INTRODUCTION:

Humans are born to vary from each other, either genetically or physically, by their unique characteristics. Morphology is believed to be the main and vital way to identify human variation, apart from other methods at microscopic levels, such as genetic and biochemical.¹Anthropometry is the longest-used tool for measuring human physical variation and surface morphology. Anthropometry originates from the Greek words "anthropos," which means human, and “metron” which means measure.²

According to the World Health Organisation (WHO), anthropometry is a cost-effective and noninvasive method used to evaluate the human body's size, proportions, and composition. It measures the whole human body, including individual parts such as the face, nose, eyes, and limbs. Nasal anthropometry concerns the measurement of different parameters of the human nose. The nose is categorised based on different nasal parameters such as nasal height, nasal width, nasal length, philtrum length, and nasal index.³ The nasal index is the percentage of the nasal width divided by the nasal height.⁴Nasal anthropometry is known as one of the best clues to racial origin.⁵ The shape and structure of the nose alter between different genders, races, and ethnicities.⁶ Therefore, the knowledge of different parameters of the nose and nasal index is important in physical anthropology and forensic medicine as it can distinguish the sex, race, and ethnicity of individuals whose identities are not known.⁴ It can be applied to living populations as well as fossils. In clinical practices, nasal index is useful in rhinoplasty, which is the plastic surgery of the nose and reconstructive surgery of the nose after an accident.⁷

By changing the patient's nose's size and shape, surgeons perform nasal analysis to achieve the desired aesthetic effect. Apart from that, dysmorphologists also utilise these parameters to make early diagnoses of some dysmorphic syndromes related to nose disorders in a healthy individual, such as cleft palate. Anthropometric data on the nasal dimensions is useful from many perspectives, including sex determination, quantifying nasofacial dysmorphology, forensic medicine, nasal surgery, and diagnostic comprehension.⁸

Nasofacial anthropometry is “ethnic sensitive” and has distinct sexual dimorphism. In Sarawak, research on the nasal index in major ethnic groups, specifically young adults, has not been done yet. Thus, the present study aims to identify and compare the anthropometric measurements of the external nose (nasal height, nasal length, nasal width, and philtrum length) among the major ethnic groups, Malay and Chinese, in Sarawak.

MATERIALS AND METHODS:

Study design and the participants:

A cross-sectional descriptive-analytical study was performed among eighty adult students of both genders (40 males and 40 females) aged 18 to 25 years from a public medical university, Sarawak. Of the 40 students, 20 were Malays, and another 20 were Chinese, both genders. The study was performed at the Anatomy Department, Faculty of Medicine and Health Sciences.

Data collection:

Nasal height, nasal length, nasal width, and philtrum length were measured by using a slide calliper and calculating the nasal index to identify the dominant types of noses among the two major ethnic groups. During the study, the same observer was assigned to carry out the measurement procedure to prevent inter-observer error and ensure the result was accurate. While sitting upright in a relaxed state with the head in an anatomical position, the observer sat beside the subject by facing the facial profile of the subject at eye level to measure the nasal length and nasal height (Figure 1). To measure nasal width and philtrum length, the observer sat at eye level in front of the subject. The subjects were asked not to make facial expressions to avoid measurement inaccuracy and prevent parallax errors. To measure the nasal height, a straight distance between the soft tissue of the nasion (n - the point on the root of the nose) and subnasale (sn - a point below the columella) was taken (Figure 2a). To measure nasal width, the distance between the right and left nasal alare (al-al – is the point at the most lateral surface of the external nose) was taken (Figure 2b). To measure nasal length, the distance between the nasion (n) and the pronasale (prn - the point at the nasal tip) was taken (Figure 2c). To measure philtrum length, the distance between the subnasale (sn) and the upper lip was taken (Figure 2d).⁹ The ratio of nasal width (al-al) to nasal height (n-sn) was calculated and then multiplied by 100 to obtain the nasal index (Figure 2e). All the measurements were taken twice to get the average value.

Figure 1: Slide calliper

Inclusion and exclusion criteria:

Students who had given consent and belonged to Malay and Chinese ethnicities were included. To avoid bias, non-Sarawakian subjects who had mixed parentage and race origin, a history of craniofacial anomalies, or previous nasal surgery were excluded from the study.

