Comparative evaluation of nasal parameters in various vertical skeletal dimensions amongst Malay female orthodontic patients
Abstract
Objectives: To establish cephalometric norms for various nasal parameters in skeletal normodivergent Malaysian Malay adult females, and to compare nasal parameter differences across normo-, hypo-, and hyperdivergent vertical skeletal dimensions.
Materials and Methods: This retrospective study analysed 156 pre-orthodontic lateral cephalometric radiographs of skeletal Class I Malay females aged 18 to 30 years (mean age= 24.12 ± 3.38). Cephalograms were categorised into normodivergent (MMPA: 24.8° ± 6.7°), hypodivergent (<18.1°), and hyperdivergent (>31.5°). Sixteen nasal parameters were manually traced, comprising nine linear (nasal depth 1, nasal depth 2, nasal bone length, nasal length, columella convexity, nasal dorsum axis, nasal tip protrusion, nasal height, and hump) and seven angular (nasomental, nasofrontal, nasofacial, nasolabial, nasal tip, soft tissue facial convexity, and nasal bone angles) parameters. One-way ANOVA with Bonferroni post-hoc test (p< 0.05) was used to compare mean nasal parameters across the three vertical skeletal groups. Intra- and inter-examiner reproducibility was assessed using the Intraclass Correlation Coefficient (ICC) with remeasurements made after one week.
Results: ICC analysis demonstrated excellent intra- and inter-examiner reliability (0.93 and 0.91, respectively). No significant differences were observed in linear nasal parameters across all groups except nasal depth 2 (p = 0.02) which was significantly greater in normodivergent than hyperdivergent group. No significant differences were found in angular nasal parameters.
Conclusions: Nasal cephalometric norms in normodivergent Malaysian Malay female were established, providing an essential reference data for nasal assessment. Nasal depth 2 varied significantly across groups, suggesting that vertical skeletal pattern can influence this specific nasal variable, which is crucial for improving orthodontic and surgical treatment planning in the Malay population.
Keywords
Ethical Statement
This study was conducted in accordance with the Declaration of Helsinki. Ethical approval was obtained from International Islamic University Malaysia Research Ethics Committee (IREC 2024-043) dated 20 February 2024.
Supporting Institution
Kulliyyah of Dentistry, International Islamic University Malaysia (IIUM)
Project Number
CHAIN 24-005-0005
Thanks
The authors sincerely acknowledge all individuals who contributed to this project, either directly or indirectly, and are thankful for the assistance provided by the dental staff at Dr Fatain’s Dental Clinic during data collection. The authors also gratefully acknowledge the financial support received from the Kulliyyah of Dentistry Postgraduate CHAIN Grant, International Islamic University Malaysia (CHAIN 24-005-0005).
References
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- 14. Ahmad Razin SM, Abdul Ghani SH, Norman NH. Bimaxillary protrusion in Malay population: cephalometric analysis of skeletal, dental and soft tissue components. J Int Dent Med Res 2019;12:203-211.
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- 17. Than M, Thwin SS, Wai MM, Yesmin T, Zaini F, Jaafar KAM, et al. Study of nasal parameters and nose types among university students in Malay population. Asian J Med Health Sci 2018;1:7-12.
- 18. Kılınç DD, Sayar G. Evaluation of nasal tip projection and rotation of nasal tip after orthognathic surgery by using Goode’s method. J Maxillofac Oral Surg 2022;21:510-514.
- 19. Narkhede S, Rao P, Sawant V, Sachdev SS, Arora S, Pawar AM, et al. Digital versus manual tracing in cephalometric analysis: A systematic review and meta-analysis. J Pers Med 2024;14:566.
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- 21. Tengku Mohd Arif TF, Muhammad Hanafi FF, Abdul Razak NWH, Chaiprakit N, Abdul Wahab H. Anthropometric characteristics of Malay nose-a pilot study. Esteem Acad J 2020;16:11–20.
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- 23. El-Hadidy M, El-Din AB, El-Bassioni L, Attal W. Cephalometric analysis for evaluating the profile nasal morphology in Egyptian adults. Egypt J Plast Reconstr Surg 2007;31:243-249.
- 24. Alharety S, Aldaghri F, Mesallam TA, Farahat M, Bukhari MA. Nasal bone length in Saudi rhinoplasty: a clinical-radiological study. Ann Saudi Med 2014;34:65-67.
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- 26. Jang YJ, Moon H. Special consideration in the management of hump noses in Asians. Facial Plast Surg 2020;36:554–562.
- 27. Rodrigues Dias D, Santos M, Sharafi M, Jalessi M, McIntosh C, Stutterheim J, et al. Nasal dorsum anatomy of major different ethnicities-surgical implications: a multicenter radiological study. Plast Reconstr Surg 2024;154:760-770.
- 28. Wen J, Liu S, Ye X, Xie X, Li J, Li H, et al. Comparative study of cephalometric measurements using 3 imaging modalities. J Am Dent Assoc 2017;148:913–921.
