Nose approximation among South African groups from cone-beam computed tomography (CBCT) using a new computer-assisted method based on automatic landmarking.

Considering the high demand for the identification of unknown remains in South Africa, a need exists to establish reliable facial approximation techniques that will take into account sex and age and, most importantly, be useful within the South African context. This study aimed to provide accurate statistical models for predicting nasal soft-tissue shape from information about the underlying skull subtract among a South African sample. The database containing 200 cone-beam computer tomography (CBCT) scans (100 black South Africans and 100 white South Africans). The acquisition and extraction of the 3D relevant anatomical structures (hard- and soft-tissue) were performed by an automated three-dimensional (3D) method based on an automatic dense landmarking procedure using MeVisLab © v. 2.7.1 software. An evaluation of shape differences attributed to known factors (ancestry, sex, size, and age) was performed using geometric morphometric and statistical models of prediction were created using a Projection onto Latent Structures Regression (PLSR) algorithm. The accuracy of the estimated soft-tissue nose was evaluated in terms of metric deviations on training and un-trained datasets. Our findings demonstrated the influence of factors (sex, aging, and allometry) on the variability of the hard- and soft-tissue among two South African population groups. This research provides accurate statistical models optimized by including additional information such as ancestry, sex, and age. When using the landmark-to landmark distances, the prediction errors ranged between 1.769mm and 2.164mm for black South Africans at the tip of the nose and the alae, while they ranged from 2.068mm to 2.175mm for the white subsample. The prediction errors on un-trained data were slightly larger, ranging between 2.139mm and 2.833mm for the black South African sample at the tip of the nose and the alae and ranging from 2.575mm to 2.859mm for the white South African sample. This research demonstrates the utilization of an automated 3Dmethod based on an automatic landmarking method as a convenient prerequisite for providing a valid and reliable nose prediction model that meets population-specific standards for South Africans.

Automatic landmarking as a convenient prerequisite for geometric morphometrics. Validation on cone beam computed tomography (CBCT)- based shape analysis of the nasal complex.

Manual landmarking is used in several manual and semi-automated prediction guidelines for approximation of the nose. The manual placement of landmarks may, however, render the analysis less repeatable due to observer subjectivity and, consequently, have an impact on the accuracy of the human facial approximation. In order to address this subjectivity and thereby improve facial approximations, we are developing an automated three-dimensional (3D) method based on an automatic dense landmarking procedure using non-rigid surface registration. The aim of this study was to validate the automatic landmarking method by comparing the intra-observer errors (INTRA-OE) and inter-observer errors (INTER-OE) between automatic and manual landmarking. Cone beam computed tomography (CBCT) scans of adult South Africans were selected from the Oral and Dental Hospital, University of Pretoria, South Africa. In this study, the validation of the automatic landmarking was performed on 20 3D surfaces. INTRA-OE and INTER-OE were analyzed by registering 41 craniometric landmarks from 10 hard-tissue surfaces and 21 capulometric landmarks from 10 soft-tissue surfaces of the same individuals. Absolute precision of the landmark positioning (both on the samples as well as the template) was assessed by calculating the measurement error (ME) for each landmark over different observers. Systematic error (bias) and relative random error (precision) was further quantified through repeated measures ANOVA (ANOVA-RM). The analysis showed that the random component of the ME in landmark positioning between the automatic observations were on average on par with the manual observations, except for the soft-tissue landmarks where automatic landmarking showed lower ME compared to manual landmarking. No bias was observed within the craniometric landmarking methods, but some bias was observed for capulometric landmarking. In conclusion, this research provides a first validation of the precision and accuracy of the automatic placement of landmarks on 3D hard- and soft-tissue surfaces and demonstrates its utilization as a convenient prerequisite for geometric morphometrics based shape analysis of the nasal complex.

Skeletal dimensions as predictors for the shape of the nose in a South African sample: A cone-beam computed tomography (CBCT) study.

The profile of the nose is an important feature for facial approximations. Although several manual and semi-automated prediction guidelines exist for estimating the shape of the nose, the reliability and applicability of these methods to South Africans groups are unknown. The aim of this study was to predict the displacements of capulometric landmarks from hard-tissue planes to facilitate nasal soft-tissue reconstruction in a South African sample. Cone beam computed tomography (CBCT) scans of 120 adult South Africans were selected from the Oral and Dental Hospital, University of Pretoria, South Africa. Measurements involving craniometric and capulometric landmarks of the nose were obtained as plane-to-plane distances. Correlation coefficients between hard- and soft-tissue measurements were determined, and regression equations computed to assist in the prediction of the most probable shape and size of the nose. All hard- and soft-tissue measurements appeared significantly different between groups, except for the distance between the pronasale and nasion in the transverse plane and for the distance between the alare and the nasion in the coronal plane. The nasal height, nasal bone length and the nasal bone projection were significant predictors of the pronasale, subnasale and alare positions. More precisely, the nasal height and the nasal bone length were significant predictors of the pronasale position in both groups. Nasal bone projection was only useful for predicting shape in white South Africans. The variation in the skeletal predictors of the external shape of the nose noted between black and white South Africans and the results of the cross-validation testing emphasize the need for population specific guidelines.

