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Preliminary cephalometric study of the relationship between facial

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DOI: 10.1016/j.bjbas.2018.03.004

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Beni-Suef University
Journal of Basic and Applied Sciences
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Full Length Article

Preliminary cephalometric study of the relationship between facial T

morphology and sex
⁎
Alhassan Kadria, Williams Kweku Darkwahb, , Abaidoo Chrissie Stassiec, Gideon Aidood,
Atuahene Ohene-Djanc
a
Clinical Research Laboratory Department, Holy Family Hospital, Nkawkaw, Ghana
b
Key Laboratory of Integrated Regulation and Resource Development on Shallow Lakes, Ministry of Education, Environmental Engineering Department, College of
Environment, Hohai University, China
c
Department of Anatomy, School of Medical Sciences, College of Allied Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
d
Clinical Laboratory Department, 37 Military Teaching Hospital, Accra, Ghana

A R T I C LE I N FO A B S T R A C T

Keywords: Morphology of the face depends on many factors, such as sex, ethnicity, race, climate, nutrition, genetic con-
Cephalometry stitution and socio-economic status. In the developed countries, there is well established database on facial
Facial height anthropometry and for the purpose of identification. In Ghana however, there is very little documented in-
Facial width formation on cephalometric indices for biometric and forensic purposes. This study therefore, aimed at estab-
Nasal width
lishing baseline data to assess the relationship between sex using upper, lower and total cephalometric indices.
Biocular diameter
One hundred participants made up of sixty males and forty females from KNUST were recruited for the study.
Sexually dimorphic
Linear facial anthropometry were taken using calibrated Shahe digital calipers whiles participants sat with head
in natural position. The facial anthropometric measurements were generally higher in males than in females.
Upper facial height, facial width, nasal width, biocular diameter, lower facial height, lip length and total facial
height were statistically significant and (p < 0.05). The present study shows the existence of statistically sig-
nificant sexual dimorphism in the study population using cephalo-facial dimensions.

1. Introduction reconstruction and research.

Anthropometry is an essential tool of biological anthropology which
involves a series of standardized measuring techniques that express
quantitatively the dimensions of human body. Cephalometry is one of
the disciplines of anthropometry which deals with the measurement of
the head and face of living human beings and cadavers. Direct facial
anthropometry is considered a gold standard method in assessing facial
dimensions (Farkas et al., 2005).
Cephalometry has been widely used by many researchers for sex
estimation. Determination of sex is of fundamental importance both for
personal identification in forensic science as well as population data
studies (Stephan et al., 2005). Sex is generally inferred from facial
morphology which is highly reliable. The ultimate aim of determining
sex in forensic science is to help law enforcement agencies in achieving
personal identity in medico-legal cases like mutilated and decomposed
body parts. In many cases cephalofacial dimensions are the only means
of evidence for forensic examination. Such studies are also useful in
forensic and clinical medicine, plastic and oral surgery, facial
Over the last decade, there has been a rise in the occurrence of
disasters such as floods, earthquakes, typhoons, fire, road traffic acci-
dents etc. In such situations, it becomes difficult to determine the sex of
the dead victims especially bodies that have decomposed. In the de-
veloped countries, facial recognition systems based on cephalometry
are used in combination with dental records to identify such victims.
However in developing countries such as Ghana, it appears there are no
metric cephalofacial data for Ghanaians. Therefore the present study
was designed to examine facial morphology and provide some baseline
cephalometric indices for the study population.
2. Materials and methods
The present study was conducted at the Anatomy Department,
School of Medical Sciences, Kwame Nkrumah University of Science and
Technology. A total of 100 undergraduate students were recruited for
the study, out of which 60 were males and 40 were females.
Participants were between the ages of 17 and 34 years. Informed

⁎
Corresponding author.
E-mail address: williams.darkwah@stu.ucc.edu.gh (W.K. Darkwah).

https://doi.org/10.1016/j.bjbas.2018.03.004
Received 11 November 2017; Accepted 17 March 2018
Available online 03 April 2018
2314-8535/ © 2018 Beni-Suef University. Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license
(http://creativecommons.org/licenses/BY-NC-ND/4.0/).
A. Kadri et al. Beni-Suef University Journal of Basic and Applied Sciences 7 (2018) 215–219

participant consent and ethical approval were sought. Participants

without facial deformities or history of facial surgery were included in
the study. Those with facial deformities or previous history of facial
trauma or surgery were excluded from the study. Their facial dimen-
sions were measured with calibrated Shahe digital calipers manu-
factured in Shanghai (China).

