Mine 1

ANTHROPOMERIC VARIATIONS OF THE INNER INTERCANTHAL AND OUTER
INTERCANTHAL DISTANCES OF THE IDOMA ETHNIC GROUP IN COLLEGE OF

HEALTH SCIENCE, BENUE STATE UNIVERSITY
BY
THOMAS AMARACHI GRACE

BSU/BM/ANA/15/047
A PROJECT SUBMITTED TO THE DEPARTMENT OF ANATOMY, FACULTY OF

BASIC AND ALLIED SCIENCE, COLLEGE OF HEALTH SCIENCE, BENUE STATE
UNIVERSITY, MAKURDI.
SUPERVISORS: PROF LINUS CHIA SAALU

MB,ChB (Jos), MPH (Lagos), M.Sc (Lagos), MPA (Lagos),
Ph.D (LASU), D.Sc (Kolkata), PGDip.Health Mgt (Lagos),
PGDip Forensic (Oxford)
Dr . RAYMOND UDEH (B.Sc., M.Sc. PhD)
JULY 2021
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TABLE OF CONTENTS
Title page
ABSTRACT
CHAPTER ONE
1.1 Background of Study
1.2 Statement of Problem
1.3 Objectives
1.4 Justification of the Study
1.5 Significance of the Study
CHAPTER TWO
2.1 Literature Review
CHAPTER THREE
3.0 Methodology
3.1 Introduction
3.2 Study Design
3.3 Study Location
3.4 Study Procedure
3.5 Study Variables
3.6 Sample Size Calculation
3.7 Inclusion Criteria
3.8 Exclusion Criteria
3.9 Equipments Used
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CHAPTER FOUR
4.1 Data Presentation, Analysis & Interpretation
CHAPTER FIVE
5.1 Discussion
5.2 Conclusion
REFERENCES
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ABSTRACT
Background: Craniofacial anthropometric parameters have been found to be relevant in

