Accepted Manuscript Title: A CT-Scan Database for the Facial Soft Tissue Thickness of Taiwan Adults Author: Ju-Hui Chung Wan-Yi Hsu Hsiao-Ting Chen Guo-Shu Huang Kai-Ping Shaw PII: DOI: Reference:
S0379-0738(15)00174-7 http://dx.doi.org/doi:10.1016/j.forsciint.2015.04.028 FSI 7984
To appear in:
FSI
Received date: Revised date: Accepted date:
12-11-2014 9-2-2015 22-4-2015
Please cite this article as: J.-H. Chung, W.-Y. Hsu, H.-T. Chen, G.-S. Huang, K.-P. Shaw, A CT-Scan Database for the Facial Soft Tissue Thickness of Taiwan Adults, Forensic Science International (2015), http://dx.doi.org/10.1016/j.forsciint.2015.04.028 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
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CT-Scan Database for a Facial Soft Tissue Thickness for Taiwan Adults
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Ju-Hui Chung a, Wan-Yi Hsu a, Hsiao-Ting Chen a, Guo-Shu Huang b, Kai-Ping Shaw ac*
Department of Forensic Medicine, Institute of Forensic Medicine, Ministry of Justice, Taipei, Taiwan.
Department of Radiology, Tri-Service General Hospital,, National Defense Medical Center,
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Taipei, Taiwan. c
Department of Pathology, Tri-Service General Hospital, National Defense Medical Center,
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Taipei, Taiwan.
CORRESPONDING AUTHOR:
Kai-Ping Shaw, M.D., Ph.D. Director Department of Forensic Pathology Institute of Forensic Medicine, Ministry of Justice No.123, Min-An St., Zhonghe Dist., New Taipei City 23552 Taiwan (R.O.C) Telephone No.: +866-2-222-383-55 FAX No.: +866-2-222-387-55 Email: [email protected] 1
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A CT-Scan Database for the Facial Soft Tissue Thickness of Taiwan Adults
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Keywords: Facial reconstruction; Forensic anthropology population data; Facial soft tissue thickness; Computerized tomography (CT)
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Abstract
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Facial reconstruction is a branch of forensic anthropology used to assist in the identification of skeletal remains. The majority of facial reconstruction techniques use facial soft tissue depth chart data to recreate facial tissue on a skull or a model of a skull through the use of modeling clay. This study relied on 193 subjects selected from the Taiwanese population on the basis of age and gender to determine the average values of 32 landmarks, include midline and bilateral measures, by means of CT scans. The mean age of the subjects was 46.9±16.4 years, with a mean age of 43.8±16.6 for males and 49.9 ±15.8 for females respectively. There were 16 landmarks with statistically significant differences between male and female subjects, namely S, G, N, Na, Ph, Sd and Id in the midline portion, FE, LD, ZA and Sub M2 in
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the bilateral-right portion, and the same in the bilateral-left portion, with the exception of the IM point (abbreviations adapted from Karen T. Taylor’s work). The mean soft tissue depth was greater in males than in females, and there was significant difference between the right and left sides of the face in Za point. This study's findings were compared with those of Bulut et al.. Introduction
Skeletonized human remains can be identified by a variety of methods, including the use of medical files, DNA comparison, and dental records. However, these methods sometimes cannot provide satisfactory results due to lack of ante-mortem information for comparison [1, 2], or when the severe decomposition of the body and bones makes it impossible to identify DNA. In the case of unidentified cadavers in homicide cases, identification is often the key to solving the case. In addition to DNA comparison, determining individual physical characteristics (gender, age, height, and facial features, etc.) with greater certainty will often accelerate identification of unidentified cadavers and provide more information for investigators.
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Facial reconstruction is a branch of forensic anthropology used to assist in the identification of skeletal remains [3]. The majority of reconstruction techniques use facial soft tissue depth chart data to recreate facial tissue on a skull or a model of a skull through the use of modeling clay [2, 3]. The thickness of facial soft tissue is connected with age, gender, and ethnicity [4], and can be measured employing methods such as magnetic resonance imaging (MRI) [1], ultrasound [2, 5], needle puncture [6], and computerized tomography (CT) [7, 8].
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Many articles in the literature contain facial soft tissue thickness databases for the populations of various countries. In 2011, Serdar et al. [1] published research concerning the Turkish population, and created a reference database containing measurements of nine points at the midline. Cha standardized the facial soft-tissue characteristics of South Korean adults, and found that men had thinner soft tissue at several landmarks [7]. Other studies investigated facial soft tissue in the populations of Brazil [9], Australia [10], and France [8]. There is no facial soft tissue database for Taiwanese, however. Although we can refer to other Asian data to help identify cadavers, this approach lacks precision, does not comply with the principle of scientific verification, and may result in error that can jeopardize the credibility of justice. Constructing a facial soft tissue database for Taiwanese will improve the identification rate of unidentified cadavers, and reduce the number of unidentified cadavers, which will ultimately lessen social costs. This study collected data on 193 subjects from population of Taiwan based on age and gender, and derived the average values for 32 landmarks, include midline and bilateral measurements, by CT scanning. Materials and methods
We employed sinus CT scanning images for 193 subjects (95 female and 98 male) from the image archiving and communication system (PACS) database of the Department of Radiology, Tri-Service General Hospital in Taiwan in 2013. The 32 facial landmarks were divided into two parts: a midline part, which included 10 points: supraglabella (S), glabella (G), nasion (N), end of nasals (Na), mid-philtrum (Ph), upper lip margin (Sd), lower lip margin (Id), chin-lip fold (CLF), mental eminence (Pog) and beneath chin (Me); and a bilateral part (left/right), which included 11 points: frontal eminence (FE), supraorbital (Sb), suborbital (Su), inferior malar (IM), lateral orbit (LO), zygomatic arch, midway (ZA), supraglenoid (Sg), gonion (Go), Supra M2, occlusal line (Ol) and Sub M2. These points are all adapted
from Karen T. Taylor's “Forensic Art and Illustration” [11], and are summarized in Table 1 and Fig. 1. 4
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The measurement steps consisted of (1) entering the subjects' ID numbers, (2) finding the corresponding axial slice of the CT-scan image (Fig. 2a), and (3) sequentially measuring the midline (Fig. 2b) and bilateral (left/right) portions using measurement software, and recording the results. This was followed by statistical analysis of the data for the 32 landmarks by age and gender. The average facial tissue thickness for each morphological point was presented as mean ± standard error mean (SEM). The paired t-test was used to determine differences in contralateral soft tissue thickness. Relative difference, which was defined as (right side thickness - left side thickness) / 0.5*(right side thickness + left side thickness) ×100%, was also calculated. The data was compared with that the results of Bulut et al.’s study [12], which measured the adult Turkish population using CT-scan, by independent t-test. The age groups in our study were adjusted to be consistent with Bulut et al.’s study, and the bilateral differences were analyzed without specific reference to right or left side. Statistical analysis, such as the independent t-test and paired t-test, was performed by using SPSS software, version 18.5 for Windows (SPSS Inc., Chicago, IL). The level of significance was set at p < 0.05 for all statistical analysis.
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This study was approved by the Local Ethics Committee of Antai Medical Care Cooperation Antai Tian-Sheng Memorial Hospital and Tri-Service General Hospital, National Defense Medical Center, Taiwan.
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Table1 List of facial landmarks.
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Figure 1. Locations of facial landmarks, including 10 landmarks in the midline portion (marked as white dots) and 11 points in the bilateral portion (marked as black dots).
Figure 2 (a) Axial slices of a CT-scan image (female, 21 years old).
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Figure 2 (b) Measurement of midline portion (female, 21 years old).
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The age distribution of the subjects by gender is presented in Table 2 and Fig. 3. The mean age of the subjects was 46.9±16.4 years, with a mean age of 43.8±16.6 years for male subjects and a mean age of 49.9 ±15.8 years for female subjects. The 51 to 60 year old age group (46 cases, 23 females, 23 males) had the greatest number of facial soft tissue thickness peaks (23.83%), followed by the 21 to 30 year old age group (38 cases, 8 females, 30 males) with 19.69%, and the middle-aged group (36 cases, 21 females, 15 males) with 18.65%.
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Table 2 Average age of Taiwanese subjects of each gender.
Figure 3. The age distribution of each gender among Taiwanese subjects. The results of facial tissue thickness measurement were tabulated with the mean, maximum, minimum and standard deviation with sample sizes. This study found that 7
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the 16 landmarks with a statistically significant difference between the males and females were S, G, N, Na, Ph, Sd and Id in the midline portion, FE, LO ZA and Sub M2 in the bilateral-right portion, and the same in the bilateral-left portion, with the exception of the IM point. The relationships between facial tissue thickness and age are presented in Table 3. The thicknesses of the landmarks were significantly different for the different genders and age groups, especially along the midline section.
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Comparing the males and the females aged 21-30 years (Table 4), significant differences were found in the points S, N, Na, Sd and Sb. When the thickness values of the males and the females aged 31-40 years(Table 5) were compared, significant difference were seen in the S, G, N and Sd thicknesses. When the thickness values of the males and the females aged 41-50 years (Table 6) were compared, significant difference were seen in the S, G, Ph, Sd and LO thicknesses. Significant differences were also observed in the N, Na, Sd, Id and ZA thicknesses of males and females aged 51-60 years (Tables 7), the Ph thickness of persons aged 61-70 years (Tables 8), and the Na and Id thicknesses of persons aged over 70 years (Tables 9). The tissue thicknesses of males were greaterer than those of females at all the above landmarks except for the LO and ZA points, which showed greaterer tissue thickness in females than in males. We can see in some points (Fig. 4a-4f) that, regardless of gender, the thickness of facial soft tissue in the midline section displays a downward trend as the age of the subjects increase, while an upward trend can be seen in some other points (Fig. 4g-4j). In the case of the bilateral portion, these trends also occur at the ZA and Sg points on both left and right sides of the face (Fig. 5a-5d).
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Table 3 Results of statistical analysis of facial tissue thickness (mm) among Taiwanese subjects.
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Table 4 Statistical analysis of facial tissue thickness (mm) for the 21-30 year age group among Taiwanese subjects.
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Table 5 Statistical analysis of facial tissue thickness (mm) for the 31-40 year age group among Taiwanese subjects.
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Table 6 Statistical analysis of facial tissue thickness (mm) for the 41-50 year age group among Taiwanese subjects.
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Table 7 Statistical analysis of facial tissue thickness (mm) for the 51-60 year age group among Taiwanese subjects.
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Table 8 Statistical analysis of facial tissue thickness (mm) for the 61-70 year age group among Taiwanese subjects.
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Table 9 Statistical analysis of facial tissue thickness (mm) for the over 70 year age group among Taiwanese subjects.
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Figure 4 (a-j). Variation in facial soft tissue depth in the midline portion (10 points) by gender for different age groups
Figure 5 (a-d). Variation in facial soft tissue depth in the bilateral portion (4 points, left and right face) by gender for different age groups. Comparison of the soft tissue thickness between the right and the left sides showed significant difference (p < 0.05) in only 1 of total 11 landmarks (Table 10). Soft tissue thickness in the ZA point was found to be significantly greater on left side than on the right side, with a discrepancy of 0.24±0.95 mm.The relative differences did not exceed ±2% except for ZA, with a value of -2.4%.
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Table 10 Statistical analysis of differences in right and left soft tissue thickness at bilateral landmarks for Taiwanese subjects (unit: mm).
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We compare our findings with those of Bulut et al.’s study [12], and the results are shown in Table 11. Regardless of age and gender, lower thicknesses were observed in 9 of total 21 points: G, N, Sd, Id, Pog, LO, Sg, Supra M2 and Sub M2 , with the most notable difference observed in Supra M2 , which ranged from 13.16 to 16.87 mm. On the other hand, larger thickness were observed in 3 of total 21 points: CLF, IM and ZA. For males, significant differences (p < 0.05) in tissue thickness between the two studies were found in (a) all points except for Na, Ph, Me, Sb, IM, LO, Go and Ol points in the 18-29 age group; (b) Id, CLF, Pog, IM, ZA, Supra M2 and Sub M2 points in the 30-39 age group; (c) all points except for S, Ph, Sd, Me, FE, Sb, Su, ZA, Go, Ol and Sub M2points in the 40-49 age group; (d) all points except for S, Sd, Me, FE, Sb, Su, LO, Go and Ol points in the 50-59 age group and (e) all points except for S, Ph, Me, FE, Sb, Su, LO, ZA, Go and Ol points in the 60+ age group. Likewise, for females; significant differences were found in (a) N, Id, LO, ZA, Supra M2 and Sub M2 points in the 18-29 age group; (b) G, N, Id, CLF, Sb, Su, IM, ZA and Supra M2 points in the 30-39 age group; (c) all points except for S, Na, Ph, FE, Sb, Go and Ol points in the 40-49 age group; (d) all points except for Ph, Me, Sb, ZA, Go and Ol points in the 50-59 age group and (e) all points except for S, Ph, Me, FE, Sb, Su, LO and Go points in the 60+ age group. The result suggest that there are more significant differences in tissue thickness between the Taiwanese and Turkish populations in the case of over 40 years old.
Table 11 Comparison of facial tissue thickness in the midline of this study with the Bulut study [12] for (a) males and (b) females (unit: mm). Discussion
Gender Differences This study found that average facial soft tissue is thicker in males than in females, which is well explained by Stephan et al. [10] and Cha [7] in terms of the fact that estrogen in females facilitates synthesis of hyaluronic acid, which is lower in males. 17
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In particular, the landmarks located on the forehead, nose, upper part of the mouth, cheek, cheek-to-eye and cheek-to-lower section showed significant differences.
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Age Differences Wilkinson [13], based on a review of prior studies, states that age-related changes in tissues are highly variable. Tissue thickness around the mouth and lower cheek tend to decrease with age, while the thickness of tissue around the chin and orbit may increase with age. Our results are consistent with these findings, with decreasing thicknesses of soft tissue on the forehead, nose, and, in particular, the area around the maxilla. The Id, CLF, Pog and Me points, which are located on the chin, showed an increasing thickness with age. Other studies also support the relationship of age to facial soft tissue thickness; Greef et al. concluded the effects of facial aging can be analyzed as changes in volume [4] and Tanushri et al. also found that the thickness at landmarks in the supra-canine, temporal and ramus region showed a statistically-significant decreasing trend [14].
