Biomedical subjects
Publications and source records attributed to L G Farkas.
We have developed a multipurpose anglemeter for measuring the face that enables us to determine accurately the size of six profile angles by both direct and indirect anthropometry in markedly reduced time.
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Five measurements of the head were taken between 1 year and 18 years of age in 1,537 North American Caucasians. By 1 year of age, the circumference (87.5%) and length (87.1%) of the head showed the highest levels of developmental level compared with their adult size. By 5 years, the developmental level of all measurements in head width, head length, and circumference increased, closely approaching maturation. Head length reached full maturation at 10 years in females (182.7 mm), and at 14 years in males (189.2 mm). In females, head width showed the most advanced maturation at 14 years (142.7 mm). In males, most of the head measurements matured at 15 years of age. Adult head height was approached at 13 years in both sexes (113.3 mm in males and 109.8 mm in females). Early rapid growth in head height and head length took place between 1 and 4 years of age, and between 1 and 6 years in forehead width. The head width and head circumference showed continuous but mild growth rates throughout this period.
Age-related growth changes in the face and the relationships between its parts were calculated by using three vertical, two horizontal, and two projective surface measurements from 1,594 healthy North American Caucasians between 1 and 18 years of age. By 1 year, the width of the mandible was highly developed (80.2%) while its height reached only 66.6% of the eventual adult size. The mandible's height and width showed significant development between 1 and 5 years, while the face height, upper face height, face width, and the two face depth measurements exhibited continuous gradual growth after 5 years of age. In general, the face matured between 12 and 15 years in males and 2 years earlier in females. At 12 years, the upper face height, the mandible height, and the width of the face reached their mature size in females. At 15 years, the face height, mandible height, face width, and the depth of the mandible reached maturity in males.
Data for analysis of age-related changes in growth in the intercanthal (en-en) and biocular (ex-ex) widths were obtained from 1,594 healthy North American Caucasians in age groups from 1 to 18 years, divided equally between males and females. At 1 year, the degree of development of the intercanthal width reached 84.1%, and that of the biocular width 85.9% of adults in both sexes. The levels of growth achieved by 5 years of age rose to 93.3% in the intercanthal width and 88.1% in the biocular width, in both sexes. The average total growth increments achieved between ages 1 and 18 years were 5.2 mm in the intercanthal width and 12.5 mm in the biocular. The intercanthal width showed very little growth after 1 year of age; in contrast, the biocular width showed significantly greater growth increments both before and after 5 years of age. Rapid growth was observed between 3 and 4 years in the intercanthal width of both sexes. The age-related growth observed in the biocular width was small but continuous up to maturation time. The intercanthal width reached full maturation at 8 years in females and 11 years in males, and the biocular width at 13 years in females and 15 years in males.
Age-related growth changes in the nasolabial region were analyzed through six measurements taken between 1 year and 18 years of age in 1,593 North American Caucasians. By 1 year of age, the length of the cutaneous portion of the upper lip and the width of the nose showed the highest levels of development compared with their adult size, 80.3 and 79.5%, respectively. By 5 years, the developmental level of the nasolabial region except nasal tip protrusion approached their maturation level. Our nasal measurements indicated that growth of the nose between 5 and 18 years was significantly greater than that of the upper lip, which revealed significantly greater growth increments between 1 and 5 years of age. The cutaneous upper lip height reached its adult size in 3-year-old females (12.7 mm) and 6-year-old males (14.4 mm). Nose width and height were fully developed in females by age 12 and in males by age 14 or 15. Rapid growth occurred in the upper lip, nose height, and nasal tip protrusion between the ages of 1 and 4 years. Knowledge of these age-related morphologic variations within the nose and upper lip may be useful in planning the time and type of reconstructive surgery and in anticipating further change in the operated regions after the surgical reconstruction.