anthropology as well as clinical and surgical practices. Objective: The objective of this study was
to provide detailed data values of the Inner canthal distance (ICD) and Outer canthal distance
(OCD) and changes with aging between genders in the Idoma ethnic group found in College of
Health Sciences , Benue State University, Makurdi. The simple random sampling technique was
adopted in this anthropometric study that included 150 participants. Inner and Outer intercanthal
distances was measured using a non stretchable ruler .The subjects were then grouped into six
groups; group 18-20, 21-23, 24-26, 27-29, 30-32, 33-35 years . Each group was made up of male
and female subjects. Statistical Analysis: The statistical analysis was done using the statistical
package for social sciences version 25 and analysis of variance (ANOVA), particularly the one
way analysis of variance was used for this analysis. Mean values and standard deviations for
each group were obtained using descriptive analysis and significant values were obtained for
p≤0.05 using Tukey Post Hoc Tests. The independent T-test was used to analyze the ICD and
OCD between the gender. Results: The results showed that the canthal distances of the males
were higher than females. The results obtained also showed that, the IICD and OICD for males
respectively was 35.68±2.82mm and104.80±3.84mm while that of females was 33.84 ± 2.81mm
and101.99 ± 5. The data revealed that all the canthal dimensions as well as the canthal index of
the males of the Idoma Ethnic Group in College of Health Sciences, Benue State University were
higher than that of females (p<0.05) using t-Test. This study will be useful in bioanthropology,
forensic medicine and in craniofacial surgery. These data would be of benefit to the
anthropologist, orthodontist and dysmorphologist.
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CHAPTER ONE
1.0 INTRODUCTION
1.1 Background of Study
Culture, traditions, dress, and geography are several factors that distinguish ethnic groups across
the world. However, the most obvious difference between individuals of varying ethnic groups is
physical appearance. From the neck down to the toes, we are all very similar; however, it is the
facial structure and skin tone that most noticeably differentiates one ethnic group from another.
The eyes are an important facial feature that determines the total facial appearance and a facial
defect or deformity cannot be easily camouflaged. The parameters of the eyes vary from one race
to another and there are also variations within the same race, it is therefore important to have
normal values for each ethnic group that would guide the plastic surgeon in nasal reconstruction
and rhinoplasty that would be culturally acceptable.
Dr Leslie Gabriel Farkas, pioneer of modern craniofacial anthropometry is quoted as saying
“how can anyone reconstruct the face if they do not know what the normal values and properties
are?”. Over the centuries, there have been remarkable changes in anthropometric measurements
due to geographical, cultural, genetic and environmental factors (N Adhikari et al.,2016) It
remains the single, most universally applicable, inexpensive, non-invasive, and reliable method
available for assessment of human body composition, size and proportions, amongst others such
as physical examination, biochemical and radiological assessments. Anthropometry is the study
of the systemic measurement of the different parts of the human body in order to determine their
respective proportions. It is a branch of anthropology concerned with measurements of the
human body. The canthal distances are one of the most important aspects in assessing the facial
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aesthetics. Several authors have described changes in the canthal distances attributable to race
and gender.
Anthropometric studies are integral part of craniofacial surgery and syndromology. Applied
anthropometry is useful as a standard approach in racial classification and assessment.
Craniofacial anthropometry which deals with the measurements of skull also includes
measurements of the inner and outer canthal distances. Craniofacial dimensions may be
determined by a single gene, gene groups or environmental factors . For effective comparison
with other population means, groups must be matched at each age, sex and ethnic origin
(Evereklioglu et al., 2012). It is important for the study of human growth and variations in
different races and also for clinical diagnosis and treatment. It has been reported earlier that
people with different genetic background subjected to significantly different environmental
influences have different craniofacial morphology.
Paul Tessier considered as the father of modern craniofacial surgery, emphasized that from a
clinical point of view, the most difficult thing to establish for any patient's facial morphology is
‘what is normal’ and ‘what is abnormal’ in that face. As there are a large number of variable
parameters, such as age, gender, ethnic background and even cultural desires for what constitutes
a ‘normal’ facial appearance, it is important to assess normal faces for each given population,
and in particular, to find normative proportional relationships that may be used to aid clinical
practice.
The keystone for successful reconstruction of the medial canthal area is adequate positioning of
the medial canthal complex to maintain proper inner canthal distance. For these reasons,
standards based on ethnic or racial data are desirable because these standards reflect the
potentially different patterns of craniofacial growth resulting from racial, ethnic and sexual
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differences (Evereklioglu et al., 2012). In diagnosing certain anomalies and syndromes,
abnormal facial features such as telecanthus, ocular hypertelorism or hypotelorism are taken into
consideration by many clinicians, geneticists and maxillofacial surgeons. Measurements become
stable once it has reached adult level in the mid to late twentyes ((E.A. Osunwoke et al., 2010).
Dysmorphologist employs canthal measurements in evaluating the degree of hypertelorism while
dentist employs inner canthal distances as a reliable predicator of maxillary canal incisor width
when it is multiplied by a decreasing function value of the geometric progression term and then
divided by two(E.A. Osunwoke et al., 2010).
The Idoma ethnic group primarily occupies the lower Western areas of Benue State, Nigeria.
The Idoma people are the second largest ethnic group in Benue State and occupy nine local
government areas in Western Benue State. These are Ado, Agatu, Apa, Obi, Ohimini,
Ogbadigbo, Oju, Okpokwu, Otukpo. There are 22 districts in Idoma Land, which has been in
place since 1935 with Ado having 5 districts, Otukpo 4 while Okpokwu and Ogbadigbo have 3
districts . Ohimini and Oju both have 2 districts each while the remaining 3 local governments
areas each have 1 district. The population of Idoma land based on the March 2006 census was
1,307,647 and was projected to be 1,764,900 in 2016.
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Fig.1 Idoma Local Government Areas of Benue State
There are other Idoma groups in parts of Nassarawa and Cross Rivers States asides in Benue
State. The majority of Idoma land speaks Idoma language with diferent dialets. These dialets are
Western Idoma (Okpokwu and Ogbadigbo), Central Idoma (Otukpo and Ohimini), Southern
Idoma (Ado) and Nothern Idoma (Agatu and Apa). Other languages spoken in Idoma land
includes Igede (Obi and Oju), Akweya (Akpa in Otukpo) and Ufia (Utonkon in Ado).
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Fig.2 Map of Idoma land Showing local governments
The people in Idoma land are predominantly farmers who grows crops like yam, cassava, corn,
rice, soyabeans and palm fruits. The Idoma colours are red and black ; with red signifying
royalty and black is strength. The ruler of Idoma people is Och’Idoma and he is resident in the
Och’Idoma Palace in Otukpo. The present ruler is HRH, Elias Ikoyi Obekpa, Och’Idoma.
There are different views as to the origin of the Idomas but most historians agree that Idoma
people migrated from Apa in Kwararafa Kingdom after her disintegration. However, in any
event, it could be said that despite their heterogeneous origin, the Idoma have cultivated
traditions and shaped a rich, cultural identity distinctly their own.
The population of the Idoma Ethnic Group in College of Health Sciences, Benue State
University is currently slightly over 500 and that is the centre of this study.
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1.2 Statement of Problem
Physical growth is a fundamental vital process and the common property of life. The bilateral
orbital region of the upper face determines the attractiveness, youthfulness and health of an
individual. The attractiveness of the face is as the result of the relationship between the
symmetry of its part. The aesthetics of face depends on all anatomic structures. The most
sensitive area of the face is the orbitonasal area, even a small difference cause disharmony,
asymmetry and disproportion. In facial surgery, determination of any disproportion of the face
with the help of indices is invaluable both before and after the operation. The importance of
facial proportions in different races has been declared by several surgeons.
According to the general craniofacial development the normal distance between orbits differs
during embryogenesis and after development. On some occasions, this distance between orbits
becomes abnormal. Although there is a wide variation of the facial dimensions between
ethnicity, gender and age, yet careful inspection and objective measurements may reveal
parameters outside normal standards which narrows down to a differential diagnosis.
The normal intercanthal distance is approximately equal to the width of the palpebral aperture or
half the interpupillary width. The distance, measured from one medial palpebral angle to the
other, is approximately 29 to 34 mm in adult women and 29 to 36 mm in adult men, but it can
vary considerably. An increase in intercanthal distance greater than 40 mm is strongly correlated
with Naso Orbital Ethmoid injury requiring surgical treatment. Injuiries to the naso-orbito-
ethmoid fracture results in traumatic telecanthus.
Telecanthus occurs in frontobasal or naso-orbito-ethmoidal (NOE) trauma, because the base of
the nose may be wedged between the orbits or the nasal skeleton. Disruption of the medial
canthal ligament results in traumatic telecanthus. Telecanthus or dystopia causes abnormally
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increased distance between the medial canthi of the eyelids with normally positioned medial
orbital walls and interpupillary distance. Chinese [Wu et al., 2011], and Caucasians
[Evereklioglu et al., 2012] Inadequate or delayed correction of traumatic telcanthus can result in
scarring and secondary deformities.
An increased distance between the orbits (more than two standard deviations from the normal
values) is described as hypertelorism. Hypertelorism is an excessive distance between eyes and it
is an integral part of various syndromes, e.g. Cat eye syndrome. Dysmorphic characters are
usually reported by clinicians in descriptive terms such as ‘wide set eyes’, ‘broad nose’ or ‘large
mouth (Agrawal J et al., 2013).’
Even though the number of advanced corrective and surgical procedures has been developed in
the field of reconstructive surgery, the lack of knowledge of the variations in the morphological
and anatomical relationship of periorbital structures among different ethnic groups can hamper
the surgeon’s efforts to retain the ethnical features. Post - traumatic and congenital deformities
can be treated with the knowledge of normal value.
Earlier many researchers have studied craniofacial parameters and come up with standard
formulations based on ethnic or racial data. In order to have accurate assessment of telecanthus,
hyper or hypotelorism we need to know standard values of IICD and OICD. .Hence, the present
study will be undertaken to find normative orbitofacial measurements of the Inner and Outer
Inter Canthal Distances in the Idoma population found in College of Health Sciences, Benue
State University to reveal deviations from normal .
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1.3 Objectives of Study
The general objective of this study is to provide detailed data values of the Inner intercanthal
distance (IICD) and Outer intercanthal distance (OICD) and changes with aging between genders
in the Idoma ethnic group found in College of Health Sciences , BSU.
Specifically, the objectives are to:
1. Evaluate data values of Inner intercanthal distance (IICD) Outer intercanthal distance
(OICD) in Idoma ethnic group population found in College of Health Sciences, BSU.
2. Obtain age of subjects selected in Idoma ethnic group population found in College of
Health Sciences, BSU.
3. Obtain gender of subjects selected in Idoma ethnic group population found in College of
4. Obtain LGA of subjects selected in Idoma ethnic group population found in College of
5. Correlate anthropometric dimensions of inner and outer canthal distances and their
related parameters such as age, sex, and LGA.
1.4 Justification of Study
Orbitofacial anthropometrics have become an important tool used in reconstructive surgery and
by genetic counsellor. Functional and cosmetic craniofacial surgery involving the eyelids and
eyebrows requires knowledge of the anatomic relationships of the landmarks as it is important in
the human appearance. Ocular adnexal changes and somatometric traits of the face such as
epicanthus, telecanthus, flat nasal bridge, widely spaced eyebrows, and blepharophimosis may
create an illusory fault in the identification of certain craniofacial syndromes, and reliable
methods are needed for the diagnosis of some craniofacial anomalies .
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Hypertelorism is an integral part of various syndromes, e.g. Cat eye syndrome. False
hypertelorism or pseudo hypertelorism due to soft tissue abnormality could be prevented by
measuring the inner and outer intercanthal distances in diagnosing craniofacial abnormalities. In
