3D CT Soft Tissue Craniofacial Analysis and Lip Morphology

Islam, Mushrath; Alam, Mohammad Khursheed; Yusof, Asilah

doi:10.1590/pboci.2021.036

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ORIGINAL ARTICLE • Pesqui. Bras. Odontopediatria Clín. Integr. 21 • 2021 • https://doi.org/10.1590/pboci.2021.036 copy

3D CT Soft Tissue Craniofacial Analysis and Lip Morphology

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objctive:

To assess the soft tissue characteristics of Bangladeshi adults to formulate soft tissue 3D CT standards using Holdaway’s (HA) and lip morphology (LM) analyses. Another aim of this study was to assess the gender dimorphism of Bangladeshi population.

Material and Methods:

One hundred and seventeen (Eighty-five men and Thirty-two women) Bangladeshi adults have obtained their computed tomography (CT) scan at the Radiology Department for normal diagnosis. Craniofacial deformities were undetected in all cases. The CT images were prepared by a 3D imaging programming software (Mimics 11.02 Materialise). Parameters from the identified landmark points were measured in 3D through this software.

Results:

Upper lip thickness (ULT) (vermillion UL-A point) measurement was significant in HA and in LM analyses, upper lip protrusion (ULP) (Ls to Sn-SPog) measurement has demonstrated significant difference among both genders, where p-value was less than 0.05. Mean measurements of Bangladeshi adults were relatively comparable except the face convexity (FC) when compared with the HA cephalometric soft tissue values.

Conclusion:

By using HA and LM analyses, 3D CT soft tissue standards were established for Bangladeshi adults. Measurements for all parameters have remained equivalent with the HA standard data apart from the FC measurement. This consequently may demonstrate that the Bangladeshi population retains a convex shape with a slight protrusive lip or retruded chin.

Keywords:
Diagnostic Imaging; Tomography, X-Ray Computed; Orthodontics

Landmark	Name	Definition
SNa	Soft Tissue Nasion	The deepest point of the concavity between the forehead and soft tissue contour of the nose.
Point A	A Point	Deepest bony point on the contour of the premaxilla below anterior nasal spine.
Point B	B Point	Deepest bony point on the contour of the mandible above the pogonion.
SPog	Soft Tissue Pogonion	The most prominent point on the soft tissue contour of the chin in the midsagittal plane.
Pog	Pogonion	The most anterior point of the convexity of the chin.
Sn	Subnasale	The junction between the lower border of the nasal septum, the partition that divides the nostrils, and the cutaneous portion of the upper lip in the midline.
Prn	Pronasale	The most protruded point of the nasal tip.
Cm	Collumela	The most antero-interior point of the soft tissue nose profile.
Vermillion UL	Vermillion Upper Lip	Height of the vermilion of the upper lip in the midline more than 2 SD above the mean.
Sl	Sublabiale	The midpoint of the labiomental sulcus.
Vermillion LL	Vermillion Lower Lip	Height of the vermilion of the lower lip in the midline more than 2 SD above the mean.
U1P	Upper Incisor Apex	Apex of upper incisor.
Ls	Labiale Superius	The midpoint of the vermilion border of the upper lip.
Li	Labiale Inferius	The midpoint of the vermilion border of the lower lip to sublabiale.
H line	Harmony Line	Tangent to the chin point to upper lip.
S line	Facial Contour Line	A line is drawn on the soft tissue contour of the chin to the middle of the 'S' formed by lower border of the nose.
E line	Esthetic Plane	A line extends from the tip of the nose to the chin.
FH	Frankfurt Horizontal Plane	This plane connects the lowest point of the orbit (orbitale) and the superior point of the external auditory meatus (porion).

Variables	Measurements
S-SNa line (mm)	A line connecting sella to nasion
Vermilion border UL-Prn (mm)	Nose prominence
SPog-Pog (mm)	Chin thickness
Vermillion UL-FH (mm)	Superior sulcus depth
Sn-H line (mm)	Sub H line
Vermillion UL-A point (mm)	Upper lip thickness
LL-H line (mm)	Lower lip to H line
SNa-SPog (mm)	Facial Plane (FP)
N-SNa/FH (º)	Soft-tissue facial angle
H line -FP (º)	H angle
N-A-Pog (º)	Convexity
Ls to E line (mm)	Upper lip to E line
Li to E line (mm)	Lower lip to E line
Ls to Sn-SPog (mm)	Protrusion of the upper lip relative to the lower face
Li to Sn-SPog (mm)	Protrusion of lower lip relative to the lower face
Cm-Sn-Ls (º)	Nasolabial angle
Ls-Sn-SPog (º)	Upper lip protrusion angle
L1-PointB-SPog (º)	Inter labial sulcus angle
L1-Sn-SPog (º)	Lower lip protrusion angle

