Nasal and labio-oral angles in young adult indigenous Ghanaians

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Matondo, Kevin Kofi Adutwum-Ofosu, Richard Michael Blay, and 7 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6556297/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background/Objective : The paucity of normative angular nasal and labio-oral anthropometric data on indigenous sub-Saharan Africans hinders the aesthetic effectiveness of reconstructive/plastic surgery on their faces. This data void also negatively affects their facial biometrics, information retrieval, forensics, dentistry, and beauty analysis. This study contributes to filling this gap by generating normative values for the nasal and labio-oral angles in young adult autochthonic Africans living in Ghana. Methods : One hundred and five volunteers (54 males and 51 females) were conveniently sampled from students at the Korle-Bu Campus of the University of Ghana. Seven nasal and labio-oral angles, namely; the Nasofrontal, Nasal tip, Nasolabial, Labiomental, Alar slope, Mandibular Frankfurt plane, and Mentocervical were measured by direct anthropometric (angle meter) and indirect anthropometric (Photogrammetry) methods. Data were assessed for sexual dimorphism using Student’s t-test. Scatter plots with Correlation Analyses were used to determine the association between the direct and indirect datasets. Results : Except for the Nasofrontal angle, which was lower in males than in females, no significant sex differences were found. For all measured angles, there were no significant differences between the values obtained using the direct and indirect anthropometric methods. Indirect measurements of each of the seven nasal and labio-oral angles strongly correlated positively with their cor-responding direct measurements. Conclusion : This study provides the first normative dataset on nasal and labio-oral angles in young Indigenous Ghanaians and shows that apart from larger nasofrontal angles in females, six other angles did not significantly differ between sexes. Our results indicate that the indirect method of measuring these angles provides a good estimate for direct measurements. Anthropometry Facial Angles Indigenous Africans Sexual Dimorphism Figures Figure 1 Figure 2 Figure 3 Introduction The human face is important for recognition and communication, and provides useful information for identifying a person [ 1 ]. Damage to the face, such as scarring or developmental deformities, adversely affects the psyche [ 2 ]. The development of the human face involves morphogenetic movements and the interplay of primordial structures that form the nose in a region around a primitive mouth [ 3 ]. The nose is essential for facial beauty; hence, rhinoplasty is among the most frequently performed aesthetic surgical procedures [ 4 ]. This is not surprising since the nose occupies a central position on the face and is a dominant part of the facial profile [ 5 ]. In addition, as a prominent facial feature, the nose is both unique and easily identified, making it a valuable biometric identification marker [ 6 ]. In humans, the mouth is another prominent feature of the face, which, in addition to being the beginning of the gastrointestinal tract, also plays a significant role in communication (both verbal and nonverbal). Normative angles of the nasal and labio-oral regions are integral and essential parts of craniofacial anthropometric data necessary for facial surgery to repair damage and orthodontic treatment to address facial developmental deformities [ 7 – 10 ]. The case has been made for the clinical application of nasal and labio-oral angles in cases of congenital alterations, disfiguring traumas [ 11 ], and facial feminization surgeries [ 12 ]. In addition to their usefulness in facial surgery and dentistry, the nasal and labio-oral angles can be incorporated into local biometric (facial) identification software programs. This may improve the increasing and promising field of Biometrics in Ghana and Africa [ 13 ]. Therefore, generating normative values for nasal and labio-oral angles is fundamental to both clinical practice and general societal life. Establishing normative values of the angles of the nasal and labio-oral regions that are complementary to the linear measurements by Ampadu [ 14 ] and Koney [15] is an important step towards building/using local reference values. These measurements may serve as standards for plastic reconstructive facial surgery and orthodontics [ 14 ]. For centuries, anthropologists and clinicians have attempted to objectively comprehend the concept of facial beauty [16]. During the Renaissance, artists emphasized symmetry and balanced proportions as the roots of facial beauty [17]. Their quantitative descriptions persisted as neoclassical canons[18, 19]. The canons assumed that certain fixed ratios exist between different variables of a harmonious face[18]. Essentially, the neoclassical canons defined three equal lengths of the face (the forehead, nose, mouth, and chin) as well as the intercanthal distance (the distance between the canthi or corners of the eye) being equal to the eye fissure length [17–20]. These neoclassical facial canons are considered precursors of the current anthropometric facial indices [18]. Subsequently, medical artists and anatomists adopted these canons. Today, they are used in reconstructive facial surgeries in many clinical settings worldwide [17, 18]. Anthropometric measurements vary with age, gender, and ethnicity; and several authors have attempted to document normative values which may serve as local references [21–25]. Three (3) studies on facial anthropometry in Ghana [14, 15, 26] are known to the authors of the present study. However, detailed angular measurements of the nasal and labio-oral regions, which are particularly crucial for maxillofacial surgical interventions, were not included in those studies. There are apparently no normative angular nasal and labio-oral anthropometric data for autochthonic young adults living in Ghana, which has the potential to limit the aesthetic effectiveness of reconstructive/plastic surgery on the face. Meanwhile, there is an increasing occurrence of traumatic facial deformities in recent years in Ghana [27, 28]. An extensive epidemiological study of injuries presented by 17,860 patients at the Korle-Bu Teaching Hospital in Ghana from January 2016 to December 2017 showed that Road Traffic accidents (RTA), especially motorcycle-related accidents, were a significant cause (39.1%) [29]. The latter study also revealed that the highest proportion (32.5%) of injuries stratified by 11 body regions involved the head (including the face, jaws, eyes, ears, and nose), while the majority of patients (67.8%) were male with an average age 27.6 years. It is expected that surgical reparative procedures in many such accident-injury cases will require data on the nasal and labio-oral angles. This study was an attempt to address the gap between normative nasal and labio-oral angles in Ghana, primarily for clinical purposes. Materials and Methods Study design and subjects The Ethical and Protocol Review Committee (EPRC) of the University of Ghana, College of Health Sciences (CHS) gave ethical clearance according to the Office of Research, Innovation, and Development's (ORID) Ethical Guidelines. A Protocol Identification Number CHS-Et/M.6-4.11/2018–2019 was assigned to this research. A Volunteer Informed Consent Form (with a Questionnaire) was designed for this study and approved by the CHS EPRC. The sample size was determined using the formula N = [z. ∂/Error] 2 [30]. Where: N = the necessary sample size, z = standard score for Confidence Level, ∂ = population standard deviation and Error = allowable error (desired level of precision). The values of z (confidence level) was = 99.7%, ∂ =0.50 for maximum variability and Error = 0.05 obtained from available literature [14, 31]. Hence, using the above formula, the sample size (N) was 99.4. As a result, a sample size of 100 was selected. The study was observational, and quantitative in design. A convenient sampling in a cross-sectional model was used to recruit participants on whom facial anthropometric measurements were made from February 2019 to August 2019. Volunteers were recruited from the Korle-Bu Campus of the University of Ghana. Persons recruited for the study were 18-30-year-old males and females with Body Mass Index ≤ 27 kg/m 2 who had a family ancestry of both sets of parents, grandparents, and great grandparents of indigenous African descent, and who agreed to sign the informed consent form (Supplementary 1). Persons who had any one of the following were excluded: plastic surgery before the study, facial trauma, congenital or developmental abnormality, or craniofacial surgery. Measurements and techniques Direct and indirect measurements Direct anthropometric (nasal and labio-oral angular) measurements were taken with the participant’s head positioned such that the Frankfurt plane was horizontal [32]. Each participant was seated on a chair, and the researcher sat on another chair in front of them with the researcher’s head at the level of the participant’s head. A novel method for accurately measuring facial angles was devised for this study using orthodontic brass wire (Dentaurum, 0,6 mm, REF 572-060-00, Germany) and a goniometer (Ever Ready Plastic 12" Goniometer 360 Degree ISO, USA). A piece of brass wire (Fig. 1 A) was bent using a pair of bird beak orthodontic pliers (Hu-Friedy, REF 678 − 304, USA; Fig. 1 B) and progressively adapted to adequately fit the profile facial angles of the volunteer (Fig. 1 D). The resulting bent brass wire was then superimposed on the goniometer (Fig. 1 C & E), leading to an accurate reading of the measured angle. To the best of the authors’ knowledge, this method has not been described or used elsewhere. An intra-researcher reliability test was performed with five subjects, and their measurements were recorded at two different times. The results of intra-researcher reliability were calculated using the Bland-Altman test, Dahlberg method, and absolute difference divided by the mean. The method showed a low error that was generally less than 2.4°, which is considered acceptable [33]. Indirect nasal and labio-oral angular measurements were performed using standard facial photographs [34]. All photographs were taken by the same investigator with the same camera (Nikon Coolpix L340, Japan) using a resolution of 20.2 megapixels, 28x optical zoom wide, and 630 mm macro focusing. A constant distance of 100 cm was maintained between the participant and investigator. Gimp 2.10.12 software (Creative Commons, California, USA) was used for indirect angular measurements. The same landmarks used for the direct measurements were used for the indirect angle measurements. Variables Measured and their landmarks Seven (7) nasal and labio-oral angles were measured using both direct and indirect methods: Nasofrontal angle (NFA); Nasal tip angle (NTA); Nasolabial angle (NLA); Alar slope angle (ASA); Labiomental angle (LMA); Mandibular-Frankfurt plane angle (MFA); and Mentocervical angle (MCA). The landmarks used for the measurement of these seven nasal and labio-oral angles are shown in Fig. 2 . They are the glabella (G), the most anterior point of the forehead at the level of the superior orbital ridges in the midsagittal plane; the soft tissue nasion (N), the point in the midline of both the nasal root and the nasofrontal suture; the Dorsum Nasi (DN), dorsum of the nose from the nasal root to the nasal tip; the subnasale (Sn), the midpoint of the angle at the columella base where the lower border of the nasal septum and the surface of the upper lip meet antero-superiorly; the labrale superius (Ls), the most anterior point on the margin of the upper membranous lip; the external surface of the ala of the nose (Al); the labrale inferius (Li), the midline point representing the mucocutaneous vermilion border of the lower lip; the sublabiale (Sbl), the midline point of greatest concavity on the facial contour of the lower lip between the labrale inferius and soft tissue menton; the soft tissue pogonion (Pog’), the most prominent midline point of the soft tissue chin pad; the Orbitale (or), the deepest point on the infraorbital margin; the Porion (Po), the most superior and outer bony surface point of the external auditory meatus; the Gonion (Go), the intersection between the mandibular line and the ramus line; soft tissue Menton (Me): the most inferior point of the mandibular soft tissue symphysis ; the Tragus (t), a tongue-like projection of the outer ear projecting posteriorly over the external auditory meatus; Cervical point (C), inner-most point between the submentum and the