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Contralateral Differences Little attention has been paid to comparison of the tissue thickness of both sides of the face. No significant difference was found in Korean and North Indian populations [14, 15]. In the case of Caucasians, however, about half of the landmarks showed significant differences at a significance level of p < 0.01 in the values of the
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right and left side of face, with relative differences being no more than 6% [16]. This study found no significant difference (p < 0.05) in bilateral landmarks, except for the ZA point, where there was a relative difference of -2.4%. Relative differences of the other points were all within ±2%. This finding suggests minor differences exists in bilateral landmarks along Taiwanese subjects. Ethnical Differences When comparing measurements with Bulut et al.’s [12] data for Turkish subjects, significant differences (p < 0.05) in tissue thickness between the two ethnical groups were observed in the Id and Supra M2 points for both genders and all age groups. In addition, significant differences were also observed in the CLF and Pog points for males and N point for females. We also found that our thickness values were generally lower than those of Bulut et al.’s study, indicating thinner soft tissue in the Taiwanese population than in Turkish population.
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References
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We determined how facial soft-tissue thicknesses in different facial areas along normal facial profiles vary with age and gender. The mean soft tissue depth was greater in males than in females, and there were no significant differences between the right and left sides of the face. The Id, CLF, Pog and Me points, which are located on the chin, showed an increasing thickness with age. We hope that the thickness and the analyses obtained in this study can provide detailed and accurate data that can be used for forensic facial reconstruction of Taiwanese adults.
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[5] I.C.S. Galdames, G.E.S. Alarcón, D.A.Z. Matamala, Best parameters for sexual dimorphism in the facial thickness tissue with ultrasonic assessment, Saúde, Ética & Justiça. 13 (2) (2008) 60-64
[6] I.C.S. Galdames, M.C. López, D.A.Z. Matamala, F.J.P. Rojas, S.R.T. Muñoz, Comparisons in Soft-Tissue Thicknesses on the Human Face in Fresh and Embalmed Corpses Using Needle Puncture Method, Int. J. Morphol. 26 (1) (2008) 165-169. doi:10.4067/s0717-95022008000100027
[7] K.S. Cha, Soft-tissue thickness of South Korean adults with normal facial profiles, Korean J Orthod. 43 (4) (2013) 178-185. doi:10.4041/kjod.2013.43.4.178
[8] F. Tilotta, F. Richard, J. Glaunes, M. Berar, S. Gey, S. Verdeille, Y. Rozenholc, J.F. Gaudy, Construction and analysis of a head CT-scan database for craniofacial reconstruction, Forensic Sci Int. 191 (1-3) (2009) 112.e111-112. doi:10.1016/j.forsciint.2009.06.017 [9] S.V. Tedeschi-Oliveira, R.F. Melani, N.H. de Almeida, L.A. de Paiva, Facial soft tissue thickness of Brazilian
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doi:10.1111/j.1556-4029.2008.00852.x [11] K.T. Taylor, Forensic Art and Illustration. CRC Press, Florida, 2000. [12] O. Bulut, S. Sipahioglu, B. Hekimoglu, Facial soft tissue thickness database for craniofacial reconstruction in the Turkish adult population, Forensic Sci Int. 242 (2014) 44-61. doi:10.1016/j.forsciint.2014.06.012
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[13] C. Wilkinson, Forensic Facial Reconstruction. Cambridge University Press, Cambridge, 2004.
[14] T. Saxena, S.R. Panat, N.C. Sangamesh, A. Choudhary, A. Aggarwal, N. Yadav, Facial Soft Tissue Thickness in North Indian Adult Population, JIAOMR. 24 (2) (2012) 121-125.
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[15] H.S. Hwang, M.K. Park, W.J. Lee, J.H. Cho, B.K. Kim, C.M. Wilkinson, Facial soft tissue thickness database for craniofacial reconstruction in Korean adults, J Forensic Sci. 57 (6) (2012)
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[16] S. De Greef, P. Claes, D. Vandermeulen, W. Mollemans, P. Suetens, G. Willems, Large-scale in-vivo Caucasian facial soft tissue thickness database for craniofacial reconstruction, Forensic Sci
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Acknowledgements
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This study has received financial support from the Ministry of Justice under technology project No. 102-1301-IFM (09)-01. We are grateful to Jen-Hung Chang for performing statistical analyses.
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Table 1
Table 1 List of facial landmarks. Anatomical landmark
Description
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Nasion (N)
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End of nasals (Na) Mid-philtrum (Ph)
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Upper lip margin (Sd)
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Lower lip margin (Id)
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Chin-lip fold (CLF)
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Mental eminence (Pog) Beneath chin (Me)
Above glabella. The most prominent point between the supraorbital ridges in the midsagittal plane. The midpoint of the suture between the frontal and the two nasal bones. The anterior tip or the farthest point out on the nasal bones. The midline of the maxilla, placed as high as possible before the curvature of the anterior nasal spine begins. Centered between the maxillary central incisors at the level of the cementum enamel junction. Centered between the mandibular central incisor at the level of the cementum enamel junction. The deepest midline point of indentation on the mandible between the teeth and the chin protrusion. The most anterior or projecting point in the midline on the chin. The lowest point on the mandible.
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Supraglabella (S) Glabella (G)
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Place on the projections at both sides of the forehead. Above the orbit, centered on the upper most margin or border. Below the orbit, centered on the lower most margin or border. The lower portion of the maxilla, still on the cheekbone. Drop a line from the outer margin of the orbit and place the marker about 10 mm below the orbit. Zygomatic arch, midway (ZA) Halfway along the zygomatic arch. Supraglenoid (Sg) Above and slightly forward of the external auditory meatus at the deepest point. Gonion (Go) The most lateral point on the mandibular angle. 2 Above the second maxillary molar. Supra M Occlusal line (Ol) On the mandible in alignment with the line where the teeth occlude or bite. Sub M2 Below the second mandibular molar.
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Bilateral (Left / Right) 11- L, R Frontal eminence (FE) 12- L, R Supraorbital (Sb) 13- L, R Suborbital (Su) 14- L, R Inferior malar (IM) 15- L, R Lateral orbit (LO)
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Table 2
Table 2 Average age and number of subjects of each gender. Female 49.9 ±15.8 95
Total 46.9±16.4 193
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Average age Case
Male 43.8±16.6 98
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Table 3
Table 3 Results of statistical analysis of facial tissue thickness (mm) among Taiwanese subjects. Male Female Landmarks n Max Min Mean S.D. n Max
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Midline Supraglabella (S) Glabella (G) Nasion (N) End of nasals (Na) Mid-philtrum (Ph) Upper lip margin (Sd) Lower lip margin (Id) Chin-lip fold (CLF) Mental eminence (Pog) Beneath chin (Me)
* p < 0.05. ** p < 0.01.
1.045 0.868 1.208 1.505 2.445 2.415 1.173 2.612 2.540 2.708
92 93 93 93 89 83 70 59 44 32
6.7 8.5 8.1 11 16.7 13.5 13.8 20.1 17.0 12.6
2.5 3.5 1.9 1.2 2.2 1.4 7.2 7.2 4.3 4.2
4.01 5.47 5.72 2.46 10.57 9.27 9.59 13.64 9.75 7.23
0.891 0.988 1.074 1.369 2.120 1.683 1.282 2.308 2.486 1.813
0.000** 0.002** 0.000** 0.025* 0.000** 0.000** 0.021* 0.474 0.726 0.517
51 94 95 90 91 93 91 21 72 59 23
7.1 10.1 11.1 23.8 12.0 15.9 19.5 28.7 18.1 33 20.9
1.8 3.3 3.3 9.3 3.2 4.8 3.6 7.1 7.8 2.6 9.5
4.79 7.31 7.08 16.20 7.57 9.42 11.04 18.39 12.92 24.11 12.48
1.158 1.370 1.716 3.116 3.116 2.142 2.968 6.042 2.220 4.949 2.362
54 95 94 87 92 85 85 24 71 60 18
6.2 10.9 13.5 25.9 17.5 15.2 18.6 28.7 17.8 34.8 16.6
2.5 3.8 3.1 1.74 3.4 6.1 4.8 1.56 6.3 2.2 5.3
4.25 7.22 7.32 16.64 9.20 10.51 10.71 17.04 11.56 24.43 10.57
0.903 1.483 2.173 3.583 2.357 1.961 2.911 6.921 2.230 4.354 2.630
0.009** 0.782 0.317 0.386 0.000** 0.000** 0.455 0.487 0.055 0.429 0.021*
50 93 92 89 91 91 91 22 68 59 22
7.6 10.2 11.5 24.3 14.6 16.7 19.6 25.6 18.4 32 19.6
1.8 4.4 3.9 1.8 3.8 5.1 4.8 6.7 8.1 7.8 9.7
4.90 7.15 7.16 14.71 8.03 9.80 11.21 18.65 13.42 24.35 12.45
1.203 1.225 1.856 3.815 1.958 2.411 3.132 9.220 2.081 4.500 2.363
5.9 11.2 14.1 25.5 15.4 15.8 17.8 29.4 18.6 33.1 15.6
0.5 3.4 2.3 5.9 4.3 6.8 1.09 1.66 6.4 17.8 6.6
4.14 7.11 7.45 16.89 9.20 10.81 10.83 16.63 12.34 23.88 10.58
1.000 1.510 2.133 3.298 2.088 2.046 3.070 7.395 2.785 3.528 2.210
0.000** 0.858 0.443 0.029* 0.000** 0.001** 0.418 0.424 0.317 0.524 0.014*
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4.80 5.90 6.86 2.94 12.42 11.51 10.07 13.97 9.92 7.61
54 94 95 88 89 87 84 23 70 60 18
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Supra M2 Occlusal line (Ol) Sub M2
2.5 3.9 3.7 0.9 1.0 0.9 7.8 1.8 4.0 2.0
ce pt
Bilateral L Frontal eminence (FE) Supraorbital (Sb) Suborbital (Su) Inferior malar (IM) Lateral orbit (LO) Zygomatic arch, midway (ZA) Supraglenoid (Sg) Gonion (Go)
p
8.5 8.8 10.6 15.1 19.3 20.9 13.1 19.7 15.8 15.8
M
Supra M2 Occlusal line (Ol) Sub M2
S.D.
98 96 95 95 90 87 74 61 56 33
ed
Bilateral R Frontal eminence (FE) Supraorbital (Sb) Suborbital (Su) Inferior malar (IM) Lateral orbit (LO) Zygomatic arch, midway (ZA) Supraglenoid (Sg) Gonion (Go)
Mean
Page 24 of 32
Table 4
Table 4
n
Mean
S.D.
Midline Supraglabella (S)
30
4.843
0.857
8
3.875
0.116
0.000**
Glabella (G)
30
5.59
0.251
8
5.062
0.48
0.07
Nasion (N)
29
6.571
0.754
8
4.925
0.402
0.000**
End of nasals (Na)
29
3.11
6.437
8
2.03
0.534
0.05*
Mid-philtrum (Ph)
29
13.57
3.643
8
11.75
5.585
0.07
Upper lip margin (Sd)
29
12.21
1.965
8
10.338
0.757
0.000**
Lower lip margin (Id)
26
9.838
1.708
8
9
1.506
0.122
Chin-lip fold (CLF)
23
13.62
11.3
6
12.15
12.275
0.383
Mental eminence (Pog)
20
9.5
8.55
3
11.07
11.253
0.524
Beneath chin (Me)
16
7.043
2.904
3
7.23
3.403
0.879
Bilateral R Frontal eminence (FE)
20
4.825
1.17
5
4.58
1.367
0.685
Supraorbital (Sb)
30
7.1
1.867
8
6.125
0.556
0.013*
Suborbital (Su)
30
6.597
2.194
8
6.125
0.867
0.282
Inferior malar (IM)
28
15.14
5.65
8
14.66
5.52
0.618
Lateral orbit (LO)
29
7.4
3.741
8
7.25
1.889
0.802
Zygomatic arch, midway (ZA)
29
9.59
3.68
8
10.76
2.5
0.098
Supraglenoid (Sg)
29
11.34
7.24
8
10.76
3.62
0.499
M
te d
Gonion (Go)
ip
t
S.D.
an
Mean
cr
p
n
us
Statistical analysis of facial tissue thickness (mm) for the 21-30 year age group among Taiwanese subjects. Male Female Landmarks
8
17.97
15.78
4
15.75
20.47
0.441
24
13.68
4.66
8
12.71
2.97
0.218
21
23.85
6.6
4
21.57
2.56
0.059
8
12.88
1.71
3
11.07
0.463
0.021*
Bilateral L Frontal eminence (FE)
20
5.07
1.396
5
4.2
0.975
0.134
Supraorbital (Sb)
30
7.05
1.1
8
5.82
0.367
0.000**
Suborbital (Su)
30
6.81
2.34
8
6.65
1.13
0.742
Inferior malar (IM)
28
15.02
11.74
8
14.71
1.744
0.705
Lateral orbit (LO)
30
7.77
2.68
8
8.01
3.5
0.752
Zygomatic arch, midway (ZA)
29
10.2
5.78
8
11.26
3.29
0.191
Supraglenoid (Sg)
29
11.3
6.36
7
8.75
15.2
0.142
Gonion (Go)
9
20.54
151.2
4
16.55
20.76
0.412
Supra M2
24
14.64
6.27
8
13.68
1.11
0.137
Occlusal line (Ol)
21
23.6
12.56
4
21.5
5.36
0.183
Sub M2
7
12.32
2.44
3
11.4
3.37
0.499
Supra M
2
Ac
Sub M2
ce p
Occlusal line (Ol)
* p < 0.05. ** p < 0.01.
Page 25 of 32
Table 5
Table 5
Mean
S.D.
