Craniofacial Anthropometry in a Turkish Population

CEM EVEREKLIOGLU,
SELIM DOGANAY,
HAMDI ER,
ABUZER GUNDUZ,
MUSTAFA TERCAN,
AYSE BALAT,
TONGABAY CUMURCU,

M.D.
M.D.
M.D.
M.D.
M.D.
M.D.
M.D.

Objective: To present norms and demonstrate the anthropometric variations in

fronto-occipital circumference, inner and outer canthal distances, near and distant
[far] anatomical interpupillary distance, canthal index, and circumference-interorbital index across age and sex in urban Turkish subjects.
Participants: Three thousand four hundred forty-eight subjects (1852 male, 1596
female) aged 7 to 40 years were included in this study.
Methods: Three age groups were studied: children aged 7 to 15 years, young
adults aged 16 to 25 years, and adults aged 26 to 40 years. Mean values for each
measured parameter were determined at each age between 7 and 25 years. Subjects were also divided into nine age subgroups to observe the change of each
parameter with advancing age.
Results: The fronto-occipital circumference and outer canthal distance of males
was significantly (p , .001) wider than females in all age groups. The near and
distant interpupillary distances of male subjects were, on average, wider than the
female subjects with greater differences with advancing age. Across all subjects
aged 7 to 40 years, the mean of all measured parameters and calculated indexes
of men and boys was significantly different from girls and women (p , .001). The
mean for interpupillary distances in our study in both sexes were found to be
similar to Arabian, Hong Kong, and British children; larger than those of Chinese,
Black, Indian, and Caucasians; and smaller than those of Mexican children and a
mixed European population.
Conclusion: This study clearly shows the anthropometric variation for frontooccipital circumference, inner canthal distance, outer canthal distance, near and
distant interpupillary distance, canthal index, and circumference-interorbital index
with age. These developmental data and the normal values of these measurements in healthy subjects are useful for dysmorphologists in the early identification of some craniofacial syndromes, hyper- and hypotelorism, and congenital
or posttraumatic telecanthus and of planning surgical intervention. We suggest
that the comparison of craniofacial dimensions of a patient must be performed
with normal standards specific for age as well as sex and race.
KEY WORDS: anthropometry, canthal distance, canthal index, circumference-interorbital index, fronto-occipital circumference, interpupillary distance

Fronto-occipital circumference, inner canthal distance, outer canthal distance and interpupillary distance are important

measurements in the evaluation of several systemic syndromes and craniofacial abnormalities and in the surgical
treatment of posttraumatic telecanthus (Laestadius et al.,
1979; Farkas et al., 1992a, 1992b). Canthal index and circumference-interorbital index, which are derived from the
measured parameters, are also an important tool to anatomists
and craniofacial surgeons (Lakshminarayana et al., 1991; Evereklioglu et al., 2001). Craniofacial dimensions may be determined by a single gene, gene groups, or environmental
factors (Poswillo, 1963). 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 sur-

Dr. Evereklioglu is an Assistant Professor of Ophthalmology, Dr. Tercan is

Assistant Professor of Plastic and Reconstructive Surgery, and Dr. Balat is
Associate Professor of Pediatrics, Gaziantep University School of Medicine,
Research Hospital, Gaziantep, Turkey. Dr. Doganay and Dr. Gunduz are Assistant Professors of Ophthalmology, Dr. Er is Associate Professor of Ophthalmology, and Dr. Cumurcu is Resident of Ophthalmology, Inonu University
School of Medicine, Turgut Ozal Medical Center, Research Hospital, Malatya,
Turkey.
Submitted February 2000; Accepted February 2001.
Reprint requests: Cem Evereklioglu, M.D., Sivas Cad. Cebeci Apt. A-Blok,
175/15, 38020, Kayseri, Turkey. E-mail evereklioglu@hotmail.com.
208

Evereklioglu et al., ANTHROPOMETRIC STUDY OF CRANIOFACIAL PARAMETERS

209

TABLE 1 Comparison of Fronto-Occipital Circumference, Inner Canthal Distance, Outer Canthal Distance, Near Interpupillary
Distance, Distant Interpupillary Distance, the Difference Between Distant and Near Interpupillary Distance, Canthal Index,
Circumference-Interorbital Index, and the Age Between Males and Females in All Groups
Male Subjects

Female Subjects

Mean 6 SD

Mean 6 SD

SE

P*

52.56
54.95
55.15
53.56

6
6
6
6

2.18
1.61
1.56
2.30

0.07
0.07
0.13
0.05

,.001
,.001
,.001
,.001

Inner Canthal Distance (mm)

0.07
940
0.09
521
0.21
135
0.05
1596

29.65
30.22
30.28
29.89

6
6
6
6

2.38
2.40
2.18
2.38

0.07
0.10
0.18
0.06

.269
,.001
.219
,.001

4.28
3.47
4.26
4.36

Outer Canthal Distance (mm)

0.12
940
0.14
521
0.33
135
0.10
1596

84.61
86.32
87.30
85.39

6
6
6
6

3.86
3.32
3.42
3.78

0.12
0.14
0.29
0.09

,.001
,.001
,.001
,.001

6
6
6
6

3.32
2.54
3.04
3.74

Near Interpupillary Distance (mm)

0.10
940
0.11
521
0.24
135
0.08
1596

55.31
58.41
59.16
56.65

6
6
6
6

3.29
2.60
2.55
3.42

0.10
0.11
0.22
0.08

,.001
,.001
,.001
,.001

6
6
6
6

3.49
2.60
3.00
4.03

Distant Interpupillary Distance (mm)

0.10
940
0.11
521
0.23
135
0.09
1596

58.03
61.30
62.24
59.45

6
6
6
6

3.31
2.66
2.65
3.51

0.10
0.11
0.23
0.08

,.001
,.001
,.001
,.001

Difference Between
6 0.59
6 0.59
6 0.55
6 0.67

Distant and Near Interpupillary Distance (mm)

0.02
940
2.71 6 0.58
2.88 6 0.57
0.02
521
3.08 6 0.64
0.04
135
2.80 6 0.59
0.02
1596

