Forensic Science International

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Forensic Anthropology Population Data

Age- and sex-related changes in the soft tissues of the orbital region

Chiarella Sforza

*

, Gaia Grandi, Francesca Catti, Davide G. Tommasi,

Alessandro Ugolini, Virgilio F. Ferrario

Functional Anatomy Research Center (FARC), Laboratorio di Anatomia Funzionale dell’Apparato Stomatognatico (LAFAS), Dipartimento di Morfologia Umana, Facolta` di Medicina e Chirurgia, Universita` degli Studi di Milano, via Mangiagalli 31, I-20133 Milano, MI, Italy

1. Introduction

Human face carries information that allows the identiﬁcation of

a single person

[1–3]

. In particular, the soft tissues of the orbital

region play a predominant role in the evaluation and recognition of

the craniofacial complex. Additionally, reference anthropometric

data of the orbital region are necessary for multiple diagnostic and

forensic procedures (evaluations of traumas, chromosomal and

single gene alterations, teratogenic-induced conditions such as the

fetal alcohol syndrome, facial reconstruction)

[4–13]

.

Several previous investigations quantitatively analyzed the

age-, sex-, and ethnic characteristics of the various components of

the orbital region, assessing both dimensions, reciprocal spatial

positions, and relative proportions

[4,8–10,12–19]

. Assessments

had been performed both with two-dimensional photographic

records and three-dimensional direct and indirect (digital)

anthropometry. In particular, current technology provides various

image analysis systems that work in the three-dimensional space

(range-camera techniques, stereophotogrammetry, laser scanning,

optoelectronic systems, and electromagnetic three-dimensional

digitizers), and that supply non-invasively the digital coordinates

of the landmarks of interest

[1,6,7,11,13,15,20]

.

Apart from sexual dimorphism and age-related changes,

ethnicity plays a major role in the deﬁnition of the soft-tissue

A R T I C L E I N F O

Article history:

Received 27 September 2008

Received in revised form 24 October 2008 Accepted 8 December 2008

Available online 18 January 2009

Keywords: Digital anthropometry Forensic anthropology Orbits Man Growth Aging A B S T R A C T

The orbital region plays a predominant role in the evaluation of the craniofacial complex. In the current study information about normal sex-related dimensions of the orbital region, and growth, development and aging, were provided. The three-dimensional coordinates of several soft-tissue landmarks on the orbits and face were obtained by a non-invasive, computerized electromagnetic digitizer in 531 male and 357 female healthy subjects aged 4–73 years. From the landmarks, biocular and intercanthal widths, paired height and inclination of the orbit relative to both the true horizontal (head in natural head position) and Frankfurt plane, length and inclination of the eye fissure, the relevant ratios, soft-tissue orbital area, were calculated, and averaged for age and sex. Comparisons were performed by factorial analysis of variance. Biocular and intercanthal widths, length of the eye fissure, soft-tissue orbital area, and the inclination of the orbit relative to the true horizontal, were significantly larger in men than in women (p<0.01), with a significant effect of age (p<0.001), and significant agesex interactions (p<0.001). Orbital height, and the height-to-width ratio increased as a function of age (p<0.001), but without gender-related differences. The inclination of the orbit relative to Frankfurt plane, and the inclination of the eye fissure did not differ between men and women, but modified as a function of age (p<0.001), with different sex-related patterns (sexage interaction,p<0.001). On average, the paired measurements were symmetric, with similar values within each sex and age group. Overall, when compared to literature data, some differences were found due to both ethnicity, and different instruments. Nevertheless, during childhood, adolescence, and young adulthood, the age-related trends for linear dimensions were similar to those found in previous studies, while no previous data exist for older adults. During aging an increment in soft-tissue orbital area was found, with a progressive downward shift of landmark orbitale. Data collected in the present investigation could serve as a data base for the quantitative description of human orbital morphology during normal growth, development and aging. Forensic applications (evaluations of traumas, craniofacial alterations, teratogenic-induced conditions, facial reconstruction, aging of living and dead persons, personal identification) may also benefit from age- and sex-based data banks.

* Corresponding author. Tel.: +39 02 503 15407; fax: +39 02 503 15387.