Assessment of the variability in the dimensions of the intact pelvic canal in South Africans: A pilot study.

Cephalopelvic disproportion is common among Africans and is a major cause of maternal and perinatal mortality and morbidity. As the dimensions of the pelvis may vary between populations and according to stature and age, they need to be considered during childbirth and also in the planning and performance of pelvic and perineal procedures. The aim of this study was to assess the possible variations in the dimensions of the intact pelvic canal in South Africans and their implications. Eighty intact cadaver pelves, belonging to 40 white South Africans (20 males and 20 females) and 40 black South Africans (20 males and 20 females) were used for both metric and geometric morphometric analyses. Pelvic inlet shapes did not differ significantly between groups but pelvic inlet and midpelvic dimensions were the greatest in white South Africans and females. The pubic symphyseal length was the greatest in white males and the smallest in black females, resulting in a smaller pelvic cavity anteriorly than for white females. Pelvic outlet shapes varied significantly between sexes in white South Africans and between white and black males. Females presented with the greatest dimensions. Black South African females presented with an elongated anteroposterior outlet diameter. Certain transverse pelvic diameters correlated positively with age in white males and with height in females. In planning childbirth options, the smaller pelvic inlet of black females and stature-dependent diameters should be considered. Pelvic and perineal surgery may be technically more challenging because of smaller pelvic dimensions in black South Africans, especially in males.

Surgical anatomy of the pudendal nerve and its branches in South Africans.

Dissection of the pudendal nerve (PN) and its branches in 71 cadavers revealed anatomic variations not previously described. Knowledge of this variation is necessary to prevent nerve injury resulting in sexual of sensory dysfunction. Because descriptions vary, this study re-evaluated the anatomy of the PN as implicated in perineal procedures in South Africans. The course of the PN from the gluteal region into the perineum was dissected in an adult sample of both sexes and of African and European ancestry. Distances between PN and branches to applicable landmarks were measured. Basic descriptive statistics and comparisons were carried out between groups. In 5/13 African females, the inferior rectal nerve (IRN) entered the gluteal region separately and in 12/13 cases it passed medial to the ischial spine with the PN. The dorsal nerve of the clitoris or penis (DNC/DNP) was closer to the bony frame in those of European ancestry. The IRN branches were more superficial in females, but deeper in males of European ancestry. In African females, a PN block and Richter stitch should be placed more medial. Outside-in transobturator tape procedures might endanger the DNC/DNP in obese individuals. In females of European ancestry the IRN branches are compromised during ischioanal abscess drainage. In males of European ancestry, the dorsal penile nerve block might be less effective. Predictions should be verified clinically.

An assessment of early mandibular growth.

Quantification of skeletal data has been shown to be an effective and reliable method of demonstrating variation in human growth as well as for monitoring and interpreting growth. In South Africa as well as internationally, few researchers have assessed mandibular growth in late fetal period and early childhood and therefore standards for growth and age determination in these groups are limited. The purpose of this study was to evaluate growth in the mandible from the period of 31 gestational weeks to 36 months postnatal. A total of 74 mandibles were used. Dried mandibles were sourced from the Raymond A. Dart Collection (University of Witwatersrand), and cadaveric remains were obtained from the Universities of Pretoria and the Witwatersrand. The sample was divided into four groups; 31-40 gestational weeks (group 1), 0-11 months (group 2), 12-24 months (group 3), and 25-36 months (group 4). Twenty-one osteological landmarks were digitized using a MicroScribe G2. Ten standard measurements were created and included: the maximum length of mandible, mandibular body length and width, mandibular notch width and depth, mental foramen to inferior border of mandible, mandibular basilar widths bigonial and biantegonial, bigonial width of mental foramen and mental angle. Data were analyzed using PAST statistical software and Morphologika2 v2.5. Statistically significant differences were noted in the linear measurements for all group comparisons except between groups 3 and 4. The mandible morphologically changed from a round, smooth contour anteriorly to adopt a more sharp and narrow adult shape. A progressive increase in the depth and definition of the mandibular arch was also noted. In conclusion, the mandible initially grows to accommodate the developing tongue (up to 11 months), progressive dental eruption and mastication from 12 to 36 months. Mastication is associated with muscle mass development; this would necessitate an increase in the dimensions of the mandibular notch and associated muscle attachment sites. These findings might be valuable in the estimation of age in unidentified individuals and to monitor prenatal growth of the mandible for the early diagnosis of conditions associated with stunted mandibular growth.