0.02
0.02
0.06
0.02

.905
,.001
,.001
,.001

34.72
34.72
34.23
34.68

6
6
6
6

2.25
2.40
2.58
2.33

0.06
010
0.20
0.05

1104
582
166
1852

5.58
5.44
5.32
5.51

6
6
6
6

0.40
0.42
0.45
0.42

1104
582
166
1852

10.92
20.69
30.84
15.78

6
6
6
6

2.70
2.91
4.44
7.12

Parameter

SE

715
1625
2640
740

1104
582
166
1852

53.26
56.77
57.52
54.75

6
6
6
6

2.14
1.68
1.63
2.67

Fronto-Occipital Circumference (cm)

0.06
940
0.07
521
012
135
0.06
1596

715
1625
2640
740

1104
582
166
1852

29.76
30.87
30.65
30.19

6
6
6
6

2.38
2.39
2.79
2.47

715
1625
2640
740

1104
582
166
1852

85.73
88.92
89.51
87.07

6
6
6
6

715
1625
2640
740

1104
582
166
1852

56.01
60.20
60.91
57.77

715
1625
2640
740

1104
582
166
1852

58.73
63.59
64.25
60.75

715
1625
2640
740

1104
582
166
1852

2.72
3.39
3.34
2.98

715
1625
2640
740

1104
582
166
1852

715
1625
2640
740
715
1625
2640
740

Canthal Index
940
521
135
1596

Circumference-Interorbital Index
0.01
940
0.01
521
0.03
135
0.01
1596

35.04
3502
34.68
35.00

6
6
6
6

2.35
2.55
1.90
2.38

0.07
0.11
0.16
0.06

.002
.047
.099
,.001

5.64
5.50
5.49
5.58

6
6
6
6

0.42
0.42
0.37
0.42

0.01
0.01
0.03
0.01

.003
.016
.001
,.001

10.78
20.43
30.90
15.63

6
6
6
6

2.66
2.83
4.68
7.05

0.08
0.12
0.40
0.17

.228
.129
.918
.542

Age (y)
0.08
0.12
0.34
0.16

940
521
135
1596

* P 5 independent samples t test.

geons. Measurement becomes stable once it has reached adult

levels in the mid- to late twenties (Pryor, 1969; Fledelius and
Stubgaard, 1986). Visual impression is mostly used to describe the anatomical interpupillary distance. However, this
description is not adequate because of variations in facial
features such as wide nasal bridge, epicanthus, and telecanthus. When comparing normative population values, groups
must be matched for age, sex, and race. This is especially
important in the early ages.
Most similar studies performed previously (Pryor, 1969;

Singh and Banerjee, 1983; Fledelius and Stubgaard, 1986;

Murphy et al., 1990; Okanlawon et al., 1990; Quant and Woo,
1992; Osuobeni and Al-Musa, 1993; Osuobeni and Faden,
1993; Kaimbo and Kayembe, 1994) evaluated only distant interpupillary distance without considering age-related changes.
Furthermore, because the common measures used by dysmorphologists include inner canthal distance, outer canthal distance, and fronto-occipital circumference, once these measures
are provided, a true appreciation of the degree of hypertelorism
can be made. In this study, normative values for these param-

210

Cleft PalateCraniofacial Journal, March 2002, Vol. 39 No. 2

TABLE 2 The Comparison of Near and Distant Interpupillary Distance in All Age Groups*
NIPD (mm)
n

Age (y)

Mean 6 SD

740
Combined
Male
Female

3448
1852
1596

15.71
15.78
15.63

57.25 6 3.65
57.77 6 3.74
56.65 6 3.42

715
Combined
Boys
Girls

2044
1104
940

10.86
10.93
10.78

1625
Combined
Men
Women

1103
582
521

2640
Combined
Men
Women

301
166
135

Group

FIPD (mm)
Mean 6 SD

Range

4671
4671
4666

60.15 6 38.6
60.75 6 4.03
59.45 6 3.51

4875
4875
4969

,.001
,.001
,.001

55.70 6 3.33
56.01 6 3.32
55.31 6 3.29

4666
4666
4665

58.41 6 3.43
58.73 6 3.49
58.03 6 3.31

4869
4869
4969

,.001
,.001
,.001

20.57
20.70
20.43

59.36 6 2.72
60.20 6 2.54
58.41 6 2.60

5167
5267
5166

62.51 6 2.87
63.59 6 2.60
61.30 6 2.66

5371
5571
5369

,.001
,.001
,.001

30.87
30.85
30.90

60.13 6 2.96
60.91 6 3.04
59.16 6 2.55

5071
52.571
5065

63.36 6 3.02
64.25 6 3.00
62.24 6 2.65

5375
5675
5368

,.001
,.001
,.001

Range

*NIPD 5 near interpupillary distance, FIPD 5 distant (far) interpupillary distance.

P 5 Difference between near and distant interpupillary distance by Students t test.

eters and for the canthal index and circumference-interorbital

index of a Turkish population are presented. In addition, the
relationship between these craniofacial dimensions and advancing age was explored.
MATERIALS

AND

METHODS

Subjects
The Turkish population was recruited from large urban primary, secondary and high schools, university students, the police academy, and hospital staff. In this cross-sectional cohort
study, the subjects were invited to participate if they met the
following criteria: age 7 through 40 years; normal craniofacial
configuration; and no known history of neurologic disease,
developmental disability, oculofacial trauma, craniofacial congenital anomaly, strabismus, and clinically manifest telecanthus or epicanthus. The choice of the lower end of this range
was based on the fact that younger children might not cooperate fully with the examiner. The upper end of the range was
chosen based on the assumption that any increase in the measured parameters with age would have stopped by age 40.
After informed consent had been obtained, measurements of
fronto-occipital circumference, inner canthal distance, outer
canthal distance, and distant and near interpupillary distances
were performed on 3448 healthy urban male (n 5 1852) and
female (n 5 1596) subjects. The overall mean age was 15.71
6 7.09 years (15.78 6 7.13 for male subjects, 15.63 6 7.05
for female subjects). Subjects were divided into three age
groups: children (1104 boys; 940 girls) aged 7 to 15 years
(mean 5 10.86 6 2.69 years), young adults (582 boys and
men; 521 girls and women) aged 16 to 25 years (mean 5 20.57
6 2.88 years), and adults (166 men; 135 women) aged 26 to
40 years (mean 5 30.87 6 4.55 years). Within all three
groups, the difference for the mean age was not significant

