Anthropometry and cephalometric facial analysis

1. Anthropometry and
Cephalometric Facial Analysis
DR. AMIT KR.CHOUDHARY
RIMS ,IMPHAL
There is no excellent beauty that hath not
some strangeness in the proportions.
-Francis Bacon

2. • Our face defines who we are as an individual. Every person's
face is unique. Even identical twins possess certain
distinguishing facial characteristics.
• The face is a mosaic of lines, contours, prominences, and
depressions producing reflections of light and shadows.
• We all know the allure of a beautiful face, but do we know
what factors make up the composite so pleasing to our eye?

3. • Concepts of facial beauty also seem to cross cultural and racial
lines.
• Our face is the most highly scrutinized area of our body. Small
changes in detail, even those produced by such innocuous
modalities as cosmetics, can effect changes that are perceived
dramatic.

4. • Strategies for preoperative assessment and planning are
necessary parallels to the surgical advances to achieve an
optimal outcome.
• Anthropometry and cephalometric analysis help clarify what
we perceive as variation from the ideal and are useful clinical
tools for surgical planning.
• Anthropometry examines the dimensions and relationships of
the face by use of soft tissue points.
• Cephalometric analysis studies bone relationships by use of a
standardized radiograph.

5. Anthropometry
• Anthropometry is the study of the human body to define size
and weight measurements and proportional relationships.
• Caliper, ruler, protractor, and angle meter.
• Anthroposcopy is the analysis of the body by visual
assessment in descriptive terms (e.g., bird-like face).
• Photogrammetry is indirect anthropometry and involves
taking measurements from standardized photographs.

6. Cephalometrics
• Cephalometrics is the measurement of the head and face by
use of bone and soft tissue points derived from a specific
reproducible radiograph called a cephalogram.
• Cephalometrics is complementary to anthropometrics as the
underlying bone gives shape to the soft tissues.

7. HISTORY OF ANTHROPOMETRY
• Albrecht DA rer, Cennino Cennini, and
Leonardo da Vinci, attempted to define the ideal
face by dividing the face into symmetric
sections and mathematical proportions.
• A pleasing face was seen as divisible into three
or four equal sections horizontally.
• The distance between the eyes the same as the
width of either of the eyes, the ear and the nose
having the same inclination, and other such
proportions.
• These relationships of the human face have
come to be called canons.
Leonardo da Vinci’s proportions of the ideal human body

8. • Czechoslovakian anthropologist and physician Ales Hrdlicka
(1869-1943).
• Karel Hajnis, another anthropologist at Charles University in
Prague, Czechoslovakia, studied children with cleft lip and palate by
use of Hrdlicka's anthropometric principles.
• Farkas has made a major contribution to our understanding of how
anthropometry relates to the face and head in normalcy, beauty, and
deformity.

9. NEOCLASSICAL CANONS
• Dividing the face into proportions has been a
convenient way to address facial analysis,
called neoclassical canons .
• Introduced by Renaissance artists such as da
Vinci and Dürer to define ideal facial form
in art.
• The canons attempt to apply mathematical
relationships to achieve a formula for facial
balance and beauty.

10. FACIAL EXAMINATION

12. The Frankfort horizontal may be approximated on lateral photographs by constructing a line from the
superior margin of the tragus to the junction between the lower eyelid and the cheek skin.

15. • The two-section canon states that the height of vertex to
endocanthion is equal to the height of endocanthion to gnathion.
This divides the face into two equal parts at the medial canthus.
• 80% of subjects had the upper face 12.3 mm (range, 2 to 29 mm)
higher than the lower facial half. Only 10% of subjects had the
same proportions as the neoclassical canon.
• Mean height from vertex to endocanthion
Men 121.3 ± 7 mm and
Women 118.7 ± 6 mm
• Mean from endocanthion to gnathion was for
Men 117.7 ± 7 mm and
Women 102.7 ± 6 mm
• Ratio of 1:0.97 for men and 1:0.86 for women between facial halves.
• Men show longer lower faces than do women on the average
DIVISION BY HALVES

16. DIVISION BY THIRDS
• The three-section canon
states equal heights of
trichion to nasion, nasion
to subnasale, and
subnasale to gnathion.
• The four-section canon
relates the heights of
vertex to trichion,
trichion to glabella,
glabella to subnasale, and
subnasale to gnathion as
being equal.

17. • The three-section canon states that the height of the nose is
equal to the height of both the forehead and the lower face.
The averages showed heights from
Trichion to nasion
67 ± 7.5 mm in men
63 ± 6 mm in women
Nasion to subnasale
55 ± 3 mm in men
51 ± 3 mm in women
subnasale to gnathion
73 ± 4.5 mm in men
64 ± 4 mm in women.
Ratios of 1:0.8:1.1 for men and 1:0.8:1 for women.

