Facial soft tissue thickness database for craniofacial reconstruction in the Turkish adult...

Forensic Science International 242 (2014) 44–61

Facial soft tissue thickness database for craniofacial reconstruction inthe Turkish adult population

Ozgur Bulut a,*, Serdar Sipahioglu b, Baki Hekimoglu c

aDepartment of Forensic Anthropology, Turkish Police Forensic Laboratory, Golbasi, Ankara, TurkeybRadiology Department, Polatlı Can Hospital, Polatlı, Ankara, TurkeycRadiology Department, Yildirim Beyazit Traning and Research Hospital, Altindag, Ankara, Turkey

A R T I C L E I N F O

Article history:Received 16 September 2013Received in revised form 6 June 2014Accepted 15 June 2014Available online 26 June 2014

Keywords:Forensic anthropology population dataFacial reconstructionFacial soft tissue thicknessComputer tomographyTurkish adults

A B S T R A C T

320 Turkish adults (160 men, 160 women) who had undergone brain CT in the radiology clinic andshowed no sign of maxillofacial pathology were analyzed in order to create a facial soft-tissue thicknessdatabase of the Turkish adult population. The soft-tissue thicknesses were measured at 31 landmarks, 10midline and 21 bilateral anatomical landmarks. Average thickness values for each landmark as well as thestandard deviation and range classified according to gender and age are reported.The differences of these mean values related to age and sexes were calculated. The values were thenstatistically compared to the findings of the European and Korean adults.Overall, the soft-tissue thickness measurements obtained in this study can be used as a database for theforensic craniofacial reconstruction of Turkish adult faces.

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1. Introduction

Forensic facial reconstruction is the process of rebuilding a faceonto a representation of an unknown skull to help withidentification in forensic investigations [1–5]. When the skeletalremains cannot be identified by DNA analysis, fingerprintcomparison, or radiographic and dental records examination,facial reconstruction may be conducted as a last resort. Therefore,it plays an important role in leading a recognition and positiveidentification of an individual [6–15].

Two-dimensional (2D) and three-dimensional (3D) techniquesare employed to recreate a face from the skull. Besidesosteological analyses and skeletal morphology of the skull, facialsoft-tissue thickness data are also used in the process of facialreconstruction [4,16–18]. The North American method, fromKrogman and Iscan [3] and the Manchester method, from RichardNeave and Caroline Wilkinson [4,7,18,19] use facial tissue depthmeasurements at a number of bony landmarks on the skull asreference guides.

Facial soft-tissue thickness (FSTT) data can be collected usingdifferent methods. The FSTT is measured not only by usingcadavers with the puncture method, but is also collected fromliving individuals by using computed tomography (CT), ultraso-nography and magnetic resonance imaging (MRI) [8,20–30].

* Corresponding author. Tel. : +90 5055430109.E-mail address: [email protected] (O. Bulut).

http://dx.doi.org/10.1016/j.forsciint.2014.06.0120379-0738/ã 2014 Elsevier Ireland Ltd. All rights reserved.

Recently, these methods have been used by a large number ofstudies on different populations for assessing the FSTT data[20,21,23,25,27,28,31–37]. The FSTT data acquired using specificanatomical landmarks varies by ethnic group; therefore, the FSTTdata of other populations, for example, cannot be applied to theTurkish population.

Only one study, by Sipahioglu et al. [36], on the FSTT of theTurkish adult population has been previously published. However,the study focused on midline facial soft-tissue thickness of 9points. No other comprehensive Turkish population-specific workhas been conducted on facial soft-tissue thickness; this includesbilateral anatomical points for the Turkish population.

In the current study, statistical means and several otherparameters describing facial soft-tissue thicknesses were exam-ined for sample head CT scans of 320 Turkish men and women,between 18 and 80 years of age, a population for which there is nopreviously published data considering the bilateral facial softtissue thickness.

2. Materials and methods

2.1. Materials

The study consisted of 320 Turkish adults (160 males and 160females) between the ages of 18 and 80 years. The sample wasdivided into 5 age groups: 18–29 years, 30–39 years, 40–49 years,50–59 years and over 60 years (Table 1). Each age group containedthe same number of individuals (n = 32).

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Table 1Means and standard deviations of ages by sex and age groups.

Sex Age groups18–29 30–39 40–49 50–59 60+

MaleFemale

24.7 � 2.4523.3 � 3.07

35.8 � 2.6034.5 � 2.91

44.7 � 2.9345.2 � 2.73

54.2 � 2.6053.9 � 2.37

67.5 � 5.7068.6 � 6.01

O. Bulut et al. / Forensic Science International 242 (2014) 44–61 45

CT scans were obtained at the Diskapi Yildirim Beyazit Trainingand Research Hospital, Ankara, Turkey, for patients referred to theradiology clinic for diagnostic brain CT scans. All the patientsunderwent CT scans for reasons not related to this study. Thesubjects with head trauma or any other facial deformities wereexcluded from the study. Among BMI categories (<20, 20–25, >25)as slender, normal and obese which were used in previous studies[8,21,32], only the subjects who fell into the normal BMI categorywere included.

A Mx8000 spiral CT scanner (Philips, Amsterdam, Netherland)with a voxel resolution of 0.5 mm, in which the subject is requiredto be in supine position, was used to obtain CT scans. Three-dimensional craniofacial data were created from the DICOM(Digital Imaging and Communications in Medicine) data acquiredfrom the CT scans. Both soft and hard-tissue images were importedinto specific software, Amira 5.2.2 (Visage Imaging, Burlington,USA), to measure the thickness of 31 anatomical landmarks (Fig. 1).This study was approved by the Ethics Committee of DiskapiYildirim Beyazit Training and Research Hospital, Ankara, Turkey.

2.2. Measurements

Every landmark was localized and measured according to theorthoslice planes (xy, yz, xz) (Fig. 2). The threshold option of thesoftware enabled to view the skull and surface of the face. It wasalso possible to see hard and soft tissues at the same time by thetransparent surface display feature of the software (Fig. 3).

The soft tissue measurements were performed at a total of 31facial anatomical points which were identified according to DeGreef et al. [8]. 10 of these measurement sites were in the midlineand 21 were bilateral (Fig. 1). The descriptions of the landmarks arepresented in Table 2. In order to eliminate inter-observer error, asingle practitioner carried out landmark identifications.

Fig. 1. Anatomical land

2.3. Statistical analysis

The statistical analysis was carried out using the SPSS software,version 19.0 for Windows (SPSS Inc. Chicago, IL). To assess the intraobserver error, CT scans from 30 subjects were selected randomly,and the measurements repeated by a single practitioner at 3-weekintervals. Non-parametric Mann–Whitney test and technical errorof measurement (TEM) were used to analyze the results.

General descriptive analyses such as mean, SD (standarddeviation) and range were determined for each anatomicallandmark, and average soft tissue thicknesses were calculatedconsidering the sex and the age groups of the individuals.Skewness and Kurtosis for normality tests was performed toassess the distribution of the data. For normally distributed data,student’s t-test (independent two-sample) was performed tocompare males and females in each age group. Bonferonnicorrection was applied to the age groups at the default settings“valid options: none”. In order to observe significant differencesamong all age groups, LSD Post Hoc test was applied to thevariances and significance level was re-determined by Dunnet CCorrection. For non-normally distributed data, Mann–Whitney Utest was used.

The average soft tissue thicknesses of the Turkish populationwere then compared to that of Koreans in the study by Hwang et al.[38] and of the White Europeans in the study by De Greef et al. [8]using one-way analysis of variance (ANOVA) test. The significantdifference level was set at p < 0.05 for all statistical analyses.

3. Results

The results of the non-parametric test indicate that allmeasurements were reproducible and no significant differenceswere observed between the first and second round of

marks of the skull.

Fig. 2. Localization and measurement of the glabella point using orthoslice plane (yz). (a, b: 45� angle view, c, d: lateral view). Courtesy of Ismail Hizliol.

46 O. Bulut et al. / Forensic Science International 242 (2014) 44–61

measurements (Table 3). The technical intra observer errors wereminimal for all the anatomical landmarks. The technical error wasfound to be less than 0.5 mm. Supra M2 showed the highestabsolute technical error (0.3 mm) (Table 3).

The means, ranges and standard deviations of the soft-tissuethickness measurements for each landmark classified by the agegroup for both sexes are presented in Table 4. Variations in soft-tissue thickness by age for both sexes are given in Table 5.

Fig. 3. Different threshold values of a CT data (a) CT scan image of the skull, (b) CT scan

Courtesy of Ismail Hizliol.

3.1. Aged-based differences

A comparison across the five male age groups showed significantdifferences(p < 0.05) for 15 anatomical landmarks (sg, n, en, mp,ul, ll,bc, lg, lna, lno, sc, mta, spg, sbm2 and g) . For the females, significantdifferences (p < 0.05) were observed for 18 landmarks (sg, gl, en, mp,me, bc, fe, so, lna, lno, mta, spg, za, lo, ol, sbm2, g and mma) across thefive age groups (Table 5 and Figs. 4 and 5).

image of the face, (c) CT scan image of the both skull and face in transparent view).

Table 2Descriptions of the anatomical landmarks of the skull.