between men and women (Table 1). The subjects were also
divided into nine age subgroups (7 through 9 years, 10 through
12 years, 13 through 15 years, 16 through 18 years, 19 through
21 years, 22 through 24 years, 25 through 27 years, 28 through
30 years, and 31 through 40 years) to statistically assess the
anthropometric variation patterns of each parameter with advancing age. Centile charts for the measured parameters between 7 and 15 years were also constructed because there were
sufficient numbers of subjects in that age range to justify the
annual increments.
Measurements
After practicing with the instruments and standardizing techniques on normal subjects of various ages, all measurements
were performed by two expert ophthalmologists. The techniques for measurements of inner and outer canthal distance
and fronto-occipital circumference are simple and universally
standard to perform. The interpupillary distance is usually
measured between the centers of the pupils (anatomical interpupillary distance) or between the visual axes (physiological
interpupillary distance). The corneal reflex pupillometer (CRP)
and millimeter ruler are the choices of technique in the measurement of physiological and anatomical interpupillary distance, respectively. Anderson (1954) stated that the observers
interpupillary distance should be the same as the patient. He
also stated that the degree of error might be 6 3 mm. This is
not true for the near interpupillary distance measurement. Because only one eye of the examiner is used for making the
near interpupillary distance measurement, interpupillary distance of the examiner will not affect the measure. On the other
hand, observer interpupillary distance could affect distant interpupillary distance measures. However, Osuobeni and alFahdi (1994) performed a study in the same patients using a
CRP and millimeter ruler for the measurement of physiological

1.54
1.74
1.72
1.99
1.72
1.77
1.60
1.72
1.63
1.74
1.80
1.65
1.37
1.30
1.50
1.69
1.71
1.16
1.90

6
6
6
6
6
6
6
6
6
6
6
6
6
6
6
6
6
6
6

50.36
51.54
51.78
52.41
52.63
52.97
53.36
54.43
54.68
54.86
54.29
54.76
54.92
55.11
55.09
55.13
55.14
55.07
55.18

169
110
110
119
100
116
122
129
129
46
40
90
71
48
35
38
73
74
67

144
103
97
101
112
96
90
89
108
47
55
59
49
60
54
46
56
43
52

7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25

7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25

(47.355)
(47.756.5)
(48.557)
(48.557)
(4957.5)
(48.557.5)
(49.557)
(50.559.5)
(51.259.5)
(5259)
(5159)
(51.559)
(5257.9)
(5158)
(51.758.2)
(50.559)
(51.959.5)
(52.958)
(51.258.7)

(4756)
(48.557)
(4957)
(4957)
(49.258)
(49.557)
(5059)
(5059)
(5059.5)
(5160)
(51.760)
(5260.5)
(53.460)
(5459.5)
(5462.6)
(54.261)
(54.561.2)
(53.661)
(54.560.6)
28.14
29.22
29.26
29.47
29.94
30.46
30.50
30.39
30.21
30.06
30.01
30.70
30.02
30.33
30.14
30.18
30.08
30.25
30.35

28.33
28.60
29.37
29.88
29.92
30.34
30.52
30.59
30.65
30.71
30.76
30.85
30.91
30.97
30.97
30.94
30.39
31.08
31.15
6
6
6
6
6
6
6
6
6
6
6
6
6
6
6
6
6
6
6

6
6
6
6
6
6
6
6
6
6
6
6
6
6
6
6
6
6
6

1.93
2.03
2.06
2.10
2.47
2.64
2.54
2.11
2.41
2.60
2.56
2.40
2.72
2.28
2.56
2.68
2.18
1.98
2.04

2.01
1.98
1.99
2.50
2.43
1.88
2.52
2.20
2.46
2.65
2.26
2.37
2.26
1.97
2.44
2.40
2.40
2.39
2.68
(2334)
(2534)
(2534)
(2534)
(2537)
(26.536)
(2635)
(2536)
(2536)
(2636)
(2537)
(2337)
(2238)
(2337)
(2237)
(2335)
(2334.5)
(2734)
(2636)

(2334)
(2534)
(2535)
(2536)
(2536)
(2636)
(2637)
(2637)
(2637)
(2637)
(2637)
(2637)
(2635)
(2635)
(2536)
(2636)
(2636)
(25.537)
(2637)

ICD (mm)
Mean 6 SD (range)

81.17
81.79
83.03
84.76
86.01
86.06
86.81
86.61
86.90
86.57
86.08
86.44
86.28
86.30
86.13
86.27
86.26
86.41
86.52

81.74
82.28
84.13
85.62
86.38
87.21
88.08
88.17
88.86
88.95
88.97
88.77
88.79
89.03
89.07
89.10
88.19
89.36
89.26
6
6
6
6
6
6
6
6
6
6
6
6
6
6
6
6
6
6
6

6
6
6
6
6
6
6
6
6
6
6
6
6
6
6
6
6
6
6

3.18
3.52
3.61
3.14
3.44
3.18
2.82
2.96
2.65
3.33
4.10
3.62
3.42
2.49
3.06
3.62
3.14
2.81
3.55

3.31
3.78
3.06
3.85
3.68
3.60
3.34
3.25
2.46
3.88
3.73
2.37
3.33
3.37
2.91
3.76
3.51
3.70
3.65
(7588)
(7590)
(7592)
(7893)
(8095)
(7893)
(8093)
(7994)
(8095)
(8096)
(7995)
(7897)
(8094)
(81.592)
(7992)
(77.595)
(7995)
(8093)
(8095)

(4592)
(7592)
(7693)
(7795)
(7897)
(7897)
(7997)
(7997)
(7997)
(8097)
(8197)
(8096)
(8098)
(7896)
(8599)
(8097)
(8098)
(8297)
(81.598)

OCD (mm)
Mean 6 SD (range)