neck. Angular measurements The nasofrontal angle (NFA) was measured as the angle formed by the intersection of the straight line from the glabella (G) to the soft tissue nasion (N) and the straight line from N tangent to the dorsum nasi (DN) (Fig. 2 , top left). The nasal tip angle (NTA) was measured as the angle formed by the intersection of the straight line tangent to the DN from its midpoint anteroinferiorly and the straight-line tangent to the profile contour of the columella from the subnasale (Sn) anterosuperior (Fig. 2 , top middle). The nasolabial angle (NLA) was measured as the angle formed by the intersection of the straight line tangent to the profile contour of the columella from the subnasale (Sn) anterosuperior and the straight line from the Sn to the labrale superius (Ls) (Fig. 2 , top middle). The alar slope angle (ASA) was measured as the angle formed by the intersection of the straight line tangent to the external surface of the ala of the nose (Al) on the right side and its counterpart on the left side (Fig. 2 , top right). The labiomental angle (LMA) was measured as the angle formed by the intersection of the straight line from the labrale inferius (Li) to the sublabiale (Sbl) and the straight line from Sbl to the soft tissue pogonion (Pog’) (Fig. 2 , bottom left). The Mandibular-Frankfurt plane angle (MFA) was measured as the angle formed by the intersection of the straight line from the orbitale to the porion (Po) and the straight line from the menton (Me) to the gonion ( Go). On the skin, Po was projected to be one centimeter superior to the tragus (t) (Fig. 2 , bottom middle). The mentocervical angle (MCA) was measured as the angle formed by the intersection of the straight line from the glabella (G) to the soft tissue pogonion ( Pog’) and the straight line from the menton (Me) to the cervical point (C) (Fig. 2 , bottom right). Statistical analysis The collected data were analyzed using IBM SPSS Statistics for Windows, Version 22.0 (IBM Corp., Armonk, N.Y., USA). The normal distribution of quantitative variables was assessed using the Shapiro-Wilk test. Statistical significance of the difference between groups was determined using Student’s independent t-test. The paired t-test was used to compare data obtained by direct and indirect measurements. Scatter plots with Pearson’s correlation analyses were used to determine the relationship between direct and indirect measurements. Differences were considered statistically significant at p ≤ 0.05. Results The results of both the direct and indirect angular measurements for all study participants (male and female) are summarized in Table 1 . An Independent t-test comparison of the direct angular nasal and labio-oral measurements of male and female participants showed no significant differences in all angles, except in the NFA (p = 0.000; Table 2 ). Similarly, indirect angular nasal and labio-oral measurements showed no significant differences between male and female participants, except for the NFA (p = 0.000; Table 3 ). There were also no significant differences between the direct and indirect measurements for all angles except for MFA (p = 0.037; t= -2.112; CI: -1.07102 to − .03374) and MCA (p = 0.013; t= -2.522; CI: -2.18766 to − .26187) (Table 4 ). Additionally, there was a significant correlation between the direct and indirect measurements for all seven nasal and labio-oral angles (Table 4 ). A summary of Pearson’s correlation analyses of direct and indirect measurements of all seven nasal and labio-oral angles of the study participants (both sexes combined) are presented in Table 5 (p = 0.000). Scatter plots of the direct versus indirect angular measurements displayed a strong linear positive correlation for all the angles measured, except for the MFA and MCA, as illustrated in Fig. 3 . In addition to a weak correlation, MFA displayed multiple outliers. Table 1 Summary of direct and indirect angular nasal and labio-oral measurements of 105 study participants (both sexes). Angles Sex N Mean Direct (º) Mean Indirect (º) NFA M 54 125.25 (SD 8.91) 125.27 (SD 8.45) F 51 134.49 (SD 7.49) 134.33 (SD 7.49) NTA M 54 72.70 (SD 5.65) 72.70 (SD 5.59) F 51 74.20 (SD 5.69) 74.11 (SD 5.51) NLA M 54 79.79 (SD 9.11) 79.92 (SD 8.82) F 51 82.41 (SD 10.21) 82.47 (SD 9.84) MLA M 54 112.34 (SD 16.84) 111.88 (SD 16. 50) F 51 82.41 (SD 13.64) 113.80 (SD 13.78) ASA M 54 108.23 (SD 15.80) 108.11 (SD 15.34) F 51 104.89 (SD 12.22) 104.96 (SD 11.86) MFA M 54 19.81 (SD 3.31) 20.18 (SD 2.54) F 51 19.17 (SD 3.29) 19.89 (SD 2.78) MCA M 54 79.86 (SD 7.78) 81.37 (SD 7.23) F 51 80.46 (SD 10.59) 81.39 (SD 10.74) Meaning of abbreviations used: NFA (nasofrontal angle); NTA (nasal tip angle); NLA (nasolabial angle); LMA (labiomental angle); ASA (Alar slope angle); MFA (Mandibular Frankfurt plane angle); MCA (mentocervical angle). M (male); F (female); SD (standard deviation). Table 2 Synopsis of independent t-test comparisons of direct angular anthropometric measurements for male and female participants. The level of significance (α) was set at 0.05. Variable t-value p-value 95% CI of the Difference Lower Upper NFA -5.733 0.000 -12.4370 -6.0434 NTA -1.355 0.178 -3.7012 0.6969 NLA -1.386 0.169 -6.3589 1.1279 LMA − .559 0.578 -7.6295 4.2755 ASA 1.206 0.231 -2.1534 8.8321 MFA 1.035 0.303 − .6117 1.9472 MCA -0.328 0.744 -4.1768 2.9923 Meaning of abbreviations used: NFA (nasofrontal angle); NTA (nasal tip angle); NLA (nasolabial angle); LMA (labiomental angle); ASA (alar slope angle); MFA (Mandibular Frankfurt plane angle); MCA (mentocervical angle). p is the probability, t is the student’s t-value, and CI is the confidence interval. Table 3 Synopsis of independent t-test comparisons of indirect angular anthropometric measurements for male and female participants. The level of significance (α) was set at 0.05. Variable t-value p-value 95% CI of the Difference Lower Upper NFA -5.794 0.000 -12.1550 -5.9561 NTA -1.303 0.196 -3.5665 0.7387 NLA -1.396 0.166 -6.1586 1.0693 MLA − .643 0.521 -7.8188 3.9888 ASA 1.172 0.244 -2.1804 8.4810 MFA 0.563 0.574 -0.7385 1.3245 MCA -0.012 0.990 -3.5481 3.5045 Meaning of abbreviations used: NFA (nasofrontal angle); NTA (nasal tip angle); NLA (nasolabial angle); LMA (labiomental angle); ASA (alar slope angle); MFA (Mandibular Frankfurt plane angle); MCA (mentocervical angle). p is the probability, t is the student’s t-value, and CI is the confidence interval. Table 4 Summary of paired t-test comparisons between Direct and Indirect Angular Nasal and Labio-oral Measurements from 105 participants in this study with the level of significance (α) set at 0.05 Direct and Indirect Angular Nasal and Labio-Oral Measurements Paired Differences Mean Std. Deviation Std. Error Mean 95% Confidence Interval of the Difference t-value p-value Lower Upper Pair 1 NFA - iNFA .06190 1.85106 .18064 − .29632 .42013 0.343 0.733 Pair 2 NTA - iNTA .04286 1.34828 .13158 − .21807 .30378 0.326 0.745 Pair 3 NLA - iNLA − .09524 1.52400 .14873 − .39017 .19969 -0.640 0.523 Pair 4 MLA - iMLA .33810 1.93214 .18856 − .03582 .71201 1.793 0.076 Pair 5 ASA - iASA .02857 1.87446 .18293 − .33418 .39133 0.156 0.876 Pair 6 MFA - iMFA − .55238 2.67999 .26154 -1.07102 − .03374 -2.112 0.037 Pair 7 MCA - iMCA -1.22476 4.97557 .48557 -2.18766 − .26187 -2.522 0.013 Meaning of abbreviations used: NFA (nasofrontal angle); NTA (nasal tip angle); NLA (nasolabial angle); LMA (labiomental angle); ASA (alar slope angle); MFA (Mandibular Frankfurt plane angle); MCA (mentocervical angle). Prefix i represents an indirect method for measuring the respective angular nasal and labio-oral variables. Table 5 A summary of Pearson’s correlation analyses of direct and indirect measurements of all seven nasal and Labio-oral angles of the study participants (both sexes combined). Variables Correlation Coefficient (r) P level Pair 1 NFA & iNFA 0.981 0.000 Pair 2 NTA & iNTA 0.972 0.000 Pair 3 NLA & iNLA 0.988 0.000 Pair 4 MLA & iLMA 0.992 0.000 Pair 5 ASA & iASA 0.991 0.000 Pair 6 MFA & iMFA 0.615 0.000 Pair 7 MCA & iMCA 0.852 0.000 Meaning of abbreviations used: NFA (nasofrontal angle); NTA (nasal tip angle); NLA (nasolabial angle); LMA (labiomental angle); ASA (alar slope angle); MFA (Mandibular Frankfurt plane angle); MCA (mentocervical angle). Prefix i represents an indirect method for measuring the respective angular nasal and labio-oral variables. As shown in Table 6 , the general trend is suggestive of decreased NLA and increased ASA compared to Caucasian values [16, 17]. The findings of the present study tended to match those of African Americans in comparison with published data [35] but showed significant differences when compared with data published by Farkas et al. [36]. Table 6 Comparison of nasal angles of females and males in the present study and other ethnic groups. Angles are in degrees (⁰). Author(s) Ethnic Group Sex N NFA NTA NLA LMA ASA MFA MCA Uzun and Ozdemir, 2014 Caucasian (Turkish) F 59 133.16 77.91 98.91 -- 80.89 -- -- Uzun and Ozdemir, 2014 Caucasian (Turkish) M 56 123.85 82.16 97.91 -- 85.98 -- -- Farkas et al., 2007 African American F 50 127.6 -- 73.9 101.6 -- -- -- Farkas et al., 2007 African American M 50 126.5 -- 71.4 101.5 -- -- -- Virdi et al., 2019 Negroid Africans (Kenya) F 36 127.9 -- 85.2 116.9 -- -- -- Virdi et al., 2019 Negroid Africans (Kenya) M 34 127.3 -- 85.5 128.2 -- -- -- Present study Negroid Africans (Ghana) F 51 134.49 74.20 82.41 114.02 104.89 19.14 80.46 Present study Negroid Africans (Ghana) M 54 125.25 72.70 79.79 112.34 108.23 19.81 79.86 Discussion A notable finding in our study was a significantly greater NFA in females than males. This contrasts with [37], who found that NFA for African American females was lower (131.90; SD 6.80) than for males (135.60:SD 5.40). Szychta et al. [38] found no significant differences in the NFA in Caucasians in Poland. Whereas Farkas et al. [36] reported similar values of NFA for African American females and males (127.60 and 126.50 respectively);, and Virdi et al. [24] had the same NFA for Kenyan females (127.90) and males (127.30). Given the assertion that NFA is a potentially important factor in the perception of facial profile attractiveness [ 5 ], and that surgical alterations of NFA can cause prominent changes in the face [39], our present finding that indigenous Ghanaian females have a larger NFA than males, contrary to previous reports on females of Negroid descent, is noteworthy. Moreover, it underscores the crucial need for local angular nasal and labio-oral measurements because of variations due to ethnicity, age, weight, and sex [40], and data that equip surgeons to prevent diagnostic errors such as obtuse NFA that can simulate a long nose [41]. According to the latter authors, females have a greater NFA than males, and the more acute NFA in males was interpreted to mean that men have a more projected nasal tip. The results of the present study are comparable to the NFA reported for young adults (18–30 years) in Turkey [17], with females having 133.6 ± 8.880 and males 123.85 ± 13.230. It has been reported [ 5 ] that among many ethnic groups, including African Americans, the NFA of 130.0 was judged to be the most attractive, and it is notable that our present report has consonant value for autochthonic Ghanaian females. The strong correlation between the direct and indirect angular measurements reported in our study confirms the usefulness of the photogrammetric method in cases of traumatic facial alterations in accidents [41]. The aesthetic effectiveness of surgical reconstruction may be enhanced by determining the nasal and labio-oral angles from photographs of the patients. This is in addition to the advantages of high availability and documentation of photogrammetry [41]. We concur with the latter authors that the problem of standardization in an indirect method that may introduce variations of a few millimeters in linear anthropometric dimensions can be eliminated by using ratios and angles between primary measures. Our results suggest that the seven nasal and labio-oral angles in this study could be accurately determined from photographs for planning and evaluating steps in reconstructive surgery of the face and orthodontics and dentofacial orthopaedics [42] as well as in criminal and forensic identification. There was no significant difference between the means of direct and indirect anthropometry, except for (2) angles, MFA, and MCA. This could be attributed to differences in the methods used to measure the above-mentioned angles. The latter two angles were directly measured using a goniometer. It can be postulated that time has come to focus more on indirect angular facial anthropometry and gradually phase out direct angular facial anthropometry as the indirect method is less physically demanding and less time-consuming. A