addition, reconstruction of the canthus following deformities of the orbit, congenital or acquired,
measurement of the canthal distances is needed to achieve anatomic restitution. Inadequate or
delayed correction of traumatic telecanthus can result in scarring and secondary deformities.
Adequate positioning of medial canthal complex is the keystone for successful reconstruction,
which will help in maintaining the normal inter canthal distance. For these reasons, standards
based on the ethnic and racial data are required. These standards reflect the potentially different
patterns of craniofacial growth resulting from ethnic, racial, and sexual differences. In deformity,
the patient’s measurement has to be compared with the normal values which are specific for
patient’s race, age and sex.
Certain studies indicates that the morphology and anatomical relationship of palpebral fissure
varies according to age, sex and ethnicity. In the surgical point of view, even though the number
of advanced corrective and surgical procedures has been developed in the field of reconstructive
surgery, the lack of knowledge of the variations in the morphological and anatomical relationship
of periorbital structures among different ethnic groups may hamper the surgeon’s efforts to retain
the ethnical features. Therefore, the knowledge of anatomic relations, morphology, coupled with
aesthetical criteria of the patient population is a crucial part of treatment planning to achieve
ideal postoperative outcomes, particularly in bilateral conditions.
Since the normal data base of one ethnic group may not represent the others, there is a
requirement for ethnically specific database. Hence this study needs to be carried out to find out
the inner-intercanthal and outer-intercanthal distance measurements in Idoma ethnic group
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population found in College of Health Sciences, Benue State University between the age group
of 18 to 35 years of age based on the assumption that any increase in the measured parameters
with the age would have stopped by age of 35. The relationship between the orbitofacial
dimensions with advancing age will be explored. The difference in the inner intercanthal distance
and outer intercanthal distance with respect to gender will be found out in the population.
1.5 Significance of Study
The true values of inner and outer canthal distances are important for successful reconstruction
of the canthal area. Using both morphological features and measurements, the face can either be
reconstructed (identifying the dead), superimposed or compared to a facial photograph (mistaken
identities or missing persons) or for the reconstruction surgeries after accidents. Thus, it is
necessary to have local data of the parameters since this standard reflects the potentially different
pattern of craniofacial growth resulting from racial, ethnic, sexual differences .
This is a useful tool in medical genetics, because many of the syndromes present at birth involve
the head and the face, so this can assist clinicians to describe what they see. Standard values of
inner intercanthal, outer-intercanthal distances have been described to be very useful in the
diagnosis of neural crest migration anomalies such as Waardenburg syndrome .
The canthal distances are one of the most important aspects in assessing the facial aesthetics.
Inner canthal distance may be used as a tentative predictor for the estimation of the combined
width of the maxillary six anterior teeth and serve as a useful additional factor in tooth selection.
To diagnose patients with hypertelorism, hypotelorism or telecanthus we require standard
baseline values. Previously, these conditions were assessed on the basis of clinical evaluation
without any standard measurements, which creates a significant source of error in establishing a
final diagnosis.
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Statistical data about the anthropometric measurements in a population are useful for forensic
scientist. Furthermore, these values are useful in the manufacture of spectacle frames and lenses.
No study on the facial parameters in relations to canthal distances of the Idoma ethnic group
under investigation has been carried out before now. Hence, in absence of any work done on this
topic with regards to the Idoma ethnic group, it is imperative that a study aimed at documenting
the canthal distances of this ethnic group will be necessary, which would be of importance in
anthropological study, forensic medicine and clinical practice (plastic surgery and orthodontics).
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CHAPTER TWO
LITERATURE REVIEW
Canthus is either corner of the eye where the upper and lower eyelids meet. The inner canthus is
called as nasal or medial cantus while Outer canthus is known as lateral or temporal canthus. The
inner canthus represents the fleshy, pink lachrymal caruncle and the canaliculi which lead into
the lachrymal sac (Agrawal J et al., 2013) The bicanthal plane is the transversal plane linking
both canthi and defines the upper boundary of the midface.
Fig.3 Diagram of the eye showing the medial and lateral canthus
Canthus is the Latinized form of the ancient Greek kanthos meaning ‘corner of eye’. The lateral
palpebral commissure (commissura palpebrarum lateralis);external canthus is more acute than
the medial and the eyelids here lie in close contact with the bulb of the eye(Agrawal J et al.,
2013). The medial palpebral commissure (commissura palpebrarum medialis); internal canthus is
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prolonged for a short distance toward the nose and the two eyelids are separated by a triangular
space ; the lacus lacrimalis. The two canthi of each eye (medial and lateral) are represented in
cephalometric analysis by the endocanthion and the exocanthion landmarks (single points
representing the points of each commissural angle). Telecanthus or dystopia canthorum is a
lateral displacement of the inner canthi of the eyes giving an appearance of a widened nasal
bridge. It is associated with Waardenburg syndrome which is due to mutation in PAX gene.
Inner intercanthal distance is the measurement of the distance between the two medial canthi of
the eyes, while outer intercanthal distance is the measurement of the distance between the lateral
canthi of the eyes (E.A. Osunwoke et al., 2010). The canthal distances are one of the most
important aspects in assessing the facial aesthetics. Several authors have described changes in the
canthal distances attributable to race and gender.
Fig.4 Image showing inner canthal distance, outer canthal distance and inter pupillary
distance
Orbitofacial anthropometrics have become an important tool used by genetic counselor and in
reconstructive surgery.The diagnosis of many dysmorphic syndromes is based on advanced
cytogenetic and molecular techniques. Before referring a case for costlier molecular diagnostic
17
tests, recognition of subtle morphological anomalies and corresponding useful diagnostic test
should be determined(E.A. Osunwoke et al., 2010).. Ocular adnexal changes and somatometric
traits of the face such as epicanthus, telecanthus and widely spaced eyebrows may create an
illusory error in the identification of certain craniofacial syndromes, and reliable methods are
needed for the diagnosis of some craniofacial anomalies.
The variability of facial features among different ethnic groups should be borne in mind when
the planning for surgeries. These variabilities plays an important role in the treatment planning of
patients requiring orthodontic, orthognathic and facial aesthetic/reconstructive procedures.
Reliance on normative craniofacial data published for populations from unrelated ethnic groups,
or using the neoclassical proportional norms, may be potentially unreliable.
Inner intercanthal distance is one of the important facial parameters which can be used as a tool
for medical genetics for diagnosis of syndromes. Also, it can be used for the evaluating several
systemic syndromes, craniofacial abnormalities, and for surgical correction of traumatic
telecanthus.
Traumatic telecanthus is the most common clinical feature associated with NOE fractures.
Medial canthal tendon is the pivotal structure in the nasal region which supports the canthus. The
paramount in study is to correct the telecanthus, enophthalmos and other clinical symptoms.
Dysmorphic craniofacial features may be apparent in individuals with syndromic conditions such
as Apert's, Crouzon's, trisomy 13, Robinson's syndromes, Williams, and the Meckel-Gruber
syndromes (Wu et al., 2011) . Also, the normative measurements of these parameters may also
be useful for preliminary identification purposes in settings were robust forensic procedures are
in limited supply.
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Laestadius and co-workers in 2011 reported that 78 percent of the adult ICD is attained by 1 year
of age; subsequently the rate of growth in this area reduces in contrast to that of the outer orbital
dimension. The intercanthal width reached full maturation at 8 years in females and 11 years in
males. In comparison with other skeletal structures, the orbital measurements showed more
advanced early development and less subsequent growth than the forehead and bizygomatic
widths.
The clinical observation of face especially the orbital region is essential in diagnosis of many
phenotypic anomalies. These anomalies can be either quantitative or qualitative. Qualitative
anomalies are easy to find out when compared with the normal phenotype. Hypertelorism is one
of the quantitative anomalies. It is the increased distance between the eyes. This condition is
etiologically and pathogenically heterogeneous. It is not an isolated syndrome by itself . It is an
anomaly which acquires as a part of syndrome or malformation sequence. Three possible
pathogenic mechanisms lesser wings of the sphenoid, fixing the orbits in fetal position or failure
of development of the nasal capsule, allowing the primitive brain vesicle to protrude into the
space normally occupied by the capsule resulting in morphokinetic arrest in the position of the
eyes; and disturbance in the development of the skull base as in craniosynostosis syndromes or in
mid-facial malformations. But in diagnosis of quantitative anomalies such as hypertelorism
knowledge about the normal values in each ethnic group is required .
Frakas, et al (2015) stated that a variety of craniofacial abnormality, traumatic facial injuries,
reconstruction and orthognathic surgery , even orthodonthic treatment produce changes in facial
appearance. An understanding of facial aesthetics, craniofacial proportions and age-, gender- and
ethnicity-specific craniofacial measurements is thereby beneficial in clinical practice, providing
guidance for both clinical diagnosis and treatment planning. One of the rarest syndrome is
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Acher’s syndrome which is characterized by blepharochalasis, double upper lip and decreased
outercanthal distance. Diagnosis of Acher’s syndrome is purely clinical. Shivcharan LC reported
a case in which the patient had decreased outercanthal distance.
Singh, et al (2011) did a studied in which they measured the Interpupillary distance (IP), inner
and outer canthal distances (IC, OC) have been investigated in an Indian population to establish
normal values for these parameters. In males, the mean values of IC and OC were found to be
3.15 ± 0.2445 and 8.44 ± 0.3172 cm, respectively. However, in females these values were 3.09 ±
0.2862 and 8.17 ± 0.3310 cm, respectively.
Omotode in 2011 carried out a research on facial measurements in newborn to access syndrome
delineation. Inner and outer intercanthal distances, palpebral fissure length, occipitofrontal
circumference, and canthal index values were determined and compared between 252 white
newborns in Cardiff and 256 black newborns in Ibadan, Nigeria. The study showed that the
white and black newborns had the same inner intercanthal distance while the outer intercanthal
distance and palpebral fissure lengthwere significantly smaller in the white newborns than in
their black counterparts. This study is aimed at determining the normal values of these
craniofacial measurements and the canthal index in a South Eastern Nigerian adult population.
Murphy, et al (2010) studied 100 black patients (71 female and 29 male). They were measured
for intercanthal and interpupillary distance. For the overall group the mean intercanthal distance
was 33.9 ± 3.0 mm; previous studies of white persons and mixed populations indicate an average
of 32 ± 3 mm. The mean interpupillary distance for this study was 63.7 ± 3.7 mm; previous
studies indicate an average of 63 ± 3 mm. This study suggests that the intercanthal and
interpupillary distances in blacks are similar to findings of previous studies on whites and mixed
populations.
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Quant et al (2010) measured the exophthalmus, intercanthal distance, interpupillary distance,
interorbital distance in 243 adults of age group ranging from 18 to 60 years and concluded that
the intercanthal distance value for male is in the range of 31.07 to 40.77mm and in males it is in
the range of 30.17 to 40.09mm. He also compared the obtained mean value with the intercanthal
values of Koreans, Caucasians, blacks ,Vietnamese and found out that the ICD of HOK is similar
to that of blacks but it is larger than Caucasians population.
Kaimbo, et al (2010) studied the orbital measurements in Zairian children. The intercanthal
distance were measured with ruler. 95 healthy subjects in the age group of 2 ½ to 18 years were
included in the study which included 47 boys and 48 girls. The study is performed by dividing
into 4 groups. First group included children in the age 21/2 to 6 years , second group in the age
of 7 to 10 years, third group in the age group of 11to 14, and fourth group in the age group of 15
to 18 years. The mean intercanthal distance was 27.4 +/- 2.7 mm for the first age group, 29.7+/-
3.1 mm for the second age group, 30 +/-2.4 mm for the third age group and 32.2 +/- 3.1 mm for
the fourth age group. The mean +/- SD outer orbital was 100 +/- 4.4 mm for the first age group,