Anatomical landmarks Description

1. Supraglabella (sg) Most anterior point on midline2. Glabella (gl) Glabella cross-point between midline and supraorbital line3. Nasion (n) Nasion midpoint of the fronto-nasal suture4. End of nasal (en) End of nasal junction between bone and cartilage of the nose5. Mid-philtrum (mp) Mid-philtrum centered between nose and mouth on midline6. Upper lip (ul) Midline on the upper lip7. Lower lip (ll) Midline on the lower lip8. Chin–lip fold (cf) Midline centered in fold chin, below lips9. Mental eminence (me) Centered on most anteriorly projecting point of chin10. Beneath chin (bc) The vertical measure of the ST on the most inferior point of the chin11. Frontal eminence (fe) Centered on pupil, most anterior point of the forehead12. Supraorbital (so) Centered on pupil, just above eyebro13. Lateral glabella (lg) Junction of the frontal, maxillary, and lacrimal bones on the medial bone of the orbit14. Lateral nasal (lna) Side of the bridge of the nose on the Frankfurt horizontal plane15. Suborbital (sbo) Centered on pupil, just under infra-orbital margin16. Inferior malar (im) Centered on pupil, just interior to zygomatic process17. Lateral nostril (lno) Next to the most lateral point of the alar border18. Naso-labial ridge (nlr) The prominence either side of the philtrum19. Supracanina (sc) Vertically lined up with the cheilion, on the horizontal level of the mid-philtrum20. Subcanina (sbc) Vertically lined up with the cheilion, on the horizontal level of the chin–lip fold21. Mental tubercleanterior (mta)

Most prominent point on the lateral bulge of the chin mound

22. Mid-lateral orbit (mlo) Vertically centered on the orbit, next to the lateral orbital border23. Supraglenoid (spg) Root of the zygomatic arch just anterior to the ear24. Zygomatic arch (za) Most lateral curvature of the zygomatic bone25. Lateral orbit (lo) Lined up with the lateral border of the eye on the center of the zygomatic process26. Supra-M2 (sm2) Cheek region, lateral: lined up with nasal base; vertical: lined up beneath lateral border of the eye27. Mid-masseter (mm) Middle of the masseter, the halfway point between the supraglenoid and the gonion28. Occlusal line (ol) Border of the masseter, on vertical level of the cheilion29. Sub-M2 (sbm2) Below the second molar on horizontally lined up with supra-M230. Gonion (g) At the angle of the mandible31. Mid-mandibularangle (mma)

Inferior border of the mandible, vertically linedup with supra-M2

Table 3Technical error of measurements and p values of facial soft tissue thickness measurements.

Landmarks P value TEM

(Mann–Whitney U Test) (Technical error of measurement)Sup-glabella 0.796 0.12Glabella 0.545 0.28Nasion 0.894 0.09End of nasal 0.876 0.10Mid-philtrum 0.545 0.28Upper lip 0.445 0.32Lower lip 0.426 0.40Chin–lip fold 0.645 0.22Mental eminence 0.496 0.30Beneath chin 0.745 0.11Frontal eminence 0.786 0.12Supra orbital 0.615 0.21Lateral glabella 0.826 0.12Lateral nasal 0.645 0.22Sub orbital 0.796 0.12Inferior malar 0.445 0.32Lateral nostril 0.756 0.12Nasolabial ridge 0.445 0.32Supra canine 0.546 0.28Sub canine 0.745 0.11Mental tuber ant 0.796 0.12Mid lateral orbit 0.745 0.11Supraglenoid 0.516 0.29Zygomatic arch 0.915 0.07Lateral orbit 0.745 0.11Supra M2 0.550 0.28Mid masseter 0.745 0.11Occlusal line 0.696 0.20Sub M2 0.745 0.11Gonion 0.496 0.30Mid mandibular 0.445 0.32


Table 4Tissue depth means for males and females: (a) between 18 and 29 years, (b) between 30 and 39 years, (c) between 40 and 49 years, (d) between 50 and 59 years and (e) 60+years (all the measurements in millimeter).

Landmarks Male (n = 32) Landmarks Female (n = 32)

Range Minimum Maximum Mean S.D. Range Minimum Maximum Mean S.D.

(a)Sup-glabella 2.01 3.14 5.15 4.04 0.54 Sup-glabella 2.16 3.15 5.31 3.73 0.50Glabella 3.85 4.47 8.32 6.43 1.07 Glabella 3.36 4.01 7.37 5.72 0.87Nasion 4.39 4.82 9.21 7.23 1.29 Nasion 3.52 5.49 9.01 7.08 1.06End of nasal 2.59 2.05 4.64 2.96 0.65 End of nasal 1.65 2.00 3.65 2.49 0.51Mid-philtrum 6.81 10.18 16.99 14.19 2.08 Mid-philtrum 5.60 9.44 15.04 12.19 1.78Upper lip 6.18 10.25 16.43 13.88 1.81 Upper lip 7.19 8.11 15.30 11.09 2.07Lower lip 5.45 11.21 16.66 14.11 1.35 Lower lip 6.32 8.55 14.87 11.73 1.88Chin–lip fold 3.30 8.74 12.04 10.31 0.91 Chin–lip fold 2.82 8.23 11.05 9.52 0.80Mental eminence 8.93 7.11 16.04 12.02 2.04 Mental eminence 5.30 7.33 12.63 10.91 1.38Beneath chin 5.91 4.36 10.27 7.26 1.37 Beneath chin 2.08 4.15 6.23 5.27 0.60Frontal eminence 2.43 3.03 5.46 4.30 0.67 Frontal eminence 2.91 2.54 5.45 3.75 0.65Supra orbital 5.94 4.28 10.22 6.74 1.59 Supra orbital 3.57 4.37 7.94 5.99 1.03Lateral glabella 4.75 4.02 8.77 6.38 1.40 Lateral glabella 3.76 3.97 7.73 5.14 1.02Lateral nasal 2.50 2.53 5.03 3.61 0.79 Lateral nasal 1.54 2.08 3.62 3.00 0.40Sub orbital 5.19 3.60 8.79 5.83 1.45 Sub orbital 3.96 3.42 7.38 5.50 1.28Inferior malar 4.90 11.42 16.32 14.02 1.31 Inferior malar 4.08 11.01 15.09 12.95 1.34Lateral nostril 4.31 9.00 13.31 10.98 1.22 Lateral nostril 3.46 7.78 11.24 9.18 0.94Nasolabial ridge 5.65 10.88 16.53 13.18 1.82 Nasolabial ridge 4.76 8.88 13.64 11.05 1.32Supra canine 4.32 9.28 13.60 11.55 1.40 Supra canine 3.42 7.51 10.93 9.05 1.12Sub canine 6.92 6.48 13.40 10.58 1.60 Sub canine 4.78 8.06 12.84 10.04 1.46Mental tuber ant 6.35 7.05 13.40 10.73 1.78 Mental tuber ant 3.78 8.14 11.92 10.16 1.06Mid lateral orbit 7.02 2.02 9.04 4.37 1.56 Mid lateral orbit 2.31 2.60 4.91 3.62 0.66Supraglenoid 6.64 9.04 15.68 12.98 1.61 Supraglenoid 8.65 7.41 16.06 11.00 2.01Zygomatic arch 7.04 4.40 11.44 7.73 2.09 Zygomatic arch 9.26 5.25 14.51 8.19 1.95Lateral orbit 6.77 4.75 11.52 7.65 1.89 Lateral orbit 7.80 7.76 15.56 9.73 1.74Supra M2 15.70 20.09 35.79 28.46 4.94 Supra M2 13.89 19.59 33.48 26.81 4.33Mid masseter 9.10 14.05 23.15 18.17 2.82 Mid masseter 9.76 14.24 24.00 17.51 2.70Occlusal line 9.44 18.96 28.40 23.48 3.09 Occlusal line 8.97 17.75 26.72 22.14 2.54Sub M2 7.69 16.92 24.61 20.87 2.46 Sub M2 11.15 14.15 25.30 20.24 2.44Gonion 17.66 6.04 23.70 14.78 5.11 Gonion 11.37 9.66 21.03 14.48 3.44Mid mandibular 5.73 7.50 13.23 10.30 1.60 Mid mandibular 6.36 6.16 12.52 9.68 1.86

(b)Sup-glabella 3.34 3.18 6.52 4.57 1.01 Sup-glabella 4.04 3.02 7.06 4.29 1.05Glabella 3.14 5.05 8.19 6.48 0.77 Glabella 3.87 4.51 8.38 6.47 0.99Nasion 3.84 5.46 9.30 7.58 1.06 Nasion 2.97 5.69 8.66 7.21 0.97End of nasal 1.69 2.37 4.06 3.04 0.55 End of nasal 1.25 1.97 3.22 2.35 0.38Mid-philtrum 5.78 9.38 15.16 12.90 1.64 Mid-philtrum 5.14 9.18 14.32 10.56 1.28Upper lip 7.23 9.31 16.54 12.42 1.87 Upper lip 6.55 7.34 13.89 10.23 1.37Lower lip 6.22 9.92 16.14 13.34 1.69 Lower lip 5.81 8.77 14.58 11.64 1.52Chin–lip fold 5.24 8.41 13.65 10.33 1.29 Chin–lip fold 4.78 7.27 12.05 9.58 1.34Mental eminence 5.87 10.08 15.95 12.43 1.41 Mental eminence 5.38 9.72 15.10 11.90 1.49Beneath chin 6.56 6.62 13.18 8.35 1.41 Beneath chin 6.63 3.88 10.51 6.10 1.62Frontal eminence 3.62 3.40 7.02 4.93 1.16 Frontal eminence 3.93 3.08 7.01 4.29 0.96Supra orbital 4.87 5.86 10.73 7.75 1.31 Supra orbital 4.97 4.25 9.22 6.32 1.20Lateral glabella 6.87 3.48 10.35 6.67 1.43 Lateral glabella 4.26 2.63 6.89 4.98 1.00Lateral nasal 2.46 2.53 4.99 3.55 0.73 Lateral nasal 1.83 2.02 3.85 2.51 0.51Sub orbital 7.77 4.08 11.85 6.33 2.19 Sub orbital 9.56 3.11 12.67 6.06 2.49Inferior malar 9.92 8.99 18.91 13.28 2.86 Inferior malar 8.10 10.00 18.10 12.66 2.18Lateral nostril 4.97 7.24 12.21 10.01 1.40 Lateral nostril 2.66 7.48 10.14 8.91 0.80Nasolabial ridge 6.08 9.62 15.70 12.88 1.79 Nasolabial ridge 4.75 7.47 12.22 10.11 1.38Supra canine 5.57 7.50 13.07 11.03 1.55 Supra canine 3.99 7.15 11.14 8.75 1.21Sub canine 5.02 8.02 13.04 10.25 1.23 Sub canine 6.00 6.40 12.40 9.29 1.44Mental tuber ant 4.36 10.01 14.37 12.46 1.31 Mental tuber ant 4.68 9.26 13.94 11.89 1.44Mid lateral orbit 5.68 2.45 8.13 3.94 1.23 Mid lateral orbit 5.41 2.51 7.92 3.73 1.41Supraglenoid 9.06 9.60 18.66 14.01 2.54 Supraglenoid 8.10 8.50 16.60 12.60 2.23Zygomatic arch 7.06 4.07 11.13 8.32 2.09 Zygomatic arch 8.04 4.24 12.28 8.59 2.46Lateral orbit 9.27 4.33 13.60 8.60 2.36 Lateral orbit 7.49 6.01 13.50 9.60 2.09Supra M2 10.86 20.74 31.60 28.49 2.67 Supra M2 15.48 20.64 36.12 27.51 3.40Mid masseter 12.03 14.04 26.07 18.25 3.41 Mid masseter 17.93 10.61 28.54 18.44 4.76Occlusal line 13.76 15.50 29.26 24.43 3.87 Occlusal line 15.83 12.21 28.04 21.19 4.26Sub M2 14.40 14.06 28.46 21.47 3.90 Sub M2 12.81 14.40 27.21 21.12 3.63Gonion 19.49 9.19 28.68 19.38 5.60 Gonion 19.55 7.96 27.51 16.74 6.08Mid mandibular 6.97 7.98 14.95 11.42 1.97 Mid mandibular 11.73 6.31 18.04 10.99 3.18

