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Background: In 1973, Saunders T. Frank described the diagonal earlobe crease (DELC) as a potential marker of cardiovascular disease. However, this anatomical finding is not routinely examined. The aim of this study was to assess the presence of this crease in the general population attending a dental setting and describe its anatomical variations to be able to categorize it as a physical sign., Methodology: A study group of 1050 white adults were selected, as participants in the framework of the "A Estrada Study of Glycation and Inflammation" (AEGIS), a cross-sectional, population-based descriptive study of a representative sample of the general adult population of the municipality of A Estrada (Pontevedra, Spain). Each participant's age, sex, and preferred head position when sleeping were recorded. Both earlobes were visually inspected and the anatomical variables of the crease were recorded (unilateral or bilateral, length, depth, and presence of secondary creases). The relationship between the study variables was analyzed using the chi-squared test, Student's t-test, the analysis of variance (ANOVA), and the nonparametric tests of Mann-Whitney and Kruskal-Wallis., Results: The DELC was observed in 65.2% of the participants. In 71.5% of the cases, the sign was complete (occupying the space from the tragus to the posterior edge of the earlobe); in 56.9% of the cases, the sign was bilateral; in 45.1% of the cases it was deep; and in the 43.6% of the cases, accessory creases were identified. Neither sex nor the habitual head position when sleeping were related to the prevalence or characteristics of the DELC. The prevalence, extent and depth of Frank's sign increased significantly with age (p < .001)., Conclusion: The prevalence of the DELC increases significantly with age, and its morphological characteristics are accentuated. This finding, therefore, gains special relevance as a marker of potential cardiovascular disease when observed in young adults., (© 2024 The Authors. Special Care in Dentistry published by Special Care Dentistry Association and Wiley Periodicals LLC.)

The external human ear is considered to be highly variable among individuals. Hence, forensic applications could be explored for human identification. This research compares the usefulness of Cameriere's ear identification method, in samples originating from six different countries (Brazil, India, Japan, Russia, South Africa and Turkey) in order to examine possible differences in their accuracy values. A sample of 2,225 photographs of the external human ear (1,134 left and 1,091 right ears) from 1,411 individuals (633 females and 778 males) was collected. The samples included healthy subjects with no systemic disorders and without any craniofacial trauma, maxillofacial abnormalities, auricular anomalies, ear diseases or previous auricular surgery. Cameriere's ear identification method was applied and measurements were performed on the images of each ear, considering four anatomic regions: helix, antihelix, concha, and lobe. The quantified measurement values were converted into a proposed coded number system. A search for identical codes was accomplished to find out the distinctiveness of the morphology of the human ear. The combined codes of left and right ears of each of the 814 subjects were not repeated in this multi-ethnic study sample. Dirichlet's distribution and the inherent study equation showed that the probability of two different individuals having the same code (false-positive identification) was found to be <0.0007. Because of the distinctive metrics of the ratios of external human ears, studies with Cameriere's ear identification method may be valuable for human identification. Studying the differences between the left and right ears of the same individual and across different ethnic groups could contribute to the development of supplementary tools for human identification., (Copyright © 2023 The Author(s). Published by Elsevier Masson SAS.. All rights reserved.)

It is aesthetically important that the auricle has a natural and beautiful shape. The sizes, position and symmetry of normal auricle are used for different purposes in different disciplines. A deformation in the auricle of neonates and its size or location on the face may indicate a possible anomaly. The aim of this study is to investigate the normal sizes, anomaly types, anomaly rates and the relationship between hearing screening test results and auricular anomaly of the neonatal auricle. The length, width, angle, and distance measurements of the auricle were made in neonates (n = 550). Anomaly types of auricle were observed. Goniometer was used to measure angles; digital caliper and ruler were used to measure lengths. Anomalies were detected by the method of observation. In the morphometric data of the neonatal auricle, differences were determined in length and width values in terms of gender. Various types of anomalies were observed in the right ear of 96 participants and in the left ear of 103 participants. Normal auricle size, position and symmetry are important for surgical reconstructions, hearing aid design, producing data banks on gender, age and ethnicity, and providing reference information for multiple diagnostic and forensic procedures. Recognition and early detection of auricular anomalies play an essential role in clinical diagnosis and their correction with special devices., (© 2022 Japanese Teratology Society.)

Three-dimensional (3D) scanning technologies, such as medical imaging and surface scanning, have important applications for capturing patient anatomy to create personalised prosthetics. Digital approaches for capturing anatomical detail as opposed to traditional, invasive impression techniques significantly reduces turnaround times and lower production costs while still maintaining the high aesthetic quality of the end product. While previous case studies utilise expensive 3D scanning and modelling frameworks, their clinical translation is limited due to high equipment costs. In this study, we develop and validate a low-cost framework for clinical 3D scanning of the external ear using photogrammetry and a smartphone camera. We recruited five novice operators who watched an instructional video before scanning 20 healthy adult participant ears who did not have microtia. Our results show that the smartphone-based photogrammetry methodology produces 3D scans of the external ear that were accurate to (1.5 ± 0.4) mm and were (71 ± 14) % complete compared with those from a gold standard reference scanner, with no significant difference observed between operators. A moderate to strong interrater reliability was determined for all novice operators, suggesting that all novice operators were able to capture repeatable scans. The development of this smartphone photogrammetry approach has the potential to provide a non-invasive, inexpensive and accessible means to capture patient morphology for use in clinical assessment and personalised device manufacture, specifically for ear prostheses. We also demonstrate that inexperienced operators can rapidly learn and apply smartphone photogrammetry for accurate and reliable scans of the external ear with important applications for future clinical translation., (Copyright © 2021. Published by Elsevier Ltd.)