E-mail address:[email protected](C. Sforza).

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characteristics of the orbital region, both in healthy subjects and in

patients

[4,5,8–12,16,21,22]

.

Overall, quantitative data on the growth and development after

birth throughout childhood and adolescence into young adulthood,

on adult individuals, as well as during aging, have been provided

for African American

[4,12]

; Asian

[8,16–18,22]

; Black South

African

[6]

; Indian

[9,22,23]

; Dutch Caucasian

[19]

; Italian

Caucasian

[15]

; North American Caucasian

[4,12,24,25]

;

Scandi-navian Caucasian

[13]

; Turkish Caucasian

[5,14,21]

; and Slavic

Bulgarian

[10]

healthy persons of both sexes.

In particular, data about European Caucasians are still scanty.

For instance, while eye ﬁssure dimensions have been reported for

persons between birth and the 9th decade of life

[13,15,19]

, no data

on biorbital and intercanthal widths can be found after the 6th

decade of life

[13,15]

. Additionally, orbital relative proportions and

three-dimensional spatial position were investigated only in

adolescence, young and mid-adulthood

[15]

, and normative data

on a wider group of persons are still lacking. Indeed, in

contemporary western society, not only the number of aged

persons is increasing, but also forensic investigations (aging of

both living and dead persons, personal identiﬁcation) are currently

performed on a wider age range than before, thus needing new

reference data on each ethnic group.

For instance, personal identiﬁcation greatly depends on facial

characteristics

[3]

, and the deﬁnition of age-, sex- and

ethnic-speciﬁc data bases may help in the identiﬁcation of those

individual features that best discriminate among persons

[1,2]

.

Additionally, there is an urgent need for age-related facial

dimensions that may help in the aging of victims from

pedo-pornography. Facial reconstructions also need data collected from

living persons of the widest possible age span, supplying

information that may assist in simulating the modiﬁcations of

facial features during normal growth and aging

[28,29,31]

.

In the current study, information about normal sex-related

linear and angular dimensions of the soft tissues of the orbital

region between childhood and old age, were provided. Data were

collected non-invasively using digital anthropometry in healthy

Italian Caucasians aged 4–73 years.

2. Materials and methods 2.1. Subjects

Data on 888 healthy white Italians aged 4–73 years were collected. The subjects were divided into several non-overlapping age groups (Table 1): for subjects younger than 18 years, 2-year spans were used, while larger intervals were used for adult subjects.

Subjects with a previous history of craniofacial trauma, orbital diseases, congenital anomalies or surgery were not included in the sample. They were previously informed about all the adopted procedures, and gave their consent to the investigation. Informed consent was also obtained from the parents/legal guardians of the subjects underage. The study protocol was approved by the local ethic committee. All procedures were not invasive, not potentially harmful, did not provoke pain and did not use any instrument or energy currently considered to be potentially dangerous to the present or future health of the subjects or of their offspring.

Part of the current data was previously published[15].

2.2. Collection of three-dimensional facial landmarks

The data collection procedure was previously described in detail[15,26]. In brief, for each subject, a single experienced operator located a set of 50 landmarks and marked them on the cutaneous surface. During landmark marking, the subjects sat relaxed with a natural head position. The reproducibility of landmark identiﬁcation, marker positioning and the reproducibility of the data collection procedure were previously reported, and found to be reliable[27]. The complete set of 50 landmarks allowed the quantitative study of head, face, orbits, nose, lips and mouth, ears in the living human subjects[26].

Three-dimensional (x,y,z) coordinates of the facial landmarks were obtained with a three-dimensional computerized electromagnetic digitizer (3 Draw, Polhemus Inc., Colchester, VT). The system has an accuracy of 0.025 cm, a resolution of 0.013 cm/cm of range, and it supplies actual metric data independent from external reference systems. Digitization of landmarks was performed by a single operator.

In the present study, from the complete set of 50 landmarks the following paired soft-tissue landmarks were further considered (right and left side noted r and l): exr,

exl, exocanthion; enr, enl, endocanthion; orr, orl, orbitale; osr, osl, orbitale superius;

tr, tl, tragion (Fig. 1).