(c)Sup-glabella 3.41 3.22 6.63 4.85 1.00 Sup-glabella 3.97 3.09 7.06 4.14 1.11Glabella 3.36 5.13 8.49 7.02 0.83 Glabella 3.45 5.06 8.51 6.51 0.90Nasion 3.87 6.25 10.12 8.32 1.00 Nasion 3.43 5.29 8.72 7.00 0.96End of nasal 2.13 2.85 4.98 3.78 0.50 End of nasal 1.35 1.97 3.32 2.36 0.40Mid-philtrum 6.48 10.33 16.81 13.56 1.84 Mid-philtrum 4.95 8.60 13.55 11.27 1.44Upper lip 7.19 9.08 16.27 13.37 1.93 Upper lip 4.91 8.12 13.03 10.36 1.45


Table4 (Continued)



Lower lip 5.35 10.64 15.99 13.92 1.51 Lower lip 4.96 9.51 14.47 11.37 1.52Chin–lip fold 4.23 8.74 12.97 10.87 1.38 Chin–lip fold 4.61 7.44 12.05 9.98 1.38Mental eminence 6.05 9.61 15.66 12.90 1.57 Mental eminence 5.38 9.72 15.10 11.93 1.57Beneath chin 5.16 5.37 10.53 8.58 1.32 Beneath chin 7.83 3.27 11.10 6.09 1.70Frontal eminence 3.86 3.19 7.05 4.87 1.17 Frontal eminence 3.70 3.07 6.77 4.42 1.09Supra orbital 3.55 5.31 8.86 7.55 0.82 Supra orbital 4.83 4.63 9.46 7.09 1.45Lateral glabella 3.83 4.23 8.06 5.69 0.90 Lateral glabella 3.80 3.07 6.87 5.15 1.08Lateral nasal 1.48 2.18 3.66 3.06 0.42 Lateral nasal 2.83 2.01 4.84 2.92 0.68Sub orbital 3.53 4.27 7.80 6.36 0.82 Sub orbital 7.15 3.08 10.23 6.29 2.18Inferior malar 4.55 10.54 15.09 13.64 1.02 Inferior malar 10.15 9.68 19.83 13.29 2.58Lateral nostril 4.80 7.60 12.40 9.79 1.30 Lateral nostril 4.99 6.50 11.49 8.22 1.41Nasolabial ridge 8.36 8.91 17.27 12.56 2.07 Nasolabial ridge 5.50 9.03 14.53 11.13 1.42Supra canine 4.54 8.07 12.61 10.84 1.35 Supra canine 6.06 6.76 12.82 9.35 1.67Sub canine 4.87 8.01 12.88 10.22 1.04 Sub canine 5.80 7.24 13.04 10.06 1.72Mental tuber ant 4.58 10.28 14.86 12.68 1.44 Mental tuber ant 4.57 9.25 13.82 12.14 1.39Mid lateral orbit 3.78 2.17 5.95 4.02 0.82 Mid lateral orbit 4.41 2.49 6.90 4.01 1.01Supraglenoid 8.55 11.76 20.31 15.88 2.47 Supraglenoid 6.82 10.93 17.75 14.60 2.05Zygomatic arch 7.26 4.54 11.80 8.64 1.79 Zygomatic arch 6.51 6.56 13.07 9.48 1.76Lateral orbit 6.79 5.92 12.71 9.36 1.42 Lateral orbit 7.49 8.79 16.28 11.54 2.30Supra M2 10.61 24.10 34.71 28.37 3.59 Supra M2 5.37 25.54 30.91 27.67 1.57Mid masseter 5.76 15.52 21.28 18.52 1.79 Mid masseter 8.96 14.06 23.02 18.28 2.83Occlusal line 10.04 18.60 28.64 25.79 2.90 Occlusal line 10.57 18.20 28.77 22.99 2.97Sub M2 8.19 19.07 27.26 24.27 2.06 Sub M2 13.62 16.08 29.70 22.13 4.21Gonion 17.85 10.30 28.15 20.32 4.99 Gonion 10.59 11.62 22.21 17.08 3.31Mid mandibular 6.73 8.49 15.22 11.60 1.99 Mid mandibular 7.61 7.34 14.95 11.54 2.19

(d)Sup-glabella 3.02 3.42 6.44 4.74 0.89 Sup-glabella 2.44 3.09 5.53 4.53 0.70Glabella 3.71 5.27 8.98 7.11 0.80 Glabella 4.39 4.86 9.25 6.99 1.15Nasion 3.66 5.99 9.65 8.03 1.10 Nasion 3.49 5.21 8.70 7.42 0.93End of nasal 1.64 2.98 4.62 3.92 0.59 End of nasal 1.71 2.98 4.69 3.71 0.48Mid-philtrum 4.05 10.15 14.20 12.68 1.03 Mid-philtrum 6.49 7.66 14.15 10.85 1.77Upper lip 5.31 10.05 15.36 12.00 1.49 Upper lip 5.94 8.06 14.00 11.28 1.29Lower lip 4.78 10.44 15.22 13.07 1.06 Lower lip 4.41 10.05 14.46 12.44 1.35Chin–lip fold 4.54 8.32 12.86 10.83 1.22 Chin–lip fold 5.27 7.61 12.88 9.74 1.39Mental eminence 5.28 9.55 14.83 12.44 1.45 Mental eminence 5.21 10.21 15.42 12.42 1.36Beneath chin 3.47 6.77 10.24 8.39 0.97 Beneath chin 5.02 4.66 9.68 6.97 1.22Frontal eminence 2.54 3.46 6.00 4.66 0.84 Frontal eminence 2.72 3.25 5.97 4.62 0.87Supra orbital 2.50 6.34 8.84 7.20 0.68 Supra orbital 3.22 5.58 8.80 7.18 0.94Lateral glabella 3.88 3.57 7.45 5.31 1.27 Lateral glabella 2.82 3.61 6.43 5.27 0.63Lateral nasal 1.34 2.34 3.68 3.09 0.40 Lateral nasal 2.80 2.34 5.14 2.98 0.66Sub orbital 7.29 4.32 11.61 6.65 2.18 Sub orbital 3.91 4.10 8.01 6.31 1.18Inferior malar 7.79 10.45 18.24 13.62 2.14 Inferior malar 9.55 8.64 18.19 13.54 2.05Lateral nostril 3.79 8.04 11.83 9.40 1.00 Lateral nostril 3.72 7.02 10.74 8.55 1.02Nasolabial ridge 5.78 10.22 16.00 12.68 1.75 Nasolabial ridge 6.47 7.78 14.25 10.59 1.66Supra canine 6.51 7.77 14.28 10.95 1.79 Supra canine 5.02 6.47 11.49 8.59 1.44Sub canine 6.02 7.73 13.75 9.78 1.44 Sub canine 6.21 7.56 13.77 9.70 1.49Mental tuber ant 6.08 9.16 15.24 12.38 1.78 Mental tuber ant 3.90 11.01 14.91 12.25 0.95Mid lateral orbit 3.34 2.06 5.40 4.06 0.89 Mid lateral orbit 3.95 2.70 6.65 4.05 0.90Supraglenoid 11.71 10.65 22.36 15.53 2.67 Supraglenoid 11.59 9.28 20.87 15.36 2.27Zygomatic arch 7.64 4.15 11.79 7.64 2.59 Zygomatic arch 9.00 5.10 14.10 10.51 2.62Lateral orbit 7.16 5.36 12.52 8.80 2.06 Lateral orbit 9.67 7.03 16.70 12.85 2.35Supra M2 13.66 22.58 36.24 27.97 3.71 Supra M2 9.64 23.98 33.62 27.83 3.13Mid masseter 14.37 11.17 25.54 18.24 3.87 Mid masseter 12.34 15.07 27.41 18.01 3.00Occlusal line 14.42 16.82 31.24 24.28 3.78 Occlusal line 14.13 15.56 29.69 23.06 4.21Sub M2 15.87 15.22 31.09 22.84 3.57 Sub M2 13.91 13.99 27.90 21.95 4.13Gonion 16.66 10.01 26.67 18.36 4.83 Gonion 18.14 8.26 26.40 17.95 4.79Mid mandibular 13.95 5.54 19.49 11.87 3.02 Mid mandibular 6.74 7.58 14.32 11.79 2.09

(e)Sup-glabella 2.74 3.03 5.77 4.70 0.71 Sup-glabella 3.29 3.14 6.43 4.40 0.82Glabella 4.35 5.01 9.36 7.04 1.30 Glabella 3.08 5.69 8.77 7.02 0.69Nasion 6.57 5.82 12.39 8.09 1.58 Nasion 4.26 5.32 9.58 7.71 1.05End of nasal 1.91 3.01 4.92 3.98 0.52 End of nasal 1.84 3.16 5.00 3.77 0.49Mid-philtrum 8.71 9.19 17.90 12.76 2.10 Mid-philtrum 6.58 7.55 14.13 10.63 1.53Upper lip 5.37 9.24 14.61 11.46 1.32 Upper lip 8.16 5.98 14.14 10.92 2.11Lower lip 4.39 10.05 14.44 12.50 1.23 Lower lip 6.58 8.74 15.32 12.24 1.83Chin–lip fold 4.42 9.15 13.57 10.95 1.18 Chin–lip fold 6.62 7.15 13.77 10.15 1.74Mental eminence 8.39 8.03 16.42 12.50 1.82 Mental eminence 6.98 9.22 16.20 12.07 1.84Beneath chin 6.95 5.47 12.42 8.44 1.89 Beneath chin 5.85 4.45 10.30 6.89 1.13Frontal eminence 3.11 3.40 6.51 4.59 0.82 Frontal eminence 2.93 3.05 5.98 4.51 0.92Supra orbital 6.24 4.41 10.65 7.20 1.75 Supra orbital 4.84 4.55 9.39 6.55 1.29Lateral Glabella 3.14 4.03 7.17 5.40 0.88 Lateral Glabella 4.38 3.38 7.76 5.33 1.03Lateral nasal 2.41 2.08 4.49 3.12 0.65 Lateral nasal 2.15 2.06 4.21 3.01 0.67Sub orbital 11.22 3.66 14.88 7.34 3.10 Sub orbital 7.20 3.56 10.76 6.78 2.04


Table 5Age comparison for: (a) males and (b) females (all the measurements in millimeter).