106.5 +/- 4.6 mm for the second age group, 111.7 +/- 6.8 mm for the third age group and 118.5
+/- 6.4 mm for the fourth age group..
Wu, et al (2011) studied the inner canthal distance, outer canthal distance, interpupillary
distance, and palpebral fissure length. 4446 normal Chinese children in Taiwan were included in
the study. The sample of 284 full term neonates, 2742 infants and children aged from 1 month to
3 years, and 1420 preschool children were measured for inner canthal distance, outer canthal
distance, interpupillary distance and palpebral fissure length. No significant sex differences were
observed. Compared with previous studies, inner canthal distance, outer canthal distance and
interpupillary distance in Chinese children in Taiwan were wider than those in Caucasian
21
children. They also found that inner canthal distance was wider than palpebral fissure length at
the same age; therefore it was not correct to diagnose hypertelorism in Chinese children in
Taiwan; as if an imaginary third eye could fit between the eyes. Thus, they suggest that
measurements should be adjusted with normal standards specific for race. Consideration of the
position of eyes is relevant for the diagnosis of a large number of syndromes.
Gupta et al (2019) did a study in the Indian population to establish the normal values for
intercanthal and outercanthal distance in the age group of 3-80 years. 2500 participants were
enrolled in the study. The intercanthal, outercanthal distance for males were in the range of 20-
36 mm and 76-105 mm and in female the values were in the range of 20-36 mm and 71-105 mm
respectively. The difference in the mean values in some groups were statistically significant.
When compared with other population the normal values in the Indian population is lower than
the other population.
Saheeb et al (2014) studied the medial and lateral canthal distances in 3 to 18 years 468 male and
408 female Nigerians and concluded that the mean value of medial canthal distance for the
Nigerians is slightly higher than the Caucasians. No significant difference in the lateral canthal
distance between the group. There is significant difference in medial canthal distance between
the Nigerian and Caucasian females. But there is no significant difference in the lateral canthal
distance.
Egwu, et al (2018) published the normal inner canthal and outer canthal distance in Nigerian
population. A total of 460 students including 264 males and 196 females. The mean age of
23.27±3.48 years for males and 21.37±2.82 years for females volunteered in this study. The
mean IICD for males and females were 43.90±4.11 mm and 41.77±3.37 mm respectively. The
mean OICD was found to be 118.34±0.66 for males and 114.76±0.34 for females. The canthal
22
index (CI) showed 37.10±2.93 for males and 36.41±2.69 for females. Persons correlation
coefficient indicated positive relationship between IICD, OICD, CI, FOD and Body surface area
(BSA). IICD and OICD correlated with height while OICD alone correlated with Body mass
index (BMI). A multiple regression equation was developed for CI as dependent variable and
FOD, Age and height as independent variables. This study will provide a databank for
craniofacial surgeons and ophthalmologists and help in the evaluation of deformities, post-
traumatic telecanthus and hypertelorism in our population.
Oladipo, et al (2010) carried out a study to determine the normal mean values of interpupillary
distance, nasal limbus to temporal limbus, inner-outer intercanthal distance, inner intercanthal
distance outer intercanthal distance, length of palpebral fissure and canthal index of Ijaw adults
distance, length of palpebral fissure and canthal index of Ijaw adults. He concluded that Nigerian
males and females had mean Inner intercanthal distance of 3.89cm and 3.7 cm, mean outer
Intercanthal distance of 10.77cm and 10.46cm respectively. The results obtained indicate a
sexual dimorphism with a significantly higher values of all the parameters in males compared to
females (p<0.05) using Z-test. They also concluded that the results of this study will be of
immense use in forensic medicine and anthropology and will also serve as a future frame work
for estimating the ocular dimension of Nigerians.
Amira, et al (2010) did a study to evaluate the hypertelorism in genetic syndromes and to start
setting up the standards for orbital parameters among children in Egypt. Head circumference,
outer intercanthal, inner intercanthal and interpupillary distances were measured in 279 children;
49 patients with syndromes involving hypertelorism and 230 normal control children within the
same age group. 13 groups were included in the control group and mean values of the orbital
measurements were estimated for all the thirteen groups. Normal values were obtained and
23
compared with the children with hypertelorism and with other population. No significant
differences were found between the sex in different orbital measurements such as intercanthal
and outercanthal distance. Also the Eygyptian orbital parameters did not match the Africans and
Americans, but it coincided with that of the Turkish. They also concluded that the craniofacial
syndromes had greatest measurements of hypertelorism. This study can acquaint the geneticists
on the need to the actual measurement, in relation to age, sex and racial standards for accurate
diagnosis of syndrome.
Jaja, et al (2011) studied the intercanthal and outer canthal distance in 16-18 years females and
males. The resultant mean inner canthal distance was 1.85±0.30cm and 2.07±0.29cm (males vs.
females, p=0.000); mean outer canthal distance, 10.39±0.56cm and 10.40±0.98cm (males vs.
female, p=0.899). The resultant mean values were lower than the other Nigerian groups.
Patil, et al (2011) studied the eyelid measurements in 160 patients between the age group of 16-
60 years in Indian population. He divided the patients into three groups Groups A to C: 16 to 30
years, 31 to 45 years, 46 to 60 years, respectively. A significant increase in palpebral fissure
from Group B to Group C was observed. As age progressed beyond 45 years increase in
intercanthal distance was observed. There was a significant decrease in the interpupillary
distance as age increased-from Group A to Group B .The anatomy of the Indian population is
distinct in that the palpebral fissure in men is less than that in women. It appears that changes in
the eye become more pronounced after 45 years, including an increase in palpebral fissure,
intercanthal distance, and height of the upper lid, along with a decrease in interpupillary distance.
Osunwoke, et al (2010) conducted a study the normal intercanthal and outercanthal,
interpupillary distance and head circumference on 3-21 years old Ijaws. Total of a thousand
people were included in the study. Vernier caliper, non stretchable plastic ruler and tape were
24
included in the study. The results showed that the intercanthal distance, outercanthal distance for
male is 28.30+-4.16 mm,92.49+- 6.30 mm respectively and for females is 28.15+-2.75 and
91.96+-5.81 mm respectively. This study found that the overall intercanthal for males is larger
than the females.
Dennis, et al (2015) studied the intercanthal and outercanthal distance in 601 subjects including
313 males and 288 females. The subjects were in the age group of 18-30 years from the Urhobo
ethnic group of Nigeria. The mean value of intercanthal distance in males is 39.7 mm while in
females it is 38.5 mm . The mean value for outercanthal distance in males is 106.8 mm while in
female is 104.4 mm. And concluded that there is significant difference in the values between the
genders.
Vasanthakumar, et al (2012) studied the palpebral fissure width (PFW), palpebral fissure height
(PFH), palpebral fissure inclination (PFI), outercanthal distance (OCD),interpupillary distance
(IPD), intercanthal distance (ICD) in the south Indian adults with the age group of 18-26 years
males and females and concluded that there is no sexual dimorphism in the intercanthal distance
(male: 34.27 mm; female: 33.41 mm) while outercanthal distance showed sexual dimorphism
(male: 95.55 mm; female: 92.44 mm). According to Caucasians norms, the ICD ranges from 30
to 35 mm
Oladipo, et al (2010) reported higher values (male: 38.9 mm; female: 37.3mm) compared to our
study. He further stated that the ethnicity and gender should be considered in the orbital surgeries
by the surgeons. The results from this study construe that there is a statistically significant gender
difference in certain parameters between males and females. When the data of the present study
were compared with the previous reports, the measured parameters showed variations and
similarities (racial and sexual) with other populations. Variations in the morphology of orbital
25
features according to race, sex and ethnicity may affect the treatment planning and diagnosis
during facial analysis. Hence, during reconstructive surgery, it is important for the surgeons to
have knowledge of local norms during facial analysis in order to evaluate and modify the
disproportionate features without disturbing the ethnical features. The results of this study will be
of immense use surgical procedures like ocular prosthetics, blepharoplasty and in forensic
science totrace missing individuals by applying facial reconstruction techniques,
dentistry,genetics and pale anthropological studies.
Esomonu, et al (2012) did a study to document the intercanthal and outer canthal distance in
2700 subjects which included 1350 males and 1350 females. The subjects were divide into age
groups of 7-9, 10-12, 13-15, 16-18, 19-21, 22-24, 25-27, 28-30 and 31-40 years. The inner
canthal distance lengthened by 6.2 mm in males and 41 mm in females for subjects between 7-9
and 13-15 years old age groups and the outer canthal distance increased by 9.2 mm in males and
in females 9.5 mm. The inner canthal distance gradually lengthened further by 6 mm in males for
ages between 16-18 and 22-25 years old groups and in females it gradually shortened by 10 mm
whereas the outer canthal distance value shortened by 3 mm in the male .In female the value
further lengthened slightly by 13 mm. In group of 25-27 and 31-40 years old, in females the
inner canthal distance gradually shortened by 7 mm while in males its values did not change .
The outer canthal distance value in the male is shortened by 3.8 mm while female value
remained the same. They concluded that aging affects the growth rate of the canthal distances.
Higher growth rate noted in the 7 to 15 years old subjects.
Agarwal (2013) conducted a study on the assessment of inter-canthal and outer-canthal distance
in Chhattisgarh region and found all the measured parameters were increasing between 7 to 25
years and the maximum growth in ICD and OCD is found in between 8 and 9 year in both sexes.
26
They obtained values as follows. In male, the mean values of ICD and OCD observed among
children (age 7-14 years) were 30.53mm and 92.57 mm respectively; in young adults (age >14 to
25 years) were 31.82 mm and 95.69mm respectively; and in adults (age >25 to 40 years) were
32.50mm and 96.10mm respectively. In female, the mean values of ICD and OCD observed
among children (age 7-14 years) were 30.44mm and 91.89 mm respectively; in young adults (age
>14 to 25 years) were 31.70 mm and 94.16mm respectively; and in adults (age >25 to 40 years)
were 32.00mm and 94.40mm respectively. All parameters were higher in males than in females ,
but the difference was not statistically significant. In conclusion, they stated that this present
study documents the anthropometric variation pattern of the orbitofacial parameters of
population residing at Chhattisgarh region and presents normative data for the measured
parameters, specific for age and sex. This data may be used as an important tool for diagnosis of
many dysmorphic syndrome by genetic counsellor, in reconstructive surgery and for identifying
dead or live person by forensic expert.
Yasas, et al (2013) studied the periocular norms in 103 subjects which includes 51 males and 52
females , between 18 and 35 years and he concluded that that the inner canthal distance for males
is 40.61 mm and females is 38.27 mm and binocular width is 93 mm for males and 88.39 mm for
females. He finally concluded that there is no significant sexual dimorphism between the gender.
Measurement of periocular structures is of great value in several clinical specialties including
optometry, ophthalmology, medical and clinical genetics, oculoplastic surgery, and
traumatology. Periocular abnormalities can also arise through trauma. Traumatic telecanthus,
which is often observed in naso-orbito-ethmoid complex fractures. It is important to note that
several interacting features such as epicanthic folds, flat nasal bridges, widely spaced eyebrows,
or narrow palpebral fissures can give rise to the visual impression of hypertelorism.
27
Kalpit, et al (2014) studied the inner intercanthal and outer intercanthal distance in 3500 subjects
from birth to 70 years of age and concluded that all these values are stabilized by 16-20 years of
age. IICD and OICD started increase only after one month .the OICD showed faster growth in
the first two years of life while IICD the growth is steady in the first decade of life. The value
obtained by him are IICD in the range of 19.82-34.14, for OICD it was 57.31-87.97 mm. They
finally concluded that this study gives a nomogram for these parameters in the average Indians
which could be relied upon in diagnosis of craniofacial syndromes and orbito-facial trauma or for
planning reconstructive surgeries for the same, in making of accurate spectacles & for
manufacture of binoculars & stereomicroscopes. The difference between the two sexes is present
but is not statistically significant in our population group.
Anibor, et al (2014) studied the intercanthal and outercantal distance in the age group of 12-35
years in the Isokos male and females. Results showed that Isoko males and females had mean
OCD of 106.17±3.73 and 107.13±2.98 respectively and mean ICD of 36.98±1.96 and
34.63±2.24 respectively. The mean OCD and ICD of Isoko males are higher than OCD and ICD
of Isoko females.He also conclude that the result also showed that the CI of Isoko males
increased as age increases when compared with the values of Isoko females. It is believed that