2.3. Data analysis

The three-dimensional coordinates of the landmarks obtained on each subject were used to calculate the following measurements[15]:

linear distances (unit: mm): biorbital width (exr–exl); intercanthal width (enr–

enl); right and left height of the orbit (os–or); right and left length of the eye

ﬁssure (en–ex);

ratios (unit: percentage): right and left height of the orbit to length of the eye ﬁssure ratio (os–or/en–ex100);

angles (unit: degrees): right and left inclination of the eye ﬁssure (angle of the en– ex line vs. the true horizontal, head in natural head position); right and left inclination of the orbit (angle of the os–or line vs. the true horizontal, head in natural head position); right and left inclination of the orbit relative to Frankfurt plane (angle between the os–or and t–or lines);

areas (unit: mm2

): right and left external orbital surface area (area of the quadrangle between ex, os, en and or).

All the measurements were performed in the three-dimensional space,i.e., the position of the landmarks relative to all the three planes (frontal, lateral and horizontal) was considered at the same time (no projections).

Descriptive statistics (mean and standard deviation) for each measurement were computed within sex and age group. Statistics of the angular measurements were computed by using the rectangular components of each angle.

Mean values between sexes and age groups were compared using two-way factorial analyses of variance. The effect of sex (factor 1 of the analysis of variance), and the effect of age (factor 2 of the analysis of variance) were assessed, as well as the sexage interaction. To investigate the age-related modiﬁcations of the analyzed orbital dimensions and angles, linear regression analyses were also performed. Signiﬁcance was set at 5% (p0.05), with two-tail statistical tests used in all analyses.

3. Results

All analyzed linear soft-tissue orbital dimensions, except right

and left orbital heights, were signiﬁcantly larger in men than in

Table 1

Subjects analyzed in the current study.

Age (years) Males Females

4–5 19 11 6–7 41 42 8–9 55 43 10–11 43 48 12–13 82 60 14–15 10 12 16–17 55 14 18–30 128 65 31–40 67 28 41–50 11 11 51–64 13 16 65–80 7 7 Total 531 357

Fig. 1.Digitized three-dimensional soft-tissue orbital landmarks used in the current study. Ex: exocanthion; en: endocanthion; or: orbitale; os: orbitale superius; t: tragion.

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women (

Tables 2–4

). A signiﬁcant sexual dimorphism was found

also for soft-tissue orbital areas, and for the orbital inclinations vs.

the true horizontal (both measurements were larger in men than in

women), while no sex-related differences were observed for the

height-to-width ratios, and the inclinations of the orbits relative to

both the true horizontal (head in natural head position) and

Frankfurt plane.

All measurements signiﬁcantly modiﬁed as a function of age,

with signiﬁcant age

sex interactions. Biocular and intercanthal

widths, orbital height, length of the eye ﬁssure, soft-tissue orbital

area all increased from childhood to old age; overall, all age-related

increments were larger in men than in women.

Between childhood and 16–17 years of age, biocular width

increased of 1.3 mm/year in men, and 0.9 mm/year in women,

while intercanthal width increased of 0.5 mm/year in men, and

0.3 mm/year in women. Age explained between 10% (intercanthal

width in men) and 46% (biorbital width women) of the variations

of these measurements (

Table 5

). Orbital heights increased of

approximately 7–9 mm in the analyzed time span; at 10–11 years

of age, the measurements attained 90% of the value of the last age

group; age explained more than 57% of their variability. In women,

the length of the eye ﬁssure increased of about 0.4 mm/year until

12–13 years of age, without subsequent age-related variations. In

men, increments of 0.5 mm/year until 12–13 years of age were

found. In the 4–5-year-old children, the soft-tissue orbital areas

were approximately 70% of their ﬁnal dimensions, with increments

of 4–5 mm

2

_{/year in men, and 3–4 mm}

2

_{/year in women. Most of the}

variability in soft-tissue orbital area was explained by age-related

modiﬁcations.

