501 mm(2); lower lip area: women, 491 mm(2); men, 569 mm(2)). The labial volume was significantly larger in men (upper lip, 2,390 mm(3); lower lip, 2,902 mm(3)) than in women (upper lip, 1,743 mm(3); lower lip, 1,764 mm(3); P = .021). The upper/lower lip area and volume ratios were similar in the 2 genders., Conclusions: Overall, men had larger lips than women. The inferior lip height/width ratio was similar in both genders, and men had a relatively thinner upper lip than women.

Objectives: Functional orthodontic devices can modify oral function thus permitting more adequate growth processes. The assessment of their effects should include both facial morphology and muscle function. This preliminary study investigated whether a preformed functional orthodontic device could induce variations in facial morphology and function along with correction of oral dysfunction in a group of orthodontic patients in the mixed and early permanent dentitions., Material and Methods: The three-dimensional coordinates of 50 facial landmarks (forehead, eyes, nose, cheeks, mouth, jaw and ears) were collected in 10 orthodontic male patients aged 8-13 years, and in 89 healthy reference boys of the same age. Soft tissue facial angles, distances, and ratios were computed. Surface electromyography of the masseter and temporalis muscles was performed, and standardized symmetry, muscular torque and activity were calculated. Soft-tissue facial modifications were analyzed non-invasively before and after a 6-month treatment with a functional device. Comparisons were made with z-scores and paired Student's t-tests., Results: The 6-month treatment stimulated mandibular growth in the anterior and inferior directions, with significant variations in three-dimensional facial divergence and facial convexity. The modifications were larger in the patients than in reference children. In several occasions, the discrepancies relative to the norm became not significant after treatment. No significant variations in standardized muscular activity were found., Conclusions: Preliminary results showed that the continuous and correct use of the functional device induced measurable intraoral (dental arches) and extraoral (face) morphological modifications. The device did not modify the functional equilibrium of the masticatory muscles.