The unique appearance of Scottish Fold cats is caused by a single gene variant in TRPV4, which impacts the development of cartilage. This results in the ears folding forward and variable effects on articular cartilage and bone. While some find this appearance desirable, early work demonstrated that homozygous cats with two copies of this variant develop severe radiographic consequences. Subsequent breeding programs have mated heterozygous cats with straight-eared cats to ensure an equal mix of heterozygous (fold) and wild-type (nonfolded) offspring, in the hope of raising healthy cats. More recent radiological surveys suggest that these heterozygous cats may also have medical problems consisting of deformed distal extremities in the worst cases and accelerated onset of osteoarthritis. However, these previous studies were undermined by selection biases, lack of controls, unblinded assessment and lack of known genotypes. Our aim was to determine if heterozygous cats exhibit radiological abnormalities when controlling for these limitations. Specifically, DNA and radiographs were acquired for 22 Scottish Fold cats. Four reviewers, blinded to the ear phenotype, assessed the lateral radiographs. Genotyping showed that all 10 folded-ear cats were heterozygous, and none of the straight-ear cats (n = 12) had the abnormal TRPV4 variant. Although each reviewer, on average, gave a numerically worse 'severity score' to folded-ear cats relative to straight-ear cats, the images in heterozygous cats showed much milder radiological signs than previously published. This study provides additional information to be considered in the complicated debate as to whether cats with the TRPV4 variant should be bred for folded ears given the potential comorbidities., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Purpose: The purpose of this study was to analyze the anatomical variability of the superficial temporal artery (STA) and to provide an easy visual landmark to find the STA and its branches to facilitate its surgical access., Methods: A retrospective study was conducted on 57 patients who underwent a head and neck computed tomography with contrast injection. A visual landmark running from the tragus to the corner of the eye was used: the "eye-tragus-line" (ETL). On the ETL, the distance between the tragus and the STA was measured. The length of the STA main branch, its parietal and frontal branch and the angle of the STA and its branches with the ETL were measured. The division of the STA was studied as above/at the same level/below the zygomatic arch (ZA) and the ETL., Results: The STA division was located above the ZA in 61.54% of cases, at the same level in 26.92% of cases and below in 11.54% of cases. Regarding the ETL, 93.27% of the STA divisions were located above the ETL, 5.77% at the same level and 0.96% below. On the ETL, the STA was located 15.55 ± 4.5 mm in front of the tragus., Conclusion: This study allowed to define an easy visual landmark: the ETL running from the tragus to the corner of the eye. The STA main branch was located 15.55 ± 4.5 mm of front of the tragus on the ETL. The STA division was nearly always located above the ETL (99.04%). Furthermore, this study provides a statistical representation of the anatomy of the STA and its branches.

Objective The earlobe crease, a wrinkle extending from the tragus to the outer border of the earlobe, is a well-known surrogate marker for a high risk of cardiovascular disease. However, information is lacking about its association with cardiovascular events among hemodialysis patients, who already have an increased risk of cardiovascular disease. We tested the hypothesis that earlobe creases are independently associated with the risk of cardiovascular events among Japanese hemodialysis patients. Methods This prospective cohort study followed 247 adult hemodialysis patients with no history of cardiovascular disease for 4 years. The presence of earlobe creases was defined by two researchers using photos of patients' earlobes on both sides while blinded to one another's assessments and clinical data. The primary outcome was defined as the first fatal or nonfatal cardiovascular event (myocardial infarction, ischemic or hemorrhagic stroke, or peripheral vascular disease requiring aortic or peripheral vascular bypass surgery or below- or above-the-knee amputation). A Fine-Gray competing risks regression model was used to examine the association between earlobe creases and cardiovascular events. Results During the 4-year follow-up period, 43 patients suffered cardiovascular events. After the competing risk of non-cardiovascular death was accounted for, patients with earlobe creases had an increased cumulative incidence of cardiovascular events compared to those without earlobe creases (subhazard ratio =2.04, 95% confidence interval: 1.09 to 3.82). This association was no longer significant after adjusting for age. Conclusion Earlobe creases were not independently associated with cardiovascular events among Japanese hemodialysis patients, suggesting that these marks are simply indicative of advanced age.

Diagonal earlobe crease (DELC) or Frank's sign is a diagonal crease in the earlobe that extends diagonally from the tragus to the edge of the auricle with an angle of approximately 45°. Although its presence increases with advancing age, several studies have shown an independent association between DELC and cardiovascular diseases as well as peripheral vascular diseases. DELC has also been demonstrated to increase the risk of cerebrovascular events (mostly ischaemic stroke), probably through atherosclerotic mechanisms. A systematic literature search was conducted using PubMed and Embase to identify studies investigating the relationship between DELC and the occurrence of cerebrovascular diseases. We identified 5 articles (1469 subjects included). Since the presence of DELC can be easily evaluated, patients with the Frank's sign should undergo a diagnostic workup to detect vascular risk factors and implement preventative therapies.

Introduction: Microsurgery of the ear requires complete evaluation of middle ear surgical anatomy, especially the posterior tympanic cavity anatomy. Preoperative assessment of the middle ear cavity is limited by the permeability of eardrum and temporal bone density. Therefore, middle ear exploration is an extremely useful method to identify structural abnormalities and anatomical variations., Objective: The aim of this study is to determine anatomic variations of the middle ear in an autopsy series., Methods: All evaluations were performed in the Forensic Medicine Institute Morgue Department. The cases over 18 years of age, with no temporal bone trauma and history of otologic surgery included in this study., Results: One hundred and two cadavers were included in the study. The mean age was 49.08±17.76 years. Anterior wall prominence of the external auditory canal was present in 27 of all cadavers (26.4%). The tympanic membrane was normal in 192 ears (94%) while several eardrum pathologies were detected in 12 ears (6%). Agenesis of the pyramidal eminence and stapedial tendon was found in 3 ears. While the ponticulus was bony ridge-shaped in 156 of 204 ears (76.4%), it was bridge-shaped in 25 ears (12.3%). The ponticulus was absent in 23 ears (11.3%). While complete subiculum was present in 136 of all ears (66.7%), incomplete subiculum was present in 21 ears (10.3%). Subiculum was absent in 47 ears (23%). Facial dehiscence was found in 32 ears and the round window niche was covered by a pseudomembrane in 85 ears (41.6%). A fixed footplate was present in 7.4% of all ears, and no persistent stapedial artery was seen in any cases., Conclusion: The pseudomembrane frequency covering the round window niche was found different from reports in the literature. In addition, the frequency of the external auditory canal wall prominence has been reported for the first time., (Copyright © 2018 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.)