After adolescence, the orbital height-to-width ratios increased

as a function of age, with overall variations of about 20%. The

inclinations of the eye ﬁssures relative to the true horizontal (head

in natural head position) increased of approximately 4

8 between

childhood and adolescence, with subsequent decrements of about

6

8 . The inclinations of the orbits relative to the true horizontal

increased until young adulthood (modiﬁcations of about 6–8

8 ) and

subsequently reduced. In contrast, small but steady age-related

increments were observed for the inclinations of the orbits relative

to Frankfurt plane, with overall modiﬁcations of about 10

8 . The

effect was particularly evident in men, where age explained 44–

59% of the variations of these measurements.

On average, the present individuals had symmetric orbital

dimensions and inclinations. Mean values of paired linear

distances differed of less than 2 mm within each sex and age

Table 2

Three-dimensional soft-tissue orbital morphometry in healthy men. Age (years) Measurement Unit 4–5 6–7 8–9 10–11 12–13 14–15 16–17 18–30 31–40 41–50 51–64 65–80 exr–exl mm Mean 82.7 82.5 84.7 89.2 90.9 94.6 96.7 94.1 95.7 96.0 93.7 93.2 S.D. 4.0 4.6 4.7 4.1 4.1 5.4 8.1 4.5 4.0 6.3 5.6 4.1 enr–enl mm Mean 25.9 26.9 27.3 28.1 28.7 30.2 32.8 30.4 29.8 31.3 28.3 29.4 S.D. 2.4 2.7 2.8 2.5 2.7 2.8 4.5 2.6 2.7 1.8 3.8 2.9 Right side os–or mm Mean 27.5 29.9 31.1 31.7 30.0 28.5 32.6 34.2 35.1 34.9 35.9 35.1 S.D. 2.6 4.6 3.8 3.5 3.3 4.1 3.0 3.2 3.3 4.2 3.1 2.7 en–ex mm Mean 30.3 30.2 30.3 32.7 33.1 34.6 33.9 33.4 34.6 33.3 33.5 32.7 S.D. 1.4 2.3 2.2 2.0 2.0 2.6 3.0 2.5 3.0 2.8 3.2 2.5 os–or/en–ex % Mean 90.97 99.65 103.26 97.46 91.00 82.38 96.82 103.01 102.33 105.44 107.69 108.40 S.D. 10.25 17.46 15.85 14.03 11.40 11.28 10.09 11.49 12.81 15.34 10.43 15.36 Area mm2 Mean 831.5 900.9 939.8 1035.0 991.6 988.4 1107.2 1141.5 1214.5 1163.0 1208.9 1145.1 S.D. 81.5 144.4 119.5 109.5 127.3 176.2 162.6 147.2 162.5 170.8 200.3 86.3 en–ex vs. TH 8 Mean 17.7 20.2 20.8 22.9 20.2 22.6 20.3 18.6 18.1 17.6 17.1 13.7 S.D. 3.2 3.1 3.8 2.5 3.8 3.0 3.1 3.4 3.9 2.5 2.1 5.9 os–or vs. TH 8 Mean 115.4 117.0 117.6 116.4 115.8 119.5 119.4 123.0 119.6 117.4 119.7 116.2 S.D. 4.0 4.9 5.4 6.2 4.5 4.0 4.8 6.5 5.8 5.8 4.7 5.5 os–or vs. FH 8 Mean 106.2 111.1 112.2 111.0 108.4 114.7 112.7 115.2 112.7 115.2 113.8 116.1 S.D. 5.5 4.8 5.5 6.7 5.1 4.7 4.7 7.3 5.8 4.9 6.6 6.6 Left side os–or mm Mean 25.8 30.0 30.2 30.9 30.0 29.0 32.8 34.0 34.9 35.0 35.4 35.4 S.D. 2.4 5.0 4.0 3.5 3.3 4.5 3.0 3.6 3.7 3.2 2.5 4.1 en–ex mm Mean 30.5 29.9 31.3 33.6 33.5 35.3 34.3 34.2 35.2 34.6 35.0 34.0 S.D. 1.9 2.1 2.3 1.9 2.2 1.8 2.9 2.5 2.8 4.3 3.3 1.9 os–or/en–ex % Mean 85.07 101.04 97.05 92.35 91.00 81.97 96.02 99.95 99.73 102.75 101.69 104.22 S.D. 10.77 18.20 16.13 13.43 11.40 10.34 9.02 11.98 12.27 16.98 7.40 11.69 Area mm2 Mean 783.0 896.4 942.8 1035.4 1005.1 1025.6 1128.3 1165.4 1229.3 1209.8 1241.6 1208.0 S.D. 74.7 160.7 126.0 106.1 137.3 199.8 168.1 156.8 171.1 166.9 191.5 172.9 en–ex vs. TH 8 Mean 19.2 19.4 19.6 21.3 20.1 21.9 19.3 18.9 18.0 16.5 15.7 15.4 S.D. 3.5 3.9 3.4 2.8 3.3 3.7 3.4 3.3 3.4 1.5 2.4 3.4 os–or vs. TH 8 Mean 114.2 115.4 115.5 116.5 115.7 115.6 118.9 121.6 118.7 114.9 117.8 115.3 S.D. 4.4 5.3 5.0 5.8 4.4 6.4 4.8 6.2 5.6 6.6 3.0 4.7 os–or vs. FH 8 Mean 103.4 108.2 108.9 109.5 107.5 108.1 109.1 113.6 111.6 112.2 111.2 114.7 S.D. 4.3 4.4 5.0 6.0 4.7 6.6 6.0 6.4 6.0 7.1 4.8 4.3