Landmarks A18–29

n = 32 B30–39

n = 32 C40–49

n = 32 D50–59

n = 32 E60+

n = 32 p I–J***

Mean S.D. Mean S.D. Mean S.D. Mean S.D. Mean S.D.

(a)Sup-glabella 4.04 0.54 4.57 1.01 4.85 1.00 4.74 0.89 4.70 0.71 0.03 A < C, A < E*

Glabella 6.43 1.07 6.48 0.77 7.02 0.83 7.11 0.80 7.04 1.30 0.07Nasion 7.23 1.29 7.58 1.06 8.32 1.00 8.03 1.10 8.09 1.58 0.04 A < C*

End of nasal 2.96 0.65 3.04 0.55 3.78 0.50 3.92 0.59 3.98 0.52 0.00 A < C,A < D, A < E, B < C, AB < D, B < E*

Mid-philtrum 14.19 2.08 12.90 1.64 13.56 1.84 12.68 1.03 12.76 2.10 0.04 A < C**

Upper lip 13.88 1.81 12.42 1.87 13.37 1.93 12.00 1.49 11.46 1.32 0.00 B < A, D < A, E < A, D < C, E < C*

Lower lip 14.11 1.35 13.34 1.69 13.92 1.51 13.07 1.06 12.50 1.23 0.00 E < A, E < C*

Chin–lip fold 10.31 0.91 10.33 1.29 10.87 1.38 10.83 1.22 10.95 1.18 0.27Mental eminence 12.02 2.04 12.43 1.41 12.90 1.57 12.44 1.45 12.50 1.82 0.59Beneath chin 7.26 1.37 8.35 1.41 8.58 1.32 8.39 0.97 8.44 1.89 0.03 A < C, A < E*

Frontal eminence 4.30 0.67 4.93 1.16 4.87 1.17 4.66 0.84 4.59 0.82 0.24Supra orbital 6.74 1.59 7.75 1.31 7.55 0.82 7.20 0.68 7.20 1.75 0.14Lateral glabella 6.38 1.40 6.67 1.43 5.69 0.90 5.31 1.27 5.40 0.88 0,00 D < A, E < A, C < B, D < B, E < B*

Lateral nasal 3.61 0.79 3.55 0.73 3.06 0.42 3.09 0.40 3.12 0.65 0.01 C < A, D < A**

Sub orbital 5.83 1.45 6.33 2.19 6.36 0.82 6.65 2.18 7.34 3.10 0.24Inferior malar 14.02 1.31 13.28 2.86 13.64 1.02 13.62 2.14 13.54 1.39 0.80Lateral nostril 10.98 1.22 10.01 1.40 9.79 1.30 9.40 1.00 9.26 1.63 0.00 C < A, D < A, E < A*

Nasolabial ridge 13.18 1.82 12.88 1.79 12.56 2.07 12.68 1.75 12.08 2.00 0.45Supra canine 11.55 1.40 11.03 1.55 10.84 1.35 10.95 1.79 10.02 1.50 0.04 E < A*

Sub canine 10.58 1.60 10.25 1.23 10.22 1.04 9.78 1.44 9.65 1.03 0.15Mental tuber ant 10.73 1.78 12.46 1.31 12.68 1.44 12.38 1.78 12.35 1.88 0.00 A < B, A < C, A < D, A < E*

Mid lateral orbit 4.37 1.56 3.94 1.23 4.02 0.82 4.06 0.89 3.69 1.23 0.49Supraglenoid 12.98 1.61 14.01 2.54 15.88 2.47 15.53 2.67 14.48 3.16 0.00 A < C, A < D**

Zygomatic arch 7.73 2.09 8.32 2.09 8.64 1.79 7.64 2.59 7.16 1.77 0.19Lateral orbit 7.65 1.89 8.60 2.36 9.36 1.42 8.80 2.06 9.18 3.46 0.17Supra M2 28.46 4.94 28.49 2.67 28.37 3.59 27.97 3.71 28.40 3.72 0.99Mid masseter 18.17 2.82 18.25 3.41 18.52 1.79 18.24 3.87 18.11 2.79 0.99Occlusal line 23.48 3.09 24.43 3.87 25.79 2.90 24.28 3.78 23.73 4.53 0.32Sub M2 20.87 2.46 21.47 3.90 24.27 2.06 22.84 3.57 20.83 4.02 0.00 A < C, B < C, E < C*

Gonion 14.78 5.11 19.38 5.60 20.32 4.99 18.36 4.83 16.90 6.79 0.02 A < B, A < C*

Mid mandibular 10.30 1.60 11.42 1.97 11.60 1.99 11.87 3.02 11.27 4.10 0.42

Landmarks A18–29

n = 32 B30–39

n = 32 C40–49

n = 32 D50–59

n = 32 E60+

n = 32 p I–J***


(b)Sup-glabella 3.73 0.50 4.29 1.05 4.14 1.11 4.53 0.70 4.40 0.82 0.04 A < D**

Glabella 5.72 0.87 6.47 0.99 6.51 0.90 6.99 1.15 7.02 0.69 0.00 A < C, A < D, A < E*

Nasion 7.08 1.06 7.21 0.97 7.00 0.96 7.42 0.93 7.71 1.05 0.16End of nasal 2.49 0.51 2.35 0.38 2.36 0.40 3.71 0.48 3.77 0.49 0.00 A < D, A < E, B < D, B < E, C < D, C < E*

Mid-philtrum 12.19 1.78 10.56 1.28 11.27 1.44 10.85 1.77 10.63 1.53 0.01 B < A, D < A,E < A*

Upper lip 11.09 2.07 10.23 1.37 10.36 1.45 11.28 1.29 10.92 2.11 0.21Lower lip 11.73 1.88 11.64 1.52 11.37 1.52 12.44 1.35 12.24 1.83 0.22Chin–lip fold 9.52 0.80 9.58 1.34 9.98 1.38 9.74 1.39 10.15 1.74 0.55Mental eminence 10.91 1.38 11.90 1.49 11.93 1.57 12.42 1.36 12.07 1.84 0.04 A < D*

Beneath chin 5.27 0.60 6.10 1.62 6.09 1.70 6.97 1.22 6.89 1.13 0.00 A < D, A < E*

Table4 (Continued)



Inferior malar 5.04 11.45 16.49 13.54 1.39 Inferior malar 6.01 10.12 16.13 13.33 1.73Lateral nostril 7.07 6.40 13.47 9.26 1.63 Lateral nostril 4.26 6.53 10.79 8.45 0.92Nasolabial ridge 7.51 8.53 16.04 12.08 2.00 Nasolabial ridge 7.51 7.52 15.03 11.07 2.10Supra canine 5.31 8.17 13.48 10.02 1.50 Supra canine 8.09 5.43 13.52 9.35 2.04Sub canine 3.61 7.37 10.98 9.65 1.03 Sub canine 7.12 7.11 14.23 9.46 1.95Mental tuber ant 7.55 7.54 15.09 12.35 1.88 Mental tuber ant 8.57 8.06 16.63 10.79 2.11Mid lateral orbit 4.64 2.07 6.71 3.69 1.23 Mid lateral orbit 2.10 2.49 4.59 3.66 0.66Supraglenoid 9.90 8.87 18.77 14.48 3.16 Supraglenoid 10.73 6.75 17.48 13.40 2.56Zygomatic arch 6.38 4.24 10.62 7.16 1.77 Zygomatic arch 7.30 4.22 11.52 7.07 2.04Lateral orbit 11.68 3.84 15.52 9.18 3.46 Lateral orbit 9.02 5.95 14.97 10.10 2.13Supra M2 13.75 21.15 34.90 28.40 3.72 Supra M2 15.70 20.84 36.54 27.04 4.28Mid masseter 10.59 11.77 22.36 18.11 2.79 Mid masseter 15.21 10.33 25.54 17.91 3.90Occlusal line 16.06 16.41 32.47 23.73 4.53 Occlusal line 10.25 14.77 25.02 20.01 3.17Sub M2 15.06 12.06 27.12 20.83 4.02 Sub M2 15.65 7.46 23.11 16.23 3.65Gonion 30.02 7.52 37.54 16.90 6.79 Gonion 13.64 6.85 20.49 13.60 4.27Mid mandibular 14.37 5.29 19.66 11.27 4.10 Mid mandibular 13.19 3.76 16.95 9.74 3.56


Fig. 4. Frontal and lateral views of the skull showing only significant age-based differences for both sexes as indicated in Table 5.

0

5

10

15

20

25

30

b) 18-29 30 -39 40-49 50-59 60+ p

0

5

10

15

20

25

30

a) 18-29 30-39 40-49 50-59 60+ p

Fig. 5. Age comparison for (a) males and (b) females.