18.  The height of the nose is less than the height of either the
forehead or the lower face for both men and women.
 The measurements show a greater proportion to lower face
height for men than for women.
 Fifty percent of the population had a lower face height greater
than the height of hairline to nasion.
 Thirty-five percent showed the opposite relationship.

19. Four-section canon
• The four-section canon states that the midface height from eyebrows to
base of the nose should equal the height of the forehead and the lower
face.
• The averages on actual subjects showed heights from
 Trichion to glabella
57 ± 7 mm for men
53 ± 6 mm for women
 Glabella to subnasale
67 ± 5 mm for men and
63 ± 4 mm for women,
 Subnasale to gnathion
73 ± 4.5 mm for men
64 ± 4 mm for women.
 Ratios of 1:1.2:1.3 for men and 1:1.2:1.2 for women.
 Men tend toward progressively larger facial thirds superior to inferior.
Women have a less prominent lower facial component to their facial
proportions and tend toward equal middle and lower facial heights

20. • The lower facial height of subnasale to gnathion is divided as
one third from subnasale to stomion and two thirds from
stomion to gnathion.
• Ratios of 1:2.3 for men and 1:2.15 for women.
• A larger proportion of the lower face height in men is
contributed by the mandible

21. FOREHEAD AND EYEBROW
• The forehead comprises the area from the hairline (trichion)
to glabella. It can be considered an aesthetic unit because it
is a seamless, homogeneous surface of the upper face.
• The average height is
6 to 7 cm in men
5 to 6 cm in women.
• The forehead viewed from the lateral has a posterior
inclination of
10 ± 4 degrees in men
6 ± 5 degrees in women.

22.  It makes an angle with the
nasal dorsum, called the
nasofrontal angle,
130 ± 7 degrees in men
134 ± 7 degrees in women
 The supraorbital rims
laterally and the glabella
medially are the most
projected areas of the
forehead.
 The depth of nasion should
be 4 to 6 mm in relation to
glabella

23. Differences between male and female ideals for the nasofrontal and nasolabial angles

24. Eyebrow
• In general, an aesthetic eyebrow is a smooth arch with its apex at the lateral
limbus of the eye. The lateral end is at or 2 to 3 mm superior to the medial
end.
• In men, the eyebrow overlies the supraorbital rim. In women, it is 1 to 3
mm above the rim.
• The top edge of the brow is 2.5 cm above the pupil and 1.5 cm above the
upper eyelid crease.

25. Eyebrow position can be altered by brow lift procedures to
produce a perceived change of both the forehead height and the
middle facial height

26. EYES
• The orbital proportion canon indicates that the distance between the medial
canthi is equal to the width of the eye fissure (the distance from medial to
lateral canthus).
• only one third of subjects showed an intercanthal distance equal to the eye
fissure width.
• It was wider by a mean of 3.5 mm in 51.5% and narrower by a mean of 2.8
mm in 15.5% .
• In adults, the intercanthal distance averages 30 to 36 mm in men and 30 to
34 mm in women.
• The eye fissure length (medial canthus to lateral canthus) averages 30 to 33
mm in men and 29 to 32 mm in women.

27. • Lateral canthus 2 to 3 mm superior to the medial canthus.
• Upper lid should cover 1 to 2 mm of the superior limbus.
• More than 2 mm of overlap - upper lid ptosis.
• The lower eyelid touches or slightly overlaps the inferior
limbus.

28. • The supraorbital rim protrudes 8 to 10 mm beyond the cornea.
• Men women
• The cornea projects 2 to 3 mm beyond the inferior orbital rim and 12 to 16
mm beyond the lateral orbital rim

29. NOSE
• Divided into three regions: the radix, dorsum, and soft nose.
• The radix is, root of the nose ,most narrow and least projected area.
• The nasal dorsum extends from the caudal end of the radix to the supratip
break, where the soft nose begins
• The soft nose consists of the mobile portion of the nasal tip, columella, and
ala.

30. Nasofacial proportion canon
• The width of the ala equals one-fourth the width of the
distance between the zygomas.
• The orbitonasal proportion canon states that the distance
between the medial canthi equals the width of the ala.

32. Nasoaural proportion canon
• Length of the nose is equal to the height of the ear.
• Inclination of the nasal dorsum is equal to the inclination of
the ear.

