|Year : 2009 | Volume
| Issue : 3 | Page : 313-319
|Craniofacial anthropometric norms of Malaysian Indians
WC Ngeow, ST Aljunid
Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, University of Malaya, Kuala Lumpur - 50603, Malaysia
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|Date of Submission||18-Jul-2008|
|Date of Decision||20-Dec-2008|
|Date of Acceptance||30-Jan-2009|
|Date of Web Publication||30-Oct-2009|
| Abstract|| |
Objective: This study was done to establish the craniofacial anthropometric norms of the young adult (18- 25 years) Malaysian Indian.
Materials and Methods: The study group consisted of convenient samples of 100 healthy volunteers, with equal number of female and male subjects who had no history of mixed racial-parentage. Twenty-two linear measurements were taken twice from 28 landmarks over six craniofacial regions. The methodology and evaluation of indices of the craniofacial region was adapted from Hajnis et al.
Results: The minimum measurements are always contributed by the female Indian except for the nose height (n-sn), (left) eye fissure length (ex-en), upper vermillion height (ls-sto), and lower vermillion height (sto-li). There is a gender difference in all the measurements except the (left) eye fissure height (independent t-test; P < 0.05). The Malaysian Indians exhibit some North American White Caucasian (NAWC) features in all regions. The cephalic index indicates a brachycephalic or relatively short wide head with a tendency towards mesocephaly. From the low nasal index, the Malaysian Indian female have a nose that is narrow or leptorrhin similar to the NAWCs. The lower value of the upper lip height to mouth width index in the Indian female indicates a relatively shorter upper lip height compared to the mouth width, also similar to the NAWC.
Conclusion: This study establishes the craniofacial anthropometric norms of the Malaysian Indian over 22 parameters. Male in general has a significantly higher measurement than female. The Malaysian Indians do exhibit some NAWC features.
Keywords: Asia, craniofacial anthropometry, ethnic, measurement, Malaysian Indians
|How to cite this article:|
Ngeow W C, Aljunid S T. Craniofacial anthropometric norms of Malaysian Indians. Indian J Dent Res 2009;20:313-9
Anthropometry is the measurement of living subjects.  It has shown to be useful in orthodontic research  and also in reconstructive surgery where the soft tissue morphology of the face can be studied more reliably than comparisons from radiographs.  Anthropometric measurements of the head and face can be used together with cephalometry, CT scans, and MRI in preparation for a patient undergoing plastic and reconstructive surgery. 
This study seeks to expand scientific research to create hands- on value to surgeons treating the Indians, who mainly reside in India, but are also found residing in almost every country in the world. Together, they make up more than one billion of the world population. Malaysian Indians are no different than their counterpart Indians who live in the Indian subcontinent (India, Sri Lanka, Pakistan, Bangladesh) as they are the decedents of the people who originated from this part of the world.  While there has been a report on the craniofacial anthropometry in Indian newborns and infants, , there is currently no comprehensive data on the adult Indian. The most extensive data on the adult Indian so far has been reported by Farkas et al. where 14 measurements were recorded from various parts of the craniofacial complex.  Other studies on the Indians were concentrated more on specific regions of the craniofacial complex, such as the lip-nose region, , the ear, , and the orbital region. ,,[ 14] Hence, it is the objective of this study to expand the baseline quantitative data of the Indians.
| Materials and Methods|| |
The study group consisted of convenient samples of 100 young adult Indians residing in Malaysia, with equal number of female and male subjects. Their age ranged from 18 to 25 years. The participants who volunteered were generally healthy and exhibited no craniofacial abnormalities either acquired through road traffic accidents or other forms of trauma, congenital or developmental discrepancies and had no history of plastic or reconstructive surgery. Subjects of mixed parentage were excluded from this study. The data were collected between June and December of 2004.
Standard anthropometric instruments were used in this study. They were Mitutoyo digital sliding caliper, spreading caliper, measuring tape, and a modified sliding caliper with bubble levels.
Twenty-two linear measurements were taken from 28 landmarks over six craniofacial regions. Every measurement was taken twice by the same examiner and recorded in the corresponding form. A third reading was taken if the initial two measurements showed large discrepancy and the two closer readings would then be used. This methodology and evaluation of indices of the craniofacial region was adapted from Hajnis et al.  To avoid errors in locating landmarks that were used for more than one measurement (e.g. nasion, subnasale), these landmarks were marked on the skin.