one-sample t-test comparing the means (NFA and NLA) obtained from this study with that of African Americans showed no significant difference. This could be attributed to the genetic link of African Americans to the indigenous Africans [31, 32, 35]. However, Farkas et al. [36] published data that showed significant differences compared to the results of the present study. Female participants in this study exhibited significant differences in the values of NFA, NLA, and MLA (p ˂ 0.05) in comparison with the data published by Farkas et al. [36], while male participants in this study showed significant differences in the values of NLA and MLA, but not in the NFA. Unlike the comparison with African Americans in the previous section that showed no significant differences (NFA and NLA) when compared with data published by Porter [35] but showed significant differences when compared with data published by Farkas et al. [36], NFA, NLA, NTA, and ASA exhibited significant differences when compared with published data on Caucasian populations [16, 17, 36]. NLA was significantly decreased in Negroid Africans in comparison with data from studies on Caucasians. This could be attributable to the predominance of a broad nose, wider mouth, and fuller lips in Negroid Africans [ 14 ] Conclusion This study produced data on angular nasal and labio-oral measurements of Indigenous Africans in Ghana. Females have NFA values that conform to the reported ideal and are greater than males. Strong correlations between the direct and indirect angular measurements suggest their accurate determination by the photogrammetric method and use when necessary. Our baseline results could be used to establish a more robust database of angular nasal and labio-oral anthropometric measurements in indigenous Ghanaians. The strong positive correlation between direct and indirect facial angular anthropometric measurements in the present study suggests the use of the indirect photogrammetric method instead of direct, tedious, and physically demanding angular anthropometric measurements, especially as image-capturing technology improves. Abbreviations The following abbreviations are used in this manuscript: EPRC Ethical and Protocol Review Committee CHS College of Health Sciences ORID Office of Research, Innovation, and Development's BW Brass wire NFA Nasofrontal angle G Glabella N Soft tissue nasion NTA Nasal tip angle NLA Nasolabial angle DN Dorsum Nasi Sn Subnasale Ls Labrale superius ASA Alar slope angle Al Alare LMA Labiomental angle Li Labrale inferius Sbl Sublabiale MFA Mandibular-Frankfurt plane angle Or Orbitale Go Gonion Me Menton Po Porion t Tragus MCA Mentocervical angle FP Facial plan L mental line G Glabella Pog’ Soft tissue pogonion Me Menton C Cervical point Declarations Ethics approval and consent to participate This work was conducted in accordance with the Declaration of Helsinki (1964). The study received approval from the University of Ghana’s Ethical and Protocol Review Committee, College of Health Sciences, under reference [ID: CHS-Et/M.6-4.11/2018-2019], and written informed consent was obtained from all participants prior to their participation in the study. Consent for publication Written informed consent was obtained from all study participants and/or their legal guardians for the publication of identifying information and facial images in an online open-access journal. All participants and/or their legal guardians understood that the images and related information would be publicly available and freely consented to publication. Availability of data and materials Data is provided within the manuscript or supplementary information files. Competing Interests The authors declare that there is no conflict of interest regarding the publication of this article. Clinical trial number Not applicable. Funding This research received no external funding. Author Contributions Conceptualisation: P.M.M, R.M.B, and K.K.A-O data curation: P.M.M, R.M.B, and K.K.A-O formal analysis: P.M.M, B.A. B.A-B and K.K.A-O Funding acquisition: P.M.M, B.A.H, J.A, B.A-B, N.K-K.K investigation: P.M.M, R.M.B, B.A.H, C.N.B.T, B.A-B and K.K.A-O methodology: P.M.M, R.M.B, B.A.H, J.A, N.K-K.K, K.K.A-O and F.K.A project administration: P.M.M, B.A-B, R.M.B, B.A.H, and J.A. resources: P.M.M, N.K-K.K, C.N.B.T, R.M.B, B.A.H, J.A, B.A-B and K.K.A-O software: P.M.M, P.O.A, B.A-B, K.K.A-O and N.K-K.K Supervision: R.M.B, B.A.H, and K.K.A-O Validation: P.M.M, R.M.B, B.A.H, C.N.B.T, J.A and F.K.A Visualisation: P.M.M, R.M.B, B.A.H, J.A, N.K-K.K, P.O.A and K.K.A-O writing original draft: P.M.M, R.M.B, K.K.A-O, B.A.H, P.O.A, and B.A-B writing review and editing: P.M.M, R.M.B, P.O.A, J.A, B.A-B, C.N.B.T and F.K.A. Acknowledgment The authors wish to thank all the members of staff of the Departments of Anatomy (UGMS) for their support. References Rice A, Phillips PJ, Natu V, et al. Unaware person recognition from the body when face identification fails. Psychol Sci 2013; 24: 2235–43. Moore KL, Persaud TVN, Torchia MG. The Developing Human-E-Book: Clinically Oriented Embryology . Saunders, 2018. Sadler TW. Langman’s medical embryology . 12th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2012. Park CW, Lee MJ, Jung YI. Photogrammetric Facial Analysis of Attractive Celebrities Using the Glabella for Planning Rhinoplasty and Analyzing Surgical Outcomes. Arch Aesthetic Plast Surg 2018; 24: 105–110. Naini FB, Cobourne MT, Garagiola U, et al. Nasofacial angle and nasal prominence: A quantitative investigation of idealized and normative values. J Cranio-Maxillofac Surg 2016; 44: 446–452. Moorhouse A, Evans AN, Atkinson GA, et al. The nose on your face may not be so plain: Using the nose as a biometric. In: IET Seminar Digest . 2009. Epub ahead of print 2009. DOI: 10.1049/ic.2009.0231. Alcalde RE, Jinno T, Orsini MG, et al. Soft tissue cephalometric norms in Japanese adults. Am J Orthod Dentofacial Orthop 2000; 118: 84–89. Dua V, Gupta S, Singh C. Evaluation of the nasolabial angle in the Indian population. Contemp Clin Dent 2010; 1: 79. Kandhasamy K, Prabu N, Sivanmalai S, et al. Evaluation of the nasolabial angle of the Komarapalayam population. J Pharm Bioallied Sci 2012; 4: 313. Nandini S, Prashanth CS, Somiah SK, et al. An evaluation of nasolabial angle and the relative inclinations of the Nose and Upper Lip. J Contemp Dent Pract 2011; 12: 152–157. Ballin AC, Carvalho B, Dolci JEL, et al. Anthropometric study of the caucasian nose in the city of Curitiba: Relevance of population evaluation. Braz J Otorhinolaryngol ; 84. Epub ahead of print 2017. DOI: 10.1016/j.bjorl.2017.06.004. Balaji S. Facial feminization - Surgical modification for Indian, European and African faces. Ann Maxillofac Surg 2016; 6: 210. Bawumia M. Government equips NIA for National ID card registration, https://www.businessghana.com/site/news/general/162108/Government-equips- NIA-for-National-ID-card-registration (2018, accessed 7 January 2020). Ampadu ED. Facial Anthropometrics indexes of Ghanaian Adults . University of Ghana Medical School, 2008. Koney NK-K. Facial anthropometrics measurements in Ghanaians aged 12-13 years . University of Ghana Medical School, 2009. Uzun A, Ozdemir F. Morfométrica análise de nasais formas e ângulos em adultos jovens. Braz J Otorhinolaryngol 2014; 80: 397–402. Edler RJ. Background Considerations to Facial Aesthetics. J Orthod ; 28. Epub ahead of print 2001. DOI: 10.1093/ORTHO/28.2.159. Farkas L, Hreczko T, Kolar J, et al. Vertical and horizontal proportions of the face in young adult North American Caucasians: revision of neoclassical canons. Plast Reconstr Surg 1985; 75: 328–338. Al-Sebaei MO. The validity of three neo-classical facial canons in young adults originating from the Arabian Peninsula. Head Face Med ; 11. Epub ahead of print 13 March 2015. DOI: 10.1186/s13005-015-0064-y. Akinlolu A. Facial biometrics using Akinlolu-Raji image-processing algorithm and anthropological facts which prove that Kebbi and Zamfara Hausas are Hausa Bakwai. Sub-Sahar Afr J Med 2016; 3: 45. Hegazy AA. ANTHROPOMETRIC STUDY OF NASAL INDEX OF EGYPTIANS. Int J Anat Res 2014; 2: 761–767. Uzun A, Akbas H, Bilgic S, et al. The average values of the nasal anthropometric measurements in 108 young Turkish males. Auris Nasus Larynx 2006; 33: 31–35. Virdi SS, Wertheim D, Naini FB. Normative anthropometry and proportions of the Kenyan-African face and comparative anthropometry in relation to African Americans and North American Whites. Maxillofac Plast Reconstr Surg 2019; 41: 9. EBOH DEO. Horizontal Facial Thirds of Young Adults in Two South-South Nigerian Ethnic Groups. Anat Biol Anthropol 2019; 32: 115. Cheetham S. Preliminary Assessment of Facial Parameters of the Akan and Ewes of Ghana . Kwame Nkrumah University of Science and Technology, 2017. Parkins G, Boamah MO, Avogo D, et al. Maxillofacial and concomitant injuries in multiple injured patients at Korle Bu Teaching Hospital, Ghana. West Afr J Med 2014; 33: 51–55. Acheampong AO, Newman-Nartey M, Obiri-Yeboah S, et al. Motorcycle Related Oral and Maxillofacial Injuries Seen at Komfo Anokye Teaching Hospital, Kumasi-Ghana. Surg Sci 2019; 10: 106–112. Blankson PK, Amoako JKA, Asah-Opoku K, et al. Epidemiology of injuries presenting to the accident centre of Korle-Bu Teaching Hospital, Ghana. BMC Emerg Med 2019; 19: 39. Charan J, Biswas T. How to calculate sample size for different study designs in medical research? Indian Journal of Psychological Medicine 2013; 35: 121–126. Farkas LG, Katic MJ, Forrest CR, et al. International anthropometric study of facial morphology in various ethnic groups/races. J Craniofac Surg 2005; 16: 615–646. Farkas LG. Anthropometry of the head and face . 2nd ed. New York: Raven Press, 1994. Kim H-Y. Statistical notes for clinical researchers: assessing normal distribution (2) using skewness and kurtosis. Restor Dent Endod 2013; 38: 52. Choi JY, Park JH, Javidnia H, et al. Effect of various facial angles and measurements on the ideal position of the nasal tip in the Asian patient population. JAMA Facial Plast Surg 2013; 15: 417–421. Porter JP. The average African American male face: An anthropometric analysis. Arch Facial Plast Surg 2004; 6: 78–81. Farkas LG, Katic MJ, Forrest CR. Comparison of craniofacial measurements of young adult African-American and North American white males and females. Ann Plast Surg 2007; 59: 692–698. Ofodile FA, Bokhari F. The African-American Nose. Ann Plast Surg 1995; 34: 123–129. Szychta P, Rykała J, Kruk-Jeromin J. Individual and ethnic aspects of preoperative planning for posttraumatic rhinoplasty. Eur J Plast Surg 2011; 34: 245–249. Pousti SB, Jalessi M, Asghari A. Management of Nasofrontal Angle in Rhinoplasty. 2010; 12: 7–11. Adelakun S, Ogunlade B, AKingbade G, et al. Anthropometric characterization of nasal parameters In adults oyemekun ethnic group in akure southwest Nigeria. Int J Anat Res 2018; 6: 5272–5279. Ballin AC, Carvalho B, Dolci JEL, et al. Anthropometric study of the caucasian nose in the city of Curitiba: relevance of population evaluation. Braz J Otorhinolaryngol 2018; 84: 486–493. Doddi NM, Eccles R. The role of anthropometric measurements in nasal surgery and research: A systematic review. Clinical Otolaryngology 2010; 35: 277–283. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6556297","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":477841229,"identity":"424fc6dc-3b55-46a3-828f-3cae3169b795","order_by":0,"name":"Paul M. Matondo","email":"","orcid":"","institution":"University of Ghana Dental School","correspondingAuthor":false,"prefix":"","firstName":"Paul","middleName":"M.","lastName":"Matondo","suffix":""},{"id":477841230,"identity":"7cc554dd-041c-4a67-877b-b68ddc297c64","order_by":1,"name":"Kevin Kofi Adutwum-Ofosu","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA+ElEQVRIiWNgGAWjYBACCQYGAyiT8QGQsIGJMiTg1XIAzGQG6U0jXcthwlok2w9vk/7Ydjiagb2Z8eHPtvOJ8x2YD97mYajNw6VFmietTOJg2+HcBp7DzMa8bbcTNx5gS7bmYThejEuLHEOOmcTBbYdz99/IPybNCNLSwGMmzcNwLLEBlxb+NxAtDRLJbJI/284BtfB/w6tFWiIHoUWCt+1A4nwGHjaglhqcWiRnPCu2OPsvHeIXnnPJxhuY2Ywt5xgcwKlF4nzyxhsVZ6xzG0Ah9qPMTnZ+e/PDG28q6nBqwQQGhxEkkUAeYnodCVpGwSgYBaNgmAMAUrxZ5QshLmQAAAAASUVORK5CYII=","orcid":"","institution":"University of Ghana Medical School","correspondingAuthor":true,"prefix":"","firstName":"Kevin","middleName":"Kofi","lastName":"Adutwum-Ofosu","suffix":""},{"id":477841231,"identity":"ea741af7-13e5-4b71-b7cd-ebac53a9bd28","order_by":2,"name":"Richard Michael Blay","email":"","orcid":"","institution":"University of Ghana Medical School","correspondingAuthor":false,"prefix":"","firstName":"Richard","middleName":"Michael","lastName":"Blay","suffix":""},{"id":477841232,"identity":"e9174794-214f-48be-b3a2-24906ec66f5f","order_by":3,"name":"John Ahenkorah","email":"","orcid":"","institution":"University of Ghana Medical School","correspondingAuthor":false,"prefix":"","firstName":"John","middleName":"","lastName":"Ahenkorah","suffix":""},{"id":477841233,"identity":"31444cf1-7a3f-4574-9236-6e7a7fc2d4de","order_by":4,"name":"Bismark Afedo Hottor","email":"","orcid":"","institution":"University of Ghana Medical School","correspondingAuthor":false,"prefix":"","firstName":"Bismark","middleName":"Afedo","lastName":"Hottor","suffix":""},{"id":477841234,"identity":"53a46b3c-9629-43f2-adac-81f6b88310fa","order_by":5,"name":"Nii Koney-Kwaku Koney","email":"","orcid":"","institution":"University of Ghana Medical School","correspondingAuthor":false,"prefix":"","firstName":"Nii","middleName":"Koney-Kwaku","lastName":"Koney","suffix":""},{"id":477841235,"identity":"22b9db24-5f4a-4756-b37c-da086ff89228","order_by":6,"name":"Benjamin Arko-Boham","email":"","orcid":"","institution":"University of Ghana Medical School","correspondingAuthor":false,"prefix":"","firstName":"Benjamin","middleName":"","lastName":"Arko-Boham","suffix":""},{"id":477841236,"identity":"d318a293-6dcf-4575-a5eb-97f5f65e3441","order_by":7,"name":"Peter Ofori Appiah","email":"","orcid":"","institution":"University of Ghana Medical School","correspondingAuthor":false,"prefix":"","firstName":"Peter","middleName":"Ofori","lastName":"Appiah","suffix":""},{"id":477841237,"identity":"e4264ab3-719b-4dfc-be21-1c58a880221e","order_by":8,"name":"Clifford Nii Boi Tagoe","email":"","orcid":"","institution":"University of Ghana Medical School","correspondingAuthor":false,"prefix":"","firstName":"Clifford","middleName":"Nii Boi","lastName":"Tagoe","suffix":""},{"id":477841238,"identity":"54e08983-a718-4d39-aed9-1cf7afc8131f","order_by":9,"name":"Frederick Kwaku Addai","email":"","orcid":"","institution":"University of Ghana Medical School","correspondingAuthor":false,"prefix":"","firstName":"Frederick","middleName":"Kwaku","lastName":"Addai","suffix":""}],"badges":[],"createdAt":"2025-04-29 12:08:22","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6556297/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6556297/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":85865653,"identity":"0bc533cf-f5e9-4262-ba39-d1faea0c9923","added_by":"auto","created_at":"2025-07-02 13:01:08","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":154238,"visible":true,"origin":"","legend":"\u003cp\u003eMaterials used for direct nasal and labio-oral angular measurements. A: Brass wire; B: A pair of Bird beak orthodontic pliers; C: Goniometer; D: Progressively adapted brass wire (BW) bent with the pair of bird beak orthodontic pliers; E: Brass wire (BW) superimposed on the goniometer enabling accurate angle reading.\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6556297/v1/17618241a810569a62e5afab.jpg"},{"id":85866637,"identity":"6887c05c-d2e4-4817-af8a-cd3aa8c7e72a","added_by":"auto","created_at":"2025-07-02 13:17:08","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":2064878,"visible":true,"origin":"","legend":"\u003cp\u003ePhotographs showing the nasal and labio-oral angles measured, and the anatomical landmarks that were used. Top left:\u003cstrong\u003e \u003c/strong\u003eNFA -Nasofrontal angle,\u003cem\u003e \u003c/em\u003eG - Glabella, N - Soft tissue nasion; Top middle: NTA - Nasal tip angle, NLA - Nasolabial angle,\u003cem\u003e \u003c/em\u003eDN - Dorsum Nasi, Sn - Subnasale, Ls - Labrale superius; Top right: ASA - Alar slope angle,\u003cem\u003e \u003c/em\u003eAl - Alare.\u003c/p\u003e\n\u003cp\u003eBottom left: LMA - Labiomental angle,\u003cem\u003e \u003c/em\u003eLi-labraleinferius, Sbl-Sublabiale, Pog’\u003cstrong\u003eS\u003c/strong\u003eoft - Soft-tissue pogonion; Bottom middle: MFA - Mandibular-Frankfurt plane angle,\u003cem\u003e \u003c/em\u003eOr - Orbitale, Go - Gonion, Me - Menton, Po(Porion), t\u003cem\u003e \u003c/em\u003e– Tragus; Bottom right: MCA–Mentocervical angle, FP–Facial plan, L–mental line,\u003cem\u003e \u003c/em\u003eG–Glabella, Pog’–\u003cstrong\u003eS\u003c/strong\u003eoft tissue pogonion, Me–Menton, C–Cervical point.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-6556297/v1/b524bc7b56a36e5e18f9c268.png"},{"id":85865659,"identity":"6aaef486-6be8-4928-9197-59786b5bc69f","added_by":"auto","created_at":"2025-07-02 13:01:08","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":207904,"visible":true,"origin":"","legend":"\u003cp\u003eThe relationship between direct and indirect angular anthropometric measurements of the nasal and labio-oral angles. The best-fit regression equation for each pair is indicated on the respective graph. Y-axis represents the indirect measurements, and the X-axis represents the direct measurements. The following angular data sets are plotted: A – NFA; B -NTA; C -NLA, D – MLA, E – ASA, F -MFA, and G - MCA\u003c/p\u003e\n\u003cp\u003eMeaning of abbreviations used: NFA (nasofrontal angle); NTA (nasal tip angle); NLA (Nasolabial angle); MLA (mentolabial angle); ASA (alar slope angle); MFA (Mandibular Frankfurt plane angle); MCA (mentocervical angle). Prefix i represents an indirect method for measuring the respective angular nasal and labio-oral variables.\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-6556297/v1/75964949361e71e637a1f9c6.png"},{"id":95850556,"identity":"566447d1-f1d0-4d31-b862-503ceee3222e","added_by":"auto","created_at":"2025-11-13 15:39:00","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":3203751,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6556297/v1/1b9045ee-ed70-47a3-91e6-75c13113f183.pdf"},{"id":85866455,"identity":"e4a264e7-fa2b-4a35-b801-df5d619ef2b4","added_by":"auto","created_at":"2025-07-02 13:09:08","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":62363,"visible":true,"origin":"","legend":"","description":"","filename":"Supplementary1.docx","url":"https://assets-eu.researchsquare.com/files/rs-6556297/v1/55fb90955b28f7700b498dfe.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Nasal and labio-oral angles in young adult indigenous Ghanaians","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe human face is important for recognition and communication, and provides useful information for identifying a person [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Damage to the face, such as scarring or developmental deformities, adversely affects the psyche [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. The development of the human face involves morphogenetic movements and the interplay of primordial structures that form the nose in a region around a primitive mouth [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. The nose is essential for facial beauty; hence, rhinoplasty is among the most frequently performed aesthetic surgical procedures [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. This is not surprising since the nose occupies a central position on the face and is a dominant part of the facial profile [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. In addition, as a prominent facial feature, the nose is both unique and easily identified, making it a valuable biometric identification marker [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e In humans, the mouth is another prominent feature of the face, which, in addition to being the beginning of the gastrointestinal tract, also plays a significant role in communication (both verbal and nonverbal). Normative angles of the nasal and labio-oral regions are integral and essential parts of craniofacial anthropometric data necessary for facial surgery to repair damage and orthodontic treatment to address facial developmental deformities [\u003cspan additionalcitationids=\"CR8 CR9\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. The case has been made for the clinical application of nasal and labio-oral angles in cases of congenital alterations, disfiguring traumas [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e], and facial feminization surgeries [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. In addition to their usefulness in facial surgery and dentistry, the nasal and labio-oral angles can be incorporated into local biometric (facial) identification software programs. This may improve the increasing and promising field of Biometrics in Ghana and Africa [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Therefore, generating normative values for nasal and labio-oral angles is fundamental to both clinical practice and general societal life. Establishing normative values of the angles of the nasal and labio-oral regions that are complementary to the linear measurements by Ampadu [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] and Koney [15] is an important step towards building/using local reference values. These measurements may serve as standards for plastic reconstructive facial surgery and orthodontics [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e For centuries, anthropologists and clinicians have attempted to objectively comprehend the concept of facial beauty [16]. During the Renaissance, artists emphasized symmetry and balanced proportions as the roots of facial beauty [17]. Their quantitative descriptions persisted as neoclassical canons[18, 19]. The canons assumed that certain fixed ratios exist between different variables of a harmonious face[18]. Essentially, the neoclassical canons defined three equal lengths of the face (the forehead, nose, mouth, and chin) as well as the intercanthal distance (the distance between the canthi or corners of the eye) being equal to the eye fissure length [17\u0026ndash;20]. These neoclassical facial canons are considered precursors of the current anthropometric facial indices [18]. Subsequently, medical artists and anatomists adopted these canons. Today, they are used in reconstructive facial surgeries in many clinical settings worldwide [17, 18]. Anthropometric measurements vary with age, gender, and ethnicity; and several authors have attempted to document normative values which may serve as local references [21\u0026ndash;25]. Three (3) studies on facial anthropometry in Ghana [14, 15, 26] are known to the authors of the present study. However, detailed angular measurements of the nasal and labio-oral regions, which are particularly crucial for maxillofacial surgical interventions, were not included in those studies. There are apparently no normative angular nasal and labio-oral anthropometric data for autochthonic young adults living in Ghana, which has the potential to limit the aesthetic effectiveness of reconstructive/plastic surgery on the face. Meanwhile, there is an increasing occurrence of traumatic facial deformities in recent years in Ghana [27, 28]. An extensive epidemiological study of injuries presented by 17,860 patients at the Korle-Bu Teaching Hospital in Ghana from January 2016 to December 2017 showed that Road Traffic accidents (RTA), especially motorcycle-related accidents, were a significant cause (39.1%) [29]. The latter study also revealed that the highest proportion (32.5%) of injuries stratified by 11 body regions involved the head (including the face, jaws, eyes, ears, and nose), while the majority of patients (67.8%) were male with an average age 27.6 years. It is expected that surgical reparative procedures in many such accident-injury cases will require data on the nasal and labio-oral angles. This study was an attempt to address the gap between normative nasal and labio-oral angles in Ghana, primarily for clinical purposes.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design and subjects\u003c/h2\u003e \u003cp\u003e The Ethical and Protocol Review Committee (EPRC) of the University of Ghana, College of Health Sciences (CHS) gave ethical clearance according to the Office of Research, Innovation, and Development's (ORID) Ethical Guidelines. A Protocol Identification Number CHS-Et/M.6-4.11/2018\u0026ndash;2019 was assigned to this research. A Volunteer Informed Consent Form (with a Questionnaire) was designed for this study and approved by the CHS EPRC. The sample size was determined using the formula N = [z. \u0026part;/Error]\u003csup\u003e2\u003c/sup\u003e [30]. Where: N\u0026thinsp;=\u0026thinsp;the necessary sample size, z\u0026thinsp;=\u0026thinsp;standard score for Confidence Level, \u0026part; = population standard deviation and Error\u0026thinsp;=\u0026thinsp;allowable error (desired level of precision). The values of z (confidence level) was =\u0026thinsp;99.7%, \u0026part; =0.50 for maximum variability and Error\u0026thinsp;=\u0026thinsp;0.05 obtained from available literature [14, 31]. Hence, using the above formula, the sample size (N) was 99.4. As a result, a sample size of 100 was selected.