Midline Supraglabella (S)
10
5.16
0.665
13
4.05
0.671
0.004**
Glabella (G)
12
6.12
0.787
12
5.37
0.613
0.038*
Nasion (N)
12
7.09
1.737
12
6
0.805
0.028*
End of nasals (Na)
12
2.917
0.436
12
2.817
2.296
0.836
Mid-philtrum (Ph)
10
12.28
2.744
12
11.058
1.989
0.082
Upper lip margin (Sd)
10
12.07
2.046
12
10.02
1.577
0.002*
Lower lip margin (Id)
10
9.94
0.418
7
9.74
1.47
0.705
Chin-lip fold (CLF)
10
14.75
6.147
6
14.32
7.926
0.761
Mental eminence (Pog)
9
9.944
4.517
4
8.625
0.313
Beneath chin (Me)
3
9.366
32.14
cr
3.735
3
5.633
1.403
0.38
Bilateral R Frontal eminence (FE)
6
5.33
1.042
7
4.35
0.362
0.11
Supraorbital (Sb)
12
7.75
2.095
13
7.33
1.194
0.425
Suborbital (Su)
12
7.25
3.18
13
7.44
2.23
0.787
Inferior malar (IM)
12
17.5
11.49
12
18.02
8.69
0.689
Lateral orbit (LO)
12
8.22
11.21
12
8.47
1.98
0.814
Zygomatic arch, midway (ZA)
12
10.36
6.63
12
11.26
3.85
0.346
Supraglenoid (Sg)
12
12.5
11.87
12
12.67
3.2
0.883
Gonion (Go)
ip
t
n
an
S.D.
te d
Mean
us
p
n
M
Statistical analysis of facial tissue thickness (mm) for the 31-40 year age group among Taiwanese subjects. Male Female Landmarks
4
16.42
62.79
2
13.7
69.6
0.738
10
13.55
3.629
10
12.7
2.56
0.294
10
23.81
17.1
9
23.82
7.789
0.994
-
-
-
-
-
-
-
Bilateral L Frontal eminence (FE)
6
4.98
1.365
7
4.28
0.598
0.247
Supraorbital (Sb)
12
6.9
1.59
13
7.12
1.66
0.666
Suborbital (Su)
12
7.46
2.76
13
7.6
2.27
0.835
Inferior malar (IM)
12
16.89
15.43
12
17.27
7.76
0.785
Lateral orbit (LO)
12
8.525
5.018
12
9.08
3.096
0.504
Zygomatic arch, midway (ZA)
12
10.7
9.218
12
11.725
4.858
0.355
Supraglenoid (Sg)
12
12.51
15.7
12
13
6.25
0.724
Gonion (Go)
4
16.525
57.55
2
11.05
126.4
0.645
Supra M2
10
14.52
7.41
10
13.9
5.38
0.59
Occlusal line (Ol)
10
25.16
15.6
9
24.4
18.2
0.697
Sub M2
-
-
-
-
-
-
-
Supra M2
Ac
Sub M2
ce p
Occlusal line (Ol)
* p < 0.05. ** p < 0.01.
Page 26 of 32
Table 6
Table 6
Mean
S.D.
Midline Supraglabella (S)
13
5.138
0.847
21
4.038
0.542
0.001**
Glabella (G)
15
6.3
0.448
20
5.37
0.66
0.000**
Nasion (N)
15
7.6
0.738
20
5.63
1.36
1.995
End of nasals (Na)
15
2.82
0.54
20
3.015
6.01
0.739
Mid-philtrum (Ph)
15
13.01
6.16
20
10.73
3.01
0.005*
Upper lip margin (Sd)
15
12.12
6.999
17
8.529
3.96
0.000**
Lower lip margin (Id)
13
10.138
1.22
18
9.61
1.39
0.214
Chin-lip fold (CLF)
9
14.889
4.03
17
13.86
4.59
0.243
Mental eminence (Pog)
8
11.1
3.34
14
10.17
0.31
Beneath chin (Me)
5
8.28
1.787
cr
5.01
10
8.1
4.68
0.846
Bilateral R Frontal eminence (FE)
7
4.57
2.22
13
4.19
0.92
0.558
Supraorbital (Sb)
13
8.02
0.96
21
7.51
2.37
0.254
Suborbital (Su)
13
7.16
4.1
21
7.61
4.93
0.554
Inferior malar (IM)
13
16.99
13.03
18
16.86
26.55
0.932
Lateral orbit (LO)
13
7.953
3.52
20
9.615
5.99
0.036*
Zygomatic arch, midway (ZA)
13
9.66
2.7
19
10.47
2.91
0.191
Supraglenoid (Sg)
12
12.04
6.06
19
11.04
8.76
0.315
Gonion (Go)
ip
t
n
an
S.D.
te d
Mean
us
p
n
M
Statistical analysis of facial tissue thickness (mm) for the 41-50 year age group among Taiwanese subjects. Male Female Landmarks
-
-
-
-
-
-
-
9
11.83
3.315
16
12.23
17.48
0.741
9
24.8
85.66
13
22.43
48.3
0.524
-
-
-
-
-
-
-
Bilateral L Frontal eminence (FE)
7
4.57
2.08
13
3.86
1.75
0.303
Supraorbital (Sb)
13
7.29
1.767
21
7.22
2.556
0.893
Suborbital (Su)
13
7.654
4.321
21
7.714
6.252
0.939
Inferior malar (IM)
13
16.484
12.2
18
17.667
13.18
0.368
Lateral orbit (LO)
13
8.253
5.044
20
10.14
6.865
0.035*
Zygomatic arch, midway (ZA)
13
9.91
2.96
19
10.93
2.075
0.091
Supraglenoid (Sg)
13
11.408
6.077
19
11.278
9.033
0.895
Gonion (Go)
-
-
-
-
-
-
-
Supra M2
9
12.9
2.61
16
13.98
19.2
0.383
Occlusal line (Ol)
9
25.77
12.62
13
24.47
11.253
0.436
Sub M2
-
-
-
-
-
-
-
Supra M2
Ac
Sub M2
ce p
Occlusal line (Ol)
* p < 0.05. ** p < 0.01.
Page 27 of 32
Table 7
Table 7
Mean
S.D.
Midline Supraglabella (S)
19
4.57
2.22
21
3.87
0.671
0.079
Glabella (G)
22
5.86
1.74
23
5.47
0.83
0.253
Nasion (N)
22
6.8
2.34
23
5.9
1.063
0.029*
End of nasals (Na)
22
2.87
0.582
23
2.24
0.323
0.003**
Mid-philtrum (Ph)
21
11.16
8.697
23
10.38
1.945
0.277
Upper lip margin (Sd)
18
10.8
13.19
22
8.82
1.254
0.037*
Lower lip margin (Id)
15
10.34
2.071
16
9.33
1.474
0.043*
Chin-lip fold (CLF)
10
13.42
3.66
13
13.09
4.6
0.697
Mental eminence (Pog)
10
9.59
6.14
6
9.15
0.694
Beneath chin (Me)
6
6.52
12.55
cr
3.5
4
7.58
0.93
0.513
Bilateral R Frontal eminence (FE)
11
4.74
1.469
12
3.97
0.559
0.089
Supraorbital (Sb)
22
7.09
2.688
23
7.46
2.157
0.436
Suborbital (Su)
22
6.81
3.678
23
7.08
4.478
0.646
Inferior malar (IM)
21
16.02
13.126
22
16.76
8.964
0.471
Lateral orbit (LO)
21
7.64
5.208
23
9.02
4.559
0.045*
Zygomatic arch, midway (ZA)
22
8.83
3.667
21
10.99
8.42
0.007**
Supraglenoid (Sg)
21
10.15
7.77
19
10.64
10.48
0.609
Gonion (Go)
ip
t
n
an
S.D.
te d
Mean
us
p
n
M
Statistical analysis of facial tissue thickness (mm) for the 51-60 year age group among Taiwanese subjects. Male Female Landmarks
5
20.96
25.44
8
15.9
73.18
0.206
16
11.28
4.525
20
10.62
4.107
0.355
12
25.11
6.6
17
24.33
15.167
0.522
5
10.94
2.648
6
9.13
2.11
0.089
Bilateral L Frontal eminence (FE)
11
4.75
1.637
12
3.95
1.003
0.111
Supraorbital (Sb)
22
6.82
2.548
22
7.22
1.779
0.378
Suborbital (Su)
22
7.01
5.524
23
7.31
3.868
0.646
Inferior malar (IM)
21
15.41
24.446
22
17.27
9.978
0.152
Lateral orbit (LO)
21
8.12
6.747
23
9.36
4.163
0.089
Zygomatic arch, midway (ZA)
22
9.29
5.7
21
11.34
5.352
0.006**
Supraglenoid (Sg)
21
10.94
13.77
19
10.65
9.442
0.788
Gonion (Go)
5
19.46
35.7
6
14.66
100.57
0.354
Supra M2
16
12.35
6.401
21
11.42
4.95
0.254
Occlusal line (Ol)
12
24.85
22.25
17
24.68
15.818
0.918
Sub M2
5
11.22
0.702
6
9.48
1.621
0.023*
Supra M2
Ac
Sub M2
ce p
Occlusal line (Ol)
* p < 0.05. ** p < 0.01.
Page 28 of 32
Table 8
Table 8
Mean
S.D.
Midline Supraglabella (S)
8
4.4
0.506
18
3.96
1.091
0.222
Glabella (G)
10
5.96
0.378
18
5.66
1.676
0.416
Nasion (N)
10
6.58
1.822
18
5.94
1.179
0.216
End of nasals (Na)
10
2.8
0.613
18
2.39
0.368
0.176
Mid-philtrum (Ph)
10
11.85
3.447
15
10.07
5.315
0.044*
Upper lip margin (Sd)
10
10.04
2.55
13
9.05
4.366
0.213
Lower lip margin (Id)
7
10.29
0.858
12
10.33
2.91
0.948
Chin-lip fold (CLF)
6
14.43
3.13
11
14.13
4.534
0.486
Mental eminence (Pog)
5
10.96
8.483
11
10.32
0.701
Beneath chin (Me)
3
9.9
8.68
cr
9.811
7
6.89
4.494
0.207
Bilateral R Frontal eminence (FE)
3
4.07
1.343
10
4.4
0.724
0.675
Supraorbital (Sb)
10
6.76
2.858
18
7.38
2.762
0.363
Suborbital (Su)
10
7.07
5.04
18
7.06
6.546
0.992
Inferior malar (IM)
10
17.05
6.876
16
16.3
12.24
0.539
Lateral orbit (LO)
10
7.07
5.196
17
9.3
4.725
0.02*
Zygomatic arch, midway (ZA)
10
8.21
5.852
16
9.64
2.461
0.119
Supraglenoid (Sg)
10
9.39
12.309
16
9.65
4.848
0.837
Gonion (Go)
ip
t
n
an
S.D.
te d
Mean
us
p
n
M
Statistical analysis of facial tissue thickness (mm) for the 61-70 year age group among Taiwanese subjects. Male Female Landmarks
-
-
-
-
-
-
-
8
10.7
3.271
9
9.9
3.365
0.38
3
21.3
126.49
10
22.12
8.128
0.912
-
-
-
-
-
-
-
Bilateral L Frontal eminence (FE)
2
4.4
3.92
10
4.46
0.425
0.973
Supraorbital (Sb)
9
6.69
1.36
18
7.13
3.64
0.467
Suborbital (Su)
9
7.84
7.21
18
7.51
6.07
0.755
Inferior malar (IM)
9
16.24
7.21
17
16.08
14.26
0.896
Lateral orbit (LO)
9
7.84
5.785
17
9.65
5.511
0.084
Zygomatic arch, midway (ZA)
9
9.62
6.964
16
10.26
3.724
0.534
Supraglenoid (Sg)
9
9.67
9.578
16
10.25
3.821
0.618
Gonion (Go)
-
-
-
-
-
-
-
Supra M2
7
11.77
3.265
9
12.14
24.452
0.838
Occlusal line (Ol)
3
22.5
162.19
10
21.91
8.938
0.943
Sub M2
-
-
-
-
-
-
-
Supra M2
Ac
Sub M2
ce p
Occlusal line (Ol)
* p < 0.05. ** p < 0.01.
Page 29 of 32
Table 9
Table 9
0.137
7
3.93
2.41
0.729
Glabella (G)
6
5.88
0.622
7
5.24
1.329
0.262
Nasion (N)
6
6.53
1.491
7
5.29
1.111
0.079
End of nasals (Na)
6
2.88
0.234
7
2.01
0.355
0.014*
Mid-philtrum (Ph)
4
10.25
3.737
6
8.23
15.031
0.308
Upper lip margin (Sd)
4
9.55
4.617
6
9.23
2.022
0.805
Lower lip margin (Id)
2
10.85
0.005
5
9.48
0.582
0.016*
Chin-lip fold (CLF)
2
14
3.38
3
14.67
1.083
0.722
Mental eminence (Pog)
3
8.9
9.61
3
9.5
0.19
0.771
Beneath chin (Me)
-
-
-
-
-
-
-
Bilateral R Frontal eminence (FE)
4
4.85
1.137
3
0.67
0.117
Supraorbital (Sb)
6
7.53
0.87
us
3.5
7
6.24
3.31
0.134
Suborbital (Su)
6
7.03
2.15
7
7.07
7.236
0.975
Inferior malar (IM)
5
16.68
5.947
6
15.65
2.463
0.442
Lateral orbit (LO)
6
7.52
3.534
7
9.06
6.266
0.232
Zygomatic arch, midway (ZA)
6
7.92
3.72
7
8.93
1.61
0.304
Supraglenoid (Sg)
6
10.32
7.342
6
7.72
1.746
0.072
Gonion (Go)
cr
ip
t
4.15
an
4
te d
Midline Supraglabella (S)
M
Statistical analysis of facial tissue thickness (mm) for the over 70 year age group among Taiwanese subjects. Male Female Landmarks p n n Mean S.D. Mean S.D.
-
-
-
-
-
-
-
2
13.1
2
4
12.78
19.81
0.9
3
23.1
37.81
3
23.73
4.623
0.881
-
-
-
-
-
-
-
Bilateral L Frontal eminence (FE)
4
5.2
0.78
3
3.5
0.36
0.03*
Supraorbital (Sb)
6
6.48
1.01
7
6.21
3.69
0.754
Suborbital (Su)
6
7.4
4.764
7
7.11
9.07
0.847
Inferior malar (IM)
5
15.62
12.787
6
16.95
7.831
0.518
Lateral orbit (LO)
6
7.83
4.693
7
9.11
5.115
0.378
Zygomatic arch, midway (ZA)
6
7.65
3.387
7
9.57
5.982
0.135
Supraglenoid (Sg)
6
11.03
12.438
6
8.27
2.082
0.119
Gonion (Go)
-
-
-
-
-
-
-
Supra M2
2
11.55
14.045
4
12.625
11.52
0.765
Occlusal line (Ol)
3
20.03
21.723
3
22.8
2.28
0.812
Sub M2
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-
-
-
-
-
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Occlusal line (Ol)
* p < 0.05. ** p < 0.01.