genetics and environmental factors may be responsible for the variation in CI and other
craniofacial indices between and within the populations.
Alkhairy, et al (2016) studied the orbital measurements. Pakistan population in 500 people which
included 227 males and 274 females and concluded that the mean intercanthal distance is 3.4cm
± 0.4cm and outer canthal distance is 10.7cm ± 3.9cm.There is no mean difference found in the
values by gender or age group separately. Also they conclude that the anthropometric variations
for head circumference, inner canthal distance, outer canthal distance and the interpupillary
28
distance are seen with age and gender. The standard baseline values should be defined for these
parameters . Also these should be considered when classifying a patient with hypertelorism,
hypotelorism or telecanthus or when planning an orbital surgery.
Meltem, et al (2016) studied the Anthropometric measurements of the orbital contour and
canthal distance in young Turkish population. He included 115 students 59 females and 54 males
in the study and found out that the male had mean value of intercanthal distance and outercanthal
distance of 28.68 ± 3.61 mm, 96.43 ± 11.90 mm respectively. Females had mean value of inner-
intercanthal distance and outer canthal distance of 27.84 ± 2.90 mm, 95.08 ± 9.85 mm
respectively. Measurements were higher in males than in females. They concluded that these
values can be used for clinical interpretation of periocular pathology and serve as reference
values when planning aesthetic and posttraumatic surgical interventions.
Nzeako et al in 2017 studied the intercanthal distance and outercanthal distance in people in the
delta state , which included 569 males and 431 females in the age of 21-35 years with normal
craniofacial configuration. A vernier calliper was used to measure the inner intercanthal distance
and outer intercanthal distance. The male (34.06mm) had higher intercanthal distance than the
females (33.59) even though the values statistically insignificant. He further compared the this
study with other studies by Bruce and Timothy (1992) who reported 34±4mm; Murphy and
Lasin (1990) reported as 33.9±3.0 mm; Ngeow and Akan (2005) reported as 33.0±2.6mm; for
Malaysians . These values are similar to the value of this study. These significant difference in
the values could be due to racial and ethnic differences caused by environmental and genetic
factors. These things could control pre-pubertal and post-pubertal development of the upper third
of the face. He concluded that the knowledge gained from this study will help in the
understanding of orbito-cranial growth patterns of females and males in this subgroup, for early
29
diagnosis of craniofacial syndrome and the surgical management of craniofacial deformities.
However, craniofacial dimension should be performed with normal standards specific for age,
sex, race and ethnic group. Thus, the data obtained in this study is important to maxillofacial
surgeons, clinicians and forensic scientist.
Adhikari et al (2016), studied the inner canthal distance, outer canthal distance and canthal index
in between Nepalese and Indian undergraduate students of Nepalgunj Medical College among
320 (160 Indians: 100 male,60 female and 160 Nepalese: 100 male and 60 female)
undergraduate students of Nepalgunj Medical College of age group 18-24 years.The value
obtained was compared among Indian and Nepalese students in both sexes by using student t-
test. Result: The study showed that there was no any significant difference on the value of inner
and outer canthal distances and canthal index observed between Nepalese and Indian population
except on the value of canthal index which was significantly different between Indian male and
Nepalese male population. However, when the comparison was done between the sexes, inner
and outer canthal distances and canthal index of males are larger than females except on the
value of canthal index of Indian males and Indian females which was non-significant.Hence,
there occurred a sexual dimorphism within Indian and Nepalese population except on canthal
index of Indian male and Indian female but there wasn't any significant differences between
Nepalese and Indian population of same sex except on canthal index of Indian male and
Nepalese male.
Esunwoke, et al (2012) did a study on the normal values of outer intercanthal, inner intercanthal
distance, canthal index, head circumference, near and far interpupillary distance conducted in 23-
42 years old Igbos. A total number of 1000 subjects comprising 500 males and 500 females were
recruited for this study. Measurements were obtained by using a vernier caliper on the medial
30
and lateral angles of the eyes, while a non stretchable tape was used to measure the head
circumference. Canthal index was derived by dividing the inner intercanthal distance by the outer
intercanthal distance and multiplying by 100. Near and far interpupillary distances were derived
by the use of a meter rule. Results showed that there was change of means with advancing age
for the measured dimensions. The mean for the outer intercanthal distance was 102.06±4.43mm
and 102.09±4.54mm for males and females respectively. Canthal index was 36.72±3.65 and
36.75±4.90 for males and females respectively. The head circumference, near and far
interpupillary distance were 59.25±6.45 cm and 59.44±4.98 cm, 68.28±5.08mm and
68.45±5.12mm.
Nausheen, et al (2011) conducted a study to quantify the normal indices of anthropometric
measures related to ophthalmology including Interpupillary distance (IPD), Inner canthal
distance (ICD), Outer canthal distance (OCD) in a normal, healthy Pakistani population. Total
500 patients were chosen randomly but 499 were included in this study. Patients were selected
randomly , over the period of five months. IPD, ICD & OCD all measurements were taken with
the help of plastic rule by only one researcher to minimize chances of error as much as possible.
IPD was reconfirmed from auto refractometer while ICD and OCD readings were taken twice by
occluding one eye of researcher to reduce error. Participants were divided into four categories on
basis of: Age, Gender, ethnicity and geographical location. Patients were further categorized on
basis of Ethnicity to Urdu Speaking, Sindhi, Punjabi, Pathan, and others. Moreover, four age
groups were drawn ranging from 15-24 years, 25-44 years, 45-64 years and 65 years and
greater.The study comprised a total of 499 patents of which 272(54.5%) were males, and
227(45.5%) were females. The mean age of the participants was 39.3 ± 14.5 years. The mean
values for the IPD, ICD and OCD in mm were 61.8 ± 6.2, 30.9 ± 2.9 and 85.2 ± 6.6 respectively.
31
A statistically significant difference was observed between IPD, ICD and OCD Indices among
male and female study participants (p<0.001, p=0.043, p<0.001). While comparing the IPD, ICD
and OCD indices amongst the different ethnic groups, they found no statistically significant
difference (p=0.09. p=0.28, p=0.06). Overall, there was no correlation between the age and other
variables i.e. IPD, ICD, OCD, (r = 0.07, p = 0.085), (r = 0.005, p = 0.906), (r = -0.08, p =
0.058).Hence, the work has recommended normative values of IPD, ICD and OCD in Pakistani
population on the basis different variables including gender, age, and ethnicity.
Mohammed, et al (2012) carried out a study to examine the relationship between inner canthal
distance and maxillary central incisor mesiodistal width in terms of the geometric progression
popularly known as the golden proportion. Two hundred twenty-nine dentate Saudi subjects (120
males, 109 females; mean age 21.46 years) free from facial and dental deformities were
examined. The mesiodistal width of each maxillary central incisor was measured between its
interproximal contact points. The inner canthal distance was measured from medial angle to
medial angle of the palpebral fissures of the eyes. The common ratios of geometric progression
are 0.618 and 1.618. The inner canthal distance of each subject was multiplied by a decreasing
function value of the geometric progression term (0.618) to provide the combined width of 2
central incisors. The product was then divided by 2 to obtain the width of a single maxillary
central incisor. A t-test was used to identify any significant differences in mesiodistal tooth width
and inner canthal distance by gender. Agreement between the measured and calculated central
incisor widths was evaluated with Pearson's correlation coefficients, as was intraexaminer
reliability. Significance was set at α=.05. Results. The mean inner canthal distance of male and
female subjects was 28.7 ± 1.7 mm and 27.9 ± 2.1 mm, respectively. The mean maxillary central
incisor width of male and female subjects was 8.87 ± 0.5 mm and 8.68 mm ± 0.4 mm,
32
respectively. Differences between the mean values for both measurements were significant ( P
=.002). The actual and calculated widths of the natural maxillary central incisors were found to
be highly correlated ( r =.943). Therefore,within the population tested, a significantly higher
mean inner canthal distance and maxillary central incisor width were recorded for male subjects.
Inner canthal distance, when multiplied by a decreasing function value of the geometric
progression term and then divided by 2, was a reliable predictor of maxillary central incisor
width.
Harinee (2018) carried out a study on Orbitofacial Anthropometric Assessment of Inner-
Intercanthal and Outer-Intercanthal Distance in Kanyakumari Population. In the study, 240
individuals between the age of 7 to 40 years from Kanyakumari District were used for the study.
In this study it was found out that the mean inner-intercanthal distance is 32.75 ±2.54 mm and
outer-intercanthal distance is (100.88 ± 58.80) mm in kanyakumari population. There was no
significant difference between the values when compared between the ages. The inner-
intercanthal distance in females ( 31.94± 1.89mm) is higher than males ( 30.45 ± 2.19mm),even
though the values are not significant. The outer-intercanthal distance in females
(100.94±2.45mm) is higher than males(99.23 ±1.45mm). Therefore,the observation from this
study suggest that the mean inner-intercanthal distance in females is found to be 32.75 ±2.54mm
and in males is100.88±58.80mm. There is difference in inner-intercanthal and outer-intercanthal
distance between the gender. Also there is gradual increase in the values with age.
33
CHAPTER THREE
3.0 Methodology
3. 1 Introduction
This chapter discussed the methods that have been used in the collection of data to aid in this
study. It explains the research design, sampling techniques and data collection methods used.
The study was conducted to measure, record and compare Inner and Outer Inter Canthal
Distances among the Idoma population in College of Health Sciences, Benue State University.
Quantitative research method was used in carrying out this research.
3.2 Study Design
This is a cross sectional study for finding the normative value for inner -intercanthal and outer-
intercanthal distance among the Idoma population in College of Health Sciences, Benue State
University, Makurdi.
3.3 Study Population
Total number of 150 subjects comprising males and females for this study from Idoma ethnic
group. The subjects are within the age range of 18-35 years with normal craniofacial
configuration and no known history of neurologic disease, developmental disability, oculofacial
trauma, craniofacial congenital anomaly, strabismus and clinically manifest telecanthus. This
was determined by physical observation and personal interview. Those found to have one form
of disability or the other were excluded from this study. Approval was obtained from ethical
committee of College of Health Sciences, Benue State University. After informed consent was
obtained from the subjects, measurements of inner and outer intercanthal distance was
performed.
34
3.4 Study Location
The study was conducted in College of Health Sciences, Benue State University.
3.5 Study Procedure
After informed consent was obtained, each subject was made to seat comfortably in a chair with
the students head at the same level as approximately 40 centimeters in front of the examiner's
head in a well illuminated room. A metre rule graduated in centimeters was used for the
measurement of the canthal distances. The inner canthal distance was measured as the medial
angle of the left eye to the medial angle of the right eye by having the subject look straight at the
examiner while the metre rule was placed in between the bridge of the subject's nose. The
examiner closed his one eye while asking patient to focus on a distant target and placed zero of
metre rule on forehead. The outer canthal distance was measured as the distance from the lateral
angle of the left eye to the lateral angle of the right eye instructing the subject to look upward to
maximize the contrast between the sclera and the skin. The distances were noted in the data
sheet.
35
Fig.5 Use Of Metre Rule In Taking Measurements Of The Inner And Outer Intercanthal
Distances
Precautions taken during measurement were included cleanliness of instrument, check for Zero
error and check for Parallax error (error due to wrong positioning of the eye). It was found that
while taking all measurements, closing one eye of examiner helped in sighting more precise
readings rather than with both eyes open. All the above mentioned readings were taken twice by
one examiner to reconfirm and avoid any kind of incongruity.
3.6 Study Variables
Data obtained on the basis of three variable of age group, gender and LGA. Participants were
further divided into six age groups; group 18-20, 21-23, 24-26, 27-29, 30-32, 33-35 years. LGA
further categorized to Okpokwu, Otukpo, Apa, Okpoga and others. Data were entered and
analyzed using a Statistical Package for the Social Sciences (SPSS) software version 25 and
analysis of variance (ANOVA), particularly the one way analysis of variance was used for this
analysis. Mean values and standard deviations for each group were obtained using descriptive
analysis and significant values were obtained for p≤0.05 using Tukey Post Hoc Tests. The
independent T-test was used to analyze the ICD and OCD between the gender.
3.7 Sampling Size calculation