Sample size calculation:

The total sample size calculated for this study was 80 students (40 male and 40 female) using

n=Z²pq/ d²

[n=the desirable estimated sample size; Z=the standard normal deviation with a 95% confidence interval; p=proportion of variants; q=0.5, d=degree of accuracy.¹⁰

Data interpretation and statistical analysis:

All the data obtained were analysed using the Statistical Programme for Social Sciences (SPSS) version 22. The average for all the parameters was taken. The mean values and standard deviations (in mm) were obtained. Independent t-tests were performed to find out if there was any statistically significant difference between the male and female subjects of each ethnic group and between the two ethnic groups, Malay and Chinese. p-value less than 0.05 was considered statistically significant.

Ethical committee approval:

The study was conducted in accordance with the principles outlined in the Declaration of Helsinki and relevant national and institutional guidelines. Permission to conduct this study was obtained from the faculty medical and research ethics committee. The consent process was comprehensive, ensuring that participants were informed about the nature of the study, potential risks and benefits, and their right to withdraw at any point without consequences.

RESULT:

Depending on the type of nose, we found one leptorrhine, 20 mesorrhine, 14 platyrrhines, and five hyperplatyrrhine nose types among the 40 Malay subjects. On the other hand, among the 40 Chinese subjects, there was one leptorrhine, 20 mesorrhine, 17 platyrrhines, and two hyperplatyrrhine nose types. The dominant type of nose based on frequency in both ethnicities was the mesorrhine nose.

Table 1 explains anthropometric measurements of nasal parameters, which show Malay males had significantly more nasal width compared to females (p<0.05).

Figure 2a: Nasal height measurement is the distance between the nasion (n) and subnasale (sn).

Figure 2b: Nasal width measurement is the distance between the right and left nasal alars (al-al).

Figure 2c: Nasal length measurement is the distance between the nasion (n) and the pronasale (prn).

Figure 2d: Philtrum length measurement is the distance between the subnasale (sn) and the upper lip.

Figure 2e: Nasal index is the ratio of nasal width (al-al) to nasal height (n-sn) multiplied by 100.

Table 1: Anthropometric measurements of nasal parameters in Malay students

Measurements	Male		Female		p-value
Measurements	Mean (mm)	Standard Deviation (mm)	Mean (mm)	Standard Deviation (mm)	p-value
Nasal height	43.650	3.317	43.950	3.170	0.772
Nasal length	37.525	3.622	38.700	4.079	0.342
Nasal width	38.825	3.625	36.400	2.393	0.018
Philtrum length	12.300	2.593	12.325	2.166	0.974
Nasal index	89.389	10.363	83.393	9.761	0.067

^*p <0.05, ^xp >0.05

Table 2: Anthropometric measurements of nasal parameters in Chinese students

Measurements	Male		Female		p-value
Measurements	Mean (mm)	Standard Deviation (mm)	Mean (mm)	Standard Deviation (mm)	p-value
Nasal height	45.475	2.552	44.300	3.122	0.201^x
Nasal length	40.625	3.594	38.625	3.418	0.079^x
Nasal width	39.425	3.690	35.175	2.214	0.000^*
Philtrum length	16.025	2.658	13.050	2.929	0.002^*
Nasal index	86.848	8.107	79.700	6.644	0.004^*

^*p <0.05, ^xp >0.05

Table 3: Comparison of the anthropometric measurements of nasal parameters in Malay and Chinese students

Measurements	Malay		Chinese		p-value
Measurements	Mean (mm)	Standard Deviation (mm)	Mean (mm)	Standard Deviation (mm)	p-value
Nasal height	43.800	3.206	44.888	2.877	0.114^x
Nasal length	38.113	3.854	39.625	3.607	0.074^x
Nasal width	37.613	3.271	37.300	3.695	0.690^x
Philtrum length	12.313	2.358	14.538	3.145	0.001^*
Nasal index	86.391	10.391	83.274	8.163	0.140^x

^*p <0.05, ^xp >0.05

Table 2 expedites the anthropometric measurements of nasal parameters in Chinese students. Nasal width, philtrum length, and nasal index were significantly higher in males than in females (p<0.05).