The landmarks used in this study are standard landmarks used in craniofacial anthropometric study, namely:
- Vertex (v), glabella (g) or nasal eminence, opisthocranium (op), ophyron (on), and eurion (eu) on the head
- zygion (zy), nasion (n), subnasale (sn), stomion (sto), and gnathion (gn) or menton on the face
- endocanthion (en), exocanthion (ex), palpebrale superius (ps), and palpebrale inferius (pi) on the eye
- alare (al) and pronasale (prn) on the nose
- cheilion (ch), labiale (or labrale) superius (ls), and Labiale (or labrale) inferius (li) on the orolabial region
- superaurale (sa), subaurale (sba), preaurale (pra), postaurale (pa) on the ear
Head, facial, orbital, nasal, orolabial, and ear measurements were derived from the measurements using these landmarks. The measurement definitions are shown in [Table 1]. The procedures for obtaining measurements were in accordance with the ethical standards of the responsible committee on human experimentation of the institution of the authors and with the Helsinki Declaration of 1975, as revised in 2000.
Data were entered using Statistical Package for Social Science (SPSS) software program (Version 11.0; SPSS Inc, Chicago, IL, USA). An independent t-test was performed to evaluate if there is any significant difference in the measurement between gender. A value of P < 0.05 was set as being statistically significant.
| Results|| |
The craniofacial anthropometric norms of the Malaysian Indians are shown in [Table 2]. In general, it can be noted that the minimum measurements are always contributed by the female Indian except for the nose height (n-sn), (left) eye fissure length (ex-en), upper vermillion height (ls-sto), and lower vermillion height (sto-li).
A P value of < 0.05 was noted in all measurement except for the (left) eye fissure height (ps-pi), indicating that there is a gender difference in all the measurements.
| Discussion|| |
Racial and ethnic differences in facial traits of various races such as the American and European Caucasian, Afro- American, Turkish, Arabs, Persian, Chinese, Vietnamese, and Thais have been reported by many researchers. ,,,,,,,,,,,,, One of the biggest comparative data on the various ethnic groups/races in the world was published in 2005 by the late Professor Farkas. This international anthropometric project studied the facial morphology of 26 ethnic groups/races in the world.  That study included five Asian ethnic groups, of which one of them was the Indians. Prior to this, there are only several publications in English that highlighted the craniofacial anthropometry of the Indians, and most of them either concentrate on newborns or infants , or specific regions of the craniofacial framework. ,,,,,,
As Farkas et al.'s data on the Indians is the only one that is most comprehensive and easily extracted for comparison, we undertake to make a descriptive comparison between these data and our current findings. We are confident that our data are comparable to Farkas et al.'s even though we were not calibrated with Farkas and his group of researchers as this study was developed with his input and were based on the methods he employed. The comparison of the craniofacial anthropometric norms between the Malaysian Indians and Indians of India is shown in [Table 3].
When analyzing the data by their means, it can be noted that in several parameters like the zygomatic width (zy- zy), lower face height (sn-gn), nose height (n-sn), nose width (al- al), and sa-sba (left) ear length, Malaysian Indians recorded slightly higher means, with the range of difference between 0.5 and 15.3 mm, as compared to Farkas et al.'s findings [Table 3]. By taking into consideration the normal distribution of Farkas et al.'s data (i.e. 2SD), it is noted that our findings can be generalized as within the same range. The differences in mean and normal range between measurements were not large and within acceptable limit. There were, however, gross differences between the standard deviations (SD) of two measurements. The SD for the zygomatic width (zy-zy) of Indian female is more than twice of its Malaysian Indian counterpart's, while that of sa-sba (left) ear length of the Malaysian Indian male is more than twice its Indian counterpart's. These differences may have resulted from the difference in the number of samples recruited in both studies (n = 50 in the present study; n = 30 in Farkas et al.).
When comparing the males, Malaysian Indians presented with a lower range value that is below that of the Indians in five parameters, namely, the zygomatic width (zy-zy), lower face height (sn-gn), intercanthal width (en-en), (left) eye fissure length (ex-en), and mouth width (ch-ch) [Table 3]. In addition, they also presented with an upper range value that is above the Indians in two parameters, the nose height (n-sn) and sa-sba (left) ear length. The ranges for the Malaysian Indian male were within that of the Indians in the remaining three parameters [Table 3]. In comparison, Malaysian Indian female presented with a lower range value that is below that of the Indians in three parameters, namely, lower face height (sn-gn), binocular width (ex-ex) and mouth width (ch-ch) [Table 3]. They also presented with an upper range value that is above the Indians in another three parameters, namely the face height (n-gn), nose height (n-sn), and nose width (al-al). The Malaysian Indian female's measurements were within that of the Indians in the remaining four parameters.