33. The nasofacial angle
• Soft tissue nasion = deepest point of concavity of the radix region.
• Approximated at the level of the lash line of the upper lid in forward gaze.
• 4 to 6 mm deep to glabella
• The nasofacial angle, a measurement of nasal dorsum inclination, is 36
degrees in men and 34 degrees in women to a line perpendicular to
Frankfort horizontal through nasion.
• Subnasale, the point at the base of the columella, should project 2 mm
caudal to the alar rim.
The angle made between the
columella and the upper lip,
the nasolabial angle, is 100
to 103 degrees in men and
105 to 108 degrees in
women

35. LIPS
• The naso-oral proportion canon
states that the width of the mouth
equals 1½ the width of the ala.
• The width of the mouth at the
commissures should fall within
vertical lines dropped from each
medial limbus.
• Artistic renderings of the balanced
lower face have described the upper
lip as forming one third and the
lower lip and chin as forming two
thirds of the lower facial height.
• A ratio of 1:2.3 in men and 1:2.15 in
women .

36. • The labiomental groove or fold is the deepest point of
contour change at the junction of the lower lip and chin.
It defines the point sublabiale.
• The labiomental groove located one-third the distance
from stomion to gnathion.
• The chin composes two thirds of this segmental lower
facial height, with the lower lip thus forming a ratio of
1:2 lower lip to chin.

38. TEETH
• The upper incisor teeth should be visible for 1 to 4
mm.
• Overbite is the amount of vertical overlap the
maxillary central incisors have over the mandibular
incisors.
• Overjet is the amount of anterior projection the
maxillary central incisors have beyond the mandibular
incisors (horizontal overlap). The normal values for
overjet and overbite are 1 to 3 mm.

39. Dental molar relationship
• A class I relationship has the mesiobuccal cusp of the maxillary first
molar occluding into the buccal groove of the mandibular first
molar.
• class II relationship, the mesiobuccal cusp is anterior (distal) to the
buccal groove. A class II molar relationship is generally associated
with an underprojected mandible termed retrognathia.
• A class III relationship has the mesiobuccal cusp posterior
(proximal) to the buccal groove. In this relationship, the mandible
can be overprojected, producing prognathia, or the molar position
can be due to maxillary retrusion.

40. • A lack of vertical incisor overlap is called an open bite.

42. CHIN PROJECTION
• Pogonion, the most anterior projection of the
chin pad, will make an angle of 11 ± 4 degrees
with a vertical line from glabella to subnasale .

44. • A perpendicular line from Frankfort horizontal through subnasale should
show pogonion 3 ± 3 mm posterior to the line.
• A perpendicular line between Frankfort horizontal and nasion should
intersect with pogonion 0 ± 2 mm .

45. • A deficient chin projection will
enhance the perception of an
over projected nasal dorsum.
• Lowering the nasal dorsum or
narrowing the radix can give
the illusion of widening the
eyes.

46. CEPHALOMETRIC ANALYSIS

47. • Cephalometric analysis is used to
assess the bone relationships of
the face and the relationships of
the jaws and teeth.
• In 1931, the technique of
cephalometric analysis was
introduced in the United States by
Broadbent and in Germany by
Hofrath.
• The technique involves making a
standardized lateral head
radiograph by keeping the x-ray
beam, subject, and film distances
constant.

48. • The subject's head is held in a
reproducible position with a
head-holding device called a
cephalostat.
• The cephalostat stabilizes the
head with ear rods and a nose
clamp.
• A lateral cephalometric head
radiograph, called a
cephalogram, is produced.
• The cephalogram shows the
skull and face bones, the teeth,
and the shadows of the
pharynx and soft tissue profile
outline.

49. • The analysis of a cephalogram is
traditionally done by use of an x-
ray view box and acetate film.
• An outline tracing is made of the
frontal, sphenoid, nasal, anterior
maxilla, palate, and mandible
bones.
• The teeth and their roots are also
included.
• Desired measurements, angles,
and planes are drawn and
analyzed.

50. • Two commonly used normative data collections are the
Bolton standards and the cephalometric standards from the
University of Michigan School Growth Study.
• Both contain data on age ranges from childhood to adult of
subjects without dentofacial deformities.
• The data are arranged in tables containing values for distances
and angles between cephalometric landmarks separated by age
and sex.