Background: Mohs micrographic surgery (MMS) is often the treatment of choice for skin cancer removal as it maximizes normal tissue sparing and can be paired with a reconstructive approach that optimizes function and cosmesis. Many tumors on the eyelid, nose, ear, and genitals are particularly well suited for MMS but can be challenging for the dermatologic surgeon., Objective: To review the complex anatomy, as well as the authors' approach to executing and interpreting Mohs layers, at each of these anatomical sites., Methods: A review of the literature on MMS of the eyelid, nose, ear, and genitals was performed using the PubMed database and relevant search terms., Conclusion: These sites present potential pitfalls for tumor resection and reconstruction, but with the proper technique, the dermatologic surgeon can minimize tumor recurrence and MMS complications. Warning signs for potentially difficult tumor resection can signify when an interdisciplinary approach is warranted.

The most conspicuous aural adaptation in northern elephant seals (NES) is complete absence of an auricle and a tortuous collapsed external acoustic meatus. The NES epitympanic recess contains massive ossicles immersed in the middle ear cavernous sinuses. Engorgement of the cavernous sinuses would make ossicles fully buoyant during deep diving. NES have a comparatively larger cochlear nerve, which carries a significantly larger number of axons than in terrestrial mammals, which would give them auditory ability similar to the obligate marine mammals such as cetaceans. Our calculations show that the traditional "air-dependent" impedance matching mechanism in NES functions to just half of the capacity compared with the one described in terrestrial mammals. Impedance matching would be further hindered in NES while diving due to fully collapsed external acoustic meatus. Thanks to similarities of acoustic impedance between the sea water, soft tissues, and blood sinuses, very little sound energy would be reflected and lost. When sound is generated underwater, the large ossicles, buoyant in the cavernous sinus, would not move due to oscillation of tympanic membrane. Rather, they would be oscillating due to their inertia and process of acoustic streaming. Our mathematical simulation shows that an increase in sound frequency would cause increased displacement of the stapedial footplate and thus transmit the sound energy to the inner ear. We contend that during diving, impedance matching and sound signal amplification in the middle ear courses through the cavernous sinuses and oscillates the enlarged ossicles, thus enabling a high-frequency ultrasonic hearing range in Phocidae. Anat Rec, 302:1605-1614, 2019. © 2018 American Association for Anatomy., (© 2018 American Association for Anatomy.)

Introduction: The human ear is divided into external, middle and internal ear. The auricle helps in the clinical diagnosis of congenital anomalies and syndromes. The aim of this study is to determine the mean auricular index from the right and left ears, mean measurements of left and right ear and sex-related dimensions of the ear., Methods: A descriptive cross-sectional study was conducted in medical students studying at a tertiary care hospital during the period of 1st April 2019 to 20th May 2019 after ethical clearance from the institutional review committee. Simple random sampling was done. Data were collected, entered in Statistical Package for Social Sciences version 20 and point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data., Results: Out of total measurements done, we found the mean auricular index was found to be for right ear 51.75±4.51mm and for left ear 54.0996±4.95682mm at 95% CI (51.75-52.37) and (53.42654.766) respectively. The mean ear length, mean ear breadth, mean lobular length and mean lobular breadth were 57.62±5.03mm, 29.72±2.79mm, 19.32±2.60mm and 20.89±3.06mm on the right side and 57.89±4.89mm, 31.21±2.95mm, 19.38±2.55mm and 21.25±2.81mm on the left side respectively., Conclusions: The mean auricular index of the external ear of medical students was within the normal range as compared to the other studies conducted.

The aim of this paper is to provide information on dependency relationships between the morphological characters of the external ear and their importance in physical identification. At present, there is a lack of population data in this field, and little research has been published. Our study sample consisted of 281 Spanish university students of European descent aged between 18 and 31 years old. We analysed a total of 562 ears. For a large number of characters, we found a dependency between anatomically related characters, confirming our hypothesis. For example, we found relationships between ear shape and protrusion, between rolling of the superior and posterior helix, and between the upper and lower parts of the scapha. However, our results also indicated that some anatomically related characters did not present relationships. Thus, we found no dependency between contour shape of the supero-posterior helix and rolling of the posterior helix or between intertragic incisure shape and tragus or antitragus shape. In addition, we found that some characters that are not anatomically related also showed relationships. These included rolling of the superior helix and intertragic incisure shape, and contour shape of the superior helix and the inferior part of the scapha. These results are of great importance and should be taken into account in forensic applications., (Copyright © 2019. Published by Elsevier B.V.)

Pinnipeds are semiaquatic carnivorans that spend most of their lives in water and use coastal terrestrial, or ice pack, environments to breed, molt and rest. Certain characteristics of the ear have been linked to ecological aspects. In our contribution we focus on the study of the macroscopic and microscopic morphology of the external ear (with the exception of the osseous outer ear canal) of six species of Southern pinnipeds. In order to recognize the different components of tissues, sections were stained following several routine protocols. In addition, double-staining and enzymatic clearing (Alcian blue-alizarin red) was performed to assess the arrangement of skeletal elements in the OEC. The basic structure of the pinna in the southern otariids studied match those previously analyzed for Northern Hemisphere species. The cartilage macro anatomy of the OEC of Mirounga leonina and Arctocephallus gazella is different from that of the Northern Hemisphere species, with only one plate of cartilage, but markedly different between them. The histology of the otariids OEC is homogeneous along the entire extension, but phocids has three different regions (distal, middle, and proximal). The cartilage histology of most phocids is also different from that of analyzed otariids, with an elastic cartilage that resembles a myxoid-like tissue, but is not present in M. leonina, were the tissue around the OEC is very rich in adipocytes. The southern elephant seal M. leonina OEC has a combination of features similar to both the rest of the phocids and to the otariids. An auditory organ that is functional both over and under water could be essential for social behavior in these species., (Copyright © 2019. Published by Elsevier GmbH.)

Introduction: The external ear is made up of the elastic cartilage. It is considered constant from the birth till death. Therefore, it's morphological variation plays important role in forensic medicine. The objective of this study was to identify this morphological variation among different nationality and the gender., Methods: The study was conducted among 50 Nepali students and 50 Indian students of Manipal College of Medical Sciences. The simple random sampling was done. The morphological variation of external ear including different nature of shape of tragus, anti-tragus, lobe and margin of helix were studied on different gender and nationalities., Results: The highest distribution in shape of tragus was round in Nepali 42 (84%) and Indian 37 (74%). Most of Nepali students had flat 26 (52%) shape of anti-tragus and medium for Indian 25 (50%). The maximum ear attached lobe were found in both Nepali and Indian 27 (54%) respectively. Most of the Indian students had elongated shape of helix 24 (48%) whereas in Nepalese round shape of helix 31 (62%). The male participants had maximum round shape of tragus 42 (76.3%), flat shape of anti-tragus 28 (50.9%), free ear lobe 28 (50.9%) and shape of the margin of helix were round 29 (52.7%). The female participants had maximum round shape of tragus 37 (82.2%), medium shape of anti-tragus 22 (48.8%), attached ear lobe 27 (60%), and round shape of margin of helix 25 (55.56%)., Conclusions: The morphology of the external ear varies with each individual. However, it shows it couldn't differentiate their nationalities and gender.