Geometric morphometric analysis of the use of mandibular gonial eversion in sex determination.

Physical anthropologists are continually looking for new ways to determine sex from skeletal remains. Determination of sex is done either metrically or descriptively (morphologically). Many characteristics cannot be metrically assessed and descriptive characteristics cannot always be objectively compared. Geometric morphometrics is a relatively new method that provides a mechanism to quantify descriptive morphological characteristics and provides statistics to interpret findings. In this study gonial eversion as a sexually dimorphic trait was re-evaluated, with the use of geometric morphometrics. Twenty-eight adult black female mandibles and 46 adult black male mandibles from South Africa were used. Photographs were taken of the posterior aspect of each mandible with a digital camera in a fixed position. The mandibles were positioned so as to optimise the demonstration of the gonial eversion.The captured electronic images (in jpg format) were then analysed with the tps series of programs (thin-plate spline analysis of digitized landmarks). Statistical analysis revealed that 71.4% of females and 73.9% of males could be accurately sexed by using the shape of the posterior aspect of the mandible. The males had a more variable shape, while the females were more similar to each other. A smaller gonial eversion involving the lower part of the mandibular ramus was seen in the females while the males tend to have a uniform and much wider curve involving the whole ramus. There was, however, considerable overlap between the sexes. Although different tendencies exist between the gonial eversion of the mandible of males and females, the extent of these differences is not adequate to predict the sex of a single individual.

Evaluation of Allen's test in both arms and arteries of left and right-handed people.

The Allen's test as described in 1929 by Edgar V. Allen has been modified, adapted and complemented by other newer modalities but remains a first line standard test to evaluate the arterial supply of the hand. In this study an attempt has been made to add more information regarding the arterial supply of the hand, in left- and right-handed individuals, left and right hands and the ulnar and radial arteries, when doing the Allen's test. A modified Allen's test using an oxygen saturation monitor was used. The sample group consisted of 80 (30 left-handed and 50 right-handed) students. No significant differences between the Allen's test of the left and right hands in the left and right-handed individuals were found. There was a marginal but not significant difference between the two arteries. The ulnar artery took slightly longer to reach baseline values as compared to the radial artery. The results suggest that a positive Allen's test can be found in both left and right-handed people, with regard to the left and right hands and both radial and ulnar arteries may be implicated. This information should be kept in mind when selecting either the radial or ulnar artery for grafting purposes (e.g. coronary angiosurgery) and forearm artery cannulation.

Geometric morphometric analysis of mandibular ramus flexure.

Many characteristics of the human skeleton can only be assessed morphologically, which may be problematic due to factors such as interobserver error and difficulties with standardization. Flexure of the mandibular ramus is one of these traits, and various researchers found widely differing results using this morphological feature. The aim of this study was to determine whether differences between male and female mandibular rami could be observed using the computerized method of geometric morphometrics, a valuable tool that helps quantify shape differences. Twenty-eight mandibular rami of black females and 43 of black males were photographed in a standard plane and assessed. It was found that the females were more scattered on the graph (more variable in shape), while the males clustered more around the center point where the two axes met (shape more constant). There was, however, considerable overlap between the sexes. Although different tendencies exist between the rami of males (being more flexed) and females (tending to be straight), the extent of these differences is not adequate to predict the sex of a single individual.

Age estimation from sternal ends of ribs by phase analysis in South African Blacks.

The sternal ends of ribs are used in age determination of unknown adult remains. Standards for American populations have been described and tested. The method described by Iscan et al. is reviewed and compared with other age markers of the human skeleton. Three hundred and thirty-nine (265 male, 74 female) sternal ends of right fourth ribs, belonging to black individuals deceased in the Gauteng Province of South Africa, were collected during 1994, 1995, and 1996. Three South African investigators applied the existing method and found the repeatability among them acceptable, although the method was less accurate to predict age in this population. New phases with adjusted criteria and age ranges were developed specifically for the South African black population. A tendency toward delayed maturation was found, as well as a diversion of the appearance of female ribs perimenopausally. Future studies involving more individuals in the older age ranges, and females of all ages, could broaden the representativeness of these phases.