|Year : 2019 | Volume
| Issue : 1 | Page : 1-5
Orbital cavity evaluation in a Brazilian population
Alanalaiz Magalhaes Pereira, Antonio Azoubel Antunes, Evelyne Pessoa Soriano, Breno Henrique Mara Rodrigues, Vinicius Balan Santos Pereira, Gabriela Granja Porto
Department of Forensic Sciences, University of Pernambuco, Camaragibe, PE, Brazil
|Date of Web Publication||11-Jun-2019|
Gabriela Granja Porto
University of Pernambuco – Faculty of Dentistry of Pernambuco, General Newton Cavalcanti Avenue, 1650, Camaragibe, PE
Source of Support: None, Conflict of Interest: None
Objective: The main objective is to analyze the differences between the orbital cavities according to age and sex in a population from the Northeast of Brazil and compare with a specific Chinese population. Methodology: Linear measurements on 8 points of the orbit were made in a sample of 113 patients, based on each sex and age range (<19, 20–39, 40–59 and ≥ 60 years old). The distances were orbital width, orbital height, medial orbital wall, lateral orbital wall, superior orbital wall, inferior orbital wall, interorbital width, and biorbital width. Results: It was noticed that the orbital cavities of men were higher in all measures than those of women (P < 0.001), except for the orbital height and the distance between the orbits. Younger patients showed a tendency to have smaller orbits. Comparing the measurements obtained for the Brazilian participants with those of Chinese, the orbits of Brazilians were significantly higher on all measures (P < 0.001), except for biorbital breath. Conclusion: There were significant differences between most measures of orbital cavities between men and women in the Brazilian population, while differences were seen in all measurements between Brazilian and Chinese population.
Keywords: Computerized tomography, human identification, orbit
|How to cite this article:|
Pereira AM, Antunes AA, Soriano EP, Mara Rodrigues BH, Santos Pereira VB, Porto GG. Orbital cavity evaluation in a Brazilian population. J Oral Maxillofac Radiol 2019;7:1-5
|How to cite this URL:|
Pereira AM, Antunes AA, Soriano EP, Mara Rodrigues BH, Santos Pereira VB, Porto GG. Orbital cavity evaluation in a Brazilian population. J Oral Maxillofac Radiol [serial online] 2019 [cited 2019 Jun 18];7:1-5. Available from: http://www.joomr.org/text.asp?2019/7/1/1/259978
| Introduction|| |
Forensic dentistry plays an important role in human identification. It is known that the identification of an individual, whether dead or alive, is a difficult task and one of the main objectives of forensic sciences. Identification is a fundamental requirement for death certificate and has personal, social, legal, and humanitarian motivations. An identification process demands five technical requirements: variability, immutability, perenniality, practicality, and the possibility of classification.
Orbits can predict individuals' ethnicity and gender for more than a century. They widen with age, and there are significant correlations between individual's height, orbit's measurements, and eye location. Thus, orbit anthropometrics variation may reveal other characteristics such as age, gender, and ethnicity.
Several previous studies quantitatively assessed age, gender, and ethnic characteristics and various aspects of the orbital region components., Therefore, studies have focused only on orbital volume measurements, while a more complete and systematic set of anatomic parameters that describe orbital features in a more precise and quantitative way have not been explored in a Brazilian population. Since differences among different populations provide an important perspective to forensic anthropometrics in the individualization process, the aim of this study is to measure orbital parameters of normal adult individuals using a three-dimensional (3D) method of reconstruction in a particular Brazilian population.
| Methodology|| |
The Ethics Committee of the University of Pernambuco approved this research under the number CAAE: 32057314.2.0000.5207.
The sample was estimated with PC-SIZE 1.1, (1990) using a data source with variables similar to those used by Ji et al. We calculated it based on mean and standard deviation of the orbital cavity ceiling length on both males and females. These were the chosen variables because it showed a significant difference and resulted in a larger sample when compared to other variables with significant differences.
The number of patients obtained was 47 for each group, giving a total of 94. A value of 0.90424 was obtained on power analysis. A significance level of 0.05 was adopted. Considering a sample loss of 20%, we used a sample of 113 patients.