Table5 (Continued)

Landmarks A18–29

n = 32 B30–39

n = 32 C40–49

n = 32 D50–59

n = 32 E60+

n = 32 p I–J***


Frontal eminence 3.75 0.65 4.29 0.96 4.42 1.09 4.62 0.87 4.51 0.92 0.03 A < D, A < E*

Supra orbital 5.99 1.03 6.32 1.20 7.09 1.45 7.18 0.94 6.55 1.29 0.01 A < C, A < D*

Lateral glabella 5.14 1.02 4.98 1.00 5.15 1.08 5.27 0.63 5.33 1.03 0.82Lateral nasal 3.00 0.40 2.51 0.51 2.92 0.68 2.98 0.66 3.01 0.67 0.04 B < A, B < D, B < E*

Sub orbital 5.50 1.28 6.06 2.49 6.29 2.18 6.31 1.18 6.78 2.04 0.32Inferior malar 12.95 1.34 12.66 2.18 13.29 2.58 13.54 2.05 13.33 1.73 0.67Lateral nostril 9.18 0.94 8.91 0.80 8.22 1.41 8.55 1.02 8.45 0.92 0.04 B < A*

Nasolabial ridge 11.05 1.32 10.11 1.38 11.13 1.42 10.59 1.66 11.07 2.10 0.22Supra canine 9.05 1.12 8.75 1.21 9.35 1.67 8.59 1.44 9.35 2.04 0.41Sub canine 10.04 1.46 9.29 1.44 10.06 1.72 9.70 1.49 9.46 1.95 0.47Mental tuber ant 10.16 1.06 11.89 1.44 12.14 1.39 12.25 0.95 10.79 2.11 0.00 A < B, A < C, A < D**

Mid lateral orbit 3.62 0.66 3.73 1.41 4.01 1.01 4.05 0.90 3.66 0.66 0.49Supraglenoid 11.00 2.01 12.60 2.23 14.60 2.05 15.36 2.27 13.40 2.56 0.00 A < C, A< D, A < E, B < C, B < D*

Zygomatic arch 8.19 1.95 8.59 2.46 9.48 1.76 10.51 2.62 7.07 2.04 0.00 A < D, B < D, E < C, E < D*

Lateral orbit 9.73 1.74 9.60 2.09 11.54 2.30 12.85 2.35 10.10 2.13 0.00 A < C, A < D, B < C, B < D*

Supra M2 26.81 4.33 27.51 3.40 27.67 1.57 27.83 3.13 27.04 4.28 0.87Mid masseter 17.51 2.70 18.44 4.76 18.28 2.83 18.01 3.00 17.91 3.90 0.93Occlusal line 22.14 2.54 21.19 4.26 22.99 2.97 23.06 4.21 20.01 3.17 0.03 E < C, E < D*

Sub M2 20.24 2.44 21.12 3.63 22.13 4.21 21.95 4.13 16.23 3.65 0.00 E < A, E < B, E < C, E < D*

Gonion 14.48 3.44 16.74 6.08 17.08 3.31 17.95 4.79 13.60 4.27 0.01 E < D**

Mid mandibular 9.68 1.86 10.99 3.18 11.54 2.19 11.79 2.09 9.74 3.56 0.03 A < D**

pB = Sig. level after Bonferroni correction (p < pB = 0.05/4 = 0.0125).* LSD Post Hoc (p < pB).** Dunnet C Post Hoc (p < pB) (Levene statistic Sig. is <0.05).*** Bonferroni correction.


Table 6Comparison of males and females (a) between 18 and 29 years. (b) between 30 and 39 years. (c) between 40 and 49 years. (d) between 50 and 59 years. and (e) 60+ (all themeasurements in millimeter).

Landmarks (a) (b) (c)

Male n = 32 Female n = 32 p Male n = 32 Female n = 32 p Male n = 32 Female n = 32 pMean S.D. Mean S.D. Mean S.D. Mean S.D. Mean S.D. Mean S.D.

Sup-glabella 4.04 0.54 3.73 0.50 0.07 4.57 1.01 4.29 1.05 0.40 4.85 1.00 4.14 1.11 0.04Glabella 6.43 1.07 5.72 0.87 0.03* 6.48 0.77 6.47 0.99 0.96 7.02 0.83 6.51 0.90 0.07Nasion 7.23 1.29 7.08 1.06 0.68 7.58 1.06 7.21 0.97 0.26 8.32 1.00 7.00 0.96 0.00**

End of nasal 2.96 0.65 2.49 0.51 0.01* 3.04 0.55 2.35 0.38 0.00** 3.78 0.50 2.36 0.40 0.00**

Mid-philtrum 14.19 2.08 12.19 1.78 0.00** 12.90 1.64 10.56 1.28 0.00** 13.56 1.84 11.27 1.44 0.00**

Upper lip 13.88 1.81 11.09 2.07 0.00** 12.42 1.87 10.23 1.37 0.00** 13.37 1.93 10.36 1.45 0.00**

Lower lip 14.11 1.35 11.73 1.88 0.00** 13.34 1.69 11.64 1.52 0.00** 13.92 1.51 11.37 1.52 0.00**

Chin–lip fold 10.31 0.91 9.52 0.80 0.01* 10.33 1.29 9.58 1.34 0.08 10.87 1.38 9.98 1.38 0.05Mental eminence 12.02 2.04 10.91 1.38 0.05 12.43 1.41 11.90 1.49 0.26 12.90 1.57 11.93 1.57 0.06Beneath chin 7.26 1.37 5.27 0.60 0.00** 8.35 1.41 6.10 1.62 0.00** 8.58 1.32 6.09 1.70 0.00**

Frontal eminence 4.30 0.67 3.75 0.65 0.01* 4.93 1.16 4.29 0.96 0.06 4.87 1.17 4.42 1.09 0.22Supra orbital 6.74 1.59 5.99 1.03 0.09 7.75 1.31 6.32 1.20 0.00** 7.55 0.82 7.09 1.45 0.22Lateral Glabella 6.38 1.40 5.14 1.02 0.00** 6.67 1.43 4.98 1.00 0.00** 5.69 0.90 5.15 1.08 0.09Lateral nasal 3.61 0.79 3.00 0.40 0.00** 3.55 0.73 2.51 0.51 0.00** 3.06 0.42 2.92 0.68 0.43Sub orbital 5.83 1.45 5.50 1.28 0.46 6.33 2.19 6.06 2.49 0.72 6.36 0.82 6.29 2.18 0.90Inferior malar 14.02 1.31 12.95 1.34 0.01* 13.28 2.86 12.66 2.18 0.45 13.64 1.02 13.29 2.58 0.57Lateral nostril 10.98 1.22 9.18 0.94 0.00** 10.01 1.40 8.91 0.80 0.00** 9.79 1.30 8.22 1.41 0.00**

Nasolabial ridge 13.18 1.82 11.05 1.32 0.00** 12.88 1.79 10.11 1.38 0.00** 12.56 2.07 11.13 1.42 0.01*

Supra canine 11.55 1.40 9.05 1.12 0.00** 11.03 1.55 8.75 1.21 0.00** 10.84 1.35 9.35 1.67 0.00**

Sub canine 10.58 1.60 10.04 1.46 0.27 10.25 1.23 9.29 1.44 0.03* 10.22 1.04 10.06 1.72 0.72Mental tuber ant 10.73 1.78 10.16 1.06 0.22 12.46 1.31 11.89 1.44 0.19 12.68 1.44 12.14 1.39 0.24Mid lateral orbit 4.37 1.56 3.62 0.66 0.06 3.94 1.23 3.73 1.41 0.63 4.02 0.82 4.01 1.01 0.97Supraglenoid 12.98 1.61 11.00 2.01 0.00** 14.01 2.54 12.60 2.23 0.07 15.88 2.47 14.60 2.05 0.08Zygomatic arch 7.73 2.09 8.19 1.95 0.47 8.32 2.09 8.59 2.46 0.71 8.64 1.79 9.48 1.76 0.15Lateral orbit 7.65 1.89 9.73 1.74 0.00** 8.60 2.36 9.61 2.09 0.16 9.36 1.42 11.54 2.30 0.00**

Supra M2 28.46 4.94 26.81 4.33 0.27 28.49 2.67 27.51 3.40 0.32 28.37 3.59 27.67 1.57 0.43Mid masseter 18.17 2.82 17.51 2.70 0.45 18.25 3.41 18.44 4.76 0.88 18.52 1.79 18.28 2.83 0.76Occlusal line 23.48 3.09 22.14 2.54 0.14 24.43 3.87 21.19 4.26 0.02* 25.79 2.90 22.99 2.97 0.00**

Sub M2 20.87 2.46 20.24 2.44 0.42 21.47 3.90 21.12 3.63 0.77 24.27 2.06 22.13 4.21 0.05Gonion 14.78 5.11 14.48 3.44 0.83 19.38 5.60 16.74 6.08 0.16 20.32 4.99 17.08 3.31 0.02*

Mid mandibular 10.30 1.60 9.68 1.86 0.27 11.42 1.97 10.99 3.18 0.61 11.60 1.99 11.54 2.19 0.92

Landmarks (d) (e)

Male n = 32 Female n = 32 p Male n = 32 Female n = 32 pMean S.D. Mean S.D. Mean S.D. Mean S.D.