Background: Earlobe crease (ELC) has been linked to cardiovascular diseases, but information on its association with cognitive decline is limited. We aimed to assess the association between ELC and cognitive performance in community-dwelling adults living in rural Ecuador., Methods: Of 863 individuals aged ≥40 years enrolled in the Atahualpa Project, 629 (73%) were included. ELC were visually identified by two independent raters, and cognitive performance was measured by the Montreal Cognitive Assessment (MoCA). Using generalized linear and interaction models, adjusted for demographics, cardiovascular risk factors and edentulism, we assessed the association between ELC and cognitive performance, as well as the influence of age in this association., Results: ELC was present in 246 (39%) individuals, and the mean MoCA score in the entire population was 21.9 ± 4.7 points. A generalized linear model showed no relationship between ELC presence and the MoCA score (p = 0.449). In this model, covariates remaining significant were age (p < 0.001), physical activity (p = 0.014) and edentulism (p < 0.001). When participants were stratified according of quartiles of age, the MoCA score did not differ according to the presence or absence of ELC. Weighted exposure-effect models - using ELC and the MoCA score as the exposure and outcome (respectively) - revealed no association between both variables., Conclusions: The association between ELC and the MoCA score is mainly related to age. These findings might be explained by the high prevalence of ELC and cognitive decline in older adults., (Copyright © 2018 Elsevier B.V. All rights reserved.)

The noseleaf and pinnae of horseshoe bats (Rhinolophus ferrumequinum) have both been shown to actively deform during biosonar operation. Since these baffle structures directly affect the properties of the animals biosonar system, this work mimics horseshoe bat sonar system with the goal of developing a platform to study the dynamic sensing principles horseshoe bats employ. Consequently, two robotic devices were developed to mimic the dynamic emission and reception characteristics of horseshoe bats. The noseleaf and pinnae shapes were modeled as smooth blanks matched to digital representations of a horseshoe bat specimens noseleaf and pinnae. Local shape features mimicking structures on the pinnae and noseleaf were added digitally. Flexible baffles with local shape feature combinations were manufactured and paired with actuation mechanisms to mimic pinnae and noseleaf deformations in vivo. Two noseleaves with and without local shape features were considered. Each noseleaf baffle was mounted to a platform called the dynamic emission head to actuate three surface elements of the baffle. Similarly, 12 pinna realizations composed of combinations of three local shape features were mounted to a platform called the dynamic reception head to deform the left and right pinnae independently. Motion of the noseleaf and pinnae were synchronized to the incoming and outgoing sonar waveform, and the joint time-frequency properties of the noseleaf and pinnae local feature combinations and pairs of pinnae and noseleaf thereof were characterized across spatial direction. Amplitude modulations to the outgoing and incoming sonar pulse information across spatial direction were observed for all pinnae and noseleaf local shape feature combinations. Peak modulation variance generated by motion of the pinnae and combinations of the noseleaf and pinnae approached a white Gaussian noise variance bound. It was found the dynamic emitter generated less modulation than either the combined or reception scenarios.

Over the last 100 years, more than 200 different methods have been described to correct prominent ear deformity. These techniques revolved around various combinations of postauricular incision, cartilage scoring, and strategic suture placement to reapproximate the antihelical fold and correct angular deformity. In the last two decades, fascial flap techniques have become prominent in otoplasty. This article gives a comprehensive review of the different surgical techniques employed to construct fascial flaps and their contributions to otoplasty.

The use of the physical appearance of the deceased has become more important because the available antemortem information for comparisons may consist only of a physical description and photographs. Twenty-one articles dealing with the identification based on the physiognomic features of the human body were selected for review and were divided into four sections: (i) visual recognition, (ii) specific facial/body areas, (iii) biometrics, and (iv) dental superimposition. While opinions about the reliability of the visual recognition differ, the search showed that it has been used in mass disasters, even without testing its objectivity and reliability. Specific facial areas being explored for the identification of dead; however, their practical use is questioned, similarly to soft biometrics. The emerging dental superimposition seems to be the only standardized and successfully applied method for identification so far. More research is needed into a potential use of the individualizing features, considering that postmortem changes and technical difficulties may affect the identification., (© 2017 American Academy of Forensic Sciences.)

The purpose of the current study was to analyze brow and ear position, and examine the relationship between these structures in patients presenting for blepharoplasty evaluation. A retrospective chart review was performed, which included all patients presenting to one oculoplastic physician for a blepharoplasty evaluation from November, 2012 to March, 2014. The prevalence of brow ptosis and brow and ear asymmetry was calculated; the proportional distribution was determined, and chi-square analysis and the z-test of proportions were used to calculate the significance. Institutional Review Board approval was obtained for this study. A total of 133 patients met the inclusion criteria. Some degree of brow ptosis was noted in 83% of patients. Brow asymmetry was found in 88% of patients, and ear asymmetry in 77%. Of those patients who had asymmetry, 61% had the right brow lower and 75% had the right ear lower; 73% of all patients had the brow and ear lower on the same side ( p  < 0.001). In this study, brow ptosis and asymmetry were quite common. In addition, the side of the lower brow correlated strongly with the side of the lower ear, and the right side structures were lower more often than the left. Patients presenting for blepharoplasty evaluation may have an element of generalized facial asymmetry which includes the brows and ears. These observations can be important for preoperative planning and patient counseling., Competing Interests: Disclosure The authors report no conflicts of interest in this work., (Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.)

