The vertical axis of the ear should be inclined 20
The vertical axis of the ear should be inclined 20 anteriorly.
The ear is positioned 1 ear length (60-65mm) posterior to the lateral orbital rim between eyebrow and columella
The width of the ear should be 55% of the height (35mm).
The helix should be visible on the frontal view 2-5mm laterally behind the antihelix.
The helical rim should be symmetrically located to within 15-20mm of the scalp with an auriculocephalic angle of protrusion of 25-35.
Conchalscaphal angle 75-105.
Note excessive glabellar prominence and supraorbital ridge projection. Treat with bone reduction with or without entry into sinus and augmentation of cavity above the bossing.
Brow rhytides – fine, heavy or secondary to animation
Ideally 20-25mm above upper lid margin when eye is closed
Medial end of eyebrow is just caudal to lateral end which sits on the supraorbital bar
Highest portion is at the junction of the lateral 1/3 to medial 2/3 – corresponds to lateral limbus
Fissure height 10mm
Cornea 2-3mm anterior to the inferior rim.
Highest point of upper lid is junction medial and middle third, lowest point of lower lid is central to lateral thirds.
Upper lid sits <2cm below upper limbus.
Margin crease distance (MCD) is the distance from the upper eyelid margin to the lid crease. In white women - 10-11 mm and in white men, 8-10 mm.
normal inter-orbital distance is 25 mm in women and 28 mm in men. Marked racial differences
Classification of hypertelorism
Tessier - interdacryon distance measured on a frontal cephalogram
grade 1 = 30 to 34 mm
grade 2 = 35 to 39 mm
grade 3 = >40 mm
Mulliken -classification based on the standard deviation (SD) of the interdacryon distance
grade 1 = +2 to 4 SD
grade 2 = +4 to 8 SD
grade 3 = >+8 SD.
Classification of lid excursion
Classification of Ptosis
Based on upper lid relation to upper limbus. Iris is 10mm
Marginal reflex distance -1 (MRD-1). Distance from light reflex to upper lid margin, should be 4mm
Marginal reflex distance -2 (MRD-2). Distance from light reflex to lower lid margin, should be 5mm
projection angle 30-36deg.
Nasofrontal angle lies at supratarsal fold level.
Nasal length equals stomion to menton (2/3 of middle third)
Nasal tip projection is 2/3 ideal nasal length
50-60% of nasal height should lie anterior to the most projecting part of upper lip
Nasal dorsum is outlined by 2 slightly curved divergent lines extending from medial brow to tip defining points
Bony base should be ¾ of alar base
Width of alar base=intercanthal distance=width of 1 eye
Lines connecting the 2 tip defining points, supratip break and alar-columella-lobular angle form 2 equilateral triangles.
Columella-labial angle 95-105 in male, 105-115 in female.
2-3mm columella show below the alar rim on lateral
Base of nose to inferior border of upper lip is 1/3 of the lower third of the face. Lower two thirds extends from this to the chin.
Vermillion border of the lower lip is midway between the base of the nose and the chin.
The corners of the mouth halfway between the alar base and pupil. Lower lip 2mm posterior to a line from chin to tip of nose, upper lip 4mm posterior.
in both men and women, the chin rests slightly posterior to the lower lip and the lower lip lies slightly posterior to the upper lip.
In the “normal” lip position on AP, the commissures lie between the pupils
In profile the lips should be slightly parted and the lower lip should lie only just posterior to the upper lip.
upper lip ideally covers two thirds of the incisors.
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