The sample consisted of patients of both sexes who sought attendance at the Radiologic Clinic of the University Hospital Oswaldo Cruz/University of Pernambuco for skull diagnosis during 4 months. Thus, patients' radiations were not the sole reason of the study.
Patients with signs of trauma; younger than 20 years old; who have had eye or orbit affecting conditions such as thyroid diseases, orbital fractures, intraocular or intraorbital tumors, congenital microphthalmia or anophthalmia; and had undergone surgery or presented artifacts on tomography were excluded from the sample.
A four-channel multislice/General Electric (GE) computerized tomography (CT), with slice thickness of 1.25 mm and increment of 1 mm, was used in the study. This kind of examination is capable of producing section images and multiplanar reconstructions of an object in three planes and three dimensions. The images obtained were visualized using a free software, Invesalius 3.0® for CT image reconstruction. Position and orientation of head planes were adjusted, and the skull and orbital cavities were observed. All orbital cavities measurements were taken using the software tools.
Measurements were taken according to Ji et al. methodology at the computer screen using the tomography console cursor with an accuracy of 0.01 mm. All measurements were taken by an independent and trained evaluator. The evaluator was previously calibrated measuring five CT-scans images, that did not take part of the study sample, for three times, in different moments. Measures obtained were then compared and kappa test was applied for results agreement. Sex and age data were taken by a different interviewer. The authors understand that the knowledge of this data could influence the measurements taken right after. All data were registered in an appropriate sheet.
Ages were grouped as follows: <19, 20–39, 40–59, and ≥60 years old.
Initially, multiplanar images (coronal and sagittal) and 3D reconstructed images were displayed on the bone window at the bottom of the original horizontal sections. A surface reconstruction of the orbital content was generated by semi-automatic 3D segmentation. To assure accuracy, a manual segmentation was used to define the orbit boundaries, limited by the four orbital walls. Posterior boundary was defined as the junction of medial and lateral walls of the optic foramen. The anatomic points at the orbit [n = 5; [Table 1] and [Figure 1] were located on the 3D model of the orbit, and the lengths were calculated [n = 8; [Table 1] and [Figure 1] using Invesalius 3.0® tools.
|Table 1: Definition of the anatomic points at the orbit and relevant lengths|
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|Figure 1: Representation of anatomic points at the orbit and the relevant lengths|
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Absolute and percent frequencies were calculated in addition to mean and standard deviation as descriptive statistics, and As inferential statistics, Student's t-test for single and paired samples, Student's t-test for two independent samples assuming equal and unequal variance and the F test (ANOVA) with Tukey's multiple comparisons or Kruskal–Wallis were performed.
It is worth stressing that Kruskal–Wallis test was chosen when normality hypothesis was not verified and the other tests were chosen otherwise. The variance equality hypothesis was verified with Levene's F test. Comparison of gender and age ranges considered the averages for the left and right sides for each individual.
The margin of error was defined as 5%. Data were organized in an Excel sheet and the statistical calculations were performed using Statistical Package for the Social Sciences (SPSS™, SPSS Inc., Chicago, USA).
| Results|| |
Of the 113 patients, six were excluded from the sample due to orbital fractures.
The patients' age ranged from 8 to 80 years, with average of 36.08 and standard deviation of 16.61 years and median of 34 years.
The data obtained in the present study were statistically compared with data of Ji et al. study, which evaluated the same parameters in a Chinese population.
According to gender and age distribution, most of the participants were distributed in the age ranges 20–39 years (46.7%) and 40–59 years (28.0%) and the other two ranges comprised 9.3%–15.9% of the studied population; more than half the sample (56.1%) were males.
[Table 2] presents the measurements according to side and gender. From this table, it is possible to observe that: for the margin of error considered (5%), only “length of orbital ceiling” and “length of orbital floor” were significantly different (P < 0.05) between the right and left sides, with the right side 0.08 mm higher on average for the ceiling and the left side 0.07 mm higher on average for the floor. All variables were consistently higher in males than in females, and the differences between sexes were significant for all variables but orbital height and intraorbital distance.
|Table 2: Means and standard deviations and value differences of orbital measurements according to side and gender|
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From [Table 3], it is worth stressing that: the first age range (<19 years old) present the highest average for “length of the orbit ceiling.” The range between 20 and 39 years old present the highest values for “orbital width” (P = 0.029), and “length of the orbit medial wall” (P = 0.033). The range 40–59 years have high averages for the variables “length of the orbit lateral wall” (P = 0.030) and “extraorbital distance” (P = 0.006). For the age range from 60 years old on, the highest variable is “intraorbital distance” (P = 0.017).