Otoplasty is one of the first procedures learned during residency. A myriad of surgical techniques and nuances exist. Many have merit, some are ineffective, some destructive, and some frankly fanciful. Adopting an effective and safe technique should be based on proven efficacy and effectiveness to avoid early disappointments. We present a review of traditional otoplasty techniques and more recent innovations. Their pros and cons are discussed in view of the relative risks/benefits balance. Recurrence rates are low for most techniques. Some techniques carry a higher risk of significant complications. A ladder approach preferring techniques that minimize cartilage damage appears advisable., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Otoplasty for prominent ears is a rewarding yet exacting surgery that demands the precise application of anatomic knowledge, anthropometric norms, and surgical creativity. The practitioner must be able to use a variety of different techniques to provide durable and acceptable cosmetic results to patients. This article provides an in-depth description of normal and abnormal auricular anatomy, the historical context for modern otoplasty, and describes in detail the common otoplastic procedures currently performed., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Uniqueness of ear morphology has been a widely debated issue in cephaloscopy, but past studies used only two-dimensional approaches. In the current investigation, the right and left ears of 10 healthy adults were imaged twice by stereophotogrammetry at the interval of a few seconds. The ear images obtained from the two acquisitions were superimposed both within subject (group of matches) and among subjects (group of mismatches). A point-to-point root mean square distance was calculated between the two three-dimensional models. Differences according to side and group were assessed by two-way analysis of variance. In total, 200 superimpositions were performed. On average, the point-to-point root mean square distance was 0.31 mm in cases of matches and 1.43 mm in cases of mismatches: differences were statistically significant (p < 0.01). Results provided quantitative data for the assessment of uniqueness of ear morphology, highlighting differences based on their three-dimensional morphology.

Nagata technique becomes most popular method of autologous rib microtia construction. To achieve successful outcome, 3 keys must be perfect: skin envelope, 3D cartilage framework, and proper location of the construct. The first step of the surgery is to identify "auricular rectangle." Relationship between the auricular rectangle and the vestige will determine if the vestige is usable for surgery. Rib cartilage must be harvested without perichondrium to prevent chest deformity. Lobule split technique is the hallmark of the Nagata technique, which allows skin envelope expansion, and allows deeper conchal cavity. Surgeons must master 3D framework construct before clinical cases., (Copyright © 2017 Elsevier Inc. All rights reserved.)

The utility of the ear crease sign, anterior tragal crease (ATC), as a marker of atherosclerosis is yet to be established. The intima-media thickness of the common carotid artery (IMT-CCA) has been used as a noninvasive surrogate marker for atherosclerosis. History of traditional risk factors for atherosclerosis was obtained from 147 volunteers; ear examination was also performed and venous blood was drawn for laboratory analysis. The volunteers then underwent an ultrasonography measurement of the IMT-CCA. In univariate analysis, presence of ATC, age, underlying hypertension, diabetes mellitus, ischemic heart disease, cerebrovascular disease, cigarette smoking, low-density lipoprotein, and high-sensitivity C-reactive protein were significantly associated with the IMT-CCA. Further multivariate analysis confirmed a significant association between the presence of ATC and IMT-CCA, when adjusted for other factors (adjusted β ATC = .010, 95% confidence interval: 0.0021-0.019). Anterior tragal crease is a potential clinical sign that can predict atherosclerosis. The sign is easily recognizable and may help health-care professionals to identify those at risk of atherosclerosis, especially in people with no clinical signs of the disease.

This article provides a review of the surgical and nonsurgical options available to manage a variety of auricular scars. The basics of wound healing are discussed in addition to the etiology of keloids and the cauliflower ear. Many auricular scars can be revised with scar excision techniques, but separate discussions for the treatment of keloids and the cauliflower ear are provided. The management plan for auricular scarring requires appropriate patient counseling regarding the risk of recurrence in keloids, regrowth of scar tissue in cauliflower ears, scar hypertrophy at the line of closure, widening of the scar, and persisting ear contour deformities., (Published by Elsevier Inc.)

The innocuous transcutaneous stimulation of nerves supplying the outer ear has been demonstrated to be as effective as the invasive direct stimulation of the vagus nerve for the treatment of some neurological and nonneurological disturbances. Thus, the precise knowledge of external ear innervation is of maximal interest for the design of transcutaneous auricular nerve stimulation devices. We analyzed eleven outer ears, and the innervation was assessed by Masson's trichrome staining, immunohistochemistry, or immunofluorescence (neurofilaments, S100 protein, and myelin-basic protein). In both the cavum conchae and the auditory canal, nerve profiles were identified between the cartilage and the skin and out of the cartilage. The density of nerves and of myelinated nerve fibers was higher out of the cartilage and in the auditory canal with respect to the cavum conchae. Moreover, the nerves were more numerous in the superior and posterior-inferior than in the anterior-inferior segments of the auditory canal. The present study established a precise nerve map of the human cavum conchae and the cartilaginous segment of the auditory canal demonstrating regional differences in the pattern of innervation of the human outer ear. These results may provide additional neuroanatomical basis for the accurate design of auricular transcutaneous nerve stimulation devices.

Background and Objectives: The size of the ProSeal laryngeal mask airway in children is determined by the patient's weight. However, in some instances, an alternative method may be required. This study aimed to compare sizing by the auricle with conventional ProSeal laryngeal mask airway sizing by weight in children., Methods: After approval by the institutional ethics board and written informed consent from parents, 197 children with American Society of Anesthesiologists physical status I-II who were scheduled for a routine genitourinary operation were included in the study. The correct ProSeal laryngeal mask airway size was determined according to the size of the auricle in children. The results were compared with the standard weight-based method recommended by the manufacturer's guidelines. The patients were classified into different groups depending on the ProSeal laryngeal mask airway sizes as determined by both methods. Agreement between both techniques was evaluated with κ coefficient statistics., Results: Insertion and adequate ventilation were achieved in 185 patients at the first attempt, and 12 patients required a second attempt. Three patients had to be intubated. Agreement between the two methods of size selection of the ProSeal laryngeal mask airway was moderate using κ statistics., Conclusions: Choosing the size of the ProSeal laryngeal mask airway in children according to the auricle of the child is valid and practical. In particular, this is an alternative method in situations where the patient's weight is unknown, such as in emergency situations., (Copyright © 2016 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.)