N = Z2pq
d2
N=desired sample per ethnic group
Z=standard normal deviation usually set at 1.96 and corresponds to a confidence level of
95%
P=Proportion in the target population within the desired age group
q= 1 – P = 0.9
Q=P-1
36
D=degree of accuracy desired usually set at 0.05
Therefore,
1.962 x 0.92
0.052 = 138.2976
This represents the minimum sample size that will give a statistically significant result based on
the population under review. A total of 150 subjects were used as sample for this study.
Total sample size of study =150.
Sampling technique : Simple random sampling method
3.8 Inclusion Criteria

1. All College of Health Science students( male and female) between the age of 18 years to
35 years with normal craniofacial configuration
2. All students with informed consent
This study protocol was reviewed then approved by the research committee , ethical committee
and all the individuals participated in the study were informed about the benefits and possible
risks.
3.9 Exclusion Criteria
1. Individuals with developmental disabilities.
2. Individuals with Oculofacial trauma.
3. Transgenders.
4. Individuals with neurological disease pertaining to eye, orbit or face, congenital or
acquired craniofacial deformity, strabismus and orbital disease were excluded.
5. Students with any craniofacial defects and with clinical manifestation of telecanthus and
epicanthus
6. Individuals not willing to participate.
37
Equipment used
1. Metre Rule.
2. Laptop
DATA SHEET:
S/N AGE SEX(male or female) LGA IICD(in mm) OICD(in
mm)
FIG. 6 Metre Rule
38
Fig. 7 Measurement of Inner-Intercanthal Distance
Fig.8 Measurement of Outer-Intercanthal Distance
39
CHAPTER FOUR
4.1 Data Presentation, Analysis and Interpretation
The purpose of this study is to evaluate the normative inner-intercanthal and outer-intercanthal
distance in the Idoma population found in College of Health Sciences, BSU. The difference in
the value with age and gender was evaluated. A total of 240 individuals including 120 males and
120 females from the age of 7- 40 years were enrolled in the study. Baseline data for IICD and
OICD were recorded in all the individuals. From the recorded values the mean for male and
female was found . Also, these recorded values can serve for diagnosis of craniofacial anomalies
, as a reference value for correction of traumatic telecanthus, forensic purposes in this local
population.
40
The statistical analysis was done using the statistical package for social sciences version 25 and
analysis of variance (ANOVA), particularly the one way analysis of variance was used for this
analysis. Mean values and standard deviations for each group were obtained using descriptive
analysis and significant values were obtained for p≤0.05 using Tukey Post Hoc Tests. The
independent T-test was used to analyze the IICD and OICD between the gender.
Table 1: showing the Mean± SD for Age, IICD and OICD according to LGA
LGA MEAN AGE MEAN IICD MEAN OICD
ADO 22.94 ± 4.28 35.41 ± 3.06 103.29 ± 4.07
APA 24.86 ± 4.66 34.64 ± 2.68 104.00 ± 6.91
AGATU 24.36 ± 4.94 35.71 ± 2.81 105.07 ± 6.53
OTUKPO 22.38 ± 3.24 35.08 ± 2.60 102.92 ± 3.31
OGBADIBO 23.45 ± 2.96 35.04 ± 3.40 103.77 ± 5.97
OHIMINI 23.57 ± 3.26 33.71 ± 1.98 102.43 ± 2.30
OKPOKWU 22.87 ± 2.91 33.82 ± 2.86 103.13 ± 5.13
Table 2: showing Mean ± SD of Age group for different test parameters