2.1. Sample collection

Data collected in the study included upper, lower and total facial
measurements. Primary data concerning age and sex were also taken.

2.2. Measurements

The landmarks, techniques and procedures recommended by Singh

and Bhasin (2004) were adopted for the study. Eight facial dimensions
Fig. 2. A photograph showing measurement of biocular diameter using Shahe
were taken from all the participants. All measurements were taken digital calipers (X 0.5).
using standard anthropometric procedure with participant sitting in a
chair in a relaxed condition and head in the natural position.

2.3. Upper facial measurements

The following dimensions were taken to the nearest millimeters

using calibrated Shahe digital calipers and the results recorded into the
log book:

1. Upper facial height (nasion-subnasion): The distance from the root

of the nose to the deepest point of the nose (Fig. 1).
2. Facial width (zygion-zygion): The maximum distance between the
most lateral points of zygomatic aches localized by palpitation.
3. Biocular diameter (ectocanthion-ectocanthion): The distance be-
tween the lateral junction points of the upper and lower eyelid of
both right and left eye (Fig. 2).
Fig. 3. A photograph showing measurement of nasal width using Shahe digital
4. Interocular diameter (endocanthion-endocanthion): The distance
calipers (X 0.5).
between the median junction points of the upper and lower eyelid of
both right and left eye.

2.4. Lower and total facial measurements

The following dimensions were taken to the nearest millimeters

using calibrated Shahe digital calipers and the results recorded into the
log book:

1. Lower facial height (subnasale-gnathion): The distance from the

base of the nose to the lowest median landmark on the border of the
mandible.
2. Nasal width (alare-alare): The distance between the most lateral

Fig. 4. A photograph showing measurement of total facial height using Shahe

digital calipers (X 0.5).

points of the right and left nostrils (Fig. 3).

3. Lip length (cheilion-cheilion): The distance between the lateral
junction points of the upper and lower lips
4. Total facial height (nasion-gnathion): The distance from the root of
the nose to the lowest median landmark on the border of the
mandible (Fig. 4).

2.5. Data analysis

The various measurements and data collected were sorted out,

Fig. 1. A photograph showing measurement of upper facial height using Shahe coded, tabulated and compiled on an excel spread sheet. The data were
digital calipers (X 0.5). then analyzed statistically using IBM Statistical Package for Social

216
A. Kadri et al. Beni-Suef University Journal of Basic and Applied Sciences 7 (2018) 215–219

Table 1
Descriptive statistics of upper facial anthropometric measurements stratified by sex.
Parameters Mean ± SD (range) P – value

Males(N = 60) Females(N = 40)

BD 10.43 ± 0.43 (9.67–11.78) 10.32 ± 0.36 (9.60–11.19) 0.010

ID 3.10 ± 0.35 (2.45–3.84) 2.98 ± 0.25 (2.39–3.50) 0.057
UFH 4.92 ± 0.44 (3.22–5.78) 4.60 ± 0.42 (3.48–5.64) 0.001
FW 13.18 ± 0.44 (12.05–13.95) 12.64 ± 0.54 (11.56–14.43) 0.000

SD = standard deviation, N = number of participants, BD = binocular diameter in centimeters, ID = interocular diameter in centimeters, UFH = upper
facial height in centimeters, FW = facial width in centimeters.

Table 2
Descriptive statistics of lower and total facial measurements for males and females.
Parameters Mean ± SD (range) P – value

Males(N = 60) Females(N = 40)

LFH 6.49 ± 0.48 (5.41–7.36) 6.15 ± 0.44 (5.31–6.93) 0.001

NW 4.29 ± 0.35 (6.30–5.16) 3.89 ± 0.34 (3.00–4.51) 0.000
LL 5.56 ± 0.44 (4.56–6.62) 5.12 ± 0.45 (4.21–6.10) 0.000
TFH 11.44 ± 0.67 (9.50–12.81) 10.77 ± 0.52 (9.81–12.19) 0.000

SD = standard deviation, N = number of participants, LFH = lower facial height in centimeters, NW = nasal width in centimeters, LL = lip length in
centimeters, TFH = total facial height in centimeters.