Table 3 describes the comparative anthropometric measurements of nasal parameters in Malay and Chinese students. The philtrum length was significantly higher in Chinese students than in Malays (p<0.05).

DISCUSSION:

The anthropometric measurement showed that Malay females had slightly longer nasal lengths than Malay males. This outcome was in contrast to research by Othman et al., which found that males' nasal length was significantly higher than that of females (p<0.05). Numerous factors, including inheritance, endocrine function, and diet, could contribute to the disparities in results between the genders.¹¹ We found that the nasal width for Malay males was slightly higher than that for Malay females, as supported by Ngeow et al., where a statistically significant difference was found in nasal width between genders involving a similar age group of Malays from 18 to 25 years old.¹² We observed a mean difference in philtrum length between males and females for the Malay ethnicity. Males had nearly the same mean philtrum length as females. The result is comparable to that of Othman et al., who reported slightly longer philtrum lengths in Malay males when compared to females.¹¹ Perhaps the reason for the difference is that their data was obtained by using mirror imaging software, which was more accurate, and our data was obtained by using a slide calliper. The other conditions are almost the same.

We did not find a significant difference in nasal index between genders in the Malay population, which corroborates with another study by Wai et al. among different genders of the three races in Malaysia.¹³ Dissimilar to our findings, Oladipo et al. reported that the nasal index in males was significantly higher than in females (p<0.05).¹⁴ supported by another study in the Hindu community of the Gwalior region, India.¹⁵ The possibility of this difference may be due to genetics, regional factors, nutrition, and other related factors. Kaushal et al. observed a significant correlation between the nasal index of a race and climate. They found that narrow and long noses were more common in cold and dry climates inhabitants, providing a larger surface area for warming the air.¹⁶ On the other hand, flat and broad noses were prevalent in warm and moist climates, likely due to natural selection during human evolution.¹⁷

Chinese males had a higher nasal height than the females, similar to the findings of Farkas et al. among the Singaporeans.⁸These findings were also consistent with Chen et al., who reported a significant difference in nasal height between genders among the Chinese Han population.¹⁸ This is probably because of the bony structure of males, which is larger than females in any race. We found higher nasal length in Chinese males, supported by another researcher in similar settings.¹³ Considering the nasal index, the Chinese have a mesorrhine type of nose, which is bigger than the platyrrhine type of Malays. Moreover, males have a bigger bony structure than females.

In the Chinese population, the nasal width of males was significantly wider (p<0.05) than that of females, which could be due to the higher demand for oxygen in men, as men generally have more lean mass and a higher rate of metabolism. Chinese males had significantly higher (p<0.05) philtrum length than females, which showed sexual dimorphism. The result could be compared with a similar study on young Turkish adults.¹⁹ Similarly, Chinese men had a much higher nasal index value than Chinese women, which is similar to what Xu et al. found in the Jingpo people of China, where males of the Archang race had a higher mean nasal index.²⁰ These differences between Chinese males and females might be related to men's heavier nature, higher bone density, and genetic makeup.

Chinese were found to have higher nasal height values than Malays. Another study reported that all craniofacial measurements were of similar sizes in Malays and Chinese of both genders. Malays and Chinese were rightfully classified as Mongoloids because of the similarities that they shared. ¹²Chinese showed a higher mean value of nasal length than the Malays, similar to research on the Chinese race in Ipoh, Perak, Malaysia, who exhibited a higher mean nasal length than Malays with a significant difference.¹³ This can also be due to the mesorrhine type of nose in Chinese, according to the nasal index.

Comparing the mean nasal width of Chinese and Malays, both ethnic groups had similar nasal width measurements, which corresponded with an anthropometrical study by Ngeow et al. in 2009.¹²This may be due to the fact that both Malay and Chinese have mesorrhine nose types according to frequency. A comparison between the philtrum length of Malays and Chinese ethnicities showed that the Chinese had a significantly higher mean philtrum length than the Malays (p<0.05). No comparative analysis can be done on this result, as no previous study compared philtrum length among Malays and Chinese. The mean Nasal index of Malays was higher than that of Chinese. Similar to Wai et al.'s (2015) study, there was no statistically significant difference between Malays and Chinese in the nasal index value.¹³