\u003c/p\u003e \u003cp\u003eThe study was observational, and quantitative in design. A convenient sampling in a cross-sectional model was used to recruit participants on whom facial anthropometric measurements were made from February 2019 to August 2019. Volunteers were recruited from the Korle-Bu Campus of the University of Ghana. Persons recruited for the study were 18-30-year-old males and females with Body Mass Index\u0026thinsp;\u0026le;\u0026thinsp;27 kg/m\u003csup\u003e2\u003c/sup\u003e who had a family ancestry of both sets of parents, grandparents, and great grandparents of indigenous African descent, and who agreed to sign the informed consent form (Supplementary 1). Persons who had any one of the following were excluded: plastic surgery before the study, facial trauma, congenital or developmental abnormality, or craniofacial surgery.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eMeasurements and techniques\u003c/h3\u003e\n\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eDirect and indirect measurements\u003c/h2\u003e \u003cp\u003eDirect anthropometric (nasal and labio-oral angular) measurements were taken with the participant\u0026rsquo;s head positioned such that the Frankfurt plane was horizontal [32]. Each participant was seated on a chair, and the researcher sat on another chair in front of them with the researcher\u0026rsquo;s head at the level of the participant\u0026rsquo;s head. A novel method for accurately measuring facial angles was devised for this study using orthodontic brass wire (Dentaurum, 0,6 mm, REF 572-060-00, Germany) and a goniometer (Ever Ready Plastic 12\" Goniometer 360 Degree ISO, USA). A piece of brass wire (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eA) was bent using a pair of bird beak orthodontic pliers (Hu-Friedy, REF 678\u0026thinsp;\u0026minus;\u0026thinsp;304, USA; Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eB) and progressively adapted to adequately fit the profile facial angles of the volunteer (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eD). The resulting bent brass wire was then superimposed on the goniometer (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eC \u0026amp; E), leading to an accurate reading of the measured angle. To the best of the authors\u0026rsquo; knowledge, this method has not been described or used elsewhere. An intra-researcher reliability test was performed with five subjects, and their measurements were recorded at two different times. The results of intra-researcher reliability were calculated using the Bland-Altman test, Dahlberg method, and absolute difference divided by the mean. The method showed a low error that was generally less than 2.4\u0026deg;, which is considered acceptable [33].\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eIndirect nasal and labio-oral angular measurements were performed using standard facial photographs [34]. All photographs were taken by the same investigator with the same camera (Nikon Coolpix L340, Japan) using a resolution of 20.2 megapixels, 28x optical zoom wide, and 630 mm macro focusing. A constant distance of 100 cm was maintained between the participant and investigator. Gimp 2.10.12 software (Creative Commons, California, USA) was used for indirect angular measurements. The same landmarks used for the direct measurements were used for the indirect angle measurements.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eVariables Measured and their landmarks\u003c/h3\u003e\n\u003cp\u003eSeven (7) nasal and labio-oral angles were measured using both direct and indirect methods: Nasofrontal angle (NFA); Nasal tip angle (NTA); Nasolabial angle (NLA); Alar slope angle (ASA); Labiomental angle (LMA); Mandibular-Frankfurt plane angle (MFA); and Mentocervical angle (MCA). The landmarks used for the measurement of these seven nasal and labio-oral angles are shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. They are the glabella (G), the most anterior point of the forehead at the level of the superior orbital ridges in the midsagittal plane; the soft tissue nasion (N), the point in the midline of both the nasal root and the nasofrontal suture; the Dorsum Nasi (DN), dorsum of the nose from the nasal root to the nasal tip; the subnasale (Sn), the midpoint of the angle at the columella base where the lower border of the nasal septum and the surface of the upper lip meet antero-superiorly; the labrale superius (Ls), the most anterior point on the margin of the upper membranous lip; the external surface of the ala of the nose (Al); the labrale inferius (Li), the midline point representing the mucocutaneous vermilion border of the lower lip; the sublabiale (Sbl), the midline point of greatest concavity on the facial contour of the lower lip between the labrale inferius and soft tissue menton; the soft tissue pogonion (Pog\u0026rsquo;), the most prominent midline point of the soft tissue chin pad; the Orbitale (or), the deepest point on the infraorbital margin; the Porion (Po), the most superior and outer bony surface point of the external auditory meatus; the Gonion (Go), the intersection between the mandibular line and the ramus line; soft tissue Menton (Me): the most inferior point of the mandibular soft tissue symphysis ; the Tragus (t), a tongue-like projection of the outer ear projecting posteriorly over the external auditory meatus; Cervical point (C), inner-most point between the submentum and the neck.\u003c/p\u003e \n\u003ch3\u003eAngular measurements\u003c/h3\u003e\n\u003cp\u003eThe nasofrontal angle (NFA) was measured as the angle formed by the intersection of the straight line from the glabella (G) to the soft tissue nasion (N) and the straight line from N tangent to the dorsum nasi (DN) (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, top left). The nasal tip angle (NTA) was measured as the angle formed by the intersection of the straight line tangent to the DN from its midpoint anteroinferiorly and the straight-line tangent to the profile contour of the columella from the subnasale (Sn) anterosuperior (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, top middle). The nasolabial angle (NLA) was measured as the angle formed by the intersection of the straight line tangent to the profile contour of the columella from the subnasale (Sn) anterosuperior and the straight line from the Sn to the labrale superius (Ls) (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, top middle). The alar slope angle (ASA) was measured as the angle formed by the intersection of the straight line tangent to the external surface of the ala of the nose (Al) on the right side and its counterpart on the left side (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, top right). The labiomental angle (LMA) was measured as the angle formed by the intersection of the straight line from the labrale inferius (Li) to the sublabiale (Sbl) and the straight line from Sbl to the soft tissue pogonion (Pog\u0026rsquo;) (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, bottom left). The Mandibular-Frankfurt plane angle (MFA) was measured as the angle formed by the intersection of the straight line from the orbitale to the porion (Po) and the straight line from the menton (Me) to the gonion \u003cb\u003e(\u003c/b\u003eGo). On the skin, Po was projected to be one centimeter superior to the tragus (t) (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, bottom middle). The mentocervical angle (MCA) was measured as the angle formed by the intersection of the straight line from the glabella (G) to the soft tissue pogonion \u003cb\u003e(\u003c/b\u003ePog\u0026rsquo;) and the straight line from the menton (Me) to the cervical point (C) (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, bottom right).\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eThe collected data were analyzed using IBM SPSS Statistics for Windows, Version 22.0 (IBM Corp., Armonk, N.Y., USA). The normal distribution of quantitative variables was assessed using the Shapiro-Wilk test. Statistical significance of the difference between groups was determined using Student\u0026rsquo;s independent t-test. The paired t-test was used to compare data obtained by direct and indirect measurements. Scatter plots with Pearson\u0026rsquo;s correlation analyses were used to determine the relationship between direct and indirect measurements. Differences were considered statistically significant at p\u0026thinsp;\u0026le;\u0026thinsp;0.05.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eThe results of both the direct and indirect angular measurements for all study participants (male and female) are summarized in Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e. An Independent t-test comparison of the direct angular nasal and labio-oral measurements of male and female participants showed no significant differences in all angles, except in the NFA (p\u0026thinsp;=\u0026thinsp;0.000; Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e). Similarly, indirect angular nasal and labio-oral measurements showed no significant differences between male and female participants, except for the NFA (p\u0026thinsp;=\u0026thinsp;0.000; Table \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e). There were also no significant differences between the direct and indirect measurements for all angles except for MFA (p\u0026thinsp;=\u0026thinsp;0.037; t= -2.112; CI: -1.07102 to \u0026minus;\u0026thinsp;.03374) and MCA (p\u0026thinsp;=\u0026thinsp;0.013; t= -2.522; CI: -2.18766 to \u0026minus;\u0026thinsp;.26187) (Table \u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e). Additionally, there was a significant correlation between the direct and indirect measurements for all seven nasal and labio-oral angles (Table \u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e). A summary of Pearson\u0026rsquo;s correlation analyses of direct and indirect measurements of all seven nasal and labio-oral angles of the study participants (both sexes combined) are presented in Table \u003cspan class=\"InternalRef\"\u003e5\u003c/span\u003e (p\u0026thinsp;=\u0026thinsp;0.000). Scatter plots of the direct versus indirect angular measurements displayed a strong linear positive correlation for all the angles measured, except for the MFA and MCA, as illustrated in Fig. \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e. In addition to a weak correlation, MFA displayed multiple outliers.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003cdiv align=\"left\" class=\"colspec\"\u003e\u003cbr\u003e\u003c/div\u003e\n \u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eSummary of direct and indirect angular nasal and labio-oral measurements of 105 study participants (both sexes).\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" style=\"width: 14.3275%;\"\u003e\n \u003cp\u003eAngles\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" style=\"width: 7.8947%;\"\u003e\n \u003cp\u003eSex\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" style=\"width: 5.5556%;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" style=\"width: 35.6725%;\"\u003e\n \u003cp\u003eMean Direct (\u0026ordm;)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" style=\"width: 36.5497%;\"\u003e\n \u003cp\u003eMean Indirect (\u0026ordm;)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\" style=\"width: 14.3275%;\"\u003e\n \u003cp\u003eNFA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 7.8947%;\"\u003e\n \u003cp\u003eM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" style=\"width: 5.5556%;\"\u003e\n \u003cp\u003e54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 35.6725%;\"\u003e\n \u003cp\u003e125.25 (SD 8.91)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 36.5497%;\"\u003e\n \u003cp\u003e125.27 (SD 8.45)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 7.8947%;\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" style=\"width: 5.5556%;\"\u003e\n \u003cp\u003e51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 35.6725%;\"\u003e\n \u003cp\u003e134.49 (SD 7.49)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 36.5497%;\"\u003e\n \u003cp\u003e134.33 (SD 7.49)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\" style=\"width: 14.3275%;\"\u003e\n \u003cp\u003eNTA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 7.8947%;\"\u003e\n \u003cp\u003eM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" style=\"width: 5.5556%;\"\u003e\n \u003cp\u003e54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 35.6725%;\"\u003e\n \u003cp\u003e72.70 (SD 5.65)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 36.5497%;\"\u003e\n \u003cp\u003e72.70 (SD 5.59)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 7.8947%;\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" style=\"width: 5.5556%;\"\u003e\n \u003cp\u003e51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 35.6725%;\"\u003e\n \u003cp\u003e74.20 (SD 5.69)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 36.5497%;\"\u003e\n \u003cp\u003e74.11 (SD 5.51)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\" style=\"width: 14.3275%;\"\u003e\n \u003cp\u003eNLA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 7.8947%;\"\u003e\n \u003cp\u003eM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" style=\"width: 5.5556%;\"\u003e\n \u003cp\u003e54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 35.6725%;\"\u003e\n \u003cp\u003e79.79 (SD 9.11)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 36.5497%;\"\u003e\n \u003cp\u003e79.92 (SD 8.82)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 7.8947%;\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" style=\"width: 5.5556%;\"\u003e\n \u003cp\u003e51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 35.6725%;\"\u003e\n \u003cp\u003e82.41 (SD 10.21)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 36.5497%;\"\u003e\n \u003cp\u003e82.47 (SD 9.84)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\" style=\"width: 14.3275%;\"\u003e\n \u003cp\u003eMLA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 7.8947%;\"\u003e\n \u003cp\u003eM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" style=\"width: 5.5556%;\"\u003e\n \u003cp\u003e54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 35.6725%;\"\u003e\n \u003cp\u003e112.34 (SD 16.84)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 36.5497%;\"\u003e\n \u003cp\u003e111.88 (SD 16. 