Variables	Gender	Mean	SD	95% CI		p-value	Holdaway's Established Value
				Lower	Upper	p-value	Holdaway's Established Value
Vermillion UL-Prn (mm)	Male	17.89	0.925	-0.402	0.419	0.967	14-24
	Female	17.88	1.177	-0.457	0.474
SPog-Pog (mm)	Male	11.81	0.937	-0.247	0.534	0.468	10-12
	Female	11.67	0.988	-0.262	0.549
Vermillion UL-FH (mm)	Male	2.37	0.236	-0.078	0.107	0.757	1-4
	Female	2.35	0.195	-0.071	0.100
Sn-H line (mm)	Male	4.45	0.205	-0.074	0.090	0.849	5 ± 2
	Female	4.45	0.184	-0.071	0.087
Vermillion UL-A point (mm)	Male	15.27	0.572	0.158	0.665	0.002^* * Significant at p<0.05.	15
Vermillion UL-A point (mm)	Female	14.86	0.762	0.124	0.698
LL-H line (mm)	Male	0.62	0.032	-0.015	0.012	0.776	0-0.5
	Female	0.63	0.034	-0.016	0.012
N-A-Pog (^O)	Male	3.62	0.285	-0.161	0.075	0.474	0.00^O
	Female	3.66	0.298	-0.165	0.079
N-SNa/FH (^O)	Male	88.89	5.004	-0.964	3.177	0.292	91^O ± 7^O
	Female	87.78	5.132	-1.012	3.226
H line -FP (^O)	Male	14.51	1.823	-1.075	0.354	0.319	7^O-15^O
	Female	14.87	1.490	-1.018	0.296

Variables	Gender	Mean	SD	95% CI		p-value
				Lower	Upper
Ls to E line (mm)	Male	2.35	0.285	-0.074	0.173	0.430
	Female	2.30	0.342	-0.087	0.186
Li to E line (mm)	Male	-0.24	0.077	-0.004	0.065	0.085
	Female	-0.27	0.101	-0.009	0.070
Ls to Sn-SPog (mm)	Male	5.22	0.398	-0.001	0.321	0.042^* * Significant at p<0.05.
	Female	5.06	0.364	-0.006	0.316
Li to Sn-SPog (mm)	Male	4.33	0.436	-0.162	0.211	0.793
	Female	4.31	0.498	-0.176	0.225
Cm-Sn-Ls (º)	Male	103.16	0.907	-0.316	0.411	0.796
	Female	103.12	0.816	-0.302	0.397
L1-Point B-SPog (^o)	Male	133.22	1.778	-0.179	1.322	0.134
	Female	132.65	1.954	-0.222	1.366
Ls-Sn-SPog (^o)	Male	8.76	0.933	-0.387	0.353	0.928
	Female	8.77	0.808	-0.366	0.333

	(3DCT)	Cephalometry
Variables	Present Study	Saudi	Japan	Chinese	Palestinian
N-A-Pog	3.62	1.75	2.42	1.5	1.76
N-SNa/FH	88.89	89.66	90.16	92.5	92.23
vermillion UL-Prn	17.89	12.36	14.54	6	18.33
Spog-Pog	11.81	11.33	13.58	9	12
vermillion UL-FH	2.37	2.92	4.46	9	3
Sn-Hline	4.45	5.03	9.06	4	4.7
Vermillion UL-Apoint	15.27	15.69	15.11	15	12.33
H line -FP	15.51	15.16	15.51	16	14.21
LL-H line	0.62	0.86	1.62	0.5	1.62
No. Subject	117	61	211	48	93

	3DCT	Cephalometry
Variables	Present Study	Malaysian Chinese	Nigerian	Malaysian Malay	North Indian	Pakistani
Ls to E line	2.35	-1.03	4.07	-0.015	*	1.38
Li to E line	-0.24	0.92	7.88	0.459	*	-0.715
Cm-Sn-Ls	103.16	99.66	*	84.893	112.14	102.7
Point B	133.22	144.48	*	124.325	128.8	104.1
Ls to Sn-Pog	5.22	*	6.77	1.249	2.59	4.552
Sn-Pog to Ls	8.76	*	9.84	26.25	*	29.36
Li-Sn-Pog	4.33	*	9.02	1.678	1.99	3.47
Sn-Pog-Li	6.9	*	10.53	13.368	*	11.42
No. Subject	117	98	100	70	100	100

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[1] Correspondence: Dr. Mohammad Khursheed Alam, Orthodontic Department, College of Dentistry, Jouf University, Sakaka, Kingdom of Saudi Arabia. E-mail:dralam@gmail.com