Regarding comparison between this study and the one in Chinese, only intraorbital distance and extraorbital distance were higher in average in the reference work. All other variables were higher in this study. These differences were statistically significant for all variables but extraorbital distance for both sexes [Table 4].
|Table 4: Comparisons between values of the Brazilian and Chinese populations|
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| Discussion|| |
The human face carries information that allows unique identification. Methods of craniofacial identification, such as facial approximation or superimposition demand accurate and reliable directions based on large databases. Reference to anthropometric data from the orbital region is necessary in several forensics and diagnostics procedures., Furthermore, forensic science may play an important role on sexual dimorphism and ethnicity characterization.
In different populations, considering racial variability, it is not possible to extrapolate measurements. Thus, the present study established a set of parameters in order to describe the main characteristics of the orbits of a certain population.
Men's orbits were significantly larger than those of women for all measurements, except for height and distance between orbits that showed no significant difference between sexes. This data agrees with the findings obtained in other studies., When compared to the Chinese study, the Brazilian population studied here showed larger measurements with statistical significance except for extraorbital distance. This is likely due to the ethnic anatomical difference between the populations. Space between superior and inferior eyelids is smaller in Asian people compared to Caucasian and African peoples. The difference is a consequence of natural evolution. People from Southeast Asia, Eskimos, and Amerindians descended from North Asia in the past 10.000 years ago. In regions like that, low temperatures and intense luminosity resulting from sunlight reflecting on snow cause temporary blindness, cataract, and other vision problems. Individuals with narrower eyelid openings are better adapted to this environment. Over generations, natural selection privileged these individuals in the population, giving Asian people almond-shaped eyes.
Younger patients showed a tendency to have smaller orbits. With age, the orbits grow in size until the age range of 60 or older, when they slightly decrease in size [Table 3]. However, it is not possible to infer a change in orbit size according to age. For this, it would be necessary to follow the same individuals over the years. Literature shows that facial bones also contribute in a significant way to alter facial appearance with aging. These bone alterations are different for different parts of the face.
Brazilian orbits are larger than those of the Chinese, since all measurements were higher in the former population. On the other hand, intraorbital and extraorbital distances are larger in the Chinese population. This result was expected given the phenotypical variability in different ethnicities. Regarding this issue, it is important to mention that in orbital reconstructions, in which measurements of medial and lateral walls of ceiling and floor are extremely important, differences regarding gender and between different populations should be considered to achieve a successful treatment. Measurements taken in one population must be used with care in another. This enforces the importance of this kind of study in different ethnicities.
About the differences between the left and right orbits, Brazilian orbits are equivalent for most of the variables, except for “length of orbit ceiling” and “length of orbit floor,” which showed significant differences with P < 0.05. Still, Brazilian orbits showed higher averages for all measurements when compared to those of the Chinese, with statistical significance. Thus, symmetry was observed in both populations.,
The standard deviations of the orbit cavities measures obtained for side, gender, and age range were small compared to the correspondent averages. This is positive since a small variability may reflect an appropriate number to reliably answer the study central hypothesis. However, the measurements presented cannot be extrapolated as a national representative due to the high miscegenation of the Brazilian population and the ethnical differences among regions. It must be mentioned that ethnic diversity in the Brazilian population may cause differences in orbital cavities measurements. Thus, other studies should be conducted in different regions to establish the variations in the parameters studied. Nonetheless, the findings are particularly relevant since there are no similar studies with Brazilian adults.
| Conclusion|| |
It can be concluded that there are significant differences in most of the orbital cavity measurements between males and females and among different age ranges in a Brazilian population. Males' orbital cavities measurements were larger than those of females' were. Significant differences were found in orbital cavities measurements between Brazilian and Chinese populations for all measurements, which enforces that different populations may have significant differences.
Financial support and sponsorship
This research had financial support from a public notice: PFA/UPE/2014.
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4]