Table 3 3. Results and discussions

Binary logistic regression equation for pooled variables.
Parameters B SE P-value 3.1. Upper facial measurements

UFH 0.046 1.455 0.975 In the present study the means of the upper facial measurements
LFH −0.289 1.742 0.686
were generally higher in males than females. With the exception of
TFH −1.364 1.722 0.428
FW −2.151 0.728 0.003
interocula diameter (p > 0.05), upper facial height, facial width and
NW −2.760 1.205 0.022 binocular diameter were statistically significant and sexually dimorphic
LL −1.317 0.974 0.177 (p < 0.05).
BD 1.742 0.987 0.078 Mean upper facial height was higher in males than females in the
Constant 44.183 11.137 0.000
present study. Facial height is sexually dimorphic and depends on sex
B = coefficient of independent variables, SE = standard error, R2 = 0.599, hormones. These hormones are thought to be the main regulators of
UFH = upper facial height in centimeters, LFH = lower facial height in cen- sexual dimorphism in physical features in males and females (McEwen,
timeters, TFH = total facial height in centimeters, FW = facial width in cen- 1981). Females are thought to have large fat deposits particularly
timeters, NW = nasal width in centimeters, LL = lip length in centimeters, around the cheek area as a result of the high levels of oestrogen. For this
BD = binocular diameter in centimeters. reason facial bone structure in females may be masked (Enlow, 1982).
Alternatively, there may be some direct evidence for testosterone af-
Table 4 fecting facial bone growth in males (Verdnock et al., 1999). This could
Binary logistic regression equation for independent variables. be related to the facial bone size particularly facial width in males. This
Parameter Constant B SE P-value Nagelkerke R2 result was consistent with a study carried out on South Indians and
Immigrant Tibetans (Vankatesh et al., 2010).
UFH 7.491 −1.657 0.528 0.002 0.149 The mean facial width in the present study was higher in males than
LFH 9.604 −1.585 0.489 0.001 0.156
females and statistically significant with sexual variation. This finding
TFH 19.102 −1.759 0.416 0.000 0.297
FW 29.748 −2.336 0.552 0.000 0.312 agrees with the mean facial widths which were observed by Raj et al.
NW 13.067 −3.298 0.763 0.000 0.321 (2014) and Moldez et al. (2006). Similarly, the result of the present
LL 12.025 −2.328 0.584 0.000 0.267 study was in accordance with the studies conducted on Malaysian
BD 14.408 −1.422 0.569 0.013 0.090 students of Melaka Manipal Medical College (Shetti et al., 2011) and
South Indians (Prasnna et al., 2013).
B = coefficient of independent variables, SE = standard error,
R2 = 0.090–0.321, UFH = upper facial height in centimeters, LFH = lower fa-
Biocular diameter was statistically significant and sexually di-
cial height in centimeters, TFH = total facial height in centimeters, FW = facial morphic (p = 0.000) while interocular diameter on the other hand
width in centimeters, NW = nasal width in centimeters, LL = lip length in showed the opposite (p = 0.057). This result showed consistency with a
centimeters, BD = binocular diameter in centimeters. study carried on Raja Rajeshwari population (Peeyush et al., 2015).
Another study on facial anthropometry of Northwest Indians was also in
Sciences, version 20 (IBM SPSS 20) and Microsoft Excel 2007. The agreement with the results of the present study (Sahni et al., 2014).
mean, range and standard deviation of the facial dimensions were de- Biocular and interocular diameters increased from childhood to young
rived and correlations were made. adulthood. In the second decade of life all age-related increments were
higher in males than females (Sforza et al., 2013).