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Table 3

Three-dimensional soft-tissue orbital morphometry in healthy women. Age (years) Measurement Unit 4–5 6–7 8–9 10–11 12–13 14–15 16–17 18–30 31–40 41–50 51–64 65–80 exr–exl mm Mean 81.4 82.5 85.6 85.7 89.5 88.9 93.1 90.2 89.6 91.8 92.6 91.5 S.D. 4.4 3.8 5.2 2.8 4.0 4.8 4.5 3.8 4.3 4.2 4.9 2.5 enr–enl mm Mean 25.1 27.2 27.9 26.7 28.0 27.6 30.5 28.5 28.2 29.6 29.9 28.7 S.D. 3.2 3.1 2.7 2.4 2.3 2.3 3.0 2.8 1.8 2.1 3.8 2.8 Right side os–or mm Mean 25.7 29.5 30.0 31.7 30.2 28.9 32.1 32.7 33.8 32.5 34.7 33.7 S.D. 2.0 3.5 4.3 3.8 2.9 1.8 2.8 2.9 2.4 2.9 2.7 4.8 en–ex mm Mean 30.3 29.0 30.5 31.3 32.7 33.4 33.2 32.3 32.0 32.6 32.8 32.4 S.D. 2.0 1.6 2.1 1.7 2.3 1.4 1.5 2.1 2.5 1.9 3.5 2.1 os–or/en–ex % Mean 85.34 101.99 98.59 101.64 92.62 86.75 96.88 101.88 105.93 99.64 106.69 104.52 S.D. 10.48 14.63 14.29 13.78 10.67 8.88 8.53 11.39 10.31 7.71 12.47 17.12 Area mm2 Mean 779.0 854.9 916.2 991.5 987.3 961.6 1066.8 1055.2 1082.0 1060.8 1142.0 1089.1 S.D. 58.0 100.9 158.4 128.3 118.8 32.9 114.5 116.3 121.1 136.1 175.9 155.3 en–ex vs. TH 8 Mean 17.4 20.5 20.4 21.1 20.2 22.8 20.0 18.1 17.2 15.9 17.6 19.5 S.D. 3.0 3.5 3.1 3.1 3.3 0.4 1.7 3.5 2.5 3.8 3.7 3.1 os–or vs. TH 8 Mean 109.4 114.6 113.9 117.0 114.2 114.4 116.1 116.7 113.8 110.5 114.8 116.6 S.D. 5.1 4.4 4.8 5.2 3.9 1.1 5.0 5.5 5.2 7.6 4.2 4.1 os–or vs. FH 8 Mean 102.8 109.8 109.2 111.9 107.7 109.8 108.8 109.9 108.1 108.1 111.7 113.1 S.D. 6.3 5.1 5.3 6.3 4.4 2.3 5.0 5.0 5.6 5.7 5.0 5.7 Left side os–or mm Mean 25.7 29.0 30.5 31.5 30.0 29.9 32.2 33.0 33.8 32.5 34.5 33.7 S.D. 2.7 4.1 4.1 4.4 3.4 2.1 2.1 2.9 2.9 2.9 3.5 3.5 en–ex mm Mean 29.6 30.0 31.3 32.1 33.1 32.7 33.4 33.0 32.5 32.5 33.3 34.2 S.D. 1.8 1.7 2.6 1.8 1.9 1.7 1.9 2.1 2.5 1.9 3.0 1.1 os–or/en–ex % Mean 87.35 97.06 97.97 98.50 91.00 91.46 96.48 100.16 104.53 100.34 103.90 96.75 S.D. 11.00 15.72 14.25 15.56 11.74 2.33 7.27 10.01 10.64 7.59 11.25 12.97 Area mm2 _Mean _760.3 _866.3 _954.5 _1010.5 _990.0 _980.3 _1074.0 _1089.0 _1097.8 _1058.4 _1150.8 _1151.0 S.D. 87.4 126.5 162.9 146.1 123.2 117.6 102.6 129.1 146.0 133.9 184.1 95.4 en–ex vs. TH 8 Mean 20.6 18.8 19.5 20.3 19.9 20.8 19.0 18.1 16.9 16.1 16.9 17.8 S.D. 2.6 3.2 3.5 3.0 3.3 0.2 2.0 3.7 2.9 3.5 3.0 2.1 os–or vs. TH 8 Mean 110.3 113.3 112.7 116.0 113.4 112.9 116.3 115.8 113.1 110.4 113.9 111.2 S.D. 4.4 4.1 4.7 5.0 4.3 2.0 4.0 5.3 4.8 7.3 3.1 4.8 os–or vs. FH 8 Mean 103.9 107.3 106.7 110.2 106.1 105.3 105.5 109.1 107.3 107.5 110.4 105.9 S.D. 5.2 4.4 4.9 5.6 4.6 1.9 5.0 5.0 6.3 5.0 4.3 5.2