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Table 10
p 0.905 0.076 0.085 0.468 0.057 0.001** 0.219 0.909 0.325 0.300 0.940
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Table 10 Comparison of right and left soft tissue thickness difference at bilateral landmarks for Taiwanese population (unit: mm). Difference beteween right and left n Right Left Rel. Diff Landmarks 95% confidence interval Mean S.D. Frontal eminence (FE) 104 4.52 4.51 0.01 0.737 (-0.135 - 0.152) 0.2% Supraorbital (Sb) 186 7.23 7.13 0.10 0.765 (-0.011 - 0.211) 1.4% Suborbital (Su) 186 7.20 7.28 -0.08 0.643 (-0.175 - 0.011) -1.1% Inferior malar (IM) 176 16.42 16.29 0.14 2.472 (-0.232 - 0.503) 0.8% Lateral orbit (LO) 177 8.34 8.47 -0.14 0.945 (-0.276 - 0.004) -1.6% Zygomatic arch, midway (ZA) 174 9.94 10.18 -0.24 0.952 (-0.379 - -0.094) -2.4% Supraglenoid (Sg) 174 10.91 11.06 -0.16 1.678 (-0.408 - 0.094) -1.4% Gonion (Go) 43 17.71 17.59 0.12 6.780 (-1.968 - 2.205) 0.7% 2 111 12.31 12.35 -0.04 0.442 (-0.125 - 0.042) -0.3% Supra M Occlusal line (Ol) 119 23.77 24.11 -0.34 3.614 (-1.001 - 0.311) -1.4% Sub M2 40 11.62 11.61 0.02 1.305 (-0.402 - 0.433) 0.1% * p < 0.05. ** p < 0.01.
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p 0.087 0.051 0.105 0.184 0.144 0.426 0.000** 0.000** 0.003** 0.795 0.695 0.297 0.218 0.000** 0.740 0.002** 0.141 0.346 0.000** 0.769 0.000**
- 0.14 - 1.14 - 1.28 0.33 0.24 - 0.60 - 2.14 3.73 - 1.82 0.08 0.12 0.88 1.38 5.11 - 0.78 2.99 - 0.27 - 4.37 -14.61 2.27 - 7.67
0.676 0.001** 0.000** 0.519 0.602 0.193 0.001** 0.040* 0.171 0.918 0.731 0.033* 0.024* 0.000** 0.245 0.001** 0.732 0.336 0.000** 0.192 N/A
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Bulut (n)
5.19 6.25 7.53 2.79 13.09 12.09 10.03 14.66 10.56 7.38 4.33 7.42 7.32 16.34 7.80 9.50 10.71 24.85 12.34 24.75 11.30
(13) (15) (15) (15) (15) (15) (13) (9) (8) (5) (7) (13) (13) (13) (13) (13) (13) (1) (9) (10) (1)
4.85 7.02 8.32 3.78 13.56 13.37 13.92 10.87 12.90 8.58 4.87 7.55 6.36 13.64 9.36 8.64 15.88 20.32 28.37 25.79 24.27
(32) (32) (32) (32) (32) (32) (32) (32) (32) (32) (32) (32) (32) (32) (32) (32) (32) (32) (32) (32) (32)
4.08 5.30 5.90 2.80 10.61 8.84 9.60 13.90 10.21 8.44 4.37 7.22 7.81 16.98 9.95 11.05 11.51 20.27 13.61 23.74 8.88
(17) (16) (16) (16) (16) (15) (14) (14) (11) (8) (9) (17) (17) (14) (15) (15) (15) (3) (13) (12) (3)
4.14 6.51 7.00 2.36 11.27 10.36 11.37 9.98 11.93 6.09 4.42 7.09 6.29 13.29 11.54 9.48 14.60 17.08 27.67 22.99 22.13
(32) (32) (32) (32) (32) (32) (32) (32) (32) (32) (32) (32) (32) (32) (32) (32) (32) (32) (32) (32) (32)
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0.58 0.53 0.62 0.26 0.86 0.49 3.58 4.36 - 2.94 0.65 0.18 - 0.43 0.84 4.07 - 0.27 2.38 - 1.36 - 2.91 -14.39 0.41 - 9.55 -
40~49 years This study (n)
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Table 11 Comparison of facial tissue thickness in the midline of this study with the Bulut study [12] for (a) males and (b) females (unit: mm). Landmarks 18~29 years 30~39 years This study (n) Bulut (n) Difference p This study (n) Bulut (n) (a) 4.83 (28) 4.04 (32) 0.79 0.000** 5.15 (11) 4.57 (32) Supraglabella (S) 5.61 (28) 6.43 (32) - 0.82 0.000** 5.95 (13) 6.48 (32) Glabella (G) 6.61 (27) 7.23 (32) - 0.62 0.034* 6.96 (13) 7.58 (32) Nasion (N) 3.20 (27) 2.96 (32) 0.24 0.651 2.78 (13) 3.04 (32) End of nasals (Na) 13.75 (26) 14.19 (32) - 0.44 0.401 12.04 (11) 12.90 (32) Mid-philtrum (Ph) 12.33 (27) 13.88 (32) - 1.55 0.001** 11.93 (11) 12.42 (32) Upper lip margin (Sd) 9.95 (24) 14.11 (32) - 4.16 0.000** 9.76 (11) 13.34 (32) Lower lip margin (Id) 13.55 (21) 10.31 (32) 3.24 0.000** 14.69 (11) 10.33 (32) Chin-lip fold (CLF) 9.81 (18) 12.02 (32) - 2.21 0.003** 9.49 (10) 12.43 (32) Mental eminence (Pog) 7.12 (14) 7.26 (32) - 0.14 0.774 9.00 (4) 8.35 (32) Beneath chin (Me) 5.01 (18) 4.30 (32) 0.71 0.023* 5.11 (7) 4.93 (32) Frontal eminence (FE) 7.11 (28) 6.74 (32) 0.37 0.307 7.32 (13) 7.75 (32) Supraorbital (Sb) 6.76 (28) 5.83 (32) 0.93 0.015* 7.17 (13) 6.33 (32) Suborbital (Su) 15.01 (26) 14.02 (32) 0.99 0.076 17.35 (13) 13.28 (32) Inferior malar (IM) 7.48 (28) 7.65 (32) - 0.17 0.723 8.33 (13) 8.60 (32) Lateral orbit (LO) 9.88 (27) 7.73 (32) 2.15 0.000** 10.70 (13) 8.32 (32) Zygomatic arch, midway (ZA) 11.30 (27) 12.98 (32) - 1.68 0.006** 12.65 (13) 14.01 (32) Supraglenoid (Sg) 18.26 (9) 14.78 (32) 3.48 0.105 16.48 (4) 19.38 (32) Gonion (Go) 14.30 (22) 28.46 (32) -14.16 0.000** 14.10 (11) 28.49 (32) Supra M2 23.72 (20) 23.48 (32) 0.24 0.780 24.84 (10) 24.43 (32) Occlusal line (Ol) 11.83 (8) 20.87 (32) - 9.04 0.000** 11.93 (6) 21.47 (32) Sub M2 (b) 3.99 (7) 3.73 (32) 0.26 0.241 4.15 (12) 4.29 (32) Supraglabella (S) 5.33 (7) 5.72 (32) - 0.39 0.283 5.34 (11) 6.48 (32) Glabella (G) 5.04 (7) 7.08 (32) - 2.04 0.000** 5.93 (11) 7.21 (32) Nasion (N) 2.04 (7) 2.49 (32) - 0.45 0.064 2.68 (11) 2.35 (32) End of nasals (Na) 12.17 (7) 12.19 (32) - 0.02 0.981 10.80 (11) 10.56 (32) Mid-philtrum (Ph) 10.70 (7) 11.09 (32) - 0.39 0.400 9.63 (11) 10.23 (32) Upper lip margin (Sd) 9.13 (6) 11.73 (32) - 2.60 0.002** 9.50 (8) 11.64 (32) Lower lip margin (Id) 12.40 (4) 9.52 (32) 2.88 0.119 13.31 (7) 9.58 (32) Chin-lip fold (CLF) 7.20 (1) 10.91 (32) 3.71 N/A 10.08 (6) 11.90 (32) Mental eminence (Pog) 7.70 (1) 5.27 (32) 2.43 N/A 6.18 (5) 6.10 (32) Beneath chin (Me) 4.56 (4) 3.75 (32) 0.81 0.326 4.41 (8) 4.29 (32) Frontal eminence (FE) 6.19 (7) 5.99 (32) 0.20 0.639 7.20 (12) 6.32 (32) Supraorbital (Sb) 6.35 (7) 5.50 (32) 0.85 0.106 7.44 (12) 6.06 (32) Suborbital (Su) 14.83 (7) 12.95 (32) 1.88 0.089 17.77 (12) 12.66 (32) Inferior malar (IM) 7.50 (7) 9.73 (32) - 2.23 0.003** 8.83 (12) 9.60 (32) Lateral orbit (LO) 10.86 (7) 8.19 (32) 2.67 0.002** 11.58 (12) 8.59 (32) Zygomatic arch, midway (ZA) 9.39 (7) 11.00 (32) - 1.61 0.053 12.33 (12) 12.60 (32) Supraglenoid (Sg) 16.15 (4) 14.48 (32) 1.67 0.372 12.38 (2) 16.74 (32) Gonion (Go) 13.65 (7) 26.81 (32) -13.16 0.000** 12.91 (10) 27.51 (32) Supra M2 22.13 (5) 22.14 (32) - 0.01 0.993 23.46 (7) 21.19 (32) Occlusal line (Ol) 11.23 (3) 20.24 (32) - 9.01 0.000** 13.45 (1) 21.12 (32) Sub M2
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Table 11
Difference
p
50~59 years This study (n)
Bulut (n)
0.34 0.77 0.79 0.99 0.47 1.28 3.89 3.79 - 2.34 - 1.20 - 0.54 - 0.13 0.96 2.70 - 1.56 0.86 - 5.17 4.53 -16.03 - 1.04 -12.97
0.285 0.002** 0.012** 0.000** 0.464 0.065 0.000** 0.000** 0.001** 0.073 0.283 0.648 0.118 0.021* 0.004** 0.142 0.000** N/A 0.000** 0.590 N/A
4.57 5.85 6.80 2.85 11.02 10.69 10.23 13.61 9.79 6.96 4.82 6.95 6.82 15.52 7.82 9.05 10.61 20.21 11.69 24.47 11.25
(20) (22) (22) (22) (21) (18) (15) (10) (10) (7) (12) (22) (22) (21) (21) (22) (21) (5) (16) (11) (4)
4.74 7.11 8.03 3.92 12.68 12.00 13.07 10.83 12.44 8.39 4.66 7.20 6.65 13.62 8.80 7.64 15.53 18.36 27.97 24.28 22.84
(32) (32) (32) (32) (32) (32) (32) (32) (32) (32) (32) (32) (32) (32) (32) (32) (32) (32) (32) (32) (32)
- 0.06 - 1.21 - 1.10 0.44 - 0.66 - 1.52 - 1.77 3.92 - 1.72 2.35 - 0.05 0.13 1.52 3.69 - 1.59 1.57 - 3.09 3.19 -14.06 0.75 -13.25
0.849 0.000** 0.000** 0.446 0.176 0.033* 0.000** 0.000** 0.007** 0.002** 0.893 0.778 0.031* 0.011* 0.041* 0.005** 0.003** 0.555 0.000** 0.627 0.000**
3.81 5.36 5.64 2.53 10.64 8.92 9.29 13.45 9.43 7.26 3.73 7.34 7.24 17.04 9.08 10.67 10.66 16.42 10.96 23.87 9.99
(24) (25) (25) (25) (25) (22) (17) (14) (7) (5) (14) (25) (25) (23) (25) (23) (22) (9) (21) (17) (6)
4.53 6.99 7.42 3.71 10.85 11.28 12.44 9.74 12.42 6.97 4.62 7.18 6.31 13.54 12.85 10.51 15.36 17.95 27.83 23.06 21.95
(32) (32) (32) (32) (32) (32) (32) (32) (32) (32) (32) (32) (32) (32) (32) (32) (32) (32) (32) (32) (32)
-
Difference 0.18 1.26 1.23 1.07 1.66 1.31 2.84 2.78 - 2.65 -1.433 0.161 -0.252 0.170 1.899 -0.983 1.415 -4.916 1.850 -16.279 0.193 -11.588
p
-
0.631 0.000** 0.001** 0.000** 0.019* 0.154 0.000** 0.003** 0.012* 0.316 0.616 0.464 0.768 0.042* 0.106 0.037* 0.000** 0.425 0.000** 0.879 0.000**
-
0.000** 0.000** 0.000** 0.001** 0.620 0.000** 0.000** 0.000** 0.018* 0.613 0.002** 0.585 0.047* 0.000** 0.000** 0.811 0.000** 0.655 0.000** 0.481 0.000**
0.72 1.63 1.78 1.18 0.21 2.36 3.15 3.71 - 2.99 0.29 - 0.90 0.16 0.93 3.50 - 3.77 0.16 - 4.70 - 1.53 -16.87 0.81 -11.96
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S0379-0738(15)00174-7 http://dx.doi.org/doi:10.1016/j.forsciint.2015.04.028 FSI 7984
To appear in:
FSI
Received date: Revised date: Accepted date:
12-11-2014 9-2-2015 22-4-2015
Please cite this article as: J.-H. Chung, W.-Y. Hsu, H.-T. Chen, G.-S. Huang, K.-P. Shaw, A CT-Scan Database for the Facial Soft Tissue Thickness of Taiwan Adults, Forensic Science International (2015), http://dx.doi.org/10.1016/j.forsciint.2015.04.028 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
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CT-Scan Database for a Facial Soft Tissue Thickness for Taiwan Adults
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Ju-Hui Chung a, Wan-Yi Hsu a, Hsiao-Ting Chen a, Guo-Shu Huang b, Kai-Ping Shaw ac*
Department of Forensic Medicine, Institute of Forensic Medicine, Ministry of Justice, Taipei, Taiwan.