AGE GROUP IICD OICD AGE
18-20 35.03 ± 2.89 103.47 ± 5.16 19.22 ± 0.79bcdef
21-23 34.03 ± 2.85de 102.65 ± 5.70 21.92 ± 0.83acdef
24-26 34.30 ± 2.48 102.60 ± 3.53 24.70 ± 0.70abdef
27-29 36.71 ± 3.16b 106.06 ± 4.53 27.76 ± 0.75abcef
30-32 36.90 ± 2.33b 105.00 ± 2.91 30.80 ± 0.92 abcdf
33-35 36.00 ± 0.00 107.00 ± 0.00 34.00 ± 0.00abcde
a
signify significance difference when different age groups are compared to age group 18-20
b
c
d
e
f
Table 3: showing mean IICD, OICD and Age according to Gender

GENDER IICD OICD AGE
P-value P-value
41
MALE 35.68 ± 2.82 0.0001 104.80 ± 0.0005 24.12 ± 3.86
3.84
FEMALE 33.84 ± 2.81 0.0001 101.99 ± 0.0005 22.35 ± 2.84
5.61
Fig 1: Bar chart showing mean level of Age, IICD and OICD according Gender
42
Fig 2: Bar chart showing mean levels of Age, IICD and OICD according to Age groups.
Fig 3: Bar chart showing mean level of Age, IICD and OICD according to LGA
43
Table no 1: Correlation of the mean±SD for age with the Inner-intercanthal distance and Outer
intercanthal distance according to LGA.
There is no significant difference between the age and the Inner-intercanthal distance and Outer
intercanthal distance according to LGA.
Table No 2: Comparison of age with the Inner-intercanthal distance and Outer intercanthal
distance.
For 18-20 years, the IICD is 35.03±2.89mm and OICD is 103.47±5.16.
There is significant difference in IICD and OICD in between the age groups
Table no 3: Comparison of age, gender of individuals with the Inner-intercanthal
Distance and Outer intercanthal Distance
The mean age of 24.12±3.86 corresponds to the IICD and 0ICD for males respectively as
35.68±2.82mm and 104.80±3.84.
44
For females, the IICD and 0ICD respectively are 33.84±2.81mm and 101.99±5.61
corresponding to the mean age of 22.35±2.84. There is no significant difference in IICD in
between the age groups in male as well as in females.
In correlating the IICD and OICD obtained in our study in males and females as compared with
the other Indian studies, there is no significant difference of IICD and OICD in males and
females in between the studies.
In this study, the IICD and OICD for males respectively are 35.68±2.82 and104.80±3.84 and
that of females are33.84 ± 2.81 and101.99 ± 5.61 while that of Vasanthakumar, et al (2012) for
males are 34.27±3.57 and 95.55±6.39 and for females are 33.41±3.09 and 92.44 ±5.71.
that of females are 33.84 ± 2.81 and101.99 ± 5.61 while that of Singh, et al (2011)for males are
31.5±0.24 and 30.9±0.28 while for females are 30.9±0.28 and 81.7±0.33.
In correlating the IICD and OICD obtained in our study in males and females as compared with
the other country studies, there is also no significant difference of IICD and OICD in males and
females in between the studies.
that of females are33.84 ± 2.81 and101.99 ± 5.61 while that of Yasas, et al (2013) for males are
40.61±4.91 and 93.00±5.56 while for females are 38.27±2.61 and 88.39±3.74.
For Oladipo, et al (2010) for males are 38.90 and 107.60±0.25 while for females are 37.30 and
104.50±0.78.
45
.
CHAPTER FIVE
5.1 Discussion
Canthus is either corner of the eye where the upper and lower eyelids meet is called Medial or
nasal canthus is the inner canthus and lateral canthus is the outer canthus. The fleshy, pink
lachrymal caruncle and the canaliculi which lead into the lachrymal sac represent the inner
canthus. Inter canthal distance is one the facial parameters which serve as a useful tool in the
medical genetics as many of the syndromes present at birth usually involves the head and the
face. During embryogenesis and after birth the distance between the orbits varies.
Soft tissue variations such as telecanthus could result in a pseudo hypertelorism or primary
telecanthus where abnormality is confined to the soft tissue only. Establishing a nomogram for
inner intercanthal distance (IICD) and outer intercanthal distance (OICD) in a normal population
has important clinical implications.
46
Accurate measurement of these distances serves as a diagnosing tool for finding hypertelorism.
True hypertelorism is when both the IICD and OICD are wide apart. Diagnosis of hypertelorism
plays a very important since it is a feature of various syndromes like faciodigitogenital dysplasia,
Greig syndrome and optitz G syndrome.
Primary hypertelorism is one in which there is increase in inner canthal distance but outer-
intercanthal distance will be normal. Illusionary hypertelorism may occur in people with flat
nasal bridge, epicanthal folds, exortopia narrow palpebral fissure, widely spaced eyebrows and
dystopia canthorum. For example, Trisomy 21 syndrome, epicanthic folds and flat nasal bridge
both contribute to the illusion of hypertelorism, although measurements actually show ocular
hypotelorism.
Traumatic telecanthus resulting from NOE fractures is difficult to treat and it involve both
aesthetic as well as functional aspect in the treatment. Inadequate ordelayed treatment of these
fractures can result in scarring in the region and can give poor results post-operatively.
These values are also serve as a tool to diagnose traumatic telecanthus which is an important
clinical sign associated with NOE fractures. Successful management of NOE fracture requires
both soft tissue as well as hard tissue is consideration. Misdiagnosis or inadequate treatment of
these fractures can result in facial deformities.
Many dysmorphic syndromes can be diagnosed based not only on advanced cytogenetic and
molecular techniques, but also on recognition of subtle morphological anomalies in craniofacial
region. Dysmorphic characters are usually reported by clinicians in descriptive terms such as
wide-set eyes, broad nose, and largemouth. However, such description is subjective.
Anthropometrical measurements can overcome these problems. Measurements taken from a
patient can be compared with the values obtained in the normal population, and deviations
47
from the normative values can be evaluated.
The normal database available for one ethnic group may not represent the other ethnic group. So
a standard for each specific group is necessary. The result of the study shows that, the inner-
intercanthal distance and outer-intercanthal distance are studied in 150 people which includes 75
males and 75 females in the Idoma population in College of Health Sciences,BSU. The distances
are measured using metre rule.
The study further revealed that, the mean IICD and OICD for males respectively are
35.68±2.82mm and104.80±3.84mm and that of females are 33.84±2.81mm and101.99±5.61mm
in this population. There is no significant difference between gender. The values are higher in
males than the females. While in a study conducted by Vasanthakumar, et al (2012) in south
Indian population the mean IICD in males is found to be 34.27± 3.57mm and female is
33.41±3.09mm. These values are lower than the values obtained in this study. Moreover, in this
study the IICD in males is higher than the females.
In a study by Oladipo, et al (2010), in Nigerian population the IICD in males and females are
38.1±2.33mm and 36±1.69mm respectively. These values are much higher than the values
obtained in the Idoma population. Also, there is significant difference in IICD between males
and females.
In a study by Amal AB, et al (2010) in Saudi population, it was concluded that there is no
significant difference in the mean values of IICD and OICD with regards to age and gender. This
conclusion coincides with the result from this present study. In the study by Vasanthakumar, et
al (2012) the OICD in males is 95.55±6.39 mm and in females is 92.44±4.71mm. These values
showed significant difference. Also, when compared with this present study, these values are
lower. This clearly marks that there is difference in IICD and OICD with region, specific race
48
and ethnic group. Oladipo, et al (2010) further indicated that in Nigerian population, the mean
OICD values obtained in males and females are 107.6±3.78mm and 104.5±3.22mm respectively.
There is significant difference between the genders in this population. The values obtained in this
population is higher than the values obtained in Idoma population. The mean IICD and OICD for
the age groups in this study are as follows;
1. For 18-20 years, the IICD is 35.03±2.89mm and OICD is 103.47±5.16.
When the values are compared between the age, the mean IICD of18-20 is higher than the mean
IICD of 21-23 years which is then lower than the obtained values of 24-26 years. Then the
obtained values of 24-26 years is lower than the mean IICD of 27-29 years which in turn is lower
than the mean IICD of 30-32 years and this is higher than the mean IICD of 33-35 years.
In the IICD, there is no significant difference in between the age groups.
Kalpit, et al (2014) in his study observed that the IICD increased till 16 years of age and which
they observed a plateau. Also this value increase only after 1 month . IICD growth was steady in
the first decade of life and after this there is minimal increase in the value which is due to orbital
divergence as the age advances. This result coincides with this study in the part that there is
increase minimal increase in the parameter as age advances.
The Inner intercanthal distances of the Idomas decreased at the 33 to 35 years group in both male
and female when compared to the previous years groups. The decrease of the Inner canthal
49
distance width is attribute to the progressive “drooping” of the eyelids with age (Ferrario et al.,
2015). In comparing the mean OICD values between the age, the mean OICD of 18-20 is higher
than that of 21-23 years which is then higher than the obtained values of 24-26 years. Then the
obtained values of 24-26 years is lower than the mean OICD of 27-29 years which in turn is
higher than the mean OICD of 30-32 years and this is lower than the mean IICD of 33-35 years.
In the OICD, there is significant difference in between the age groups.
Gupta, et al (2019) in his study observed by that OICD reached adult dimensions by the second
decade and varied little after that. They also found a significant difference in the values of OICD
in males and females in the third, fifth, sixth & eighth decades. Kalpit et al 2014 in his study
stated that there is no change in the value of OICD until 1 month after which there is an increase
in the value. 16-20 years OICD is stabilized and then they observed a plteau. There is faster
growth of OICD in first two years of life..
The mean values of IICD and OICD in males and females is compared with values in other
studies. In this study, the IICD and OICD for males respectively are 35.68±2.82 and104.80±3.84
and that of females are 33.84 ± 2.81 and101.99 ± 5.61 while that of Vasanthakumar, et al (2012)
for males are 34.27±3.57 and 95.55±6.39 and for females are 33.41±3.09 and 92.44 ±5.71. There
is no significant difference in IICD between the two population but there is significant difference
in OICD. This is compared with Singh, et al (2011) study, the IICD and OICD in male
population is found to be 31.5±0.24mm and 99.23±1.45mm. There is significant difference.
The obtained values were compared with the values obtained by Oladipo, et al (2010) in
Nigerian population in which the IICD in males is 38.90mm and in females is 37.30mm .These
values are higher than the values obtained in this present study while the OICD in Nigerian
population in males is 107.60±0.25mm and in females is 104.50±0.78mm.17 These values are
50
higher than the values obtained in this study. Also there is statistical significance present when
these values were compared.
Usman, et al (2015) in his study in subject of Nigerian population got a mean IICD and OICD in
males as 42±5mm and 111±14mm respectively. In females it is 39± 3mm for IICD and 120 ± 7
mm. These values are higher than the values obtained in this study .This can be due to the ethnic
differences in the Nigerian population.
In a study by Meltam, et al (2016)in Turkish population the mean IICD in males and females is
28.68 ± 3.61mm, 27.84±2.90 mm respectively and the OICD is 96.43± 11.90 mm, 95.08 ± 9.85
mm respectively. Both the values of IICD and OICD are lower in this study when compared with
Turkish population.
In a study by Mohammad, et al (2012) on Iran population, found out that the IICD and OICD in
males are 29.16 ±3.31mm and 78.86±7.7mm and in females is 29.2±3.4mm and 80.45±9.22mm.
These values are lower than the values in this study.
When comparing the obtained values with the study by Yasas, et al (2013) in Hong Kong
population, IICD is lower in the males and females in this study while the OICD in Hong kong
population is lower than the values obtained in this study. There is significant difference present
between the two population. This clearly gives the importance of studying normative values in
each specific group. In this study, the inner intercanthal distance as well as the outer intercanthal
distance in males is higher than the males. While in some of the studies the values obtained in
females is higher than the males . This forms a significance of the study . This clearly give the
importance of studying the normative values in a particular population. These changes could be
due to change in environment racial difference associated with a population.
51
The obtained values can be used for diagnosis of hypertelorism such as holoprosencephaly,
Meckel Gruber syndrome, Coffins Siris syndrome and Williams syndromes, in construction of
spectacles, for more accurate correction of traumatic telecanthus, for aesthetic surgeries such as
blepharoplasty, in forensic studies in our population.
Conclusion
The mean IICD and OICD of 150 participants in the Idoma population in College of Health
Sciences,Benue State University was found out in this study. The values of OICD and IICD in
males was found to be higher than the values of OICD and IICD in females. There is much
difference in the values when compared other ethnic groups. This normative value developed can
be used in further reduction of NOE fractures, to diagnose syndromes in our population and it
would be of benefit not only to the maxillofacial and plastic surgeons, but also to the orthodontist
and dysmorphologist.
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ANTHROPOMERIC VARIATIONS OF THE INNER INTERCANTHAL AND OUTER