(4658)
(4860)
(5063)
(4964)
(5164)
(5163)
(5465)
(5163)
(5366)
(5466)
(5265)
(5366)
(5467)
(5664)
(5667)
(5667)
(5565)
(5667)
(5665)
(4757)
(4660)
(4758)
(5062)
(5062)
(5162)
(5264)
(5365)
(5365)
(5365)
(5363.5)
(5164.5)
(5264)
(5363)
(5366)
(5564)
(5265)
(5264.5)
(5165)

Male Subjects
52.67 6 2.18
53.40 6 2.27
54.62 6 2.54
55.88 6 2.74
56.38 6 2.98
57.21 6 2.72
57.76 6 2.58
58.11 6 2.42
58.86 6 2.73
59.00 6 2.59
59.34 6 2.70
60.01 6 2.36
60.73 6 2.67
60.24 6 2.28
59.69 6 2.19
60.56 6 2.73
60.12 6 2.38
60.68 6 2.75
60.83 6 2.34
Female Subjects
51.85 6 1.87
23.32 6 2.47
53.39 6 2.30
54.94 6 2.48
55.69 6 2.40
56.88 6 2.77
57.75 6 2.27
58.06 6 2.88
57.90 6 2.57
58.24 6 2.77
57.65 6 2.49
58.72 6 2.78
58.71 6 2.75
58.61 6 2.15
58.37 6 2.54
58.61 6 2.58
58.47 6 2.42
58.30 6 2.50
58.39 6 3.10

NIPD (mm)
Mean 6 SD (range)

54.58
55.95
56.07
57.63
58.43
59.49
60.30
60.78
60.90
60.98
60.20
61.54
61.72
61.62
61.19
61.65
61.46
61.40
61.28

55.28
55.96
57.22
58.53
59.04
59.88
60.50
60.97
61.92
62.09
62.66
63.38
64.09
63.64
63.25
64.11
63.59
64.16
64.21
6
6
6
6
6
6
6
6
6
6
6
6
6
6
6
6
6
6
6

6
6
6
6
6
6
6
6
6
6
6
6
6
6
6
6
6
6
6

1.87
2.36
2.23
2.47
2.48
2.82
2.25
2.86
2.62
2.84
2.74
2.83
2.83
2.12
2.58
2.77
2.44
2.38
2.98

2.28
2.22
2.62
2.88
3.19
2.89
2.70
2.63
2.73
2.58
2.82
2.38
2.68
2.29
2.21
2.74
2.42
2.86
2.45
(5060)
(4963)
(5062)
(5365)
(5266)
(5465)
(5566)
(5568)
(5669)
(5568)
(5667)
(5367.5)
(5567.5)
(5666)
(5669)
(5766.5)
(5568)
(5667.5)
(5467)

(4861)
(5163)
(5365.5)
(5267)
(5368)
(5466)
(5668)
(5366)
(5669)
(5769)
(5568)
(5769)
(5771)
(5968)
(59.570)
(6070)
(5969)
(6070)
(5869)

FIPD (mm)
Mean 6 SD (range)

34.66
35.75
35.27
34.77
34.79
35.38
35.13
35.10
34.76
34.74
34.90
35.50
34.76
35.17
35.01
34.96
34.91
35.01
35.09

34.67
34.79
34.92
34.88
34.63
34.81
34.64
34.71
34.51
34.53
34.62
34.74
34.81
34.79
34.77
34.76
34.44
34.80
34.90
6
6
6
6
6
6
6
6
6
6
6
6
6
6
6
6
6
6
6

6
6
6
6
6
6
6
6
6
6
6
6
6
6
6
6
6
6
6

1.83
2.35
2.31
2.21
2.35
2.56
2.66
2.23
2.58
2.77
2.90
2.17
2.47
2.80
2.92
2.54
2.54
2.12
2.10

2.21
2.13
2.18
2.10
2.26
1.97
2.35
2.33
2.66
2.71
2.81
2.35
2.19
1.80
2.52
2.66
2.18
2.47
2.61
(30.6739.03)
(29.4141.03)
(30.4342.50)
(29.2139.76)
(29.5543.02)
(30.8140.96)
(28.5742.17)
(30.0042.35)
(29.7643.37)
(28.8941.86)
(27.6643.37)
(29.3039.78)
(26.8340.43)
(26.4445.12)
(26.5142.05)
(28.0940.00)
(24.2139.43)
(30.6838.75)
(30.4339.18)

(28.7542.50)
(28.8940.51)
(28.8940.23)
(29.4140.00)
(29.7641.76)
(29.7940.70)
(29.5540.70)
(28.4243.53)
(28.8941.18)
(28.9541.57)
(28.4243.02)
(28.1339.36)
(28.4938.25)
(31.8738.89)
(27.7839.77)
(27.6640.00)
(29.0340.00)
(28.6542.29)
(29.5540.78)

C-I
Mean 6 SD (range)

5.59
5.67
5.65
5.62
5.68
5.75
5.71
5.58
5.52
5.48
5.53
5.60
5.46
5.50
5.47
5.47
5.45
5.49
5.50

5.49
5.49
5.58
5.66
5.65
5.71
5.64
5.56
5.53
5.53
5.52
5.49
5.44
5.43
5.43
5.38
5.30
5.43
5.42

6
6
6
6
6
6
6
6
6
6
6
6
6
6
6
6
6
6
6

6
6
6
6
6
6
6
6
6
6
6
6
6
6
6
6
6
6
6

0.37
0.35
0.41
0.39
0.44
0.44
0.48
0.40
0.45
0.47
0.45
0.38
0.45
0.41
0.46
0.49
0.37
0.34
0.39

0.37
0.37
0.34
0.43
0.41
0.38
0.43
0.37
0.43
0.53
0.43
0.39
0.38
0.31
0.47
0.43
0.44
0.41
0.44

(4.516.54)
(4.646.35)
(4.906.67)
(4.576.43)
(4.687.12)
(4.916.80)
(4.736.86)
(4.466.43)
(4.506.61)
(4.666.73)
(4.556.64)
(4.436.49)
(4.076.56)
(4.146.98)
(3.786.38)
(4.316.54)
(4.286.11)
(4.866.14)
(4.526.29)

(4.346.46)
(4.746.54)
(4.766.54)
(4.736.79)
(4.636.60)
(4.816.73)
(4.736.98)
(4.686.79)
(4.646.67)
(4.627.25)
(4.566.79)
(4.646.36)
(4.686.37)
(4.606.14)
(4.176.34)
(4.526.31)
(4.456.31)
(4.506.90)
(4.556.45)

C-II
Mean 6 SD (range)

* FOC 5 fronto-occipital circumference; ICD 5 inner canthal distance; OCD 5 outer canthal distance; NIPD 5 near interpupillary distance; FIPD 5 distant (far) interpupillary distance; C-I 5 canthal index; C-II 5 circumference-interorbital index; SD 5
standard deviation.