- 29. Gu Y, McNamara Jr JA, Sigler LM, Baccetti T. Comparison of craniofacial characteristics of typical Chinese and Caucasian young adults. Eur J Orthod 2011;33:205-211.
- 30. Knigge RP, McNulty KP, Oh H, Hardin AM, Leary EV, Duren DL, et al. Geometric morphometric analysis of growth patterns among facial types. Am J Orthod Dentofacial Orthop 2021;160:430–441.
- 31. Roy AS, Tandon P, Chandna AK, Sharma VP, Nagar A, Singh GP. Jaw morphology and vertical facial types: A cephalometric appraisal. J Orofac Res 1970;2:131–138.
- 32. Al-Mashhadany SM, Al-Chalabi HMH, Nahidh M. Evaluation of facial soft tissue thickness in normal adults with different vertical discrepancies. Int J Sci Res 2017;6:938–942.
- 33. Mohan A, Sivakumar A, Nalabothu P. Evaluation of accuracy and reliability of OneCeph digital cephalometric analysis in comparison with manual cephalometric analysis-a cross-sectional study. BDJ Open 2021;7:22.
- 34. Padmanabham S, Sankar AS, Sridevi E, Sankar KS, Krishna VSS, Ktss R. Comparative evaluation of digital and manual cephalometric analysis in mouth-breathing patients: an ex vivo study. Int J Clin Pediatr Dent 2025;18:776-783.
- 35. Ottaviano G. Nasal patency measurement: State of the art of the acoustic rhinometry. Facial Plast Surg 2024;40:304-309.
Abstract
Project Number
CHAIN 24-005-0005
References
- 1. Vertu-Ciolino D, Brunard F, Courtial EJ, Pasdeloup M, Marquette CA, Perrier-Groult E, et al. Challenges in nasal cartilage tissue engineering to restore the shape and function of the nose. Tissue Eng Part B Rev 2024;30:581-595.
- 2. Pham TB, Sah RL, Masuda K, Watson D. Human septal cartilage tissue engineering: current methodologies and future directions. Bioengineering (Basel) 2024;11:1123.
- 3. Singh A, Purkait R. Three-dimensional prediction of the nose for facial reconstruction: a preliminary study on north Indian adults. J Forensic Leg Med 2024;105:102708.
- 4. Vu NH, Trieu NM, Anh Tuan HN, Khoa TD, Thinh NT. Review: facial anthropometric, landmark extraction, and nasal reconstruction technology. Appl Sci 2022;12:9548.
- 5. Strapasson RAP, Herrera LM, Melani RFH. Forensic facial reconstruction: relationship between the alar cartilage and piriform aperture. J Forensic Sci 2017;62:1460–1465.
- 6. Armengou X, Frank K, Kaye K, Brébant V, Möllhoff N, Cotofana S, et al. Facial anthropometric measurement and principles – overview and implications for aesthetic treatments. Facial Plast Surg 2024;40:348-362.
- 7. Jankowska A, Janiszewska-Olszowska J, Grocholewicz K. Nasal morphology and its correlation to craniofacial morphology in lateral cephalometric analysis. Int J Environ Res Public Health 2021;18:3064.
- 8. Bhandari PS, Dhar S, Gulati A. Anthropometric analysis of linear parameters of the Indian nose: a cross-sectional study and comparison with literature. J Plast Reconstr Aesthet Surg 2021;74:3421–3430.
- 9. Kim NG, Park SW, Park HO, Choi TH, Kim J, Choi J. Are differences in external noses between whites and Koreans caused by differences in the nasal septum? J Craniofac Surg 2015;26:922-926.
- 10. Sahoo R, Parihar AV, Chaturvedi TP, Verma S. Relationship of nasal morphology with different dentoskeletal patterns: a systematic review. J Indian Orthod Soc 2021;55:122-137.
- 11. Shrivastava R, Shrestha BK, Sah MP, Chhetri A, Gahatraj S, Shrestha S. Comparison of various nasal parameters in different anteroposterior jaw relationships and growth patterns. Orthod J Nepal 2023;13:15-20.
- 12. Gülşen A, Okay C, Aslan BI, Uner O, Yavuzer R. The relationship between craniofacial structures and the nose in Anatolian Turkish adults: a cephalometric evaluation. Am J Orthod Dentofacial Orthop 2006;130:e15-e25.
- 13. Norman NH, Mohd Khairul Azmi NA, Tajor Amar SN, Abdul Ghani SH. Cephalometric norms of the Malay population. Int Med J 2020;27:216–219.
- 14. Ahmad Razin SM, Abdul Ghani SH, Norman NH. Bimaxillary protrusion in Malay population: cephalometric analysis of skeletal, dental and soft tissue components. J Int Dent Med Res 2019;12:203-211.
- 15. Aljabaa AH. Lateral cephalometric analysis of the nasal morphology among Saudi adults. Clin Cosmet Investig Dent 2019;15:9–17.