TH: true horizontal; FH: Frankfurt plane.

Table 4

p-Values from the two-way factorial analyses of variance.

Measurement Sex Age Sexage

Biorbital width (exr–exl) 0.009 <0.001 <0.001

Intercanthal width (enr–enl) 0.002 <0.001 <0.001

Right side

Height of the orbit (os–or) NS <0.001 <0.001 Length of the eye fissure (en–ex) 0.012 <0.001 <0.001 Orbital height-to-eye fissure length NS <0.001 <0.001 External orbital surface area <0.001 <0.001 <0.001 Inclination of the eye fissure vs. TH NS <0.001 <0.001 Orbital inclination vs. TH 0.027 <0.001 <0.001 Orbital inclination vs. FH NS <0.001 <0.001 Left side

Height of the orbit (os–or) NS <0.001 <0.001 Length of the eye fissure (en–ex) 0.013 <0.001 <0.001 Orbital height-to-eye fissure length NS <0.001 <0.001 External orbital surface area <0.001 <0.001 <0.001 Inclination of the eye fissure vs. TH NS <0.001 <0.001 Orbital inclination vs. TH 0.027 <0.001 <0.001 Orbital inclination vs. FH NS <0.001 <0.001 Degrees of freedom: sex 1864; age 11,864; sexage 11,864. NS: not significant (p>0.05). TH: true horizontal; FH: Frankfurt plane.

Table 5

R-squared values from the linear regression analyses with age.

Measurement Men Women

exr–exl 0.312 0.459 enr–enl 0.101 0.324 Right side os–or 0.670 0.573 en–ex 0.165 0.218 os–or/en–ex 0.463 0.354 Area 0.595 0.571 en–ex vs. TH 0.637 0.201 os–or vs. TH 0.019# 0.025# os–or vs. FH 0.438 0.269 Left side os–or 0.678 0.571 en–ex 0.307 0.437 os–or/en–ex 0.421 0.273 Area 0.643 0.594 en–ex vs. TH 0.775 0.573 os–or vs. TH 0.011# 0.076 os–or vs. FH 0.590 0.074

TH: true horizontal; FH: Frankfurt plane. The regressions are signiﬁcant at the 1% level unless indicated (#).