1.57
1.49
1.77
1.78
2.08
1.44
1.77
1.85
1.80
1.96
1.71
1.75
1.47
1.39
2.04
1.55
1.41
1.37
1.13

6
6
6
6
6
6
6
6
6
6
6
6
6
6
6
6
6
6
6

51.55
52.05
52.60
52.80
52.97
53.16
54.02
55.02
55.38
55.59
55.73
56.10
56.74
56.95
57.10
57.51
57.27
57.24
57.39

Age

FOC (cm)
Mean 6 SD (range)

TABLE 3 Mean Values at Each Age for Fronto-Occipital Circumference, Inner Canthal Distance, Outer Canthal Distance, Near Interpupillary Distance, Distant Interpupillary
Distance, Canthal Index, and Circumference-Interorbital Index of Male and Female Subjects Aged 7 to 25 Years*

Evereklioglu et al., ANTHROPOMETRIC STUDY OF CRANIOFACIAL PARAMETERS

211

212

Cleft PalateCraniofacial Journal, March 2002, Vol. 39 No. 2

TABLE 4 Percentile Norms for Fronto-Occipital Circumference, Inner Canthal Distance, Outer Canthal Distance, Near Interpupillary
Distance, Distant Interpupillary Distance, Canthal Index, and Circumference-Interorbital Index of Male and Female Children From 7 to
15 Year-Old*
Female Subjects