We believed the methods employed for obtaining measurements may have influenced the outcomes. For example, Purkait and Singh,  using the Knuίmann method reported a measurement of 57.7 ± 2.2 for left ear length for male, as compared to 64.6 ± 4 that we observed. This may be due to difference in methods employed as we used the Farkas' method instead. Similarly, though we found that the intercanthal distances and binocular widths in our samples were within the range of that reported by Gupta et al.,  we found that there was gender difference that was not reported by them. So, within the limitation of methodology and sample size differences, we believe it is not wrong to suggest that our findings indicate that the Malaysian Indians are not different from their Indian counterparts as reported by Farkas et al. 
We also undertook the task to compare our finding with that of Farkas' data on the North American White Caucasian (NAWC) young adult.  This is shown in [Table 4]. The NAWC was chosen instead of other Asian ethnic groups because of recent finding by Farkas et al. who found that the Indians present with Caucasian features.  This is not surprising, considering that the Indians belongs to the subgroup of Caucasoid called Indo-Dravidian (Indo- European). 
It is noted that the Malaysian Indian in general, has smaller measurements in 18 parameters, though within the range of those of the NAWC. Only the biocular width (ex-ex), nose width (al-al), and (left) ear length (sa-sba) of Malaysian Indians are more than the NAWC. Apart from skin colour, these are the three additional parameters that could be useful to differentiate them from the NAWC.
While it is interesting to note that the Malaysian Indians and NAWC shared many measurements which were either similar or only differed slightly from each other in the head, face, eye, nose, and orofacial region, several features stand out when comparing their craniofacial features using the cephalic index, facial index, upper face index, eye fissure index, nasal index, and the upper lip height to mouth width index.
The cephalic index is the ratio of the head width to the head circumference and is expressed as percent. The cephalic index indicated a brachycephalic or relatively short wide head with a tendency toward a mesocephal in the Malaysian Indians (mean cephalic index 81.5, SD ± 4.1 in male and 82.8, SD ± 3.9 in female). In contrast, the NAWC had a mesocephalic or medium wide-long head (mean cephalic index 79.2, SD ± 4.6 in male and 78.2, SD ± 4.2 in female). 
The facial framework is expressed by the facial index, which is the ratio of facial length to facial width. This index indicated a proportionally more balanced facial frame (mesoprop) for the Malaysian Indians (facial index 85.4, SD ± 3.9 in female and 85.5, SD ± 4.4 in male). Comparing to a similar study by Farkas  only the NAWC female had mesoprosop-type face, whereas the NAWC male has a face that is long (leptoprosop) in relation to its width (88.5, SD ± 5.1).
In the upper face index, which is the ratio of upper face height to the face width, a mesen or medial type face is seen in Malaysian Indian male as indicated by a small index value (53.5 ± 3.3). The NAWC with upper face index of 54.0 (SD ± 3.1) in male and 52.6 (SD ± 3.4) in female shared this mesen type face.  In contrast, the upper face index for Malaysian Indian female (54.0 ± 2.7) which was slightly higher defined a lepten type face.
The eye fissure index is the ratio between the (left) eye fissure height to the eye fissure length. The eye fissure indices of the Malaysian Indians (33.0, SD ± 1.4 for male and 35.6, SD ± 1.2 female) are not much different to that of the NAWC (33.4, SD ± 3.5 for male and 36.2, SD ± 3.1 for female).  The nasal framework as described by nasal index was higher in Indian males (76.6 mm ± 8.3) as compared to females (70.3 mm ± 7.3). The nasal index in NAWC is smaller in comparison, with 65.8 (SD ± 6.8) for males and 65.1 (SD ± 5.8) in females. From this index, we can see that the Malaysian Indian females and North American Caucasians has low nasal index value that describes a nose as narrow or leptorrhin.
In the orolabial region, the upper lip height to mouth width index of the Indian females had a value of 42.5 (SD ± 4.6) that is almost similar to the Caucasian males (41.1 ± 5.4). The lower value in the Indian females indicates a relatively shorter upper lip height compared to the mouth width and shared the same feature as the Caucasians.
So, based on the measurements obtained and indices that were derived, it is noted that the Malaysian Indians shared some similar features with the NAWC. Both races share the same mesen-type face for both genders. In addition, Malaysian Indian females more prominently manifest Caucasian features in their facial framework, eye, nose, and orolabial region.
Limitations of study
The subjects chosen were of convenient sample and included students from the various states in Malaysia. However, due to a relatively small sample size and the fact that they were not randomized, the results obtained in this study may not be representative of the norms for the whole population of two million Indians in Malaysia.
| Conclusion|| |
This study establishes the craniofacial anthropometric norms of the Malaysian Indians over 22 parameters. Males in general have a significantly higher reading than females. The Malaysian Indians are no differente from the counterparts in India and they do exhibit some NAWC features in all craniofacial regions.
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W C Ngeow
Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, University of Malaya, Kuala Lumpur - 50603
[Table 1], [Table 2], [Table 3], [Table 4]
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