217
A. Kadri et al.
3.2. Lower and total facial measurements
The means of all the measurements for lower facial dimensions and
total facial height were higher in males than females. Statistical sig-
nificance and sexual variations were observed in all the measurements
(p < 0.05).
In the present study, nasal width was significantly higher in males
than females which again demonstrated the existence of sexual di-
morphism. This is similar to a study conducted at the Ilorin Teaching
Hospital in Nigeria (Ogah and Segun, 2014). Another study on Nigerian
adults also reported the same results (Garandawa et al., 2008). Also
Zankl et al. (2002) concluded that the growth and subsequent nasal
projections continued in both males and females after skeletal growth
had subsided.
In the present study, lip length showed a significantly higher mean
in males than females. This finding is consistent with the outcome of a
study on adults Igbo’s resident in Maiduguri (Emelike et al., 2012).
Nagle et al. (2005) also reported similar results in a group of healthy
Latvian residents. Many investigators have shown significant differ-
ences in craniofacial complex among ethnic and racial groups (Hwang
et al., 2002). Several other investigators also suggested that genetic
factors exert a substantial influence on the individual difference in body
shape and configuration (Livhits et al., 2002).
In the present study, the mean lower facial heights were higher than
the mean upper facial heights. This coincides with a study carried on
young Turkish adults (Bormah et al., 1999). It is also in agreement with
a study by Hatwal et al. (2015) on Garhwali population of Uttarakhand.
The reverse of the present finding was observed in a study conducted in
adult Nigerians (Garandawa et al., 2008). This difference in variations
could be attributed to shape and length of nose, race, tribe and en-
vironmental climatic conditions.
Total facial height obtained in the present study conforms to the
established anatomical principle that females have smaller crania with
shorter facial height than males (Moore et al., 2006). The results are
also in agreement with those of previous anthropometric studies which
reported sexual dimorphism with males having higher mean values of
total facial height than females, such as in Binis of Edo State by
Omotoso et al. (2011)
A total of 100 participants were recruited for the study with 60%
males and 40% females. The mean age of participants was
22.03 ± 2.95 years with a range of 17–34 years. The mean age of
males and females was 22.22 ± 3.10 years and 21.75 ± 2.73 years
respectively.
3.3. Upper facial measurements
Males had mean biocular diameter of 10.53 ± 0.43 cm whereas
females had 10.32 ± 0.36 cm. The mean interocular diameter was
3.10 ± 0.35 cm for males and 2.98 ± 0.25 cm for females. The mean
upper facial height was 4.92 ± 0.44 cm and 4.60 ± 0.42 cm for males
and females respectively. The mean facial width for males was
13.18 ± 0.44 cm and that of females was 12.64 ± 0.54 cm. With the
exception of interocular diameter, the rest of the measurements were
statistically significant and sexually dimorphic (p < 0.05) in (Table 1).
3.4. Sex determination
In the present study the means of the statistically significant mea-
surements were greater in males than females. Binary logistic regres-
sion analyses were performed on the pooled variables and individual
variables to check for the best reliable results. In the present study,
binary logistic regression analysis of the pooled variables showed sta-
tistical significance (p < 0.05) and accurate sex determination at a rate
of 85% for males and 77.5% for females with an overall rate of 82%
(Nagelkerke R2 = 0.599). It was noted that facial and nasal widths were
the major variables in sex determination. This finding is however in
218
Beni-Suef University Journal of Basic and Applied Sciences 7 (2018) 215–219
disagreement with a study which showed an accurate sex determination
rate of 92% for males and 51% for females with an overall rate of 71%
(Singh et al., 2012). This difference in accuracy rates could be linked to
the difference in sample size Tables 2–4.
The independent variables were further assessed for sex determi-
nation using binary logistic regression. The best individual predictor
was nasal width which had classification accuracies of 83% for males
and 55% for females with an overall accuracy of 72% (R2 = 0.321). The
present result is in contrast to a study by Patil and Mody (2005) on
Central Indian populations where individual variable showed sig-
nificant accuracy rate (R2 > 0.50). Comparing the two analyses of the
present study, the pooled variables showed a better and reliable result
than the individual variables.
The present study appears to be the first study on binary logistic
regression for determination of sex on a KNUST student population. As
differences exist in various races with regard to sex determination the
results may be true for one population but may not be necessarily true
for another.
4. Conclusion
The present study showed that the mean values of males were
generally higher than those of females for all the measured parameters.
With the exception of interocular diameter, the rest of the measure-
ments were statistically significant and showed sexual dimorphism. The
binary logistic regression analysis of the pooled variables provided a
better sex determination accuracy rate than the individual variables.
The results of the present study can be used as a baseline data for
further studies.
Conflict of interest statement
I declare that I have no conflict of interest.
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