Male Subjects
3

10

25

50

75

90

97

Age

10

25

50

75

90

97

48.5
48.8
49.5
49.5
50
51
51
51.5
52

50
50
50.5
51
50.5
51.5
52
52.5
53.2

50.5
51
51.5
51.5
51.5
52
53
53.6
54

51.5
52
52.5
52.5
52.7
53
53.9
55
55

52.5
53
53.6
54
54
54
55.2
56.5
56.5

54
54
55.6
55
55.9
55
56.4
57
58

55
54.5
56
56.5
58
56.2
57.9
59
59

FOC (cm)
7
8
9
10
11
12
13
14
15

47.5
48
49
49
50
49.4
50
51
52

48.2
49.7
49.5
49.5
50.5
50.7
51
52
52.4

49.4
50.5
50.4
51
51.5
52
52.5
53.5
53.5

50.5
51.5
52
52.5
52.5
53
53.5
54
55

51
52.5
53
54
54
54
54.5
55.7
56

52.5
53.8
54
55
54.5
55.1
55.5
56.5
57

53.1
55.9
55
56.5
57.5
56.1
56.2
58
57.5

24.1
26
26
26
25
26
26
27
26

26
26
27
27
27
28
27
27
27

27
27
28
28
28.1
29
29
29
29

28
28
29.5
30
30
30
31
30
31

30
30
31
31
31
32
32
32
32

31
31.4
31
33
33
33
34
34
34

32
34
34.3
35
35
33.5
36.3
35.1
35

ICD (mm)
7
8
9
10
11
12
13
14
15

25
25.1
26
25
26
26.5
26
26.7
26

26
26.5
27
26.2
27
27
27
27
27

27
28
28
28
28
28
29
29
28

28
29
29
30
30
30
31
30.4
30

29.8
30
30.5
31
31
32
32
32
32

31
32
32
32
33
35
34
33
33.1

32
34
34
33
36
36
35
34
35.4

75
75
78
78
80
82
82
82
82.9

78
77.1
80
81
83
83
84
84
85

79
80
82
83
84
85
86
86
86

82
83
84
85
86
87
87
88
90

83
85
87
88
88
90
90
90
91

86
87
88
90
91
92
92
92
92

88
90
89.6
95
97
94
97
95
94.1

OCD (mm)
7
8
9
10
11
12
13
14
15

75
75.1
77
78.1
80
78
80.7
82
83

77
77.4
78.6
80.2
82
82
83
83
83.9

79.2
80
80
83
83.2
84
85
84.5
85

81
82
83
85
86
86
87
86
87

83
85
86
87
88
88
89
89
88

86
86.6
88
89
90
90
90
90
90.1

88
88
89.1
91.9
95
93
92
93
92

48.1
49.3
50
50.6
51
52.5
54
54.5
54.5

50
51
52
52
53
54
55
55
55

51
52
52
54
55
55
55
56
56

52
54
55
55.5
56
57.5
58
58
59

55
55
56
58
58
59
60
60
61

55
55
58
60
60
61
61
61
62

56
58.6
60
61.4
61.9
62
62.3
62.5
64

NIPD (mm)
7
8
9
10
11
12
13
14
15

48
48
48
50.1
51.3
51.9
52.7
53
54

50
50
50
52
53
54
55
55
55

51
52
52
53
54
55
56
56
56

52
53
54
55
55.5
57
57
57
57

53
55
55
57
57
59
59.2
60
60

54
56
56
58
58
61
60
62
61

55
56.5
57
61
61
62
62.2
63.3
63

51.1
52
53
53
54
54
56.7
57
57

52
53
54
55
55
56
57
58
58

53.5
54
55
57
57
58
58
59
60

55
56
57
58
59
60
60
61
62

57
57
59
60
61
62
63
63
64

58
58
61
62.5
63
64
64
65
65

59
60.6
63
64.4
65
65.2
65.3
65.5
67

FIPD (mm)
7
8
9
10
11
12
13
14
15

51
52
52
53
54
54
55.7
56
57

53
53
53
55
55
56
57
57
57.9

53
54
55
56
57
57
59
59
59

55
56
56
57.5
58.2
59.5
60
60
61

56
57
57
59
60
61.5
62
63
63

57
58
58.2
60.8
61
63
63
65
65

58
60.5
61
63.9
64
65
65.2
66.3
66

30.47
31.39
30.89
31.29
30.12
30.94
30.47
29.81
29.33

32.53
32.53
31.84
32.05
31.80
31.74
31.78
32.14
31.03

32.94
33.71
33.33
33.33
32.95
33.43
32.93
33.33
32.94

34.17
34.61
35.22
35.22
34.46
34.94
34.46
34.52
34.48

36.14
36.03
36.47
36.36
36.08
36.36
36.07
36.36
36.05

37.50
37.50
37.48
37.50
37.61
37.20
38.11
37.77
38.63

38.46
40.00
39.76
39.27
38.55
38.11
39.41
38.42
39.62

C-I
7
8
9
10
11
12
13
14
15

31.32
30.95
31.27
29.44
31.03
30.81
30.00
31.07
30.26

32.89
32.71
32.53
31.52
31.39
32.17
31.06
32.14
31.10

33.33
34.44
33.74
33.70
32.94
33.33
33.33
33.70
32.93

34.16
35.89
35.00
35.16
34.83
35.63
35.55
35.29
34.52

35.71
37.17
36.78
36.14
36.78
36.64
36.90
36.51
36.67

37.50
39.05
37.77
37.58
37.60
38.72
38.08
37.80
37.78

38.92
39.47
40.96
38.81
38.70
40.96
40.08
40.12
39.76

Evereklioglu et al., ANTHROPOMETRIC STUDY OF CRANIOFACIAL PARAMETERS

213

TABLE 4 (Continued)
Female Subjects

Male Subjects
3

4.67
4.90
5.02
4.83
4.63
4.90
4.84
4.77
4.77

10

25

50

75

90

97

Age

5.00
5.00
5.10
5.04
5.13
5.27
5.09
5.09
4.92

5.24
5.24
5.34
5.30
5.32
5.45
5.37
5.26
5.24

5.56
5.47
5.60
5.65
5.68
5.66
5.63
5.55
5.55

5.74
5.76
5.74
5.99
5.94
6.03
5.91
5.81
5.79

5.90
5.88
6.07
6.21
6.11
6.22
6.22
6.03
6.11

6.36
6.53
6.32
6.46
6.48
6.35
6.58
6.26
6.48

C-II
7
8
9
10
11
12
13
14
15

5.00
4.90
4.95
4.77
4.81
5.03
4.75
4.81
4.68

10

25

50

75

90

97

5.14
5.12
5.17
5.10
5.14
5.25
5.00
5.00
5.00

5.31
5.47
5.33
5.40
5.42
5.36
5.36
5.37
5.14

5.61
5.66
5.60
5.65
5.59
5.74
5.74
5.58
5.50

5.89
5.88
6.00
5.88
5.98
6.03
6.03
5.86
5.87

6.10
6.17
6.26
6.13
6.27
6.36
6.29
6.09
6.10

6.36
6.28
6.47
6.33
6.45
6.73
6.71
6.37
6.48

* FOC 5 fronto-occipital circumference; ICD 5 inner canthal distance; OCD 5 outer canthal distance; NIPD 5 near interpupillary distance; FIPD 5 distant (far) interpupillary distance; C-I 5
canthal index; C-II 5 circumference-interorbital index.

and anatomical interpupillary distance, respectively. They

found only a 0.1-mm difference between distant physiological
and anatomical interpupillary distance and concluded that
there was generally a good agreement between the two. In a
recent study by comparing Viktorins, corneal reflection, and
pupillometer methods to determine inter- and intraexaminer
repeatability of measurement of interpupillary distance, Holland and Siderov (1999) found that the difference among the
three methods was small enough not to be clinically significant
for the majority of patients.
Because the present study was primarily designed to observe
the anthropometric variation pattern of measured parameters
with advancing age, we used the modified Viktorins method
and measured the distance between the nasal and lateral limbus
of subjects (anatomical interpupillary distance) with a millimeter ruler. The reason for choosing this method is based on
the conclusions of studies cited above and that many of the
previous studies used one variation of this technique (Osuobeni
and Al-Musa, 1993; Chen and OLeary, 1997; Evereklioglu et
al., 2001). Therefore, the results of the present study can be
compared with the results of other populations with similar
age groups. In contrast to previous studies, we also measured
interpupillary distance of each subject twice in opposite directions to avoid involuntary measurement errors and enhance
data stability and reliability. For most of the subjects, it was
observed that the results of the two measurements were the
same. In addition, given the large size of the population in the
present study, we believe that the population average is likely
to be an accurate estimate. Anisocoria will not change the measurement results in this modified method because the measurement is made between the inner and outer limbus of each
eye (corneoscleral junction), which is a stable point and is not
dependent on the pupillary diameter (Anderson, 1954).
Each subject was seated comfortably in a chair. The subjects head was at the same level as, and 40 cm in front of,
the examiners head. The subjects face was well illuminated,
and the ruler was held tightly against the subjects nose. The
examiner first closed his right eye and asked the subject to
look at the examiners opened left eye. The zero mark on the
ruler was placed at the outer limbus margin of the subjects
right eye while the examiner sighted with his opened left eye

the point of the ruler that corresponded to the inner limbus of

the subjects left eye. This measurement is equivalent to the
near interpupillary distance. The examiner then closed his left
eye and asked the subject to look at the examiners opened
right eye. While still maintaining the zero mark on the ruler
at the outer limbus of the subjects right eye, the examiner
sighted the point on the ruler that corresponded to the inner
limbus of the subjects left eye. This measurement is equivalent
to distant interpupillary distance. A second measurement of
interpupillary distance was made for each subject in the opposite direction. This time the examiner closed his left eye first
and asked the subject to look at examiners opened right eye,
and so on. The average of the two values was then recorded.
A nonstretchable plastic tape was used for the measurement
of fronto-occipital circumference. Maximal fronto-occipital
circumference was obtained by placing the tape just on the
occipital prominence and the supraorbital ridges while an assistant viewed the subject laterally. In the cases of some hairstyles, we simply drew the tape tightly and compressed the
hair as much as possible. In the cases of braids in girls, the
tape was placed against the skin and not over the lumps of
hair.
A nonstretchable plastic ruler was used for the measurement
of intercanthal distances. The inner canthal distance was measured by having the subject look straight at the examiner while
the millimeter ruler was held tightly against the bridge of the
subjects nose. The subject was instructed to look upward for
the outer canthal distance, thus maximizing the contrast between the sclera and the skin. Inner and outer canthal distances
were measured between the median and lateral angles of the
palpebral fissures, respectively.
The canthal index (100 3 inner canthal distance in centimeters/outer canthal distance in centimeters) and circumference-interorbital index (100 3 inner canthal distance in centimeters/fronto-occipital circumference in centimeters) were
calculated from the data in subjects aged 7 to 25 years.
Statistical Analysis
A commercially available statistical software program was
used to analyze the data. Multiple comparisons were made