Age-related growth changes in the ear were analyzed by measuring the width and length of ears in 1,590 North American Caucasians between 1 year and 18 years of age. By 1 year, ear width reached 93.5% of adult size in both sexes, only 2.3 mm less than the mean value at 18 years. In contrast, ear length attained a developmental level of only 76.4% by 1 year in both sexes, requiring an increment five times greater (12.3 mm) to reach the size of the ear at 18 years of age. At 5 years, the developmental level in width (96.7%) was almost equal to that of an adult, while the length reached 86.6% in both sexes, and requires 8.2 additional millimeters to attain adult size. Annual growth increments in ear width are small, interrupted with a few periods of no growth. Ear length in males showed an early rapid growth rate (between 2 and 3 years); subsequent growth was generally limited, interrupted with short periods of no changes. The same growth pattern appeared in females. Ear width reached its mature size in males at 7 years and in females at 6 years; ear length matured in males at 13 years and in females at 12. At the time of maturation, the ear was shorter than at 18 years by a mean of 1.1 to 1.4 mm.
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Dysmorphology--in the form of minor physical anomalies--has been frequently reported in children with attention deficit disorder (ADD). The authors report an overrepresentation of minor physical anomalies in both ADD probands and their first-degree relatives. Further, ADD probands who are not dysmorphic have non-ADD relatives who are dysmorphic; this familial pattern suggests that a single underlying factor may influence transmission of both traits. A genetic latent structure model was fit to these data to describe the factor's mode of transmission. In this analysis, an autosomal dominant model emerged. Successfully fitting this model is not equivalent to testing the validity of the model itself. Meaningful tests of the model will require larger samples than available at present, and would benefit from diagnostic refinement of the ADD and dysmorphic phenotypes.
The development of surface measurements of the palpebral fissures and age-related changes in the quality of the relationships between the individual measurements were followed in 1552 healthy Caucasians between ages 2 and 18. At age 2, the height of the palpebral fissure and the biocular width (ex-ex) were the most developed features (93.3% and 86%) and the least developed was the intercanthal width (77.6% to 82.9%). The measurements reached adult size between ages 8 (intercanthal width in girls) and 16 (palpebral fissure inclination in boys). The rate of growth in the orbital measurements was usually moderate, seldom above-average and fast only in intercanthal width between ages 3 and 4. The study determined the periods with minimal growth (approximately ages 5 to 7 and 9 to 10) for each of the measurements. After maturation, the changes in measurements were minimal. A knowledge of the developmental levels of the measurements at an early age, their changes with age and their maturation times are of great importance in timing early or final corrective surgical procedures.
Surface measurements of the ear are needed to assess damage in patients with disfigurement or defects of the ears and face. Population norms are useful in calculating the amount of tissue needed to rebuild the ear to adequate size and natural position. Anthropometry proved useful in defining grades of severe, moderate, and mild microtia in 73 patients with various facial syndromes. The division into grades was based on the amount of tissue lost and the degree of asymmetry in the position of the ears. Within each grade the size and position of the ears varied greatly. In almost one-third, the nonoperated microtic ears were symmetrically located, promising the best aesthetic results with the least demanding surgical procedures. In slightly over one-third, the microtic ears were associated with marked horizontal and vertical asymmetries. In cases of horizontal and vertical dislocation exceeding 20 mm, surgical correction of the defective facial framework should precede the building up of a new ear. Data on growth and age of maturation of the ears in the normal population can be useful in choosing the optimal time for ear reconstruction.
Anthropometric and cephalometric orbital measurements were compared in 63 North American Caucasian patients (24 males, 39 females) aged 3 to 29 years who had 13 craniofacial syndromes involving hypertelorism. The hypertelorism, which was diagnosed anthropometrically, was mild in 11 patients, moderate in 25 and severe in 27. The surface intercanthal width was larger than the bony interorbital distance in all patients (mean 12.2 mm). The differences were smaller in mild cases and larger in severe cases. The soft-tissue binocular width was shorter than the bony lateral orbital distance in 53 patients, by a mean of 4.4 mm; in the other 10 patients the two measurements were identical. The hypertelorism was confirmed by cephalometry in 8 of the 11 cases identified as mild by anthropometry (72.7%), 24 of the 25 moderate cases (96.0%) and 25 of the 27 severe cases (92.6%). The abnormally wide surface intercanthal distance was matched by an abnormally wide bony interorbital distance in 57 of the 63 patients (90.5%). In the other six patients (3 with the mild form, 1 with the moderate form and 2 with the severe form) the bony widths were near the upper limit of the normal range (mean + 2 standard deviations).
