Facial Measures in a sample Kenyan population. 2019

Many patterns of growth, development, and treatment changes may be recorded with good levels of precision using anthropometry [1,2,3,4,5]. The first study to test the pertinence of neoclassical facial canons included samples of 6-, 12-, and 18-year-old North American Caucasians [4]. Over the years, the appropriateness of these canons has been tested in other ethnic groups including Indian [6, 7], African-American [8], Turkish [9], Vietnamese, Thai, and Chinese populations [10]. These anthropometric studies were performed by means of using direct manual methodology, such as spreading and sliding calipers, and have permitted the evaluation of numerous craniofacial measurements in various ethnic groups [11]. However, data on Kenyans of African descent is inadequate [12].

Anthropometric information provides useful data on the distribution of numerous measurements of human subjects, enabling the impartial appraisal of outcomes before and after treatment [13, 14]. Craniofacial anthropometry is an uncomplicated, economical, effective, and non-invasive process for quantitative analysis of craniofacial morphology and it involves taking direct clinical measurements such as linear distances, proportions, angles, and ratios [15]. Craniofacial anthropometry is appropriate for population studies because of the accessibility of comparative and conventional databases [15].

An extensively utilized collection of anthropometric measurements, comprising of 47 surface landmarks (Fig. 1), to develop facial canons in order to help in analyzing and describing the faces of North American Caucasians have been described [16]. These canons were subsequently tested on a variety of ethnic groups with participants from 13 European countries (Azerbaijan, Bulgaria, Croatia, Czech Republic, Germany, Greece, Hungary, Italy, Poland, Portugal, Russia, Slovakia, and Slovenia), 3 Middle Eastern countries (Egypt, Iran, and Turkey), 5 East Asian countries (India, Japan, the Chinese of Singapore, Vietnam, and Thailand), 3 African states (Angola, Tonga, and Zulu), and African Americans from the USA [16].

An investigation compared the Sudanese female (SF) face with those of African Americans (AA) and North American whites (NAW) and recognized differences, expressing that the neoclassical norms were unreliable guides to the SF face as they were considerably taller and narrower than the AA or NAW female face respectively [11]. Another investigation recognized that the typical AA female does not fit the neoclassical criterion of facial proportions, and varied considerably in the horizontal dimension measurements when compared to those of white subjects [17].

Photogrammetric analysis may be less accurate than anthropometric analysis [18]. Nevertheless, an investigation comprising the angular photogrammetric comparison of soft tissue profiles of 177 black Kenyans and 156 Chinese was undertaken, which established numerous contrasts in the typical angular measurements of facial profiles between black Kenyans, Chinese, and white standards [12]. Jeffries et al. [19] photogrammetrically examined 200 AA participants and compared the results with those of Farkas et al. [14]. They determined that AA and white participants had comparable vertical facial proportions, though the horizontal proportions varied considerably and were in accordance with previously published data [19]. Two investigations have noted that the South Indian population, in general, had a wider lower face while NAW showed wider midface and overall greater values of proportional indices than North American Caucasian population [6, 7]. A Turkish population study clearly shows anthropometric variation for fronto-occipital, circumference, intercanthal distance, outer canthal distance, near and distant interpupillary distance, canthal index, and circumference-interorbital index with age [9].

Normative craniofacial anthropometric values (linear, angular, and proportional) aid in diagnostic determination and treatment planning for patients, who come from diverse ethnic backgrounds and have need for esthetic and reconstructive dentofacial or craniofacial surgery. A database of normative values for each ethnic group is essential. Universally applied criteria of esthetic attractiveness and proportions may be misleading, due to ethnic variation, and dependence on neoclassical proportional canons, may be equally spurious [1]. To date, normative anthropometric data and comparative information that could be used for treatment planning in craniofacial and orthognathic surgery has been inaccessible for Kenyans of African descent. The proposed investigation aimed to gather the required normative data, and to assess the differences in facial proportions between Kenyan participants compared to those of African Americans (AA), North American Whites (NAW), and neoclassical canons.