214

Cleft PalateCraniofacial Journal, March 2002, Vol. 39 No. 2

between the measured parameters, groups, and sex by Students t test or independent samples t test as indicated (Daniel,
1987).
RESULTS
Mean and SD values of fronto-occipital circumference, inner canthal distance, outer canthal distance, near interpupillary
distance, distant interpupillary distance, canthal index, and circumference-interorbital index for male and female subjects in
each of the three age groups are shown in Table 1. Averages
for each parameter calculated over the entire age range are
also shown. Of particular interest is the observation that the
overall anatomical distant interpupillary distance (FIPD) was,
on the average, 3 mm wider than the near interpupillary distance (NIPD), a significant (p , .001) difference.
Table 2 shows a more detailed statistical comparison of
NIDP and FIDP for male and female subjects across all
groups. As would be expected, the difference between the
NIDP and FIDP was statistically significant in all particular
age groups in either sex.
The mean values for fronto-occipital circumference, inner
canthal distance, outer canthal distance, near interpupillary distance, distant interpupillary distance, canthal index, and circumference-interorbital index for male and female subjects are
presented for each age from 7 to 25 years in Table 3.
The 3rd, 10th, 25th, 50th, 75th, 90th, and 97th percentile
values of the measured parameters and of the calculated indexes for boys and girls in each year between 7 and 15 are
given in Table 4.
The change of means with advancing age for the measured
dimensions, including both indexes, is presented in Table 5.
Finally, Table 6 shows the comparison of the present study
with other populations, where available, in the literature.
DISCUSSION
Anthropometric studies are an integral part of craniofacial
surgery and syndromology (Farkas et al., 1992a, 1992b). 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 error
in the identification of certain craniofacial syndromes, and reliable methods are needed for the diagnosis of some craniofacial anomalies (DeMyer, 1967; Pryor, 1969; Farkas et al.,
1992a, 1992b). Therefore, normal values for fronto-occipital
circumference, inner canthal distance, outer canthal distance,
NIPD, and FIPD are integral measurements in the evaluation
of telecanthus, ocular hypotelorism (decreased interpupillary
distance), or hypertelorism (increased interpupillary distance).
Congenital and posttraumatic deformities (e.g., traumatic telecanthus) can also be better treated with the knowledge of
normal values for this region to produce the best esthetic and
functional result. 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 differences.
Feingold and Bossert (1974) obtained normal values of
FIPD from individuals without regard for age, sex, and race.
Juberg et al. (1975) obtained FIPD and noting sex, race, and
age but only for 5- to 11-year-olds. Fledelius and Stubgaard
(1986) studied European Caucasians aged 5 to 80 years and
measured FIPD using an ordinary ruler. Latta et al. (1991)
studied edentulous patients aged 29 to 87 years and measured
distant interpupillary distance from midpupil to midpupil. Osuobeni and Faden (1993) and Osuobeni and Al-Musa (1993)
obtained normal values for both FIPD and NIPD between inner
and outer limbus using a ruler. None of the studies cited above
provided average values for inner canthal distance, outer canthal distance, fronto-occipital circumference, canthal index,
and circumference-interorbital index. Without these measures,
a true appreciation of the degree of hypo- and hypertelorism
cannot be made. However, the current study makes these comparisons across sex and age in 7- to 25-year-olds and additionally determined normative values for fronto-occipital circumference, inner canthal distance, outer canthal distance, canthal index, and circumference-interorbital index. In addition,
centile values are presented for each parameter in annual increments from 7 through 15 years.
Pryor (1969) reported that interpupillary distance increases
with age from birth to 24 years. Fledelius and Stubgaard
(1986) found that the rate of interpupillary distance change
was higher in subjects under 20 years of age than in those over
age 20. Bruckner et al. (1987) showed that the increase of
interpupillary distance continues until 30 years of age. Lakshminarayana et al. (1991) demonstrated that interpupillary distance increases from birth to 5 years, with negligible changes
thereafter. Osuobeni and Faden (1993) suggested that increases
in interpupillary distance slow down from the middle 20s to
late 30s and stops increasing in the fourth decade of life. Chen
and OLeary (1997) revealed a significant difference in interpupillary distance growth rate between men and women.
Pointer (1999) demonstrated a 3% increase in the magnitude
of distant interpupillary distance from the midteens to later
middle age, which was attained by early middle age in males,
and altered little thereafter.
In contrast, women continued to record an increase in this
facial parameter into later middle age. In our study, there was
a significant increase in NIPD and FIPD measurements until
age 19 years in male subjects (Tables 3 and 5) and until age
14 in girls. This increase in either interpupillary distance then
slows down but continues up to the mid-30s. After this age,
the changes are negligible. We observed similar changes in the
fronto-occipital circumference measurements. This demonstrates the earlier maturation of women over men. Our results
concerning FIPD were consistent with these of Fledelius and
Stubgaard (1986). We also observed that interpupillary distance in men and boys is significantly larger than girls and
women from childhood. In boys and men, the average total