In the present study, the dominant type of nose based on nasal index in Malays was the platyrrhine nose type, with a mean nasal index of 86.391±10.391mm. Chinese were found to have a mean nasal index of 83.274±8.163mm, indicating the dominance of the mesorrhine nose type. This showed that Malay had a broader nose compared to Chinese. However, when the result was compared by using the frequency of nose types among a total of 80 samples in the two ethnicities, it showed the highest frequency of mesorrhine nose in both Malays and Chinese. Earlier research showed dominance in mesorrhine nose type in 31 both Malay and Chinese young adults.¹³ The nasal index of Nepal's Mongolian and Tharu populations also falls under the mesorrhine nose type.²¹ The dominant nose type in the Hindu community of the Gwalior region has a similarity.¹⁵ Thus, the mesorrhine type of nose was frequently named the Asian nose, as it was usually found in Asians.

CONCLUSION:

In the present study, there was a significant difference in nasal width between genders in Malay ethnicity. In contrast, in Chinese ethnicity, there were significant differences in nasal width, philtrum length, and nasal index between genders. All nasal parameters showed no significant difference between the Malay and Chinese populations except philtrum length. The dominant type of nose based on the mean nasal index in the Malay population was the platyrrhine nose, while the Chinese population had a mesorrhine nose. However, when the result is compared by using the frequency of nose types in the two ethnicities, it shows the highest frequency of mesorrhine nose in both Malay and Chinese. Study results confirmed the existence of sexual and racial differences in several nasal parameters in Sarawakian, possibly due to genetic, hormonal, nutritional, and other related factors. Anthropometric data on the nose obtained would be useful for sex determination, forensic medicine, identifying nasofacial dysmorphology, and reconstructive facial and nasal surgeries. Further studies were needed to meet the demand in the medical field.

LIMITATIONS AND FUTURE SCOPE OF THE STUDY:

The limitation of this research was the difficulty in finding Malay and Chinese subjects of pure Sarawakian parentage and race origin in a limited area. This was because most of them were born to parents of mixed-race origin. For the future scope of the study, a larger sample size should be used to confirm the accuracy of the findings since the current study may not be representative of the whole Malay and Chinese population in Sarawak. Furthermore, the data collection should be extended to a larger area to reduce limitations and obtain a better representation of the particular ethnic groups. Moreover, the age group should also be in various ranges.

RELEVANCE OF THE STUDY:

The Malay and Chinese are the major ethnic groups in Sarawak, but no anthropometric study of the nose has been carried out on them. Our results confirmed the existence of sexual and racial differences in several nasal parameters in Sarawakian, possibly due to genetic, hormonal, nutritional, and other related factors.

Anthropometric data of the nose obtained from this study would be useful for sexual determination, forensic medicine, nasofacial dysmorphology identification, and reconstructive facial and nasal surgeries.

Further study should be carried out in (1) a larger population to confirm the accuracy of the findings of this study; (2) a larger area to reduce limitations; (3) a longer period of data collection time; and (4) various age groups.

CONFLICT OF INTEREST:

No conflict of interest between authors.

ACKNOWLEDGEMENT:

By using this opportunity, we would like to express our deepest gratitude to everyone who has supported us at the University of Malaysia Sarawak. We would like to express our gratitude and appreciation to Dr. Joanne Tan Cho Ee, Dr. Shalini Satheeaseela, Dr. Norhafizah binti Haruna, and Dr. Abg Muhammad Subirin bin Abang Merhasan for helping with study planning, data collection, and data analysis that helped us bring this study to fruition. We would like to thank the pre-clinical medical students at UNIMAS who gave their precious time for this study.

REFERENCES:

1. Mascie-Taylor CN, Yasukouchi A, Ulijaszek S, editors. Human variation: from the laboratory to the field. CRC Press; 2010 Mar 17.

2. Khan N, Leela V, Annavarapu G. A study of craniofacial anthropometrics in Hyderabad (Deccan)-and a review of literature. Journal of Medical and Allied Sciences. 2012 Aug 31; 2(2):54.

3. Jimoh RO, Alabi SB, Kayode AS, Salihu AM, Ogidi OD. Rinometria: espectro do perfil nasal entre os africanos da Nigéria. Brazilian Journal of Otorhinolaryngology. 2011; 77:589-93.