Patients with Treacher Collins syndrome were studied regarding 10 nasal, 1 orbital, and 4 facial measurements as well as 10 facial proportion indexes. Data from 15 to 24 patients were related to normal values. The most normal feature was found to be the nose, whose basic measurements were optimal. Because harmony between the nose and the face is a basic requirement of aesthetic balance in a healthy face, the nose in these patients is the key for calculating changes in the markedly damaged general framework of the face. Abnormal proportion indexes must be corrected by adjusting the abnormal measurement to its optimal level. Thus, the abnormally short bizygomatic width had to be increased by a mean of 13 to 21 mm. Both the nose and the face were usually normal-long, producing acceptable proportions in these patients. Some size disproportions were found between the root and the soft nose. Their adjustment should be part of the general plan to correct the face of a patient with Treacher Collins syndrome.
Twenty-four craniofacial proportion indices were calculated from 26 surface measurements taken directly from the head and face in 61 patients with Crouzon syndrome, aged 11 days to 32 years. All patients were North American caucasians who had not undergone facial repair. The measurements and proportions were compared with those in healthy controls of the same age and sex. In most patients, the only disproportions present were a wide forehead in relation to the cranial breadth and wide orbital region compared with the face width. The proportions were in the normal range in most cases (71.7%), although many tended toward its extremities. Disproportions were associated most frequently with a combination of abnormal and normal measurements (48.9%); however, a large number (42.4%) involved two normal measurements. Among the normal proportions, most involved two normal measurements, although almost one fourth (22.8%) were associated with one or two abnormal measurements.
Age-related changes were studied in 32 linear measurements from the faces of 180 healthy Chinese subjects of Singapore, aged 6, 12 and 18 years, with equal representation of the sexes. In addition, the differences in 10 inclinations and 6 angles of the facial profile between thirty 6-year-olds and thirty 18-year-olds of each sex were determined. The total absolute and relative growth between 6 and 18 years was established and, in the linear measurements, the relative increments were separately calculated for the 6- to 12-year-old and 12- to 18-year-old periods.
The rhinoplasty surgeon must convert a mental image into a surgical reality through aesthetics, anatomy, and analysis. This article attempts to provide a reasoned solution to the recurrent difficulty of progressing from image to reality.
Advances in surgical techniques for correction of craniofacial anomalies have necessitated the development of objective pre- and postoperative quantitative assessments. Standard anthropometric techniques, supplemented by additional methods oriented to specific clinical problems, have proved useful in defining surface dysmorphology in craniofacial patients. A series of 77 surface measurements of the head and face and 41 proportions were determined in 20 preoperative patients with Treacher Collins syndrome, a rare congenital defect of the first and second branchial arches. To permit comparison with age- and sex-specific data for healthy North American children, the patient data were converted to standard (Z) scores. To test the hypothesis Z = 0, Student's t-test was performed on all variables. The anthropometric findings verified many of the clinical findings in this syndrome. In addition, a number of previously unreported defects were found. The cranium was low and short with a low, narrow forehead and a narrow cranial base. The face was narrow and shallow, the mandible long and narrow, and the lower face receding. The eye fissures were short with an antimongoloid inclination, but the orbits were hyperteloric. The nasal root was high and wide, the nasofrontal angle open, and the bridge inclination low. The labial fissure was narrow, and the ears were microtic. Except in the nasal root the defects were hypoplastic. Most of these defects were either horizontal or anteroposterior. Recognition of the defective areas and their contribution to disproportions of the head and face is important in the development of surgical strategies.
In Down's syndrome patients, surgical correction of the palpebral fissure obliquity through an external approach may produce a red, slightly hypertrophic scar. A transconjunctival approach for this repair was used for 15 Down's syndrome patients aged 3 to 17 years (mean 8.7 years), and the results were compared with those in two boys aged 6 and 17 years who underwent correction by the external approach. Palpebral fissure inclinations were recorded using anthropometric measurements preoperatively and 6 months postoperatively. Inclinations were reduced significantly by either technique; however, often the precise degree of the improvement was clear only from the measurements rather than from photographs. Complications of the transconjunctival approach were few, and there were no problems with wound healing and no ocular injury. Transconjunctival lateral canthopexy is a safe, effective method that avoids a potentially stigmatizing external scar.