Department of Radiology, Tri-Service General Hospital,, National Defense Medical Center,
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Taipei, Taiwan. c
Department of Pathology, Tri-Service General Hospital, National Defense Medical Center,
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Taipei, Taiwan.
CORRESPONDING AUTHOR:
Kai-Ping Shaw, M.D., Ph.D. Director Department of Forensic Pathology Institute of Forensic Medicine, Ministry of Justice No.123, Min-An St., Zhonghe Dist., New Taipei City 23552 Taiwan (R.O.C) Telephone No.: +866-2-222-383-55 FAX No.: +866-2-222-387-55 Email: [email protected] 1
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A CT-Scan Database for the Facial Soft Tissue Thickness of Taiwan Adults
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Keywords: Facial reconstruction; Forensic anthropology population data; Facial soft tissue thickness; Computerized tomography (CT)
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Abstract
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Facial reconstruction is a branch of forensic anthropology used to assist in the identification of skeletal remains. The majority of facial reconstruction techniques use facial soft tissue depth chart data to recreate facial tissue on a skull or a model of a skull through the use of modeling clay. This study relied on 193 subjects selected from the Taiwanese population on the basis of age and gender to determine the average values of 32 landmarks, include midline and bilateral measures, by means of CT scans. The mean age of the subjects was 46.9±16.4 years, with a mean age of 43.8±16.6 for males and 49.9 ±15.8 for females respectively. There were 16 landmarks with statistically significant differences between male and female subjects, namely S, G, N, Na, Ph, Sd and Id in the midline portion, FE, LD, ZA and Sub M2 in
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the bilateral-right portion, and the same in the bilateral-left portion, with the exception of the IM point (abbreviations adapted from Karen T. Taylor’s work). The mean soft tissue depth was greater in males than in females, and there was significant difference between the right and left sides of the face in Za point. This study's findings were compared with those of Bulut et al.. Introduction
Skeletonized human remains can be identified by a variety of methods, including the use of medical files, DNA comparison, and dental records. However, these methods sometimes cannot provide satisfactory results due to lack of ante-mortem information for comparison [1, 2], or when the severe decomposition of the body and bones makes it impossible to identify DNA. In the case of unidentified cadavers in homicide cases, identification is often the key to solving the case. In addition to DNA comparison, determining individual physical characteristics (gender, age, height, and facial features, etc.) with greater certainty will often accelerate identification of unidentified cadavers and provide more information for investigators.
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Facial reconstruction is a branch of forensic anthropology used to assist in the identification of skeletal remains [3]. The majority of reconstruction techniques use facial soft tissue depth chart data to recreate facial tissue on a skull or a model of a skull through the use of modeling clay [2, 3]. The thickness of facial soft tissue is connected with age, gender, and ethnicity [4], and can be measured employing methods such as magnetic resonance imaging (MRI) [1], ultrasound [2, 5], needle puncture [6], and computerized tomography (CT) [7, 8].
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Many articles in the literature contain facial soft tissue thickness databases for the populations of various countries. In 2011, Serdar et al. [1] published research concerning the Turkish population, and created a reference database containing measurements of nine points at the midline. Cha standardized the facial soft-tissue characteristics of South Korean adults, and found that men had thinner soft tissue at several landmarks [7]. Other studies investigated facial soft tissue in the populations of Brazil [9], Australia [10], and France [8]. There is no facial soft tissue database for Taiwanese, however. Although we can refer to other Asian data to help identify cadavers, this approach lacks precision, does not comply with the principle of scientific verification, and may result in error that can jeopardize the credibility of justice. Constructing a facial soft tissue database for Taiwanese will improve the identification rate of unidentified cadavers, and reduce the number of unidentified cadavers, which will ultimately lessen social costs. This study collected data on 193 subjects from population of Taiwan based on age and gender, and derived the average values for 32 landmarks, include midline and bilateral measurements, by CT scanning. Materials and methods
We employed sinus CT scanning images for 193 subjects (95 female and 98 male) from the image archiving and communication system (PACS) database of the Department of Radiology, Tri-Service General Hospital in Taiwan in 2013. The 32 facial landmarks were divided into two parts: a midline part, which included 10 points: supraglabella (S), glabella (G), nasion (N), end of nasals (Na), mid-philtrum (Ph), upper lip margin (Sd), lower lip margin (Id), chin-lip fold (CLF), mental eminence (Pog) and beneath chin (Me); and a bilateral part (left/right), which included 11 points: frontal eminence (FE), supraorbital (Sb), suborbital (Su), inferior malar (IM), lateral orbit (LO), zygomatic arch, midway (ZA), supraglenoid (Sg), gonion (Go), Supra M2, occlusal line (Ol) and Sub M2. These points are all adapted
from Karen T. Taylor's “Forensic Art and Illustration” [11], and are summarized in Table 1 and Fig. 1. 4
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The measurement steps consisted of (1) entering the subjects' ID numbers, (2) finding the corresponding axial slice of the CT-scan image (Fig. 2a), and (3) sequentially measuring the midline (Fig. 2b) and bilateral (left/right) portions using measurement software, and recording the results. This was followed by statistical analysis of the data for the 32 landmarks by age and gender. The average facial tissue thickness for each morphological point was presented as mean ± standard error mean (SEM). The paired t-test was used to determine differences in contralateral soft tissue thickness. Relative difference, which was defined as (right side thickness - left side thickness) / 0.5*(right side thickness + left side thickness) ×100%, was also calculated. The data was compared with that the results of Bulut et al.’s study [12], which measured the adult Turkish population using CT-scan, by independent t-test. The age groups in our study were adjusted to be consistent with Bulut et al.’s study, and the bilateral differences were analyzed without specific reference to right or left side. Statistical analysis, such as the independent t-test and paired t-test, was performed by using SPSS software, version 18.5 for Windows (SPSS Inc., Chicago, IL). The level of significance was set at p < 0.05 for all statistical analysis.
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This study was approved by the Local Ethics Committee of Antai Medical Care Cooperation Antai Tian-Sheng Memorial Hospital and Tri-Service General Hospital, National Defense Medical Center, Taiwan.
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Table1 List of facial landmarks.
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Figure 1. Locations of facial landmarks, including 10 landmarks in the midline portion (marked as white dots) and 11 points in the bilateral portion (marked as black dots).
Figure 2 (a) Axial slices of a CT-scan image (female, 21 years old).
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Figure 2 (b) Measurement of midline portion (female, 21 years old).
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The age distribution of the subjects by gender is presented in Table 2 and Fig. 3. The mean age of the subjects was 46.9±16.4 years, with a mean age of 43.8±16.6 years for male subjects and a mean age of 49.9 ±15.8 years for female subjects. The 51 to 60 year old age group (46 cases, 23 females, 23 males) had the greatest number of facial soft tissue thickness peaks (23.83%), followed by the 21 to 30 year old age group (38 cases, 8 females, 30 males) with 19.69%, and the middle-aged group (36 cases, 21 females, 15 males) with 18.65%.
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Table 2 Average age of Taiwanese subjects of each gender.
Figure 3. The age distribution of each gender among Taiwanese subjects. The results of facial tissue thickness measurement were tabulated with the mean, maximum, minimum and standard deviation with sample sizes. This study found that 7
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the 16 landmarks with a statistically significant difference between the males and females were S, G, N, Na, Ph, Sd and Id in the midline portion, FE, LO ZA and Sub M2 in the bilateral-right portion, and the same in the bilateral-left portion, with the exception of the IM point. The relationships between facial tissue thickness and age are presented in Table 3. The thicknesses of the landmarks were significantly different for the different genders and age groups, especially along the midline section.
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Comparing the males and the females aged 21-30 years (Table 4), significant differences were found in the points S, N, Na, Sd and Sb. When the thickness values of the males and the females aged 31-40 years(Table 5) were compared, significant difference were seen in the S, G, N and Sd thicknesses. When the thickness values of the males and the females aged 41-50 years (Table 6) were compared, significant difference were seen in the S, G, Ph, Sd and LO thicknesses. Significant differences were also observed in the N, Na, Sd, Id and ZA thicknesses of males and females aged 51-60 years (Tables 7), the Ph thickness of persons aged 61-70 years (Tables 8), and the Na and Id thicknesses of persons aged over 70 years (Tables 9). The tissue thicknesses of males were greaterer than those of females at all the above landmarks except for the LO and ZA points, which showed greaterer tissue thickness in females than in males. We can see in some points (Fig. 4a-4f) that, regardless of gender, the thickness of facial soft tissue in the midline section displays a downward trend as the age of the subjects increase, while an upward trend can be seen in some other points (Fig. 4g-4j). In the case of the bilateral portion, these trends also occur at the ZA and Sg points on both left and right sides of the face (Fig. 5a-5d).
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Table 3 Results of statistical analysis of facial tissue thickness (mm) among Taiwanese subjects.
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Table 4 Statistical analysis of facial tissue thickness (mm) for the 21-30 year age group among Taiwanese subjects.
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Table 5 Statistical analysis of facial tissue thickness (mm) for the 31-40 year age group among Taiwanese subjects.
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Table 6 Statistical analysis of facial tissue thickness (mm) for the 41-50 year age group among Taiwanese subjects.
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Table 7 Statistical analysis of facial tissue thickness (mm) for the 51-60 year age group among Taiwanese subjects.
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Table 8 Statistical analysis of facial tissue thickness (mm) for the 61-70 year age group among Taiwanese subjects.
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Table 9 Statistical analysis of facial tissue thickness (mm) for the over 70 year age group among Taiwanese subjects.
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Figure 4 (a-j). Variation in facial soft tissue depth in the midline portion (10 points) by gender for different age groups
Figure 5 (a-d). Variation in facial soft tissue depth in the bilateral portion (4 points, left and right face) by gender for different age groups. Comparison of the soft tissue thickness between the right and the left sides showed significant difference (p < 0.05) in only 1 of total 11 landmarks (Table 10). Soft tissue thickness in the ZA point was found to be significantly greater on left side than on the right side, with a discrepancy of 0.24±0.95 mm.The relative differences did not exceed ±2% except for ZA, with a value of -2.4%.
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Table 10 Statistical analysis of differences in right and left soft tissue thickness at bilateral landmarks for Taiwanese subjects (unit: mm).
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We compare our findings with those of Bulut et al.’s study [12], and the results are shown in Table 11. Regardless of age and gender, lower thicknesses were observed in 9 of total 21 points: G, N, Sd, Id, Pog, LO, Sg, Supra M2 and Sub M2 , with the most notable difference observed in Supra M2 , which ranged from 13.16 to 16.87 mm. On the other hand, larger thickness were observed in 3 of total 21 points: CLF, IM and ZA. For males, significant differences (p < 0.05) in tissue thickness between the two studies were found in (a) all points except for Na, Ph, Me, Sb, IM, LO, Go and Ol points in the 18-29 age group; (b) Id, CLF, Pog, IM, ZA, Supra M2 and Sub M2 points in the 30-39 age group; (c) all points except for S, Ph, Sd, Me, FE, Sb, Su, ZA, Go, Ol and Sub M2points in the 40-49 age group; (d) all points except for S, Sd, Me, FE, Sb, Su, LO, Go and Ol points in the 50-59 age group and (e) all points except for S, Ph, Me, FE, Sb, Su, LO, ZA, Go and Ol points in the 60+ age group. Likewise, for females; significant differences were found in (a) N, Id, LO, ZA, Supra M2 and Sub M2 points in the 18-29 age group; (b) G, N, Id, CLF, Sb, Su, IM, ZA and Supra M2 points in the 30-39 age group; (c) all points except for S, Na, Ph, FE, Sb, Go and Ol points in the 40-49 age group; (d) all points except for Ph, Me, Sb, ZA, Go and Ol points in the 50-59 age group and (e) all points except for S, Ph, Me, FE, Sb, Su, LO and Go points in the 60+ age group. The result suggest that there are more significant differences in tissue thickness between the Taiwanese and Turkish populations in the case of over 40 years old.
Table 11 Comparison of facial tissue thickness in the midline of this study with the Bulut study [12] for (a) males and (b) females (unit: mm). Discussion
Gender Differences This study found that average facial soft tissue is thicker in males than in females, which is well explained by Stephan et al. [10] and Cha [7] in terms of the fact that estrogen in females facilitates synthesis of hyaluronic acid, which is lower in males. 17
Page 17 of 32
In particular, the landmarks located on the forehead, nose, upper part of the mouth, cheek, cheek-to-eye and cheek-to-lower section showed significant differences.
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Age Differences Wilkinson [13], based on a review of prior studies, states that age-related changes in tissues are highly variable. Tissue thickness around the mouth and lower cheek tend to decrease with age, while the thickness of tissue around the chin and orbit may increase with age. Our results are consistent with these findings, with decreasing thicknesses of soft tissue on the forehead, nose, and, in particular, the area around the maxilla. The Id, CLF, Pog and Me points, which are located on the chin, showed an increasing thickness with age. Other studies also support the relationship of age to facial soft tissue thickness; Greef et al. concluded the effects of facial aging can be analyzed as changes in volume [4] and Tanushri et al. also found that the thickness at landmarks in the supra-canine, temporal and ramus region showed a statistically-significant decreasing trend [14].
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Contralateral Differences Little attention has been paid to comparison of the tissue thickness of both sides of the face. No significant difference was found in Korean and North Indian populations [14, 15]. In the case of Caucasians, however, about half of the landmarks showed significant differences at a significance level of p < 0.01 in the values of the
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right and left side of face, with relative differences being no more than 6% [16]. This study found no significant difference (p < 0.05) in bilateral landmarks, except for the ZA point, where there was a relative difference of -2.4%. Relative differences of the other points were all within ±2%. This finding suggests minor differences exists in bilateral landmarks along Taiwanese subjects. Ethnical Differences When comparing measurements with Bulut et al.’s [12] data for Turkish subjects, significant differences (p < 0.05) in tissue thickness between the two ethnical groups were observed in the Id and Supra M2 points for both genders and all age groups. In addition, significant differences were also observed in the CLF and Pog points for males and N point for females. We also found that our thickness values were generally lower than those of Bulut et al.’s study, indicating thinner soft tissue in the Taiwanese population than in Turkish population.