Sup-glabella 4.74 0.89 4.53 0.70 0.41 4.70 0.71 4.40 0.82 0.24Glabella 7.11 0.80 6.99 1.15 0.71 7.04 1.30 7.02 0.69 0.94Nasion 8.03 1.10 7.42 0.93 0.07 8.09 1.58 7.71 1.05 0.38End of nasal 3.92 0.59 3.71 0.48 0.24 3.98 0.52 3.77 0.49 0.20Mid-philtrum 12.68 1.03 10.85 1.77 0.00** 12.76 2.10 10.63 1.53 0.00**

Upper lip 12.00 1.49 11.28 1.29 0.11 11.46 1.32 10.92 2.11 0.35Lower lip 13.07 1.06 12.44 1.35 0.11 12.50 1.23 12.24 1.83 0.60Chin lip fold 10.83 1.22 9.74 1.39 0.01* 10.95 1.18 10.15 1.74 0.10Mental eminence 12.44 1.45 12.42 1.36 0.96 12.50 1.82 12.07 1.84 0.46Beneath chin 8.39 0.97 6.97 1.22 0.00** 8.44 1.89 6.89 1.13 0.00**

Frontal eminence 4.66 0.84 4.62 0.87 0.88 4.59 0.82 4.51 0.92 0.77Supra orbital 7.20 0.68 7.18 0.94 0.92 7.20 1.75 6.55 1.29 0.19Lateral glabella 5.31 1.27 5.27 0.63 0.89 5.40 0.88 5.33 1.03 0.82Lateral nasal 3.09 0.40 2.98 0.66 0.55 3.12 0.65 3.01 0.67 0.58Sub orbital 6.65 2.18 6.31 1.18 0.55 7.34 3.10 6.78 2.04 0.50Inferior malar 13.62 2.14 13.54 2.05 0.89 13.54 1.39 13.33 1.73 0.67Lateral nostril 9.40 1.00 8.55 1.02 0.01* 9.26 1.63 8.45 0.92 0.06Nasolabial ridge 12.68 1.75 10.59 1.66 0.00** 12.08 2.00 11.07 2.10 0.13Supra canine 10.95 1.79 8.59 1.44 0.00** 10.02 1.50 9.35 2.04 0.24Sub canine 9.78 1.44 9.70 1.49 0.86 9.65 1.03 9.46 1.95 0.71Mental tuber ant 12.38 1.78 12.25 0.95 0.77 12.35 1.88 10.79 2.11 0.02*

Mid lateral orbit 4.06 0.89 4.05 0.90 0.96 3.69 1.23 3.66 0.66 0.93Supraglenoid 15.53 2.67 15.36 2.27 0.83 14.48 3.16 13.40 2.56 0.24Zygomatic arch 7.64 2.59 10.51 2.62 0.00** 7.07 1.77 7.16 2.04 0.89Lateral orbit 8.80 2.06 12.85 2.35 0.00** 9.18 3.46 10.10 2.13 0.32Supra M2 27.97 3.71 27.83 3.13 0.90 28.40 3.72 27.04 4.28 0.29Mid masseter 18.24 3.87 18.01 3.00 0.83 18.11 2.79 17.91 3.90 0.85Occlusal line 24.28 3.78 23.06 4.21 0.34 23.73 4.53 20.01 3.17 0.00**

Sub M2 22.84 3.57 21.95 4.13 0.47 20.83 4.02 16.23 3.65 0.00**

Gonion 18.36 4.83 17.95 4.79 0.79 16.90 6.79 13.60 4.27 0.07Mid mandibular 11.87 3.02 11.79 2.09 0.92 11.27 4.10 9.74 3.56 0.21

* p < 0.05.** p < 0.01.


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Fig. 6. Comparison of males and females (a) between 18 and 29 years, (b) between 30 and 39 years, (c) between 40 and 49 years, (d) between 50 and 59 years, and (e) 60 +.


3.2. Sex-based differences

The largest soft-tissue difference observed between the sexeswas at the occlusal line and sub M2 (4,6 mm); significantdifferences (p < 0.05) are shown in Table 6 and Fig. 6. Whencomparing male and females between 18 and 29 years of age(Table 6a and Fig. 6a), significant differences (p < 0.05) wereobserved for 16 landmarks (gl, en, mp, ul, ll, cf, bc, fe, lg, lna, im, lno,nlr, sc, spg and lo). The soft-tissue thickness measurements of themales were greater than those of the females were at thelandmarks. When the thickness values of the males and femalesaged 30–39 years were compared (Table 6b and Fig. 6b), significantdifferences (p < 0.05) were seen for 13 landmarks (en, mp, ul, ll, bc,so, lg, lna, lno, nlr, sc, sbc and ol), with the values of the males beingsignificantly higher than those of females. Significant differences(p < 0.05) were also observed for 12 landmarks (n, en, mp, ul, ll, bc,

lno, nlr, sc, lo, ol and g) of males and females between the ages of40–49 years (Table 6c and Fig. 6c). The tissue thicknesses at thesepoints were greater for males of this age group. When the thicknessvalues of the males and females aged 50–59 years were compared(Table 6d and Fig. 6d), significantly higher values (p < 0.05) wereseen in the mp, cf, bc, lno, nlr, sc, za and lo points for the males.However, in the 60+ age group (Table 6e and Fig. 6e), significantlyhigher values (p < 0.05) were observed at the mp, bc, mta, ol andsbm2 points.

3.3. Ethnicity-based differences

A comparison between the results of this study and the resultsreported by Hwang et al. [38] has been presented in Table 7 andFigs. 7 and 8. Statistically significant differences were observed inmales at the following landmarks: sg, gl, n, en, mp, ul, ll, cf, fe, lg, lna,

Table 7Comparison of tissue depth measurements of this study with the Hwang et al. (38) study for males and females (all the measurements in millimeter).

Landmarks Male Female

This study Hwang Difference p This study Hwang Difference pn = 42 n = 50 n = 42 n = 50

Sup-glabella 4.21 5.3 �1.09 0.00** 3.94 4.80 �0.86 0.00**

Glabella 6.40 5.6 0.80 0.00** 6.03 5.30 0.73 0.00**

Nasion 7.32 6.4 0.92 0.00** 7.16 5.40 1.76 0.00**

End of nasal 2.97 2.3 0.67 0.00** 2.38 2.20 0.18 0.32Mid-philtrum 13.85 12.5 1.35 0.00** 11.38 10.70 0.68 0.06Upper lip 13.67 11.7 1.97 0.00** 10.58 9.90 0.68 0.09Lower lip 14.03 13 1.03 0.02* 11.47 11.60 �0.14 0.99Chin–lip fold 10.27 11.6 �1.33 0.00* 9.56 10.20 �0.64 0.74Mental eminence 11.93 12.3 �0.37 0.32 11.38 12.00 �0.62 0.01*

Beneath chin 7.50 8 �0.50 0.15 5.57 6.90 �1.33 0.00**

Frontal eminence 4.48 6.2 �1.72 0.00** 4.02 5.40 �1.38 0.00**

Supra orbital 6.94 7.2 �0.26 0.37 6.17 6.40 �0.23 0.31Lateral glabella 6.38 9.2 �2.82 0.00** 5.15 8.20 �3.05 0.00**

Lateral nasal 3.53 7.3 �3.77 0.00** 2.77 6.50 �3.73 0.00**

Sub orbital 5.92 7.4 �1.48 0.00** 5.47 7.30 �1.83 0.00**

Inferior malar 14.02 18.6 �4.58 0.00** 12.88 17.50 �4.62 0.00**

Lateral nostril 10.73 14.3 �3.57 0.00** 9.01 12.40 �3.39 0.00**

Nasolabial ridge 13.05 12.9 0.15 0.63 10.76 10.90 �0.14 0.62Supra canine 11.55 11 0.55 0.04* 8.75 10.30 �1.55 0.00**

Sub canine 10.45 12.2 �1.75 0.00** 9.67 10.80 �1.13 0.00**

Mental tuber ant 11.12 9.5 1.62 0.00** 10.98 8.80 2.18 0.00**

Mid lateral orbit 4.21 4.8 �0.59 0.02* 3.49 5.20 �1.71 0.00**

Supraglenoid 13.16 12.6 0.56 0.24 11.45 11.20 0.25 0.59Zygomatic arch 7.83 8.1 �0.27 0.53 8.06 8.70 �0.64 0.11Lateral orbit 7.90 8.6 �0.70 0.07 9.40 10.20 �0.80 0.00**

Supra M2 28.42 28.5 �0.08 0.92 26.76 27.70 �0.94 0.27Mid masseter 18.26 19.5 �1.24 0.15 18.38 17.50 0.88 0.22Occlusal line 23.42 22.9 0.52 0.43 21.41 21.20 0.21 0.75Sub M2 21.11 21.1 0.01 0.99 20.33 20.30 0.03 0.96Gonion 15.62 14.3 1.32 0.23 14.74 12.90 1.84 0.01*

Mid mandibular 10.41 7.9 2.51 0.00** 9.78 7.70 2.08 0.00**

* p < 0.05.** p < 0.01.


sbo, im, lno, sc, sbc, mta, mlo and mma. Similarly, soft-tissuethickness of females differed significantly at sg, gl, n, me, bc, fe, lg,lna, sbo, im, lno, sc, sbc, mta, mlo, lo, g and mma landmarks.

A comparison between the results of this study and those of DeGreef et al. [8] have been presented in Table 8 and Figs. 9–12.Significant differences (p < 0.05) in tissue thickness were observedbetween the two studies for both the sexes (Figs.10 and 11). For themales: (a) gl, n, mp, ul, ll, me, bc, so, sbo, im, lno, nlr, sc, mta, spg, za,

Fig. 7. Frontal and lateral views of the skull showing only significant ethnicity-based

indicated in Table 7.

sm2, ol and sbm2 landmarks in the 18–29 age group; (b) alllandmarks except for the en, lna, sbc, mlo and mm points in the 30–39 age group; (c) all landmarks except for the points sg, cf, fe, lno,sc, sbc, mm and mma in the 40–49 age group; (d) all landmarksexcept for the points sg, ll, cf, fe, lg, lno, sbc, za, lo, mm and mma inthe 50–59 age group and (e) all landmarks except for the points sg,cf, fe, lno, sc, lo, sm2, mm, sbm2, g and mma in the 60+ age groupwere significantly different. Similarly, for females; (a) sg, gl, n, mp,

differences for both sexes between Turkish population and Korean population as

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Fig. 8. Comparison of tissue depth measurements of this study with the Hwang et al. (38) study for (a) males and (b) females.

Table 8Comparison of tissue depth measurements of this study with the De Greef et al. (8) study for males and females (a) between 18 and 29 years. (b) between 30 and 39 years. (c)between 40 and 49 years. (d) between 50 and 59 years. and (e) 60+ years (all the measurements in millimeter).**p < 0.0.