INTERCANTHAL DISTANCES OF THE IDOMA ETHNIC GROUP IN COLLEGE OF

THOMAS AMARACHI GRACE

A PROJECT SUBMITTED TO THE DEPARTMENT OF ANATOMY, FACULTY OF

SUPERVISORS: PROF LINUS CHIA SAALU

Dr . RAYMOND UDEH (B.Sc., M.Sc. PhD)

1.1 Background of Study

1.2 Statement of Problem

1.4 Justification of the Study

1.5 Significance of the Study

2.1 Literature Review

3.2 Study Design

3.3 Study Location

3.4 Study Procedure

3.5 Study Variables

3.6 Sample Size Calculation

3.7 Inclusion Criteria

3.8 Exclusion Criteria

3.9 Equipments Used

4.1 Data Presentation, Analysis & Interpretation

Background: Craniofacial anthropometric parameters have been found to be relevant in

1.1 Background of Study

and rhinoplasty that would be culturally acceptable.

Dr Leslie Gabriel Farkas, pioneer of modern craniofacial anthropometry is quoted as saying

due to geographical, cultural, genetic and environmental factors (N Adhikari et al.,2016) It

as physical examination, biochemical and radiological assessments. Anthropometry is the study

respective proportions. It is a branch of anthropology concerned with measurements of the

anthropometry is useful as a standard approach in racial classification and assessment.

people with different genetic background subjected to significantly different environmental

influences have different craniofacial morphology.

consideration by many clinicians, geneticists and maxillofacial surgeons. Measurements become

Dysmorphologist employs canthal measurements in evaluating the degree of hypertelorism while

divided by two(E.A. Osunwoke et al., 2010).

1,307,647 and was projected to be 1,764,900 in 2016.

traditions and shaped a rich, cultural identity distinctly their own.

facial proportions in different races has been declared by several surgeons.

parameters outside normal standards which narrows down to a differential diagnosis.

other, is approximately 29 to 34 mm in adult women and 29 to 36 mm in adult men, but it can

vary considerably. An increase in intercanthal distance greater than 40 mm is strongly correlated

ethmoid fracture results in traumatic telecanthus.

Telecanthus occurs in frontobasal or naso-orbito-ethmoidal (NOE) trauma, because the base of

canthal ligament results in traumatic telecanthus. Telecanthus or dystopia causes abnormally

scarring and secondary deformities.

values) is described as hypertelorism. Hypertelorism is an excessive distance between eyes and it

mouth (Agrawal J et al., 2013).’

can be treated with the knowledge of normal value.

State University to reveal deviations from normal .

in the Idoma ethnic group found in College of Health Sciences , BSU.

Specifically, the objectives are to:

Health Sciences, BSU.

Health Sciences, BSU.

Health Sciences, BSU.

related parameters such as age, sex, and LGA.

1.4 Justification of Study

eyebrows requires knowledge of the anatomic relationships of the landmarks as it is important in

methods are needed for the diagnosis of some craniofacial anomalies .

hypertelorism or pseudo hypertelorism due to soft tissue abnormality could be prevented by

measurement of the canthal distances is needed to achieve anatomic restitution. Inadequate or

patient’s race, age and sex.

ideal postoperative outcomes, particularly in bilateral conditions.

the inner-intercanthal and outer-intercanthal distance measurements in Idoma ethnic group

1.5 Significance of Study

reconstructed (identifying the dead), superimposed or compared to a facial photograph (mistaken