Conclusions 18
Page 18 of 32
References
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We determined how facial soft-tissue thicknesses in different facial areas along normal facial profiles vary with age and gender. The mean soft tissue depth was greater in males than in females, and there were no significant differences between the right and left sides of the face. The Id, CLF, Pog and Me points, which are located on the chin, showed an increasing thickness with age. We hope that the thickness and the analyses obtained in this study can provide detailed and accurate data that can be used for forensic facial reconstruction of Taiwanese adults.
[1] S. Sipahioglu, H. Ulubay, H.B. Diren, Midline facial soft tissue thickness database of Turkish MRI
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[3] V.M. Phillips, N.A. Smuts, Facial reconstruction: utilization of computerized tomography to
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measure facial tissue thickness in a mixed racial population, Forensic Sci Int. 83 (1) (1996) 51-59. [4] S. De Greef, D. Vandermeulen, P. Claes, P. Suetens, G. Willems, The influence of sex, age and body
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mass index on facial soft tissue depths, Forensic Sci Med Pathol. 5 (2) (2009) 60-65. doi:10.1007/s12024-009-9085-9
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[5] I.C.S. Galdames, G.E.S. Alarcón, D.A.Z. Matamala, Best parameters for sexual dimorphism in the facial thickness tissue with ultrasonic assessment, Saúde, Ética & Justiça. 13 (2) (2008) 60-64
[6] I.C.S. Galdames, M.C. López, D.A.Z. Matamala, F.J.P. Rojas, S.R.T. Muñoz, Comparisons in Soft-Tissue Thicknesses on the Human Face in Fresh and Embalmed Corpses Using Needle Puncture Method, Int. J. Morphol. 26 (1) (2008) 165-169. doi:10.4067/s0717-95022008000100027
[7] K.S. Cha, Soft-tissue thickness of South Korean adults with normal facial profiles, Korean J Orthod. 43 (4) (2013) 178-185. doi:10.4041/kjod.2013.43.4.178
[8] F. Tilotta, F. Richard, J. Glaunes, M. Berar, S. Gey, S. Verdeille, Y. Rozenholc, J.F. Gaudy, Construction and analysis of a head CT-scan database for craniofacial reconstruction, Forensic Sci Int. 191 (1-3) (2009) 112.e111-112. doi:10.1016/j.forsciint.2009.06.017 [9] S.V. Tedeschi-Oliveira, R.F. Melani, N.H. de Almeida, L.A. de Paiva, Facial soft tissue thickness of Brazilian
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doi:10.1016/j.forsciint.2009.09.002 [10] C.N. Stephan, E.K. Simpson, Facial soft tissue depths in craniofacial identification (part I): An analytical review of the published adult data, J Forensic Sci. 53 (6) (2008) 1257-1272. 19
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doi:10.1111/j.1556-4029.2008.00852.x [11] K.T. Taylor, Forensic Art and Illustration. CRC Press, Florida, 2000. [12] O. Bulut, S. Sipahioglu, B. Hekimoglu, Facial soft tissue thickness database for craniofacial reconstruction in the Turkish adult population, Forensic Sci Int. 242 (2014) 44-61. doi:10.1016/j.forsciint.2014.06.012
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[13] C. Wilkinson, Forensic Facial Reconstruction. Cambridge University Press, Cambridge, 2004.
[14] T. Saxena, S.R. Panat, N.C. Sangamesh, A. Choudhary, A. Aggarwal, N. Yadav, Facial Soft Tissue Thickness in North Indian Adult Population, JIAOMR. 24 (2) (2012) 121-125.
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[15] H.S. Hwang, M.K. Park, W.J. Lee, J.H. Cho, B.K. Kim, C.M. Wilkinson, Facial soft tissue thickness database for craniofacial reconstruction in Korean adults, J Forensic Sci. 57 (6) (2012)
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1442-1447. doi:10.1111/j.1556-4029.2012.02192.x
[16] S. De Greef, P. Claes, D. Vandermeulen, W. Mollemans, P. Suetens, G. Willems, Large-scale in-vivo Caucasian facial soft tissue thickness database for craniofacial reconstruction, Forensic Sci
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Acknowledgements
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This study has received financial support from the Ministry of Justice under technology project No. 102-1301-IFM (09)-01. We are grateful to Jen-Hung Chang for performing statistical analyses.
21
Page 21 of 32
Table 1
Table 1 List of facial landmarks. Anatomical landmark
Description
3
Nasion (N)
4 5
End of nasals (Na) Mid-philtrum (Ph)
6
Upper lip margin (Sd)
7
Lower lip margin (Id)
8
Chin-lip fold (CLF)
9 10
Mental eminence (Pog) Beneath chin (Me)
Above glabella. The most prominent point between the supraorbital ridges in the midsagittal plane. The midpoint of the suture between the frontal and the two nasal bones. The anterior tip or the farthest point out on the nasal bones. The midline of the maxilla, placed as high as possible before the curvature of the anterior nasal spine begins. Centered between the maxillary central incisors at the level of the cementum enamel junction. Centered between the mandibular central incisor at the level of the cementum enamel junction. The deepest midline point of indentation on the mandible between the teeth and the chin protrusion. The most anterior or projecting point in the midline on the chin. The lowest point on the mandible.
t
Supraglabella (S) Glabella (G)
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Midline 1 2
21- L, R
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20- L, R
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18- L, R 19- L, R
Place on the projections at both sides of the forehead. Above the orbit, centered on the upper most margin or border. Below the orbit, centered on the lower most margin or border. The lower portion of the maxilla, still on the cheekbone. Drop a line from the outer margin of the orbit and place the marker about 10 mm below the orbit. Zygomatic arch, midway (ZA) Halfway along the zygomatic arch. Supraglenoid (Sg) Above and slightly forward of the external auditory meatus at the deepest point. Gonion (Go) The most lateral point on the mandibular angle. 2 Above the second maxillary molar. Supra M Occlusal line (Ol) On the mandible in alignment with the line where the teeth occlude or bite. Sub M2 Below the second mandibular molar.
Ac
16- L, R 17- L, R
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Bilateral (Left / Right) 11- L, R Frontal eminence (FE) 12- L, R Supraorbital (Sb) 13- L, R Suborbital (Su) 14- L, R Inferior malar (IM) 15- L, R Lateral orbit (LO)
Page 22 of 32
Table 2
Table 2 Average age and number of subjects of each gender. Female 49.9 ±15.8 95
Total 46.9±16.4 193
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Average age Case
Male 43.8±16.6 98
Page 23 of 32
Table 3
Table 3 Results of statistical analysis of facial tissue thickness (mm) among Taiwanese subjects. Male Female Landmarks n Max Min Mean S.D. n Max
Min
Midline Supraglabella (S) Glabella (G) Nasion (N) End of nasals (Na) Mid-philtrum (Ph) Upper lip margin (Sd) Lower lip margin (Id) Chin-lip fold (CLF) Mental eminence (Pog) Beneath chin (Me)
* p < 0.05. ** p < 0.01.
1.045 0.868 1.208 1.505 2.445 2.415 1.173 2.612 2.540 2.708
92 93 93 93 89 83 70 59 44 32
6.7 8.5 8.1 11 16.7 13.5 13.8 20.1 17.0 12.6
2.5 3.5 1.9 1.2 2.2 1.4 7.2 7.2 4.3 4.2
4.01 5.47 5.72 2.46 10.57 9.27 9.59 13.64 9.75 7.23
0.891 0.988 1.074 1.369 2.120 1.683 1.282 2.308 2.486 1.813
0.000** 0.002** 0.000** 0.025* 0.000** 0.000** 0.021* 0.474 0.726 0.517
51 94 95 90 91 93 91 21 72 59 23
7.1 10.1 11.1 23.8 12.0 15.9 19.5 28.7 18.1 33 20.9
1.8 3.3 3.3 9.3 3.2 4.8 3.6 7.1 7.8 2.6 9.5
4.79 7.31 7.08 16.20 7.57 9.42 11.04 18.39 12.92 24.11 12.48
1.158 1.370 1.716 3.116 3.116 2.142 2.968 6.042 2.220 4.949 2.362
54 95 94 87 92 85 85 24 71 60 18
6.2 10.9 13.5 25.9 17.5 15.2 18.6 28.7 17.8 34.8 16.6
2.5 3.8 3.1 1.74 3.4 6.1 4.8 1.56 6.3 2.2 5.3
4.25 7.22 7.32 16.64 9.20 10.51 10.71 17.04 11.56 24.43 10.57
0.903 1.483 2.173 3.583 2.357 1.961 2.911 6.921 2.230 4.354 2.630
0.009** 0.782 0.317 0.386 0.000** 0.000** 0.455 0.487 0.055 0.429 0.021*
50 93 92 89 91 91 91 22 68 59 22
7.6 10.2 11.5 24.3 14.6 16.7 19.6 25.6 18.4 32 19.6
1.8 4.4 3.9 1.8 3.8 5.1 4.8 6.7 8.1 7.8 9.7
4.90 7.15 7.16 14.71 8.03 9.80 11.21 18.65 13.42 24.35 12.45
1.203 1.225 1.856 3.815 1.958 2.411 3.132 9.220 2.081 4.500 2.363
5.9 11.2 14.1 25.5 15.4 15.8 17.8 29.4 18.6 33.1 15.6
0.5 3.4 2.3 5.9 4.3 6.8 1.09 1.66 6.4 17.8 6.6
4.14 7.11 7.45 16.89 9.20 10.81 10.83 16.63 12.34 23.88 10.58
1.000 1.510 2.133 3.298 2.088 2.046 3.070 7.395 2.785 3.528 2.210
0.000** 0.858 0.443 0.029* 0.000** 0.001** 0.418 0.424 0.317 0.524 0.014*
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4.80 5.90 6.86 2.94 12.42 11.51 10.07 13.97 9.92 7.61
54 94 95 88 89 87 84 23 70 60 18
Ac
Supra M2 Occlusal line (Ol) Sub M2
2.5 3.9 3.7 0.9 1.0 0.9 7.8 1.8 4.0 2.0
ce pt
Bilateral L Frontal eminence (FE) Supraorbital (Sb) Suborbital (Su) Inferior malar (IM) Lateral orbit (LO) Zygomatic arch, midway (ZA) Supraglenoid (Sg) Gonion (Go)
p
8.5 8.8 10.6 15.1 19.3 20.9 13.1 19.7 15.8 15.8
M
Supra M2 Occlusal line (Ol) Sub M2
S.D.
98 96 95 95 90 87 74 61 56 33
ed
Bilateral R Frontal eminence (FE) Supraorbital (Sb) Suborbital (Su) Inferior malar (IM) Lateral orbit (LO) Zygomatic arch, midway (ZA) Supraglenoid (Sg) Gonion (Go)
Mean
Page 24 of 32
Table 4
Table 4
n
Mean
S.D.
Midline Supraglabella (S)
30
4.843
0.857
8
3.875
0.116
0.000**
Glabella (G)
30
5.59
0.251
8
5.062
0.48
0.07
Nasion (N)
29
6.571
0.754
8
4.925
0.402
0.000**
End of nasals (Na)
29
3.11
6.437
8
2.03
0.534
0.05*
Mid-philtrum (Ph)
29
13.57
3.643
8
11.75
5.585
0.07
Upper lip margin (Sd)
29
12.21
1.965
8
10.338
0.757
0.000**
Lower lip margin (Id)
26
9.838
1.708
8
9
1.506
0.122
Chin-lip fold (CLF)
23
13.62
11.3
6
12.15
12.275
0.383
Mental eminence (Pog)
20
9.5
8.55
3
11.07
11.253
0.524
Beneath chin (Me)
16
7.043
2.904
3
7.23
3.403
0.879
Bilateral R Frontal eminence (FE)
20
4.825
1.17
5
4.58
1.367
0.685
Supraorbital (Sb)
30
7.1
1.867
8
6.125
0.556
0.013*
Suborbital (Su)
30
6.597
2.194
8
6.125
0.867
0.282
Inferior malar (IM)
28
15.14
5.65
8
14.66
5.52
0.618
Lateral orbit (LO)
29
7.4
3.741
8
7.25
1.889
0.802
Zygomatic arch, midway (ZA)
29
9.59
3.68
8
10.76
2.5
0.098
Supraglenoid (Sg)
29
11.34
7.24
8
10.76
3.62
0.499
M
te d
Gonion (Go)
ip
t
S.D.
an
Mean
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p
n
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Statistical analysis of facial tissue thickness (mm) for the 21-30 year age group among Taiwanese subjects. Male Female Landmarks
8
17.97
15.78
4
15.75
20.47
0.441
24
13.68
4.66
8
12.71
2.97
0.218
21
23.85
6.6
4
21.57
2.56
0.059
8
12.88
1.71
3
11.07
0.463
0.021*
Bilateral L Frontal eminence (FE)
20
5.07
1.396
5
4.2
0.975
0.134
Supraorbital (Sb)
30
7.05
1.1
8
5.82
0.367
0.000**
Suborbital (Su)
30
6.81
2.34
8
6.65
1.13
0.742
Inferior malar (IM)
28
15.02
11.74
8
14.71
1.744
0.705
Lateral orbit (LO)
30
7.77
2.68
8
8.01
3.5
0.752
Zygomatic arch, midway (ZA)
29
10.2
5.78
8
11.26
3.29
0.191
Supraglenoid (Sg)
29
11.3
6.36
7
8.75
15.2
0.142
Gonion (Go)
9
20.54
151.2
4
16.55
20.76
0.412
Supra M2
24
14.64
6.27
8
13.68
1.11
0.137
Occlusal line (Ol)
21
23.6
12.56
4
21.5
5.36
0.183
Sub M2
7
12.32
2.44
3
11.4
3.37
0.499
Supra M
2
Ac
Sub M2
ce p
Occlusal line (Ol)
* p < 0.05. ** p < 0.01.
Page 25 of 32
Table 5
Table 5
Mean
S.D.