This study Greef Difference p This study Greef Difference pn = 32 n = 211 n = 32 n = 50

(a)Sup-glabella 4.04 4.1 �0.06 0.65 3.73 4.1 �0.37 0.01*

Glabella 6.43 5 1.43 0.00** 5.72 5.1 0.62 0.00**

Nasion 7.23 5.9 1.33 0.00** 7.08 6.3 0.78 0.01*

End of nasal 2.96 2.8 0.16 0.33 2.49 2.6 �0.11 0.55Mid-philtrum 14.19 11.2 2.99 0.00** 12.19 9.8 2.39 0.00**

Upper lip 13.88 11 2.88 0.00** 11.09 10 1.09 0.01*

Lower lip 14.11 12.5 1.61 0.00** 11.73 11 0.73 0.12Chin–lip fold 10.31 10.1 0.21 0.49 9.52 9.6 �0.08 0.73Mental eminence 12.02 9.5 2.52 0.00** 10.91 9.6 1.31 0.00**

Beneath chin 7.26 6.1 1.16 0.00** 5.27 5.6 �0.33 0.27Frontal eminence 4.30 4.1 0.2 0.19 3.75 3.9 �0.15 0.30Supra orbital 6.74 5.1 1.64 0.00** 5.99 5.4 0.59 0.01*

Lateral glabella 6.38 6 0.38 0.22 5.14 5.7 �0.56 0.03*

Lateral nasal 3.61 3.7 �0.09 0.57 3 3.7 �0.7 0.00**

Sub orbital 5.83 8.3 -2.47 0.00** 5.5 9.4 �3.9 0.00**

Inferior malar 14.02 16.2 �2.18 0.00** 12.95 17.9 �4.95 0.00**

Lateral nostril 10.98 10.1 0.88 0.01* 9.18 9.5 �0.32 0.29Nasolabial ridge 13.18 11.1 2.08 0.00** 11.05 9.5 1.55 0.00**

Supra canine 11.55 10.4 1.15 0.01* 9.05 9.5 �0.45 0.29Sub anine 10.58 10.5 0.08 0.84 10.04 10.3 �0.26 0.47Mental tuber ant 10.73 9.6 1.13 0.00** 10.16 9.6 0.56 0.13Mid lateral orbit 4.37 4.6 �0.23 0.30 3.62 5 �1.38 0.00**

Supraglenoid 12.98 9.8 3.18 0.00** 11 9.6 1.4 0.01*

Zygomatic arch 7.73 5.7 2.03 0.00** 8.19 6.9 1.29 0.00**

Lateral orbit 7.65 7.4 0.25 0.47 9.73 10 �0.27 0.51Supra M2 28.46 25 3.46 0.00** 26.81 26.6 0.21 0.82Mid masseter 18.17 16.8 1.37 0.14 17.51 17.2 0.31 0.70Occlusal line 23.48 19.4 4.08 0.00** 22.14 19.4 2.74 0.00**

Sub M2 20.87 17.2 3.67 0.00** 20.24 19 1.24 0.09Gonion 14.78 14.4 0.38 0.58 14.48 14.4 0.08 0.90Mid mandibular 10.30 9.8 0.5 0.35 9.68 11.4 �1.72 0.00**



(b)Sup-glabella 4.57 4.1 0.47 0.03* 4.29 4.1 0.19 0.35Glabella 6.48 4.7 1.78 0.00** 6.47 4.9 1.57 0.00**

Nasion 7.58 5.6 1.98 0.00** 7.21 6.2 1.01 0.01*

End of nasal 3.04 2.7 0.34 0.06 2.35 2.5 �0.15 0.31Mid-philtrum 12.9 10.6 2.3 0.00** 10.56 9.2 1.36 0.00**

Upper lip 12.42 9.8 2.62 0.00** 10.23 9.4 0.83 0.06Lower lip 13.34 11.8 1.54 0.01* 11.64 10.7 0.94 0.06Chin–lip fold 10.33 9.6 0.73 0.04* 9.58 10.2 �0.62 0.17Mental eminence 12.43 9.4 3.03 0.00** 11.9 9.7 2.20 0.00**


Table8 (Continued)



Beneath chin 8.35 6.2 2.15 0.00** 6.1 5.7 0.40 0.33Frontal eminence 4.93 4.1 0.83 0.00** 4.29 4 0.29 0.13Supra orbital 7.75 5 2.75 0.00** 6.32 5.2 1.12 0.00**

Lateral glabella 6.67 5.5 1.17 0.00** 4.98 5.5 �0.52 0.14Lateral nasal 3.55 3.6 �0.05 0.77 2.51 3.6 �1.09 0.00**

Sub orbital 6.33 8.4 �2.07 0.00** 6.06 9.3 �3.24 0.00**

Inferior malar 13.28 16.5 �3.22 0.00** 12.66 17.4 �4.74 0.00**

Lateral nostril 10.01 9.2 0.81 0.02* 8.91 8.8 0.11 0.71Nasolabial ridge 12.88 10.8 2.08 0.00** 10.11 9.4 0.71 0.09Supra canine 11.03 9.7 1.33 0.01* 8.75 8.4 0.35 0.46Sub canine 10.25 9.7 0.55 0.15 9.29 9.9 �0.61 0.16Mental tuber ant 12.46 9.5 2.96 0.00** 11.89 9.9 1.99 0.00**

Mid lateral orbit 3.94 4.4 �0.46 0.07 3.73 4.7 �0.97 0.00**

Supraglenoid 14.01 8.8 5.21 0.00** 12.6 8.8 3.80 0.00**

Zygomatic arch 8.32 5.8 2.52 0.00** 8.59 6.8 1.79 0.00**

Lateral orbit 8.6 7.3 1.3 0.02* 9.6 9.7 �0.10 0.87Supra M2 28.49 24.1 4.39 0.00** 27.51 25.6 1.91 0.04*

Mid masseter 18.25 16.9 1.35 0.16 18.44 16.8 1.64 0.08Occlusal line 24.43 18.8 5.63 0.00** 21.19 18.8 2.39 0.00**

Sub M2 21.47 16.5 4.97 0.00** 21.12 18.1 3.02 0.00**

Gonion 19.38 14.2 5.18 0.00** 16.74 14.2 2.54 0.03*

Mid mandibular 11.42 9.9 1.52 0.01* 10.99 11 �0.01 0.99



(c)Sup-glabella 4.85 4.5 0.35 0.17 4.14 4.3 �0.16 0.50Glabella 7.02 5.1 1.92 0.00** 6.51 4.8 1.71 0.00**

Nasion 8.32 6.4 1.92 0.00** 7.00 6.3 0.70 0.02*

End of nasal 3.78 3.1 0.68 0.00** 2.36 2.5 �0.14 0.36Mid-philtrum 13.56 9.7 3.86 0.00** 11.27 8.5 2.77 0.00**

Upper lip 13.37 10.6 2.77 0.00** 10.36 9.2 1.16 0.02*

Lower lip 13.92 11.7 2.22 0.00** 11.37 10.3 1.07 0.05Chin–lip fold 10.87 10.9 �0.03 0.95 9.98 10.3 �0.32 0.36Mental eminence 12.90 10.8 2.10 0.00** 11.93 9.9 2.03 0.00**

Beneath chin 8.58 6.4 2.18 0.00** 6.09 5.7 0.39 0.37Frontal eminence 4.87 4.7 0.17 0.55 4.42 4.1 0.32 0.18Supra orbital 7.55 5.3 2.25 0.00** 7.09 5.3 1.79 0.00**

Lateral glabella 5.69 6.6 �0.91 0.01* 5.15 5.6 �0.45 0.09Lateral nasal 3.06 4 �0.94 0.00** 2.92 3.4 �0.48 0.01*

Sub orbital 6.36 9.7 �3.34 0.00** 6.29 10 �3.71 0.00**

Inferior malar 13.64 17.9 �4.26 0.00** 13.29 18.1 �4.81 0.00**

Lateral nostril 9.79 9.6 0.19 0.68 8.22 9.2 �0.98 0.02*

Nasolabial ridge 12.56 10.4 2.16 0.00** 11.13 8.7 2.43 0.00**

Supra canine 10.84 9.9 0.94 0.08 9.35 8.3 1.05 0.01*

Sub canine 10.22 10.9 �0.68 0.07 10.06 10.5 �0.44 0.34Mental tuber ant 12.68 10.8 1.88 0.00** 12.14 10.1 2.04 0.00**

Mid lateral orbit 4.02 5 �0.98 0.01* 4.01 4.8 �0.79 0.01*

Supraglenoid 15.88 10.8 5.08 0.00** 14.60 9.2 5.40 0.00**

Zygomatic arch 8.64 6.1 2.54 0.00** 9.48 7 2.48 0.00**

Lateral orbit 9.36 8.1 1.26 0.01* 11.54 9.5 2.04 0.00**

Supra M2 28.37 24.9 3.47 0.00** 27.67 26 1.67 0.02*

Mid masseter 18.52 18.2 0.32 0.74 18.28 16.4 1.88 0.02*

Occlusal line 25.79 19.5 6.29 0.00* 22.99 17.7 5.29 0.00**

Sub M2 24.27 18.7 5.57 0.00* 22.13 18.7 3.43 0.00**

Gonion 20.32 15.6 4.72 0.00* 17.08 13.9 3.18 0.00**

Mid mandibular 11.60 11.9 �0.30 0.67 11.54 11.3 0.24 0.71

Landmarks Male FemaleThis study Greef Difference p This study Greef Difference pn = 32 n = 71 n = 32 n = 72

(d)Sup-glabella 4.74 4.6 0.14 0.57 4.53 4.3 0.23 0.18Glabella 7.11 5.5 1.61 0.00** 6.99 4.8 2.19 0.00**

Nasion 8.03 6.8 1.23 0.01* 7.42 6.2 1.22 0.00**

End of nasal 3.92 2.7 1.22 0.00** 3.71 2.6 1.11 0.00**

Mid-philtrum 12.68 10.4 2.28 0.00** 10.85 8.1 2.75 0.00**

Upper lip 12.00 9.8 2.20 0.00** 11.28 9.1 2.18 0.00**

Lower lip 13.07 12.8 0.27 0.64 12.44 10.3 2.14 0.00**

Chin–lip fold 10.83 10.5 0.33 0.41 9.74 10.1 �0.36 0.38Mental eminence 12.44 10.2 2.24 0.00** 12.42 10 2.42 0.00**