51. Performing a Cephalometric
Analysis

55. ANALYSIS
STEP 1: TRACING THE CEPHALOGRAM
Trace the frontal
Trace the outline of the nasal bone.
Trace the outline of the sella turcica
Trace the backward J-shaped outline of the lateral and
inferior orbital rim.
Find porion or use the superior point of the ear rod
shadow as a substitute.
Trace inferiorly along the piriform rim, anterior nasal
spine, and maxillary alveolus.
Trace the maxillary and mandibular incisor teeth.
Trace the mandible including the coronoid process,
condyle,
The soft tissue profile, including the forehead and neck,
is traced

56. STEP 2: ANALYSIS OF SKELETAL REGIONS
CRANIAL BASE
 Cranial base length is the
measurement of sella to nasion. The
average is 83 ± 4 mm in men and
77 ± 4 mm in women.
 Frankfort horizontal makes an
angle of approximately 5 to 9
degrees inferior (clockwise) to SN
in most normal individuals.
 Cranial base length can be
increased by monobloc Le Fort III
advancement.

57. ORBITS
• Frankfort horizontal passes from porion
through orbitale, the lowest point of the
inferior orbital rim.
• The distance from porion to orbitale is
74.5 ± 5 mm in men and 70.5 ± 4.5
mm in women.
• A line connecting the superior orbital
rim with the inferior orbital rim
intersects Frankfort horizontal at an
angle of 72 ± 9 degrees in men and
75.8 ± 7.6 degrees in women.
• These measurements are valuable in
assessing deficiencies in orbital rim
projection .

58. MAXILLA
• Angle formed by the intersection of
the lines sella-nasion and nasion-A
point.
• The angle of SNA is 82 ± 4 degrees
for both men and women.
• Angle formed by the intersection of
Frankfort horizontal and nasion-A
point. This relationship, called
maxillary depth, is 90 ± 3 degrees.
• A line that passes through anterior
nasal spine and posterior nasal spine.
This line, called the palatal plane,
makes an angle of 8 ± 3 degrees with
SN and of 25 ± 5 degrees with the
mandibular plane.
The anterior-posterior position of the maxilla relative to cranial base can be
evaluated with the angle ormed by the intersection of the lines sella-nasion (SN) and
nasion-A point. The angle of SNA is 82 ± 4 degrees for both men and women. An
alternative relationship is based on the angle formed by the intersection of Frankfort
horizontal (FH) and nasion-A point. This relationship, called maxillary depth (MD), is
90 ± 3 degrees.

59. DENTAL RELATIONSHIPS
• The occlusal plane of the maxilla
makes an angle with Frankfort
horizontal of 8 ± 4 degrees.
• The long axis of the maxillary
central incisor (I) makes an angle
with the line nasion-A point of 22
± 2 degrees.

60. • The long axes of the maxillary and
mandibular incisors make an angle with
each other of 130 ± 10 degrees .
• The maxillary central incisor should be
exposed 1 to 4 mm from the inferior edge of
the upper lip.
• The amount of tooth exposure is an
indication of the amount of anterior vertical
maxillary excess.
• Maxillary excess or deficiency can be
corrected by Le Fort I procedures.

61. MANDIBLE
• The anterior-posterior position of the
mandible relative to cranial base can be
evaluated with the angle formed by the
intersection of the lines sella-nasion and
nasion-B point.
• The angle of SNB is 79 ± 4 degrees for
both men and women.
• An alternative relationship is based on the
angle formed by the intersection of
Frankfort horizontal and nasion-B point.
This angle, called mandibular depth, is
88 ± 3 degrees .

62. CHIN
• The most projected point of the chin is
pogonion.
• The anterior-posterior chin prominence in
relationship to the mandible is assessed
from the projection of pogonion beyond
the line nasion-B point. Pogonion should
project 4 to 6 mm beyond NB.
• The relationship of pogonion to the
mandibular central incisors is assessed
with a line from A point to pogonion. The
mandibular incisor tip should project 2 ±
2 mm beyond the line.
• Angle formed by the intersection of the
lines glabella-subnasale and subnasale-
pogonion should be 11 ± 4 degrees. This
relationship is called the angle of facial
convexity.

63. FACIAL HEIGHTS
• The upper facial height from nasion
to the anterior nasal spine is 52 to
57 mm.
• The lower facial height from
anterior nasal spine to menton is 63
to 68 mm.
• Probably of more value is the ratio
of the upper and lower heights,
which is 1:1.2.
• Changes to the facial heights can be
made with Le Fort maxillary
procedures and surgeries to the
mandibular symphysis region.

64. Compiling Analytic Information
• Anthropometry of the face and cephalometric analysis of the
facial skeleton are disciplines that complement each other in
the evaluation of deformities and surgical planning of
aesthetic, dentofacial, and craniofacial procedures.
• One's subjective clinical assessment and the patient's desires
must also be considered in the overall treatment plan.
• However, the ability to perform a thorough facial and
cephalometric analysis can be useful when there is an unclear
etiology to a patient's perceived deformity.

65. Thank you