Midline Supraglabella (S)
10
5.16
0.665
13
4.05
0.671
0.004**
Glabella (G)
12
6.12
0.787
12
5.37
0.613
0.038*
Nasion (N)
12
7.09
1.737
12
6
0.805
0.028*
End of nasals (Na)
12
2.917
0.436
12
2.817
2.296
0.836
Mid-philtrum (Ph)
10
12.28
2.744
12
11.058
1.989
0.082
Upper lip margin (Sd)
10
12.07
2.046
12
10.02
1.577
0.002*
Lower lip margin (Id)
10
9.94
0.418
7
9.74
1.47
0.705
Chin-lip fold (CLF)
10
14.75
6.147
6
14.32
7.926
0.761
Mental eminence (Pog)
9
9.944
4.517
4
8.625
0.313
Beneath chin (Me)
3
9.366
32.14
cr
3.735
3
5.633
1.403
0.38
Bilateral R Frontal eminence (FE)
6
5.33
1.042
7
4.35
0.362
0.11
Supraorbital (Sb)
12
7.75
2.095
13
7.33
1.194
0.425
Suborbital (Su)
12
7.25
3.18
13
7.44
2.23
0.787
Inferior malar (IM)
12
17.5
11.49
12
18.02
8.69
0.689
Lateral orbit (LO)
12
8.22
11.21
12
8.47
1.98
0.814
Zygomatic arch, midway (ZA)
12
10.36
6.63
12
11.26
3.85
0.346
Supraglenoid (Sg)
12
12.5
11.87
12
12.67
3.2
0.883
Gonion (Go)
ip
t
n
an
S.D.
te d
Mean
us
p
n
M
Statistical analysis of facial tissue thickness (mm) for the 31-40 year age group among Taiwanese subjects. Male Female Landmarks
4
16.42
62.79
2
13.7
69.6
0.738
10
13.55
3.629
10
12.7
2.56
0.294
10
23.81
17.1
9
23.82
7.789
0.994
-
-
-
-
-
-
-
Bilateral L Frontal eminence (FE)
6
4.98
1.365
7
4.28
0.598
0.247
Supraorbital (Sb)
12
6.9
1.59
13
7.12
1.66
0.666
Suborbital (Su)
12
7.46
2.76
13
7.6
2.27
0.835
Inferior malar (IM)
12
16.89
15.43
12
17.27
7.76
0.785
Lateral orbit (LO)
12
8.525
5.018
12
9.08
3.096
0.504
Zygomatic arch, midway (ZA)
12
10.7
9.218
12
11.725
4.858
0.355
Supraglenoid (Sg)
12
12.51
15.7
12
13
6.25
0.724
Gonion (Go)
4
16.525
57.55
2
11.05
126.4
0.645
Supra M2
10
14.52
7.41
10
13.9
5.38
0.59
Occlusal line (Ol)
10
25.16
15.6
9
24.4
18.2
0.697
Sub M2
-
-
-
-
-
-
-
Supra M2
Ac
Sub M2
ce p
Occlusal line (Ol)
* p < 0.05. ** p < 0.01.
Page 26 of 32
Table 6
Table 6
Mean
S.D.
Midline Supraglabella (S)
13
5.138
0.847
21
4.038
0.542
0.001**
Glabella (G)
15
6.3
0.448
20
5.37
0.66
0.000**
Nasion (N)
15
7.6
0.738
20
5.63
1.36
1.995
End of nasals (Na)
15
2.82
0.54
20
3.015
6.01
0.739
Mid-philtrum (Ph)
15
13.01
6.16
20
10.73
3.01
0.005*
Upper lip margin (Sd)
15
12.12
6.999
17
8.529
3.96
0.000**
Lower lip margin (Id)
13
10.138
1.22
18
9.61
1.39
0.214
Chin-lip fold (CLF)
9
14.889
4.03
17
13.86
4.59
0.243
Mental eminence (Pog)
8
11.1
3.34
14
10.17
0.31
Beneath chin (Me)
5
8.28
1.787
cr
5.01
10
8.1
4.68
0.846
Bilateral R Frontal eminence (FE)
7
4.57
2.22
13
4.19
0.92
0.558
Supraorbital (Sb)
13
8.02
0.96
21
7.51
2.37
0.254
Suborbital (Su)
13
7.16
4.1
21
7.61
4.93
0.554
Inferior malar (IM)
13
16.99
13.03
18
16.86
26.55
0.932
Lateral orbit (LO)
13
7.953
3.52
20
9.615
5.99
0.036*
Zygomatic arch, midway (ZA)
13
9.66
2.7
19
10.47
2.91
0.191
Supraglenoid (Sg)
12
12.04
6.06
19
11.04
8.76
0.315
Gonion (Go)
ip
t
n
an
S.D.
te d
Mean
us
p
n
M
Statistical analysis of facial tissue thickness (mm) for the 41-50 year age group among Taiwanese subjects. Male Female Landmarks
-
-
-
-
-
-
-
9
11.83
3.315
16
12.23
17.48
0.741
9
24.8
85.66
13
22.43
48.3
0.524
-
-
-
-
-
-
-
Bilateral L Frontal eminence (FE)
7
4.57
2.08
13
3.86
1.75
0.303
Supraorbital (Sb)
13
7.29
1.767
21
7.22
2.556
0.893
Suborbital (Su)
13
7.654
4.321
21
7.714
6.252
0.939
Inferior malar (IM)
13
16.484
12.2
18
17.667
13.18
0.368
Lateral orbit (LO)
13
8.253
5.044
20
10.14
6.865
0.035*
Zygomatic arch, midway (ZA)
13
9.91
2.96
19
10.93
2.075
0.091
Supraglenoid (Sg)
13
11.408
6.077
19
11.278
9.033
0.895
Gonion (Go)
-
-
-
-
-
-
-
Supra M2
9
12.9
2.61
16
13.98
19.2
0.383
Occlusal line (Ol)
9
25.77
12.62
13
24.47
11.253
0.436
Sub M2
-
-
-
-
-
-
-
Supra M2
Ac
Sub M2
ce p
Occlusal line (Ol)
* p < 0.05. ** p < 0.01.
Page 27 of 32
Table 7
Table 7
Mean
S.D.
Midline Supraglabella (S)
19
4.57
2.22
21
3.87
0.671
0.079
Glabella (G)
22
5.86
1.74
23
5.47
0.83
0.253
Nasion (N)
22
6.8
2.34
23
5.9
1.063
0.029*
End of nasals (Na)
22
2.87
0.582
23
2.24
0.323
0.003**
Mid-philtrum (Ph)
21
11.16
8.697
23
10.38
1.945
0.277
Upper lip margin (Sd)
18
10.8
13.19
22
8.82
1.254
0.037*
Lower lip margin (Id)
15
10.34
2.071
16
9.33
1.474
0.043*
Chin-lip fold (CLF)
10
13.42
3.66
13
13.09
4.6
0.697
Mental eminence (Pog)
10
9.59
6.14
6
9.15
0.694
Beneath chin (Me)
6
6.52
12.55
cr
3.5
4
7.58
0.93
0.513
Bilateral R Frontal eminence (FE)
11
4.74
1.469
12
3.97
0.559
0.089
Supraorbital (Sb)
22
7.09
2.688
23
7.46
2.157
0.436
Suborbital (Su)
22
6.81
3.678
23
7.08
4.478
0.646
Inferior malar (IM)
21
16.02
13.126
22
16.76
8.964
0.471
Lateral orbit (LO)
21
7.64
5.208
23
9.02
4.559
0.045*
Zygomatic arch, midway (ZA)
22
8.83
3.667
21
10.99
8.42
0.007**
Supraglenoid (Sg)
21
10.15
7.77
19
10.64
10.48
0.609
Gonion (Go)
ip
t
n
an
S.D.
te d
Mean
us
p
n
M
Statistical analysis of facial tissue thickness (mm) for the 51-60 year age group among Taiwanese subjects. Male Female Landmarks
5
20.96
25.44
8
15.9
73.18
0.206
16
11.28
4.525
20
10.62
4.107
0.355
12
25.11
6.6
17
24.33
15.167
0.522
5
10.94
2.648
6
9.13
2.11
0.089
Bilateral L Frontal eminence (FE)
11
4.75
1.637
12
3.95
1.003
0.111
Supraorbital (Sb)
22
6.82
2.548
22
7.22
1.779
0.378
Suborbital (Su)
22
7.01
5.524
23
7.31
3.868
0.646
Inferior malar (IM)
21
15.41
24.446
22
17.27
9.978
0.152
Lateral orbit (LO)
21
8.12
6.747
23
9.36
4.163
0.089
Zygomatic arch, midway (ZA)
22
9.29
5.7
21
11.34
5.352
0.006**
Supraglenoid (Sg)
21
10.94
13.77
19
10.65
9.442
0.788
Gonion (Go)
5
19.46
35.7
6
14.66
100.57
0.354
Supra M2
16
12.35
6.401
21
11.42
4.95
0.254
Occlusal line (Ol)
12
24.85
22.25
17
24.68
15.818
0.918
Sub M2
5
11.22
0.702
6
9.48
1.621
0.023*
Supra M2
Ac
Sub M2
ce p
Occlusal line (Ol)
* p < 0.05. ** p < 0.01.
Page 28 of 32
Table 8
Table 8
Mean
S.D.
Midline Supraglabella (S)
8
4.4
0.506
18
3.96
1.091
0.222
Glabella (G)
10
5.96
0.378
18
5.66
1.676
0.416
Nasion (N)
10
6.58
1.822
18
5.94
1.179
0.216
End of nasals (Na)
10
2.8
0.613
18
2.39
0.368
0.176
Mid-philtrum (Ph)
10
11.85
3.447
15
10.07
5.315
0.044*
Upper lip margin (Sd)
10
10.04
2.55
13
9.05
4.366
0.213
Lower lip margin (Id)
7
10.29
0.858
12
10.33
2.91
0.948
Chin-lip fold (CLF)
6
14.43
3.13
11
14.13
4.534
0.486
Mental eminence (Pog)
5
10.96
8.483
11
10.32
0.701
Beneath chin (Me)
3
9.9
8.68
cr
9.811
7
6.89
4.494
0.207
Bilateral R Frontal eminence (FE)
3
4.07
1.343
10
4.4
0.724
0.675
Supraorbital (Sb)
10
6.76
2.858
18
7.38
2.762
0.363
Suborbital (Su)
10
7.07
5.04
18
7.06
6.546
0.992
Inferior malar (IM)
10
17.05
6.876
16
16.3
12.24
0.539
Lateral orbit (LO)
10
7.07
5.196
17
9.3
4.725
0.02*
Zygomatic arch, midway (ZA)
10
8.21
5.852
16
9.64
2.461
0.119
Supraglenoid (Sg)
10
9.39
12.309
16
9.65
4.848
0.837
Gonion (Go)
ip
t
n
an
S.D.
te d
Mean
us
p
n
M
Statistical analysis of facial tissue thickness (mm) for the 61-70 year age group among Taiwanese subjects. Male Female Landmarks
-
-
-
-
-
-
-
8
10.7
3.271
9
9.9
3.365
0.38
3
21.3
126.49
10
22.12
8.128
0.912
-
-
-
-
-
-
-
Bilateral L Frontal eminence (FE)
2
4.4
3.92
10
4.46
0.425
0.973
Supraorbital (Sb)
9
6.69
1.36
18
7.13
3.64
0.467
Suborbital (Su)
9
7.84
7.21
18
7.51
6.07
0.755
Inferior malar (IM)
9
16.24
7.21
17
16.08
14.26
0.896
Lateral orbit (LO)
9
7.84
5.785
17
9.65
5.511
0.084
Zygomatic arch, midway (ZA)
9
9.62
6.964
16
10.26
3.724
0.534
Supraglenoid (Sg)
9
9.67
9.578
16
10.25
3.821
0.618
Gonion (Go)
-
-
-
-
-
-
-
Supra M2
7
11.77
3.265
9
12.14
24.452
0.838
Occlusal line (Ol)
3
22.5
162.19
10
21.91
8.938
0.943
Sub M2
-
-
-
-
-
-
-
Supra M2
Ac
Sub M2
ce p
Occlusal line (Ol)
* p < 0.05. ** p < 0.01.
Page 29 of 32
Table 9
Table 9
0.137
7
3.93
2.41
0.729
Glabella (G)
6
5.88
0.622
7
5.24
1.329
0.262
Nasion (N)
6
6.53
1.491
7
5.29
1.111
0.079
End of nasals (Na)
6
2.88
0.234
7
2.01
0.355
0.014*
Mid-philtrum (Ph)
4
10.25
3.737
6
8.23
15.031
0.308
Upper lip margin (Sd)
4
9.55
4.617
6
9.23
2.022
0.805
Lower lip margin (Id)
2
10.85
0.005
5
9.48
0.582
0.016*
Chin-lip fold (CLF)
2
14
3.38
3
14.67
1.083
0.722
Mental eminence (Pog)
3
8.9
9.61
3
9.5
0.19
0.771
Beneath chin (Me)
-
-
-
-
-
-
-
Bilateral R Frontal eminence (FE)
4
4.85
1.137
3
0.67
0.117
Supraorbital (Sb)
6
7.53
0.87
us
3.5
7
6.24
3.31
0.134
Suborbital (Su)
6
7.03
2.15
7
7.07
7.236
0.975
Inferior malar (IM)
5
16.68
5.947
6
15.65
2.463
0.442
Lateral orbit (LO)
6
7.52
3.534
7
9.06
6.266
0.232
Zygomatic arch, midway (ZA)
6
7.92
3.72
7
8.93
1.61
0.304
Supraglenoid (Sg)
6
10.32
7.342
6
7.72
1.746
0.072
Gonion (Go)
cr
ip
t
4.15
an
4
te d
Midline Supraglabella (S)
M
Statistical analysis of facial tissue thickness (mm) for the over 70 year age group among Taiwanese subjects. Male Female Landmarks p n n Mean S.D. Mean S.D.