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group (most were smaller than 0.5 mm), the height-to-length ratio

of less than 5% (except the 8–9 and 10–11-year-old boys, and the

oldest women), the areas of less than 50 mm

2

_{(except the oldest}

men and women), the inclinations of less than 4

8 (except the

orbital inclination relative to FH in the 14–15-year-old

adoles-cents, and the orbital inclination relative to TH in the oldest

women).

4. Discussion

In the present investigation, dimensions and position of the soft

tissues of the orbital region have been found to be sexually

dimorphic, and to modify between childhood, adolescence and

young adulthood, and even after young adulthood into the 8th

decade of life. The present data were cross-sectional, and therefore

do not represent true growth or aging but only estimates of the

biological phenomena: different groups of subjects were examined

at the different ages. Indeed, the possible presence of secular

trends, with individuals with different craniofacial characteristics

examined in the various age groups, should be considered.

Nevertheless, even the scanty longitudinal studies where persons

up to the 7th decade of life were examined, showed signiﬁcant

increments in facial dimensions

[28]

. The increments were larger

in the soft tissues (nose and ears), but they were found even in

those facial dimensions more determined but the underlying hard

tissues (e.g., bizygomatic width)

[28]

.

Overall, in both sexes biorbital width measured in the current

study was somewhat larger than previous values collected in

Caucasian subjects (

Fig. 2

)

[5,12–14,24]

, but smaller than data

reported for AfroAmerican and Asian persons

[12,17,18]

. Apart the

ethnic differences (in no other study Italian Caucasians were

analyzed), different instruments were used in the various

investigations, and the current method (electromagnetic digitizer)

was not employed by other research groups. Nevertheless, the

age-related trend for this measurement was similar to those reported

in literature, also considering that only Gupta et al.

[9]

analyzed a

similar age span.

In contrast, the current values for intercanthal width were

among the smallest of those reported in literature (

Fig. 3

)

[4–

6,12,13,16,19,21,22,24,25]

. In both sexes, the largest values were

listed by Park et al.

[16]

for Asian persons, with a trend very similar

to that found in the current Italian subjects.

In no previous study, eye ﬁssure length was reported for a time

span as long as that analyzed in the current study, but considering

the general trend of literature reports, age-related increments up

to the 4–5th decades of life, with subsequent reductions, were

found in most ethnic groups (

Fig. 4

)

[4–6,12,13,16,19,21,22,

24,25]

.

Fig. 2.Biorbital width: current and literature data in various age and ethnic groups. (A) Men and (B) women. Italy (Italian Caucasians): current data; Scand. 1999 (Scandinavian Caucasians):[13]; AA 1999 (AfroAmericans):[12]; Asian 1993:[18]; Turkish 2002:[14]; Indian 2003:[9]; NAC 1999 (North American Caucasians):[12]; NAC 1994:[24]; SA 2006 (black South African):[6]; Asian 1992:[17]; Turkish 2003:[5].

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Data on orbital height reported by Farkas et al.

[24]

for North

American Caucasians were smaller than the current values, but

even in that study no sex-related differences were observed. Even

if the young adolescents had already attained 90% of the value of

the last age group, small but steady increments were recorded in

both sexes. These increments explained the modiﬁcations in the

orbital height-to-eye ﬁssure length ratio, a rough assessment of the

‘‘shape’’ of the orbital region, which was coupled with increments

in the soft-tissue orbital area. At the same time, the inclinations of

the orbits relative to Frankfurt plane gradually increased from

childhood to old age. In the young adults, the latter value was

similar to that reported by Farkas et al.

[24]

. Unfortunately, no

measurements in other age groups were found.

Taken all together, these data could be explained by a

progressive shift of the lower eyelid and landmark orbitale: their

position became more inferior with advancing age

[19,29]

. With

aging, progressive modiﬁcations of the microscopic structure of

facial dermis have been reported in previous investigations

[30]

:

the observed reduction in elastic ﬁbers may explain the

macro-scopic modiﬁcations in the position of facial structures.