4. Paul O, Yinka OS, Taiye AS, Gift AM. An anthropometric study of some basic nasal parameters of three major ethnic groups in Kogi State, Nigeria. Am J Clin Exp Med. 2015; 3(2):62-7.

5. Staka G, Dragidella F, Disha M. Anthropometric study of nasal index of the Kosovo Albanian population. Antrocom Online Journal of Anthropology. 2012; 8(2)457-62.

6. Esomonu UG, Ude RA, Lukpata PU, Nandi EM. Anthropometric study of the nasal index of Bekwara, ethnic group of cross river state, Nigeria. International Research Journal of Applied and Basic Sciences 2013;5(10):1262-5.

7. Otobo T, Tarimobo‐Otobo R. The Clinical Significance of Nasal Index in Ethno‐Racial Specific Rhinoplasty. The FASEB Journal. 2015 Apr;29:697-1.

8. Farkas LG, Katic MJ, Forrest CR. International anthropometric study of facial morphology in various ethnic groups/races. Journal of Craniofacial Surgery. 2005 Jul 1; 16(4):615-46.

9. Antibor E, Etetafia MO, Eboh DE, Akpobasha O. Anthropometric study of the nasal parameters of the Isokos in delta state of Nigeria. Ann Biol Res, 2011; 2(6)408-13.

10. Tubbs RS, Michelson J, Loukas M, Shoja MM, Ardalan MR, Salter EG, Oakes WJ. The transverse genicular ligament: anatomical study and review of the literature. Surgical and Radiologic Anatomy. 2008 Feb; 30:5-9.

11. Othman S, Majawit LP, Hassan WNW, Wey MC, Razi RM. Anthropometric study of three-dimensional facial morphology in Malay adults. PloS one, 2016; 11(10):e0164180.

12. Ngeow WC, Aljunid ST. Craniofacial anthropometric norms of Malays. Singapore medical journal. 2009;50(5):525.

13. Wai MM, Thwin SS, Yesmin T, Ahmad A, Adnan AS, Hassan AA, Ahmad N, Zakariah NI. Nasofacial anthropometric study among university students of three races in Malaysia. Advances in Anatomy. 2015 Jan 22; 2015.

14. Oladipo GS, Eroje MA, Fahwehinmi HB. Anthropometric comparison of nasal indices between Andoni and Okrika tribes of Rivers State, Nigeria. International Journal of Medicine and Medical Sciences. 2009 Apr; 1(4):135-7.

15. Sharma SK, Jehan M, Sharma RL, Saxena S, Trivedi A, Bhadkaria V. Anthropometric Comparison of nasal parameters between male and female of Gwalior region. Journal of Dental and Medical Sciences. 2014 May; 1(5):57-62.

16. Kaushal S, Patnaik VV, Kaur P. Somatometric analysis of nasal morphology in the endogamous groups of Punjab. Hum Biol Rev. 2013; 2(1):1-1.

17. Oladipo G, Fawehinmi H, Suleiman Y. The study of nasal parameters (nasal height, nasal width, nasal index) amongst the Yorubas of Nigeria. Internet J Biol Anthropol. 2008; 3(2):457-62.

18. Chen F, Chen Y, Yu Y, Qiang Y, Liu M, Fulton D, Chen T. Age and sex related measurement of craniofacial soft tissue thickness and nasal profile in the Chinese population. Forensic science international. 2011 Oct 10; 212(1-3):272-e1.

19. Ozdemir ST, Sigirli D, Ercan I, Cankur NS. Photographic facial soft tissue analysis of healthy Turkish young adults: anthropometric measurements. Aesthetic plastic surgery. 2009 Mar; 33:175-84.

20. Xu B, Wang Y, Ma J, Li M, Xu L. A computer-aid study on the craniofacial features of Archang race in Yunnan province of China. Hua xi kou Qiang yi xue za zhi= Huaxi Kouqiang Yixue Zazhi= West China Journal of Stomatology. 2001 Dec 1;19(6):394-6.

Received on 23.12.2023 Modified on 29.01.2024

Research J. Pharm. and Tech. 2024; 17(3):1256-1261.

DOI: 10.52711/0974-360X.2024.00196