-
-
-
-
-
-
-
2
13.1
2
4
12.78
19.81
0.9
3
23.1
37.81
3
23.73
4.623
0.881
-
-
-
-
-
-
-
Bilateral L Frontal eminence (FE)
4
5.2
0.78
3
3.5
0.36
0.03*
Supraorbital (Sb)
6
6.48
1.01
7
6.21
3.69
0.754
Suborbital (Su)
6
7.4
4.764
7
7.11
9.07
0.847
Inferior malar (IM)
5
15.62
12.787
6
16.95
7.831
0.518
Lateral orbit (LO)
6
7.83
4.693
7
9.11
5.115
0.378
Zygomatic arch, midway (ZA)
6
7.65
3.387
7
9.57
5.982
0.135
Supraglenoid (Sg)
6
11.03
12.438
6
8.27
2.082
0.119
Gonion (Go)
-
-
-
-
-
-
-
Supra M2
2
11.55
14.045
4
12.625
11.52
0.765
Occlusal line (Ol)
3
20.03
21.723
3
22.8
2.28
0.812
Sub M2
-
-
-
-
-
-
-
Supra M2
Ac
Sub M2
ce p
Occlusal line (Ol)
* p < 0.05. ** p < 0.01.
Page 30 of 32
Table 10
p 0.905 0.076 0.085 0.468 0.057 0.001** 0.219 0.909 0.325 0.300 0.940
Ac ce
pt
ed
M
an
us
cr
ip t
Table 10 Comparison of right and left soft tissue thickness difference at bilateral landmarks for Taiwanese population (unit: mm). Difference beteween right and left n Right Left Rel. Diff Landmarks 95% confidence interval Mean S.D. Frontal eminence (FE) 104 4.52 4.51 0.01 0.737 (-0.135 - 0.152) 0.2% Supraorbital (Sb) 186 7.23 7.13 0.10 0.765 (-0.011 - 0.211) 1.4% Suborbital (Su) 186 7.20 7.28 -0.08 0.643 (-0.175 - 0.011) -1.1% Inferior malar (IM) 176 16.42 16.29 0.14 2.472 (-0.232 - 0.503) 0.8% Lateral orbit (LO) 177 8.34 8.47 -0.14 0.945 (-0.276 - 0.004) -1.6% Zygomatic arch, midway (ZA) 174 9.94 10.18 -0.24 0.952 (-0.379 - -0.094) -2.4% Supraglenoid (Sg) 174 10.91 11.06 -0.16 1.678 (-0.408 - 0.094) -1.4% Gonion (Go) 43 17.71 17.59 0.12 6.780 (-1.968 - 2.205) 0.7% 2 111 12.31 12.35 -0.04 0.442 (-0.125 - 0.042) -0.3% Supra M Occlusal line (Ol) 119 23.77 24.11 -0.34 3.614 (-1.001 - 0.311) -1.4% Sub M2 40 11.62 11.61 0.02 1.305 (-0.402 - 0.433) 0.1% * p < 0.05. ** p < 0.01.
Page 31 of 32
p 0.087 0.051 0.105 0.184 0.144 0.426 0.000** 0.000** 0.003** 0.795 0.695 0.297 0.218 0.000** 0.740 0.002** 0.141 0.346 0.000** 0.769 0.000**
- 0.14 - 1.14 - 1.28 0.33 0.24 - 0.60 - 2.14 3.73 - 1.82 0.08 0.12 0.88 1.38 5.11 - 0.78 2.99 - 0.27 - 4.37 -14.61 2.27 - 7.67
0.676 0.001** 0.000** 0.519 0.602 0.193 0.001** 0.040* 0.171 0.918 0.731 0.033* 0.024* 0.000** 0.245 0.001** 0.732 0.336 0.000** 0.192 N/A
ed
ce pt
Ac
* p < 0.05. ** p < 0.01.
Bulut (n)
5.19 6.25 7.53 2.79 13.09 12.09 10.03 14.66 10.56 7.38 4.33 7.42 7.32 16.34 7.80 9.50 10.71 24.85 12.34 24.75 11.30
(13) (15) (15) (15) (15) (15) (13) (9) (8) (5) (7) (13) (13) (13) (13) (13) (13) (1) (9) (10) (1)
4.85 7.02 8.32 3.78 13.56 13.37 13.92 10.87 12.90 8.58 4.87 7.55 6.36 13.64 9.36 8.64 15.88 20.32 28.37 25.79 24.27
(32) (32) (32) (32) (32) (32) (32) (32) (32) (32) (32) (32) (32) (32) (32) (32) (32) (32) (32) (32) (32)
4.08 5.30 5.90 2.80 10.61 8.84 9.60 13.90 10.21 8.44 4.37 7.22 7.81 16.98 9.95 11.05 11.51 20.27 13.61 23.74 8.88
(17) (16) (16) (16) (16) (15) (14) (14) (11) (8) (9) (17) (17) (14) (15) (15) (15) (3) (13) (12) (3)
4.14 6.51 7.00 2.36 11.27 10.36 11.37 9.98 11.93 6.09 4.42 7.09 6.29 13.29 11.54 9.48 14.60 17.08 27.67 22.99 22.13
(32) (32) (32) (32) (32) (32) (32) (32) (32) (32) (32) (32) (32) (32) (32) (32) (32) (32) (32) (32) (32)
us
0.58 0.53 0.62 0.26 0.86 0.49 3.58 4.36 - 2.94 0.65 0.18 - 0.43 0.84 4.07 - 0.27 2.38 - 1.36 - 2.91 -14.39 0.41 - 9.55 -
40~49 years This study (n)
cr
Difference
M an
Table 11 Comparison of facial tissue thickness in the midline of this study with the Bulut study [12] for (a) males and (b) females (unit: mm). Landmarks 18~29 years 30~39 years This study (n) Bulut (n) Difference p This study (n) Bulut (n) (a) 4.83 (28) 4.04 (32) 0.79 0.000** 5.15 (11) 4.57 (32) Supraglabella (S) 5.61 (28) 6.43 (32) - 0.82 0.000** 5.95 (13) 6.48 (32) Glabella (G) 6.61 (27) 7.23 (32) - 0.62 0.034* 6.96 (13) 7.58 (32) Nasion (N) 3.20 (27) 2.96 (32) 0.24 0.651 2.78 (13) 3.04 (32) End of nasals (Na) 13.75 (26) 14.19 (32) - 0.44 0.401 12.04 (11) 12.90 (32) Mid-philtrum (Ph) 12.33 (27) 13.88 (32) - 1.55 0.001** 11.93 (11) 12.42 (32) Upper lip margin (Sd) 9.95 (24) 14.11 (32) - 4.16 0.000** 9.76 (11) 13.34 (32) Lower lip margin (Id) 13.55 (21) 10.31 (32) 3.24 0.000** 14.69 (11) 10.33 (32) Chin-lip fold (CLF) 9.81 (18) 12.02 (32) - 2.21 0.003** 9.49 (10) 12.43 (32) Mental eminence (Pog) 7.12 (14) 7.26 (32) - 0.14 0.774 9.00 (4) 8.35 (32) Beneath chin (Me) 5.01 (18) 4.30 (32) 0.71 0.023* 5.11 (7) 4.93 (32) Frontal eminence (FE) 7.11 (28) 6.74 (32) 0.37 0.307 7.32 (13) 7.75 (32) Supraorbital (Sb) 6.76 (28) 5.83 (32) 0.93 0.015* 7.17 (13) 6.33 (32) Suborbital (Su) 15.01 (26) 14.02 (32) 0.99 0.076 17.35 (13) 13.28 (32) Inferior malar (IM) 7.48 (28) 7.65 (32) - 0.17 0.723 8.33 (13) 8.60 (32) Lateral orbit (LO) 9.88 (27) 7.73 (32) 2.15 0.000** 10.70 (13) 8.32 (32) Zygomatic arch, midway (ZA) 11.30 (27) 12.98 (32) - 1.68 0.006** 12.65 (13) 14.01 (32) Supraglenoid (Sg) 18.26 (9) 14.78 (32) 3.48 0.105 16.48 (4) 19.38 (32) Gonion (Go) 14.30 (22) 28.46 (32) -14.16 0.000** 14.10 (11) 28.49 (32) Supra M2 23.72 (20) 23.48 (32) 0.24 0.780 24.84 (10) 24.43 (32) Occlusal line (Ol) 11.83 (8) 20.87 (32) - 9.04 0.000** 11.93 (6) 21.47 (32) Sub M2 (b) 3.99 (7) 3.73 (32) 0.26 0.241 4.15 (12) 4.29 (32) Supraglabella (S) 5.33 (7) 5.72 (32) - 0.39 0.283 5.34 (11) 6.48 (32) Glabella (G) 5.04 (7) 7.08 (32) - 2.04 0.000** 5.93 (11) 7.21 (32) Nasion (N) 2.04 (7) 2.49 (32) - 0.45 0.064 2.68 (11) 2.35 (32) End of nasals (Na) 12.17 (7) 12.19 (32) - 0.02 0.981 10.80 (11) 10.56 (32) Mid-philtrum (Ph) 10.70 (7) 11.09 (32) - 0.39 0.400 9.63 (11) 10.23 (32) Upper lip margin (Sd) 9.13 (6) 11.73 (32) - 2.60 0.002** 9.50 (8) 11.64 (32) Lower lip margin (Id) 12.40 (4) 9.52 (32) 2.88 0.119 13.31 (7) 9.58 (32) Chin-lip fold (CLF) 7.20 (1) 10.91 (32) 3.71 N/A 10.08 (6) 11.90 (32) Mental eminence (Pog) 7.70 (1) 5.27 (32) 2.43 N/A 6.18 (5) 6.10 (32) Beneath chin (Me) 4.56 (4) 3.75 (32) 0.81 0.326 4.41 (8) 4.29 (32) Frontal eminence (FE) 6.19 (7) 5.99 (32) 0.20 0.639 7.20 (12) 6.32 (32) Supraorbital (Sb) 6.35 (7) 5.50 (32) 0.85 0.106 7.44 (12) 6.06 (32) Suborbital (Su) 14.83 (7) 12.95 (32) 1.88 0.089 17.77 (12) 12.66 (32) Inferior malar (IM) 7.50 (7) 9.73 (32) - 2.23 0.003** 8.83 (12) 9.60 (32) Lateral orbit (LO) 10.86 (7) 8.19 (32) 2.67 0.002** 11.58 (12) 8.59 (32) Zygomatic arch, midway (ZA) 9.39 (7) 11.00 (32) - 1.61 0.053 12.33 (12) 12.60 (32) Supraglenoid (Sg) 16.15 (4) 14.48 (32) 1.67 0.372 12.38 (2) 16.74 (32) Gonion (Go) 13.65 (7) 26.81 (32) -13.16 0.000** 12.91 (10) 27.51 (32) Supra M2 22.13 (5) 22.14 (32) - 0.01 0.993 23.46 (7) 21.19 (32) Occlusal line (Ol) 11.23 (3) 20.24 (32) - 9.01 0.000** 13.45 (1) 21.12 (32) Sub M2
ip t
Table 11
Difference
p
50~59 years This study (n)
Bulut (n)
0.34 0.77 0.79 0.99 0.47 1.28 3.89 3.79 - 2.34 - 1.20 - 0.54 - 0.13 0.96 2.70 - 1.56 0.86 - 5.17 4.53 -16.03 - 1.04 -12.97
0.285 0.002** 0.012** 0.000** 0.464 0.065 0.000** 0.000** 0.001** 0.073 0.283 0.648 0.118 0.021* 0.004** 0.142 0.000** N/A 0.000** 0.590 N/A
4.57 5.85 6.80 2.85 11.02 10.69 10.23 13.61 9.79 6.96 4.82 6.95 6.82 15.52 7.82 9.05 10.61 20.21 11.69 24.47 11.25
(20) (22) (22) (22) (21) (18) (15) (10) (10) (7) (12) (22) (22) (21) (21) (22) (21) (5) (16) (11) (4)
4.74 7.11 8.03 3.92 12.68 12.00 13.07 10.83 12.44 8.39 4.66 7.20 6.65 13.62 8.80 7.64 15.53 18.36 27.97 24.28 22.84
(32) (32) (32) (32) (32) (32) (32) (32) (32) (32) (32) (32) (32) (32) (32) (32) (32) (32) (32) (32) (32)
- 0.06 - 1.21 - 1.10 0.44 - 0.66 - 1.52 - 1.77 3.92 - 1.72 2.35 - 0.05 0.13 1.52 3.69 - 1.59 1.57 - 3.09 3.19 -14.06 0.75 -13.25
0.849 0.000** 0.000** 0.446 0.176 0.033* 0.000** 0.000** 0.007** 0.002** 0.893 0.778 0.031* 0.011* 0.041* 0.005** 0.003** 0.555 0.000** 0.627 0.000**
3.81 5.36 5.64 2.53 10.64 8.92 9.29 13.45 9.43 7.26 3.73 7.34 7.24 17.04 9.08 10.67 10.66 16.42 10.96 23.87 9.99
(24) (25) (25) (25) (25) (22) (17) (14) (7) (5) (14) (25) (25) (23) (25) (23) (22) (9) (21) (17) (6)
4.53 6.99 7.42 3.71 10.85 11.28 12.44 9.74 12.42 6.97 4.62 7.18 6.31 13.54 12.85 10.51 15.36 17.95 27.83 23.06 21.95
(32) (32) (32) (32) (32) (32) (32) (32) (32) (32) (32) (32) (32) (32) (32) (32) (32) (32) (32) (32) (32)
-
Difference 0.18 1.26 1.23 1.07 1.66 1.31 2.84 2.78 - 2.65 -1.433 0.161 -0.252 0.170 1.899 -0.983 1.415 -4.916 1.850 -16.279 0.193 -11.588
p
-
0.631 0.000** 0.001** 0.000** 0.019* 0.154 0.000** 0.003** 0.012* 0.316 0.616 0.464 0.768 0.042* 0.106 0.037* 0.000** 0.425 0.000** 0.879 0.000**
-
0.000** 0.000** 0.000** 0.001** 0.620 0.000** 0.000** 0.000** 0.018* 0.613 0.002** 0.585 0.047* 0.000** 0.000** 0.811 0.000** 0.655 0.000** 0.481 0.000**
0.72 1.63 1.78 1.18 0.21 2.36 3.15 3.71 - 2.99 0.29 - 0.90 0.16 0.93 3.50 - 3.77 0.16 - 4.70 - 1.53 -16.87 0.81 -11.96
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