- 16. Kim Y, Jang YJ. Radiologic measurement of the nasal length and keystone area in relation to nasal bony and septal cartilaginous dimensions in Korean adults. J Rhinol 2019;26:75–81.
- 17. Than M, Thwin SS, Wai MM, Yesmin T, Zaini F, Jaafar KAM, et al. Study of nasal parameters and nose types among university students in Malay population. Asian J Med Health Sci 2018;1:7-12.
- 18. Kılınç DD, Sayar G. Evaluation of nasal tip projection and rotation of nasal tip after orthognathic surgery by using Goode’s method. J Maxillofac Oral Surg 2022;21:510-514.
- 19. Narkhede S, Rao P, Sawant V, Sachdev SS, Arora S, Pawar AM, et al. Digital versus manual tracing in cephalometric analysis: A systematic review and meta-analysis. J Pers Med 2024;14:566.
- 20. Obaje GS, Mbagwu M, Egwu AO. The power of predictive model for age and sex using nasal parameters. J Craniofac Surg 2021;32:600–602.
- 21. Tengku Mohd Arif TF, Muhammad Hanafi FF, Abdul Razak NWH, Chaiprakit N, Abdul Wahab H. Anthropometric characteristics of Malay nose-a pilot study. Esteem Acad J 2020;16:11–20.
- 22. Gülşen A, Şibar S, Ismail BK. Relationship between the nasal profile and craniofacial structures: does part of the nasal profile reflect some craniofacial structures? Anat Sci Int 2023;98:228–239.
- 23. El-Hadidy M, El-Din AB, El-Bassioni L, Attal W. Cephalometric analysis for evaluating the profile nasal morphology in Egyptian adults. Egypt J Plast Reconstr Surg 2007;31:243-249.
- 24. Alharety S, Aldaghri F, Mesallam TA, Farahat M, Bukhari MA. Nasal bone length in Saudi rhinoplasty: a clinical-radiological study. Ann Saudi Med 2014;34:65-67.
- 25. Noback ML, Harvati K, Spoor F. Climate-related variation of the nasal cavity. Am J Phys Anthropol 2011;145:599-614.
- 26. Jang YJ, Moon H. Special consideration in the management of hump noses in Asians. Facial Plast Surg 2020;36:554–562.
- 27. Rodrigues Dias D, Santos M, Sharafi M, Jalessi M, McIntosh C, Stutterheim J, et al. Nasal dorsum anatomy of major different ethnicities-surgical implications: a multicenter radiological study. Plast Reconstr Surg 2024;154:760-770.
- 28. Wen J, Liu S, Ye X, Xie X, Li J, Li H, et al. Comparative study of cephalometric measurements using 3 imaging modalities. J Am Dent Assoc 2017;148:913–921.
- 29. Gu Y, McNamara Jr JA, Sigler LM, Baccetti T. Comparison of craniofacial characteristics of typical Chinese and Caucasian young adults. Eur J Orthod 2011;33:205-211.
- 30. Knigge RP, McNulty KP, Oh H, Hardin AM, Leary EV, Duren DL, et al. Geometric morphometric analysis of growth patterns among facial types. Am J Orthod Dentofacial Orthop 2021;160:430–441.
- 31. Roy AS, Tandon P, Chandna AK, Sharma VP, Nagar A, Singh GP. Jaw morphology and vertical facial types: A cephalometric appraisal. J Orofac Res 1970;2:131–138.
- 32. Al-Mashhadany SM, Al-Chalabi HMH, Nahidh M. Evaluation of facial soft tissue thickness in normal adults with different vertical discrepancies. Int J Sci Res 2017;6:938–942.
- 33. Mohan A, Sivakumar A, Nalabothu P. Evaluation of accuracy and reliability of OneCeph digital cephalometric analysis in comparison with manual cephalometric analysis-a cross-sectional study. BDJ Open 2021;7:22.
- 34. Padmanabham S, Sankar AS, Sridevi E, Sankar KS, Krishna VSS, Ktss R. Comparative evaluation of digital and manual cephalometric analysis in mouth-breathing patients: an ex vivo study. Int J Clin Pediatr Dent 2025;18:776-783.
- 35. Ottaviano G. Nasal patency measurement: State of the art of the acoustic rhinometry. Facial Plast Surg 2024;40:304-309.
Details
| Primary Language | English |
|---|---|
| Subjects | Orthodontics and Dentofacial Orthopaedics |
| Journal Section | Research Article |
| Authors | |
| Project Number | CHAIN 24-005-0005 |
| Submission Date | July 6, 2025 |
| Acceptance Date | February 18, 2026 |
| Publication Date | March 27, 2026 |
| DOI | https://doi.org/10.7126/cumudj.1735666 |
| IZ | https://izlik.org/JA83KH59MJ |
| Published in Issue | Year 2026 Volume: 29 Issue: 1 |
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