50)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 7.8947%;\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" style=\"width: 5.5556%;\"\u003e\n \u003cp\u003e51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 35.6725%;\"\u003e\n \u003cp\u003e82.41 (SD 13.64)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 36.5497%;\"\u003e\n \u003cp\u003e113.80 (SD 13.78)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\" style=\"width: 14.3275%;\"\u003e\n \u003cp\u003eASA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 7.8947%;\"\u003e\n \u003cp\u003eM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" style=\"width: 5.5556%;\"\u003e\n \u003cp\u003e54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 35.6725%;\"\u003e\n \u003cp\u003e108.23 (SD 15.80)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 36.5497%;\"\u003e\n \u003cp\u003e108.11 (SD 15.34)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 7.8947%;\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" style=\"width: 5.5556%;\"\u003e\n \u003cp\u003e51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 35.6725%;\"\u003e\n \u003cp\u003e104.89 (SD 12.22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 36.5497%;\"\u003e\n \u003cp\u003e104.96 (SD 11.86)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\" style=\"width: 14.3275%;\"\u003e\n \u003cp\u003eMFA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 7.8947%;\"\u003e\n \u003cp\u003eM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" style=\"width: 5.5556%;\"\u003e\n \u003cp\u003e54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 35.6725%;\"\u003e\n \u003cp\u003e19.81 (SD 3.31)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 36.5497%;\"\u003e\n \u003cp\u003e20.18 (SD 2.54)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 7.8947%;\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" style=\"width: 5.5556%;\"\u003e\n \u003cp\u003e51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 35.6725%;\"\u003e\n \u003cp\u003e19.17 (SD 3.29)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 36.5497%;\"\u003e\n \u003cp\u003e19.89 (SD 2.78)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\" style=\"width: 14.3275%;\"\u003e\n \u003cp\u003eMCA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 7.8947%;\"\u003e\n \u003cp\u003eM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" style=\"width: 5.5556%;\"\u003e\n \u003cp\u003e54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 35.6725%;\"\u003e\n \u003cp\u003e79.86 (SD 7.78)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 36.5497%;\"\u003e\n \u003cp\u003e81.37 (SD 7.23)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 7.8947%;\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" style=\"width: 5.5556%;\"\u003e\n \u003cp\u003e51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 35.6725%;\"\u003e\n \u003cp\u003e80.46 (SD 10.59)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 36.5497%;\"\u003e\n \u003cp\u003e81.39 (SD 10.74)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eMeaning of abbreviations used: NFA (nasofrontal angle); NTA (nasal tip angle); NLA (nasolabial angle); LMA (labiomental angle); ASA (Alar slope angle); MFA (Mandibular Frankfurt plane angle); MCA (mentocervical angle). M (male); F (female); SD (standard deviation).\u0026nbsp;\u003c/p\u003e\n\u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eSynopsis of independent t-test comparisons of direct angular anthropometric measurements for male and female participants. The level of significance (\u0026alpha;) was set at 0.05.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003et-value\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e95% CI of the Difference\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eLower\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eUpper\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNFA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-5.733\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-12.4370\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-6.0434\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNTA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-1.355\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.178\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-3.7012\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.6969\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNLA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-1.386\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.169\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-6.3589\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.1279\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLMA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026minus;\u0026thinsp;.559\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.578\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-7.6295\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4.2755\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eASA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.206\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.231\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-2.1534\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e8.8321\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMFA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.035\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.303\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026minus;\u0026thinsp;.6117\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.9472\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMCA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-0.328\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.744\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-4.1768\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.9923\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eMeaning of abbreviations used: NFA (nasofrontal angle); NTA (nasal tip angle); NLA (nasolabial angle); LMA (labiomental angle); ASA (alar slope angle); MFA (Mandibular Frankfurt plane angle); MCA (mentocervical angle). p is the probability, t is the student\u0026rsquo;s t-value, and CI is the confidence interval.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003ctable id=\"Tab3\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eSynopsis of independent t-test comparisons of indirect angular anthropometric measurements for male and female participants. The level of significance (\u0026alpha;) was set at 0.05.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003et-value\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e95% CI of the Difference\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eLower\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eUpper\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNFA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-5.794\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-12.1550\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-5.9561\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNTA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-1.303\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.196\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-3.5665\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.7387\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNLA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-1.396\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.166\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-6.1586\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.0693\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMLA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026minus;\u0026thinsp;.643\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.521\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-7.8188\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.9888\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eASA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.172\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.244\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-2.1804\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e8.4810\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMFA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.563\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.574\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-0.7385\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.3245\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMCA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-0.012\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.990\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-3.5481\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.5045\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003eMeaning of abbreviations used: NFA (nasofrontal angle); NTA (nasal tip angle); NLA (nasolabial angle); LMA (labiomental angle); ASA (alar slope angle); MFA (Mandibular Frankfurt plane angle); MCA (mentocervical angle). p is the probability, t is the student\u0026rsquo;s t-value, and CI is the confidence interval.\u0026nbsp;\u003c/p\u003e\n\u003ctable id=\"Tab4\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eSummary of paired t-test comparisons between Direct and Indirect Angular Nasal and Labio-oral Measurements from 105 participants in this study with the level of significance (\u0026alpha;) set at 0.05\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\" rowspan=\"3\"\u003e\n \u003cp\u003eDirect and Indirect Angular Nasal and Labio-Oral Measurements\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"5\"\u003e\n \u003cp\u003ePaired Differences\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eMean\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eStd. Deviation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eStd. Error Mean\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e95% Confidence Interval of the Difference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003et-value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLower\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUpper\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePair 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNFA - iNFA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.06190\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.85106\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.18064\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;\u0026thinsp;.29632\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.42013\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.343\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.733\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePair 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNTA - iNTA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.04286\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.34828\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.13158\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;\u0026thinsp;.21807\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.30378\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.326\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.745\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePair 3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNLA - iNLA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;\u0026thinsp;.09524\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.52400\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.14873\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;\u0026thinsp;.39017\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.19969\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-0.640\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.523\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePair 4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMLA - iMLA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.33810\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.93214\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.18856\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;\u0026thinsp;.03582\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.71201\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.793\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.076\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePair 5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eASA - iASA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.02857\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.87446\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.18293\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;\u0026thinsp;.33418\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.39133\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.156\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.876\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePair 6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMFA - iMFA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;\u0026thinsp;.55238\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.67999\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.26154\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-1.07102\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;\u0026thinsp;.03374\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-2.112\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.037\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePair 7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMCA - iMCA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-1.22476\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4.97557\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.48557\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-2.18766\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;\u0026thinsp;.26187\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-2.522\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.013\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eMeaning of abbreviations used: NFA (nasofrontal angle); NTA (nasal tip angle); NLA (nasolabial angle); LMA (labiomental angle); ASA (alar slope angle); MFA (Mandibular Frankfurt plane angle); MCA (mentocervical angle). Prefix i represents an indirect method for measuring the respective angular nasal and labio-oral variables.\u003c/p\u003e\n\u003ctable id=\"Tab5\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eA summary of Pearson\u0026rsquo;s correlation analyses of direct and indirect measurements of all seven nasal and Labio-oral angles of the study participants (both sexes combined).\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCorrelation Coefficient (r)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eP level\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePair 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNFA \u0026amp; iNFA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.981\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePair 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNTA \u0026amp; iNTA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.972\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePair 3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNLA \u0026amp; iNLA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.988\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePair 4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMLA \u0026amp; iLMA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.992\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePair 5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eASA \u0026amp; iASA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.991\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePair 6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMFA \u0026amp; iMFA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.615\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePair 7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMCA \u0026amp; iMCA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.852\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eMeaning of abbreviations used: NFA (nasofrontal angle); NTA (nasal tip angle); NLA (nasolabial angle); LMA (labiomental angle); ASA (alar slope angle); MFA (Mandibular Frankfurt plane angle); MCA (mentocervical angle). Prefix i represents an indirect method for measuring the respective angular nasal and labio-oral variables.\u003c/p\u003e\n\u003cp\u003eAs shown in Table \u003cspan class=\"InternalRef\"\u003e6\u003c/span\u003e, the general trend is suggestive of decreased NLA and increased ASA compared to Caucasian values [16, 17]. The findings of the present study tended to match those of African Americans in comparison with published data [35] but showed significant differences when compared with data published by Farkas et al. [36].\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u0026nbsp;\u003ctable id=\"Tab6\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eComparison of nasal angles of females and males in the present study and other ethnic groups. Angles are in degrees (⁰).\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eAuthor(s)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eEthnic Group\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSex\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eNFA\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eNTA\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eNLA\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eLMA\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eASA\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMFA\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMCA\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUzun and Ozdemir, 2014\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCaucasian (Turkish)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e133.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e77.91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e98.91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e80.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUzun and Ozdemir, 2014\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCaucasian (Turkish)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e123.85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e82.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e97.91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e85.98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFarkas et al., 2007\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAfrican American\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e127.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e73.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e101.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFarkas et al., 2007\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAfrican American\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e126.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e71.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e101.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eVirdi et al., 2019\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNegroid Africans (Kenya)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e127.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e85.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e116.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eVirdi et al., 2019\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNegroid Africans (Kenya)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e127.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e85.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e128.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePresent study\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNegroid Africans (Ghana)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e134.49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e74.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e82.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e114.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e104.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e80.46\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePresent study\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNegroid Africans (Ghana)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e125.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e72.70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e79.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e112.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e108.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e79.86\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eA notable finding in our study was a significantly greater NFA in females than males. This contrasts with [37], who found that NFA for African American females was lower (131.90; SD 6.80) than for males (135.60:SD 5.40). Szychta et al. [38] found no significant differences in the NFA in Caucasians in Poland. Whereas Farkas et al. [36] reported similar values of NFA for African American females and males (127.60 and 126.50 respectively);, and Virdi et al. [24] had the same NFA for Kenyan females (127.90) and males (127.30). Given the assertion that NFA is a potentially important factor in the perception of facial profile attractiveness [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e], and that surgical alterations of NFA can cause prominent changes in the face [39], our present finding that indigenous Ghanaian females have a larger NFA than males, contrary to previous reports on females of Negroid descent, is noteworthy. Moreover, it underscores the crucial need for local angular nasal and labio-oral measurements because of variations due to ethnicity, age, weight, and sex [40], and data that equip surgeons to prevent diagnostic errors such as obtuse NFA that can simulate a long nose [41]. According to the latter authors, females have a greater NFA than males, and the more acute NFA in males was interpreted to mean that men have a more projected nasal tip. The results of the present study are comparable to the NFA reported for young adults (18\u0026ndash;30 years) in Turkey [17], with females having 133.6\u0026thinsp;\u0026plusmn;\u0026thinsp;8.880 and males 123.85\u0026thinsp;\u0026plusmn;\u0026thinsp;13.230. It has been reported [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e] that among many ethnic groups, including African Americans, the NFA of 130.0 was judged to be the most attractive, and it is notable that our present report has consonant value for autochthonic Ghanaian females.\u003c/p\u003e \u003cp\u003eThe strong correlation between the direct and indirect angular measurements reported in our study confirms the usefulness of the photogrammetric method in cases of traumatic facial alterations in accidents [41]. The aesthetic effectiveness of surgical reconstruction may be enhanced by determining the nasal and labio-oral angles from photographs of the patients. This is in addition to the advantages of high availability and documentation of photogrammetry [41]. We concur with the latter authors that the problem of standardization in an indirect method that may introduce variations of a few millimeters in linear anthropometric dimensions can be eliminated by using ratios and angles between primary measures. Our results suggest that the seven nasal and labio-oral angles in this study could be accurately determined from photographs for planning and evaluating steps in reconstructive surgery of the face and orthodontics and dentofacial orthopaedics [42] as well as in criminal and forensic identification.\u003c/p\u003e \u003cp\u003eThere was no significant difference between the means of direct and indirect anthropometry, except for (2) angles, MFA, and MCA. This could be attributed to differences in the methods used to measure the above-mentioned angles. The latter two angles were directly measured using a goniometer.