This study aims to enhance the anatomical knowledge of the ear of the adult quail (Coturnix coturnix) through the creation of a scaled 3D model utilizing data from micro-CT images. In addition, 17 annotated histological sections of the quail's ear are aligned to their 3D position in the model. The resulting anatomical atlas provides an intuitive insight into the 3D anatomy and can be used for medical education. The model also allows measuring anatomical structures and can thus serve as reference for the quail's auricular anatomy and as a basis to evaluate clinical diagnostic imaging results., (© 2015 Blackwell Verlag GmbH.)

Beyond the first peak of head-related transfer functions or pinna-related transfer functions (PRTFs) human pinnae are known to have two normal modes with "vertical" resonance patterns, involving two or three pressure anti-nodes in cavum, cymba, and fossa. However, little is known about individual variations in these modes, and there is no established model for estimating their center-frequencies from anthropometry. Here, with geometries of 38 pinnae measured, PRTFs were calculated and vertical modes visualized by numerical simulation. Most pinnae were found to have both Cavum-Fossa and Cavum-Cymba modes, with opposite-phase anti-nodes in cavum and either fossa or cymba, respectively. Nevertheless in both modes, fossa involvement varied substantially across pinnae, dependent on scaphoid fossa depth and cymba shallowness. Linear regression models were evaluated in mode frequency estimation, with 3322 measures derived from 31 pinna landmarks. The Cavum-Fossa normal mode frequency was best estimated [correlation coefficient r = 0.89, mean absolute error (MAE) = 257 Hz or 4.4%] by the distance from canal entrance to helix rim, and cymba horizontal depth. The Cavum-Cymba normal mode frequency was best estimated (r = 0.92, MAE = 247 Hz or 3.2%) by the sagittal-plane distance from concha floor to cymba anterior wall, and cavum horizontal depth.

The external ear is accessible to direct examination; the clinical history and otoscopy are sufficient to diagnose and treat most diseases of the external ear. We aim to describe the normal anatomy of the external ear, specify the indications for imaging tests, and review the clinical and radiological manifestations of the most common diseases affecting the external ear. We classify these diseases according to their origin into congenital, inflammatory, infectious, or traumatic disease or benign bone tumors or malignant tumors. Imaging does not play an important role in diseases of the external ear, but in certain clinical scenarios it can be crucial for reaching a concrete diagnosis and establishing the best treatment. Computed tomography is the first-choice technique for most diseases. Magnetic resonance imaging complements computed tomography and makes it possible to differentiate among different tissue types and to evaluate the extension of disease accurately., (Copyright © 2015 SERAM. Published by Elsevier España, S.L.U. All rights reserved.)

In spite of the growing interest in rodents with subterranean activity in general and the spalacids (Spalacidae) in particular, little is known about the biology of most members of this clade, such as the Chinese bamboo rat (Rhizomys sinensis). Here, we analyzed the ear morphology of R. sinensis with respect to hearing specialization for subterranean or aboveground modes of communication. It is well-known that ecology and style of life of a particular species can be reflected in morphology of its ear, its hearing and vocalization, so we expect that such information could provide us insight into its style of life and its sensory environment. The ratio between the eardrum and stapedial footplate areas, which influences the efficiency of middle ear sound transmission, suggests low hearing sensitivity, as is typical for subterranean species. The cochlea had 3.25 coils and resembled species with good low frequency hearing typical for subterranean mammals. The length of the basilar membrane was 18.9 ± 0.8 mm and its width slowly increased towards the cochlear apex from 60 to 85 μm. The mean density of outer hair cells was 344 ± 22 and of inner hair cells 114 ± 7.3 per 1 mm length of the organ of Corti, and increased apically. These values (except for relatively low hair cell density) usually characterize ears specialized for low frequency hearing. There was no evidence for an acoustic fovea. Apart of low hair cell density which is common in aboveground animals, this species has also relatively large auricles, suggesting the importance of sound localization during surface activity. The ear of the Chinese bamboo rat thus contains features typical for both aboveground and subterranean mammals and suggests that this spalacid has fossorial habits combined with regular aboveground activity., (© 2016 Wiley Periodicals, Inc.)

The unique outer ear of crocodylians consists of a large meatal chamber (MC) concealed by a pair of muscular earlids that shape a large part of the animal's head. This chamber is limited medially by the enlarged tympanic membrane. Yet, the anatomy of this distinctive and complex region is underexplored and its evolutionary history untraced. The osteology and soft tissues of the MC in extant crocodylians was analysed to describe it and establish osteological correlates within this region. A broad survey of the osteological correlates was conducted in major clades of fossil crocodyliforms to estimate evolutionary trends of the MC. The reorganization of the MC at the origin of crocodyliforms includes characters also present in more basal taxa such as 'sphenosuchians' as well as unique traits of crocodyliforms. Three major patterns are recognized in the MC of basal mesoeucrocodylians. The distinct 'thalattosuchian pattern' indicates that extensive modifications occurred in this clade of aquatic fossil crocodyliforms, even when multiple alternative phylogenetic positions are taken into account. Some traits already established in putative closely related clades are absent or modified in this group. The 'basal notosuchian/sebecian pattern' is widespread among basal metasuchians, and establishes for the first time characters maintained later in neosuchians and extant forms. The 'advanced notosuchian pattern' includes modifications of the MC possibly related to a terrestrial lifestyle and potentially a structure analogous to the mammalian pinna. The main variation in the MC of neosuchians is associated with the homoplastic secondary opening of the cranioquadrate passage. The inferred phylogenetic trends in the crocodyliform MC suggest the great anatomical disparity in this region followed a complex evolutionary pattern, and tympanic hearing played an important role in the origin and diversification of Crocodyliformes., (© 2016 Anatomical Society.)

Recently, much attention has focused on replacement or/and enhancement of biological tissues via the use of cell-laden hydrogel scaffolds with an architecture that mimics the tissue matrix, and with the desired three-dimensional (3D) external geometry. However, mimicking the heterogeneous tissues that most organs and tissues are formed of is challenging. Although multiple-head 3D printing systems have been proposed for fabricating heterogeneous cell-laden hydrogel scaffolds, to date only the simple exterior form has been realized. Here we describe a computer-aided design and manufacturing (CAD/CAM) system for this application. We aim to develop an algorithm to enable easy, intuitive design and fabrication of a heterogeneous cell-laden hydrogel scaffolds with a free-form 3D geometry. The printing paths of the scaffold are automatically generated from the 3D CAD model, and the scaffold is then printed by dispensing four materials; i.e., a frame, two kinds of cell-laden hydrogel and a support. We demonstrated printing of heterogeneous tissue models formed of hydrogel scaffolds using this approach, including the outer ear, kidney and tooth tissue. These results indicate that this approach is particularly promising for tissue engineering and 3D printing applications to regenerate heterogeneous organs and tissues with tailored geometries to treat specific defects or injuries.