Beneath chin 8.39 6.2 2.19 0.00** 6.97 5.9 1.07 0.01*


Table8 (Continued)

Landmarks Male FemaleThis study Greef Difference p This study Greef Difference pn = 32 n = 71 n = 32 n = 72

Frontal eminence 4.66 4.6 0.06 0.80 4.62 4.3 0.32 0.11Supra orbital 7.20 5.8 1.40 0.00** 7.18 5.3 1.88 0.00**

Lateral glabella 5.31 6 �0.69 0.14 5.27 5.5 �0.23 0.41Lateral nasal 3.09 4 �0.91 0.00** 2.98 3.4 �0.42 0.03*

Sub orbital 6.65 9 �2.35 0.01* 6.31 9.1 �2.79 0.00**

Inferior malar 13.62 18.2 �4.58 0.00** 13.54 19.2 �5.66 0.00**

Lateral nostril 9.40 9.7 �0.30 0.54 8.55 8.4 0.15 0.68Nasolabial ridge 12.68 10.4 2.28 0.00** 10.59 8.4 2.19 0.00**

Supra canine 10.95 9.4 1.55 0.01* 8.59 8.1 0.49 0.28Sub canine 9.78 10.5 �0.72 0.18 9.70 9.9 �0.20 0.59Mental tuber ant 12.38 10.9 1.48 0.01* 12.25 10.4 1.85 0.00**

Mid lateral orbit 4.06 4.8 �0.74 0.01* 4.05 5 �0.95 0.01*

Supraglenoid 15.53 9.5 6.03 0.00** 15.36 8.6 6.76 0.00**

Zygomatic arch 7.64 6.3 1.34 0.07 10.51 6.8 3.71 0.00**

Lateral orbit 8.80 8 0.80 0.18 12.85 9.9 2.95 0.00**

Supra M2 27.97 23.7 4.27 0.00** 27.83 27.2 0.63 0.48Mid masseter 18.24 18 0.24 0.83 18.01 16.4 1.61 0.06Occlusal line 24.28 19.1 5.18 0.00** 23.06 18 5.06 0.00**

Sub M2 22.84 17.3 5.54 0.00** 21.95 17.9 4.05 0.00**

Gonion 18.36 13.1 5.26 0.00** 17.95 14 3.95 0.00**

Mid mandibular 11.87 11.4 0.47 0.57 11.79 11.4 0.39 0.51



(e)Sup-glabella 4.70 4.30 0.40 0.09 4.40 4.40 0.00 1.00Glabella 7.04 5.20 1.84 0.00** 7.02 5.30 1.72 0.00**

Nasion 8.09 6.30 1.79 0.00** 7.71 7.20 0.51 0.12End of nasal 3.98 3.20 0.78 0.02* 3.77 2.50 1.27 0.00**

Mid-philtrum 12.76 9.00 3.76 0.00** 10.63 8.00 2.63 0.00**

Upper lip 11.46 9.40 2.06 0.00** 10.92 9.90 1.02 0.09Lower lip 12.50 10.10 2.40 0.00** 12.24 10.70 1.54 0.00**

Chin–lip fold 10.95 10.10 0.85 0.06 10.15 10.80 �0.65 0.18Mental eminence 12.50 10.50 2.00 0.01* 12.07 10.50 1.57 0.01*

Beneath chin 8.44 6.80 1.64 0.02* 6.89 7.00 �0.11 0.83Frontal eminence 4.59 4.50 0.09 0.75 4.51 4.60 �0.09 0.70Supra orbital 7.20 5.50 1.70 0.00** 6.55 5.50 1.05 0.00**

Lateral glabella 5.40 6.60 �1.20 0.01* 5.33 6.10 �0.77 0.02*

Lateral nasal 3.12 4.70 �1.58 0.00** 3.01 3.70 �0.69 0.00**

Sub orbital 7.34 10.50 �3.16 0.01* 6.78 10.40 �3.62 0.00**

Inferior malar 13.54 18.30 �4.76 0.00** 13.33 19.80 �6.47 0.00**

Lateral nostril 9.26 10.20 �0.94 0.14 8.45 9.60 �1.15 0.00**

Nasolabial ridge 12.08 9.00 3.08 0.00** 11.07 8.40 2.67 0.00**

Supra canine 10.02 9.20 0.82 0.11 9.35 8.10 1.25 0.04*

Sub canine 9.65 10.50 �0.85 0.04* 9.46 11.10 �1.64 0.00**

Mental tuber ant 12.35 10.80 1.55 0.01* 10.79 10.90 �0.11 0.83Mid lateral orbit 3.69 4.50 �0.81 0.03* 3.66 5.00 �1.34 0.00**

Supraglenoid 14.48 9.10 5.38 0.00** 13.40 9.60 3.80 0.00**

Zygomatic arch 7.16 5.90 1.26 0.03* 7.07 6.50 0.57 0.25Lateral orbit 9.18 7.80 1.38 0.18 10.10 9.70 0.40 0.41Supra M2 28.40 28.00 0.40 0.78 27.04 27.10 �0.06 0.95Mid masseter 18.11 17.30 0.81 0.47 17.91 15.70 2.21 0.01*

Occlusal line 23.73 18.60 5.13 0.00** 20.01 18.00 2.01 0.03*

Sub M2 20.83 19.80 1.03 0.40 16.23 21.20 �4.97 0.00**

Gonion 16.90 14.00 2.90 0.16 13.60 13.60 0.00 1.00Mid mandibular 11.27 13.00 �1.73 0.19 9.74 14.00 �4.26 0.00**

*p < 0.05.**p < 0.0.


ul, me, so, lg, lna, sbo, im, nlr, mlo, spg, za, ol and mma landmarksin the 18–29 age group; (b) gl, n, mp, me, so, lna, sbo, im, mta,mlo, spg, za, sm2, ol, sbm2 and g points in the 30–39 age group;(c) all values except for the sg, en, ll, cf, bc, fe, lg, sbc and mmapoints in the 40–49 age group; (d) all values except for the sg, cf,fe, lg, lno, sc, sbc, sm2, mm and mma points in the 50–59 agegroup and (e) all values except for the sg, n, ul, cf, bc, fe, mta, za,lo, sm2 and g in the group over 60 years were significantlydifferent.

4. Discussion

The present study measured the FSTT of a sample population ofTurkish adults for 31 anatomical landmarks (10 midline and 21bilateral). Reliable measurements can be obtained using landmarkdefinitions with the use of the CT data. Sahni et al. [20] and Rochaet al. [39] have reported that using CT scans for data collection is oneof the most accurate techniques for measuring soft tissuethicknesses.

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et al. (8) study for males (a) between 18 and 29 years, (b) between 30 and 39 years, (c)


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mparison between male and female subjects, most of thelandmarks showed sex-based differences, with greater valuesfor the males than for the females. We noticed that there wereseveral significant differences between the sexes and among theage groups. 16 landmarks significantly different in the 18–29 agegroup, 13 in the 30–39 age group, 10 in the 40–49 age group, 8 inthe 50–59 age group and 5 in the 60+ age group; it is thereforeevident that the differences decreased with age. In particular, largedifferences (almost 2.0 mm) can be seen at the landmarks at themouth and lower part of the nose area (mp, ul, ll, nlr, sc) in almost allof the age groups.

Although most of the landmarks indicated greater values inmales than in females, two landmarks, the zygomatic arch andlateral orbit were smaller for males’ age groups than those for the

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Fig. 9. Comparison of tissue depth measurements of this study with the De Greefbetween 40 and 49 years, (d) between 50 and 59 years, and (e) 60+ years.

females’ age groups were. Hwang et al. [38] also reported a similarpattern.

We compared the results of this study with those obtained fromstudies on Koreans and White Europeans. In a comparison of ourmeasurements with those from Hwang et al. (Koreans) [38], themajority of the landmarks had lower soft tissue depth values,indicating thinner soft tissues in the Turkish population than thosein Korean population. The FSTT showed different patternsaccording to the measurement sites: no significant sex differencesfor some landmarks, while statistically significant differences forothers. A comparison between the results of this study and those ofDe Greef et al. (White Europeans) [8], found that our thicknessvalues were generally higher than those of the De Greef et al. [8].

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Fig. 10. Comparison of tissue depth measurements of this study with the De Greef et al. (8) study for females (a) between 18 and 29 years, (b) between 30 and 39 years, (c)between 40 and 49 years, (d) between 50 and 59 years, and (e) 60+ years.


Our study also demonstrated the presence of interpopulationvariations in the FSTTs, when comparing our Turkish adult datasetwith those of other populations.

5. Conclusion

This study performed measurements of the FSTT of Turkishadults. General descriptive analyses were performed, includingrange, mean and standard deviation, considering the sex and age ofthe individuals. It was observed that 18 of the 31 landmarksshowed sex-based differences. The males have larger landmarkvalues, except for two landmarks sites corresponding to the cheek

area (zygoma), which showed smaller values in male than infemale subjects.

The results of this study also suggest significant differences infacial tissue thickness between Turkish and Korean adults.Likewise, there are also significant differences between Turkishand White European adults. We believe that the FSTT measure-ments obtained in this study can be used as a database forcraniofacial reconstruction of Turkish adults in forensic cases andother research studies.

Additionally, the influence of BMI on facial soft tissue depthsindicates a strong correlation between the two parameters. Due tothe significant relationships between BMI and tissue thickness atmultiple landmarks for both males and females, it is important to

Fig.11. Frontal and lateral views of the skull showing ethnicity-based differences for all male age groups between Turkish population and European population as indicated inTable 8.

Fig. 12. Frontal and lateral views of the skull showing only significant ethnicity-based differences for all female age groups between Turkish population and Europeanpopulation as indicated in Table 8.


collect and analyze the FSTT data from all categories of BMI forfuture studies on Turkish population.

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Facial soft tissue thickness database for craniofacial reconstruction in the Turkish adult...

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