\u003c/p\u003e \u003cp\u003eIt can be postulated that time has come to focus more on indirect angular facial anthropometry and gradually phase out direct angular facial anthropometry as the indirect method is less physically demanding and less time-consuming. A one-sample t-test comparing the means (NFA and NLA) obtained from this study with that of African Americans showed no significant difference. This could be attributed to the genetic link of African Americans to the indigenous Africans [31, 32, 35]. However, Farkas et al. [36] published data that showed significant differences compared to the results of the present study. Female participants in this study exhibited significant differences in the values of NFA, NLA, and MLA (p ˂ 0.05) in comparison with the data published by Farkas et al. [36], while male participants in this study showed significant differences in the values of NLA and MLA, but not in the NFA.\u003c/p\u003e \u003cp\u003eUnlike the comparison with African Americans in the previous section that showed no significant differences (NFA and NLA) when compared with data published by Porter [35] but showed significant differences when compared with data published by Farkas et al. [36], NFA, NLA, NTA, and ASA exhibited significant differences when compared with published data on Caucasian populations [16, 17, 36]. NLA was significantly decreased in Negroid Africans in comparison with data from studies on Caucasians. This could be attributable to the predominance of a broad nose, wider mouth, and fuller lips in Negroid Africans [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study produced data on angular nasal and labio-oral measurements of Indigenous Africans in Ghana. Females have NFA values that conform to the reported ideal and are greater than males. Strong correlations between the direct and indirect angular measurements suggest their accurate determination by the photogrammetric method and use when necessary. Our baseline results could be used to establish a more robust database of angular nasal and labio-oral anthropometric measurements in indigenous Ghanaians. The strong positive correlation between direct and indirect facial angular anthropometric measurements in the present study suggests the use of the indirect photogrammetric method instead of direct, tedious, and physically demanding angular anthropometric measurements, especially as image-capturing technology improves.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eThe following abbreviations are used in this manuscript:\u003c/p\u003e\n\u003cp\u003eEPRC\u0026nbsp;\u0026nbsp;Ethical and Protocol Review Committee\u003c/p\u003e\n\u003cp\u003eCHS\u0026nbsp; \u0026nbsp;\u0026nbsp;College of Health Sciences\u003c/p\u003e\n\u003cp\u003eORID\u0026nbsp;\u0026nbsp;Office of Research, Innovation, and Development's\u003c/p\u003e\n\u003cp\u003eBW\u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Brass wire\u003c/p\u003e\n\u003cp\u003eNFA\u0026nbsp; \u0026nbsp;\u0026nbsp;Nasofrontal angle\u003c/p\u003e\n\u003cp\u003eG\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Glabella\u003c/p\u003e\n\u003cp\u003eN\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Soft tissue nasion\u003c/p\u003e\n\u003cp\u003eNTA\u0026nbsp; \u0026nbsp;\u0026nbsp;Nasal tip angle\u003c/p\u003e\n\u003cp\u003eNLA\u0026nbsp; \u0026nbsp;\u0026nbsp;Nasolabial angle\u003c/p\u003e\n\u003cp\u003eDN\u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Dorsum Nasi\u003c/p\u003e\n\u003cp\u003eSn\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Subnasale\u003c/p\u003e\n\u003cp\u003eLs\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Labrale superius\u003c/p\u003e\n\u003cp\u003eASA\u0026nbsp; \u0026nbsp;\u0026nbsp;Alar slope angle\u003c/p\u003e\n\u003cp\u003eAl\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Alare\u003c/p\u003e\n\u003cp\u003eLMA\u0026nbsp; \u0026nbsp;Labiomental angle\u003c/p\u003e\n\u003cp\u003eLi\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Labrale inferius\u003c/p\u003e\n\u003cp\u003eSbl\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Sublabiale\u003c/p\u003e\n\u003cp\u003eMFA\u0026nbsp; \u0026nbsp;\u0026nbsp;Mandibular-Frankfurt plane angle\u003c/p\u003e\n\u003cp\u003eOr\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Orbitale\u003c/p\u003e\n\u003cp\u003eGo\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Gonion\u003c/p\u003e\n\u003cp\u003eMe\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Menton\u003c/p\u003e\n\u003cp\u003ePo\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Porion\u003c/p\u003e\n\u003cp\u003et\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Tragus\u003c/p\u003e\n\u003cp\u003eMCA\u0026nbsp; \u0026nbsp;Mentocervical angle\u003c/p\u003e\n\u003cp\u003eFP\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Facial plan\u003c/p\u003e\n\u003cp\u003eL\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;mental line\u003c/p\u003e\n\u003cp\u003eG\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Glabella\u003c/p\u003e\n\u003cp\u003ePog’\u0026nbsp; \u0026nbsp; \u0026nbsp;Soft tissue pogonion\u003c/p\u003e\n\u003cp\u003eMe\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Menton\u003c/p\u003e\n\u003cp\u003eC \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Cervical point\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eThis work was conducted in accordance with the Declaration of Helsinki (1964). The study received approval from the University of Ghana’s Ethical and Protocol Review Committee, College of Health Sciences, under reference [ID: CHS-Et/M.6-4.11/2018-2019], and written informed consent was obtained from all participants prior to their participation in the study. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Written informed consent was obtained from all study participants and/or their legal guardians for the publication of identifying information and facial images in an online open-access journal. All participants and/or their legal guardians understood that the images and related information would be publicly available and freely consented to publication.\u003c/p\u003e\n\u003ch3\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/h3\u003e\n\u003cp\u003eData is provided within the manuscript or supplementary information files.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that there is no conflict of interest regarding the publication of this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003ch5\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/h5\u003e\n\u003cp\u003eThis research received no external funding.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConceptualisation: P.M.M, R.M.B, and K.K.A-O data curation: P.M.M, R.M.B, and K.K.A-O formal analysis: P.M.M, B.A. B.A-B and K.K.A-O Funding acquisition: P.M.M, B.A.H, J.A, B.A-B, N.K-K.K investigation: P.M.M, R.M.B, B.A.H, C.N.B.T, B.A-B and K.K.A-O methodology: P.M.M, R.M.B, B.A.H, J.A, N.K-K.K, K.K.A-O and F.K.A project administration: P.M.M, B.A-B, R.M.B, B.A.H, and J.A. resources: P.M.M, N.K-K.K, C.N.B.T, R.M.B, B.A.H, J.A, B.A-B and K.K.A-O software: P.M.M, P.O.A, B.A-B, K.K.A-O and N.K-K.K Supervision: R.M.B, B.A.H, and K.K.A-O Validation: P.M.M, R.M.B, B.A.H, C.N.B.T, J.A and F.K.A Visualisation: P.M.M, R.M.B, B.A.H, J.A, N.K-K.K, P.O.A and K.K.A-O writing original draft: P.M.M, R.M.B, K.K.A-O, B.A.H, P.O.A, and B.A-B writing review and editing: P.M.M, R.M.B, P.O.A, J.A, B.A-B, C.N.B.T and F.K.A.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgment\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors wish to thank all the members of staff of the Departments of Anatomy (UGMS) for their support.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eRice A, Phillips PJ, Natu V, et al. 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Kwame Nkrumah University of Science and Technology, 2017.\u003c/li\u003e\n\u003cli\u003e Parkins G, Boamah MO, Avogo D, et al. Maxillofacial and concomitant injuries in multiple injured patients at Korle Bu Teaching Hospital, Ghana. \u003cem\u003eWest Afr J Med\u003c/em\u003e 2014; 33: 51\u0026ndash;55.\u003c/li\u003e\n\u003cli\u003e Acheampong AO, Newman-Nartey M, Obiri-Yeboah S, et al. Motorcycle Related Oral and Maxillofacial Injuries Seen at Komfo Anokye Teaching Hospital, Kumasi-Ghana. \u003cem\u003eSurg Sci\u003c/em\u003e 2019; 10: 106\u0026ndash;112.\u003c/li\u003e\n\u003cli\u003e Blankson PK, Amoako JKA, Asah-Opoku K, et al. Epidemiology of injuries presenting to the accident centre of Korle-Bu Teaching Hospital, Ghana. \u003cem\u003eBMC Emerg Med\u003c/em\u003e 2019; 19: 39.\u003c/li\u003e\n\u003cli\u003e Charan J, Biswas T. 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Individual and ethnic aspects of preoperative planning for posttraumatic rhinoplasty. \u003cem\u003eEur J Plast Surg\u003c/em\u003e 2011; 34: 245\u0026ndash;249.\u003c/li\u003e\n\u003cli\u003e Pousti SB, Jalessi M, Asghari A. Management of Nasofrontal Angle in Rhinoplasty. 2010; 12: 7\u0026ndash;11.\u003c/li\u003e\n\u003cli\u003e Adelakun S, Ogunlade B, AKingbade G, et al. Anthropometric characterization of nasal parameters In adults oyemekun ethnic group in akure southwest Nigeria. \u003cem\u003eInt J Anat Res\u003c/em\u003e 2018; 6: 5272\u0026ndash;5279.\u003c/li\u003e\n\u003cli\u003e Ballin AC, Carvalho B, Dolci JEL, et al. Anthropometric study of the caucasian nose in the city of Curitiba: relevance of population evaluation. \u003cem\u003eBraz J Otorhinolaryngol\u003c/em\u003e 2018; 84: 486\u0026ndash;493.\u003c/li\u003e\n\u003cli\u003e Doddi NM, Eccles R. The role of anthropometric measurements in nasal surgery and research: A systematic review. \u003cem\u003eClinical Otolaryngology\u003c/em\u003e 2010; 35: 277\u0026ndash;283.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Anthropometry, Facial Angles, Indigenous Africans, Sexual Dimorphism","lastPublishedDoi":"10.21203/rs.3.rs-6556297/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6556297/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground/Objective\u003c/strong\u003e: The paucity of normative angular nasal and labio-oral anthropometric data on indigenous sub-Saharan Africans hinders the aesthetic effectiveness of reconstructive/plastic surgery on their faces. This data void also negatively affects their facial biometrics, information retrieval, forensics, dentistry, and beauty analysis. This study contributes to filling this gap by generating normative values for the nasal and labio-oral angles in young adult autochthonic Africans living in Ghana.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e: One hundred and five volunteers (54 males and 51 females) were conveniently sampled from students at the Korle-Bu Campus of the University of Ghana. Seven nasal and labio-oral angles, namely; the Nasofrontal, Nasal tip, Nasolabial, Labiomental, Alar slope, Mandibular Frankfurt plane, and Mentocervical were measured by direct anthropometric (angle meter) and indirect anthropometric (Photogrammetry) methods. Data were assessed for sexual dimorphism using Student’s t-test. Scatter plots with Correlation Analyses were used to determine the association between the direct and indirect datasets.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e: Except for the Nasofrontal angle, which was lower in males than in females, no significant sex differences were found. For all measured angles, there were no significant differences between the values obtained using the direct and indirect anthropometric methods. Indirect measurements of each of the seven nasal and labio-oral angles strongly correlated positively with their cor-responding direct measurements.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e: This study provides the first normative dataset on nasal and labio-oral angles in young Indigenous Ghanaians and shows that apart from larger nasofrontal angles in females, six other angles did not significantly differ between sexes. Our results indicate that the indirect method of measuring these angles provides a good estimate for direct measurements.\u003c/p\u003e","manuscriptTitle":"Nasal and labio-oral angles in young adult indigenous Ghanaians","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-02 13:01:03","doi":"10.21203/rs.3.rs-6556297/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"5ac17985-f4ce-4847-9b67-7ad7022ae248","owner":[],"postedDate":"July 2nd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-11-13T15:38:47+00:00","versionOfRecord":[],"versionCreatedAt":"2025-07-02 13:01:03","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6556297","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6556297","identity":"rs-6556297","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}