Objective: This study was designed to examine the prevalence of unilateral and bilateral diagonal earlobe creases (DELCs) with respect to the diagnosis of coronary heart disease (CHD)., Methods: A total of 558 consecutive participants (402 males and 156 females) aged 36-91 years who underwent coronary angiography were enrolled in this study. The participants were classified as being without a DELC, having a unilateral DELC and having bilateral DELCs; participants with either a unilateral DELC or bilateral DELCs were defined as participants with DELCs. Significant CHD was defined as at least one major vessel with >50% stenosis, and coronary atherosclerosis severity was defined using the Gensini scoring system., Results: In the present study, bilateral DELCs were more frequently among male (p=0.001), CHD (p=0.000), older people (p=0.000) and those with more severe coronary artery atherosclerosis (p=0.000). The results of the multiple regression analyses indicated that DELCs (OR, 4.861; 95% CI 3.093 to 7.642, p=0.000) remained independently associated with a risk of CHD. It was assumed that participants without a DELC have a certain background risk for CHD (OR is assumed to be 1); the results of the multivariate logistic regression indicated that the relative risk of CHD among participants with bilateral DELCs was 5.690 among all participants (OR, 5.690; 95% CI 3.450 to 9.384, p=0.000), 5.436 among male participants (OR, 5.436; 95% CI 2.808 to 10.523, p=0.000) and 7.148 among female participants (OR, 7.148; 95% CI 3.184 to 16.049, p=0.000). Moreover, a positive association between DELC and age (SI=1.21, SIM=1.65, AP =0.132), gender (SI=2.09, SIM=0.81, AP=0.49) and smoking status (SI=1.49, SIM=0.73, AP=0.29) was found, respectively., Conclusions: The results of the present study indicated that DELCs are a simple and a feasible means of identifying CHD. However, the exact mechanism underlying the relationship between DELCs and CHD warrants further study., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/)

Background: Facial anthropometric analysis is essential for planning cosmetic and reconstructive facial surgery, but has not been available in detail for modern Greeks. In this study, multiple measurements of the face were performed on young Greek males and females to provide a complete facial anthropometric profile of this population and to compare its facial morphology with that of North American Caucasians., Materials and Methods: Thirty-one direct facial anthropometric measurements were obtained from 152 Greek students. Moreover, the prevalence of the various face types was determined. The resulting data were compared with those published regarding North American Caucasians., Results: A complete set of average anthropometric data was obtained for each sex. Greek males, when compared to Greek females, were found to have statistically significantly longer foreheads as well as greater values in morphologic face height, mandible width, maxillary surface arc distance, and mandibular surface arc distance. In both sexes, the most common face types were mesoprosop, leptoprosop, and hyperleptoprosop. Greek males had significantly wider faces and mandibles than the North American Caucasian males, whereas Greek females had only significantly wider mandibles than their North American counterparts., Conclusions: Differences of statistical significance were noted in the head and face regions among sexes as well as among Greek and North American Caucasians. With the establishment of facial norms for Greek adults, this study contributes to the preoperative planning as well as postoperative evaluation of Greek patients that are, respectively, scheduled for or are to be subjected to facial reconstructive and aesthetic surgery.

Introduction: Sagittal soft-tissue analyses made from photographic records (sagittal photogrammetric analysis of the soft tissues) allow orthodontists to quantify the sagittal dimension and situation of the facial soft tissues. These tissues maintain close anatomical relationships with the underlying dental arches. However, little importance has been given to the description and the comparison of the sagittal soft tissue morphology according to dental arches parameters. The purpose of this study was to determine the correlation between the sagittal photogrammetric soft tissue profile and the dental arches measurements., Materials and Methods: A cross-sectional study was performed in a group of students. Standardized facial-profile photographs were taken with each student in natural head position, and relaxed lip posture. Photogrammetric parameters were measured on paper sheet using a graduated ruler. Dental arches measurements were also performed directly into the mouth with an electronic caliper. The strength of the association between sagittal photogrammetric soft tissue measurements and dental arches parameters was investigated by a Pearson's correlation. Results were regarded as significant at p=0.05., Results: The lips protrusion parameters were significantly and positively correlated with the dental arch lengths. The overjet was significantly and positively correlated with Ls/Sn-Sm. The overbite was significantly and negatively correlated with the sagittal labial parameters Ls/N-Ort, Li/N-Ort, Ls-E, Li E, Ls-S, Li S, Ls/Sn-Sm and Li/Sn-Sm., Conclusion: The correlations found in this study show the importance of taking into account the soft tissue in the diagnosis and orthodontic treatment of patients., (© EDP Sciences, SFODF, 2015.)

Two experiments are presented to explore the limits when matching a sample to a suspect utilising the hand as a novel biometric. The results of Experiment 1 revealed that novice participants were able to match hands at above-chance levels as viewpoint changed. Notably, a moderate change in viewpoint had no notable effect, but a more substantial change in viewpoint affected performance significantly. Importantly, the impact of viewpoint when matching hands was smaller than that when matching ears in a control condition. This was consistent with the suggestion that the flexibility of the hand may have minimised the negative impact of a sub-optimal view. The results of Experiment 2 confirmed that training via a 10-min expert video was sufficient to reduce the impact of viewpoint in the most difficult case but not to remove it entirely. The implications of these results were discussed in terms of the theoretical importance of function when considering the canonical view and in terms of the applied value of the hand as a reliable biometric across viewing conditions.

Prominent ears affect approximately 5% of the population and can have a significant psychological impact on patients. A wide variety of otoplasty techniques have been described, all sharing the goal of re-creating the normal appearance of the ear and achieving symmetry between the 2 sides. Recent trends in otoplasty techniques have consistently moved toward less invasive options, ranging from nonsurgical newborn ear molding to cartilage-sparing surgical techniques and even incisionless, office-based procedures. Herein, we review anatomy of the external ear, patient evaluation, the evolution of nonsurgical and surgical otoplasty techniques, otoplasty outcomes, and future trends for treatment of prominent ears.