A deep knowledge of the relative positions of facial structures in

the different age and ethnic groups, as well as in the two sexes, is

therefore mandatory for a correct reconstruction of the global

facial appearance

[31]

. Unfortunately, literature data on this topic

are still scanty. For instance, the inclination of the eye ﬁssure (en–

ex line) was analyzed by Farkas et al.

[24]

, Kunjur et al.

[22]

, and

Park et al.

[16]

, but the measurements were performed with

different reference lines. Farkas et al.

[24]

reported data relative to

Frankfurt plane, while Kunjur et al.

[22]

and Park et al.

[16]

assessed the inclination of the en–ex line relative to the inner

intercanthal line. While absolute data cannot be compared, it is

interesting to note that the age-related pattern reported by Park

et al.

[16]

is very similar to the current one, with gradual

decrements after adolescence.

On average, the paired measurements were symmetric, with

similar values within each sex and age group. Similar

considera-tions can be made for literature data

[4,10,13,19,24]

.

A signiﬁcant sexual dimorphism was found for all analyzed

soft-tissue orbital dimensions except os–or. According to most literature

reports, a signiﬁcant sexual dimorphism in soft-tissue orbital

dimensions is present in the adult

[4,9,14,16,21]

, during growth

[14,16]

, and already at birth

[8,10]

, with larger dimensions in men

than in women. Some differences were found also for the positions of

the orbital structures

[16]

. In contrast, other investigators reported

scarce male–female differences

[9,12]

. Different ethnic groups,

different age ranges, and different techniques used for the

measurements may explain this discrepancy.

The number of subjects examined in the present investigation is

quite comparable to that analyzed in most cross-sectional

[4,12,13,16,24]

and longitudinal

[28]

anthropometric

investiga-tions, even if some studies analyzed two or three thousands of

individuals

[9,14]

. It has to be mentioned that those investigations

measured only linear distances

[9,14]

. Data collected in the present

investigation could therefore represent a useful data base for the

quantitative description of orbital morphology in normal Italian

Caucasian subjects.

Fig. 3.Intercanthal width: current and literature data in various age and ethnic groups. (A) Men and (B) women. Italy (Italian Caucasians): current data; NAC 1999 (North American Caucasians):[12]; NAC 1999b:[4]; UK 2006 (British Caucasians):[22]; Scand. 1999 (Scandinavian Caucasians):[13]; NAC 1994:[24]; AA 1999 (AfroAmericans):

[12]; AA 1999b:[4]; SA 2006 (black South African):[6]; Asian 1992:[17]; Asian 1993;[18]; Asian 2006:[22]; Indian 2003:[9]; Indian 2006:[22]; Turkish 1999:[21]; Turkish 2003:[5], 2003; Asian 2008:[16].

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5. Conclusion

In the current study, a detailed information about the normal

sex- and age-related linear and angular dimensions of the soft

tissues of the orbital region in healthy Italian Caucasians were

provided. The analyzed age interval covered 8 decades of life, being

one of the widest reported in literature. Overall, when compared to

literature data, some differences were found, pointing out the

necessity of data collected on each ethnic group. The age-related

trends for linear dimensions were similar to those found in

previous studies, showing a progressive downward shift of

landmark orbitale with advancing age.

Data collected in the present investigation could serve as a data

base for the quantitative description of human orbital morphology

during normal growth, development and aging, also considering

sex- and ethnic-related variations. Soft-tissue facial characteristics

are among those most used for personal identiﬁcation, and

knowledge of their age-related modiﬁcations is necessary to build

data banks informative for forensic investigations. Among the

others, the detection of facial dimensions that remain stable over

time (or that have reduced age-related variations) may help in

personal identiﬁcation even years after the actual crime.

A further application (using those characteristics that show the

largest age-related variations) may be the estimation of the age of

both living and dead persons, using direct measurements as well as

photographic records. The same data may enter into simulations of

facial growth and aging, helping in personal identiﬁcation.

Conﬂict of interest

The authors have no conﬂict of interest related to the current

investigation.

Acknowledgements

The authors are grateful to all the subjects who volunteered for

the study. The precious secretarial assistance of Ms. Cinzia Lozio is

gratefully acknowledged.

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