During auricle reconstruction, lobular transposition has become a routine technique applied by most of surgeons. But to some low-set remnant ears, it is difficult to manipulate the conventional lobule transposition method in clinical application. In this article, the authors introduce a method to retrogradely transpose the remnant ear with the the ratio of length:width of the lobular flap being 4-5:1. The lobule transposition could be applied during the first stage of Nagata method or the third stage using expansion method. The authors take the superior part of the remnant ear as the pedicle and make the incision at the middle and inferior parts of the remnant ear to form the lobular flap. Then the inferior lobule is rotated posteriorly and superiorly to cover the rear end of the framework and to form the inferior part of helical rim. The results of the reconstructed auricles are satisfactory with aesthetic natural earlobes and the location of the reconstructed ear is symmetric to the contralateral ear. The authors believe that to the 2% to 5% patients with low-set microtia, this is a good way to make use of remnant ear for the purpose of a real earlobe.

The directional properties of bat ears as receivers is a current area of interest in ultrasound research. This paper presents a new approach to analyse the relationship between morphological features and acoustical properties of the external ear of bat species. The beam pattern of Rousettus leschenaultii's right ear is measured and compared to that of receiver structures whose design is inspired by the bat ear itself and made of appropriate geometric shapes. The regular shape of these receivers makes it possible to control the key reception parameters and thus to understand the effect on the associated beam pattern of the parameters themselves. Measurements show one receiver structure has a beam pattern very similar to that of R. leschenaultii's ear, thus explaining the function of individual parts constituting its ear. As it is applicable to all bat species, this approach can provide a useful tool to investigate acoustics in bats, and possibly other mammals.

The external ear and its prints have multifaceted roles in medico-legal practice, e.g., identification and facial reconstruction. Furthermore, its norms are essential in the diagnosis of congenital anomalies and the design of hearing aids. Body part dimensions vary in different ethnic groups, so the most accurate statistical estimations of biological attributes are developed using population-specific standards. Sudan lacks comprehensive data about ear norms; moreover, there is a universal rarity in assessing the possibility of sex estimation from ear dimensions using robust statistical techniques. Therefore, this study attempts to establish data for normal adult Sudanese Arabs, assessing the existence of asymmetry and developing a population-specific equation for sex estimation. The study sample comprised 200 healthy Sudanese Arab volunteers (100 males and 100 females) in the age range of 18-30years. The physiognomic ear length and width, lobule length and width, and conchal length and width measurements were obtained by direct anthropometry, using a digital sliding caliper. Moreover, indices and asymmetry were assessed. Data were analyzed using basic descriptive statistics and discriminant function analyses employing jackknife validations of classification results. All linear dimensions used were sexually dimorphic except lobular lengths. Some of the variables and indices show asymmetry. Ear dimensions showed cross-validated sex classification accuracy ranging between 60.5% and 72%. Hence, the ear measurements cannot be used as an effective tool in the estimation of sex. However, in the absence of other more reliable means, it still can be considered a supportive trait in sex estimation. Further, asymmetry should be considered in identification from the ear measurements., (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)

The veracity of virtual audio is degraded by the use of non-individualized head-related transfer functions (HRTFs) due to the introduction of front-back, elevation confusions, and timbral coloration. Hence, an accurate reproduction of spatial sound demands the use of individualized HRTFs. Measuring distance-dependent individualized HRTFs can be extremely tedious, since it requires precise measurements at several distances in the proximal region (<1 m) for each individual. This paper proposes a technique to model distance-dependent individualized HRTFs in the horizontal plane using "frontal projection headphones playback" that does not require individualized measurements. The frontal projection headphones [Sunder, Tan, and Gan (2013). J. Audio Eng. Soc. 61, 989-1000] project the sound directly onto the pinnae from the front, and thus inherently create listener's idiosyncratic pinna cues at the eardrum. Perceptual experiments were conducted to investigate cues (auditory parallax and interaural level differences) that aid distance perception in anechoic conditions. Interaural level differences were identified as the prominent cue for distance perception and a spherical head model was used to model these distance-dependent features. Detailed psychophysical experiments revealed that the modeled distance-dependent individualized HRTFs exhibited localization performance close to the measured distance-dependent individualized HRTFs for all subjects.

Head-related transfer functions (HRTFs) can be numerically calculated by applying the boundary element method on the geometry of a listener's head and pinnae. The calculation results are defined by geometrical, numerical, and acoustical parameters like the microphone used in acoustic measurements. The scope of this study was to estimate requirements on the size and position of the microphone model and on the discretization of the boundary geometry as triangular polygon mesh for accurate sound localization. The evaluation involved the analysis of localization errors predicted by a sagittal-plane localization model, the comparison of equivalent head radii estimated by a time-of-arrival model, and the analysis of actual localization errors obtained in a sound-localization experiment. While the average edge length (AEL) of the mesh had a negligible effect on localization performance in the lateral dimension, the localization performance in sagittal planes, however, degraded for larger AELs with the geometrical error as dominant factor. A microphone position at an arbitrary position at the entrance of the ear canal, a microphone size of 1 mm radius, and a mesh with 1 mm AEL yielded a localization performance similar to or better than observed with acoustically measured HRTFs.

Introduction: Facial soft-tissue analyses made from photographic records (photogrammetric analysis of the soft tissues) showed interracial dimorphism. Standard of these facial analyses, originally obtained from Caucasian might not be appropriate for the diagnosis and treatment planning of other groups of orthodontic patients. The purpose of this study was to compare the sagittal photogrammetric soft tissue profile characteristics between Senegalese and Moroccan adults., Materials and Methods: A cross-sectional study was performed in a group of Senegalese and Moroccan students in the Faculty of Medicine, Pharmacy and Dentistry of Dakar. Standardized facial-profile photographs were taken with each student in natural head position, centric relation, and relaxed lip posture. Twenty four linear parameters were measured on paper sheet using a graduated ruler. For each variable mean and SD were calculated. In addition independent samples t-test was performed to detect sexual and racial dimorphism. Results were regarded as significant at p = 0.05., Results: Senegalese subjects had significantly more lips protrusion than Moroccan who had significantly a more elongated and more anterior positioned nose, a more chin prominence and a tendency to cutaneous class II than Senegalese., Conclusion: Further studies including different age groups subjects would allow having longitudinal data according to age.