5.63 6 0.38

35.16 6 2.18

2.69 6 0.52

55.40 6 2.23

52.71 6 2.30

81.88 6 3.48

28.78 6 2.07

51.12 6 1.77

.081

.295

.950

,.001

,.001

,.001

,.001

,.001

5.68 6 0.43

34.97 6 2.38

2.68 6 0.58

58.50 6 2.68

55.81 6 2.65

85.62 6 3.31

29.95 6 2.44

52.66 6 1.84

10.98 6 0.80

,.001

7.86 6 0.82

5.67 6 0.41

34.78 6 2.10

2.66 6 0.58

59.15 6 3.02

56.48 6 2.85

86.40 6 3.76

30.05 6 2.28

52.97 6 1.77

1012
n 5 309
Mean 6 SD

,.001

.987

.086

,.001

,.001

,.001

,.001

,.001

79
n 5 344
Mean 6 SD

5.52 6 0.36

34.78 6 2.18

2.59 6 0.53

56.01 6 2.49

53.42 6 2.44

82.57 6 3.52

28.70 6 2.03

51.99 6 1.66

10.99 6 0.83

,.001

7.84 6 0.83

.025

.962

.100

,.001

,.001

,.001

.039

,.001

,.001

.003

.349

,.001

,.001

,.001

,.001

,.001

,.001

,.001

5.60 6 0.45

34.98 6 2.50

2.77 6 0.69

60.67 6 2.59

57.90 6 2.57

86.78 6 2.80

30.36 6 2.36

54.19 6 1.74

14.06 6 0.83

1315
n 5 287
Mean 6 SD

5.58 6 0.41

34.62 6 2.45

2.89 6 0.62

61.14 6 2.74

58.24 6 2.61

88.38 6 3.24

30.59 6 2.39

54.82 6 1.89

14.01 6 0.81

1315
n 5 380
Mean 6 SD

.157

.708

.268

.350

.224

.169

.751

.010

,.001

.077

.840

,.001

,.001

,.001

.106

.357

,.001

,.001

5.54 6 0.43

35.07 6 2.62

2.70 6 0.57

60.92 6 2.84

58.21 6 2.70

86.36 6 3.70

30.28 6 2.52

54.63 6 1.74

17.07 6 0.81

1618
n 5 161
Mean 6 SD

5.51 6 0.43

34.66 6 2.45

3.28 6 0.56

62.87 6 2.58

59.59 6 2.52

88.86 6 3.42

30.79 6 2.41

55.88 6 1.80

17.25 6 0.84

1618
n 5 176
Mean 6 SD

.208

.789

,.001

.051

.234

.752

.701

.018

,.001

.119

.609

.043

.002

.007

.865

.555

,.001

,.001

5.48 6 0.44

34.99 6 2.74

2.94 6 0.54

61.50 6 2.50

58.56 6 2.46

86.24 6 2.97

30.17 6 2.50

55.04 6 1.38

20.03 6 0.79

1921
n 5 163
Mean 6 SD

Female Subjects

5.44 6 0.43

34.80 6 2.14

3.41 6 0.53

63.75 6 2.46

60.34 6 2.46

88.84 6 3.66

30.94 6 2.20

56.89 6 1.59

19.76 6 0.79

1921
n 5 154
Mean 6 SD

Male Subjects

.877

.908

.147

.983

.732

.838

.982

.673

,.001

.128

.561

.044

.550

.736

.824

.517

.011

,.001

5.47 6 0.40

34.96 6 2.41

3.03 6 0.54

61.50 6 2.50

58.46 6 2.48

86.31 6 3.19

30.17 6 2.27

55.12 6 1.55

22.97 6 0.78

2224
n 5 145
Mean 6 SD

5.37 6 0.43

34.65 6 2.40

3.49 6 0.59

63.92 6 2.66

60.43 6 2.60

88.84 6 3.66

30.78 6 2.41

57.31 6 1.42

23.19 6 0.75

2224
n 5 185
Mean 6 SD

.871

.607

.584

.569

.483

.413

.991

.619

,.001

.621

.806

.059

.818

.536

.903

.849

.491

,.001

5.46 6 0.41

34.80 6 2.11

2.99 6 0.67

61.70 6 2.96

58.71 6 2.89

86.68 6 3.68

30.17 6 2.27

55.23 6 1.82

25.56 6 0.71

2527
n 5 92
Mean 6 SD

5.34 6 0.43

34.58 6 2.43

3.37 6 0.64

63.99 6 2.52

60.62 6 2.49

88.79 6 3.82

30.72 6 2.74

57.42 6 1.42

25.65 6 0.81

2527
n 5 119
Mean 6 SD

.805

.974

.694

.861

.935

.747

.854

.883

,.001

.919

.524

.527

.462

.554

.294

.942

.763

,.001

5.48 6 0.32

34.81 6 1.67

3.04 6 0.65

61.79 6 2.16

58.75 6 2.03

86.90 6 3.27

30.25 6 1.65

55.18 6 1.43

28.71 6 0.71

2830
n 5 38
Mean 6 SD

5.34 6 0.43

34.31 6 2.45

3.44 6 0.59

64.35 6 3.38

60.91 6 3.44

89.52 6 4.29

30.69 6 2.34

57.50 6 1.74

28.82 6 0.80

2830
n 5 45
Mean 6 SD

.353

.885

.776

.167

.185

.154

.462

.651

,.001

.660

.887

.095

.689

.487

.231

.587

.828

,.001

5.55 6 0.35

34.76 6 1.92

3.07 6 0.58

62.54 6 2.78

59.46 6 2.82

87.86 6 3.13

30.56 6 2.21

55.03 6 1.54

35.59 6 3.35

3140
n 5 57
Mean 6 SD

5.38 6 0.50

34.23 6 2.97

3.26 6 0.55

64.59 6 3.00

61.33 6 3.00

90.50 6 4.23

30.98 6 3.05

57.57 6 1.48

35.44 6 2.95

3140
n 5 69
Mean 6 SD

* FOC 5 fronto-occipital circumference; ICD 5 inner canthal distance; OCD 5 outer canthal distance; NIPD 5 near interpupillary distance; FIPD 5 distant (far) interpupillary distance; Diff-F/N 5 difference between distant and near interpupillary
distance; C-I 5 canthal index; C-II 5 circumference-interorbital index.
P 5 independent samples t test.

Age (y)
P5
FOC (cm)
P5
ICD (mm)
P5
OCD (mm)
P5
NIPD (mm)
P5
FIPD (mm)
P5
Diff-F/N (mm)
P5
C-I
P5
C-II
P5

Parameters

Age (y)
P 5
FOC (cm)
P5
ICD (mm)
P5
OCD (mm)
P5
NIPD (mm)
P5
FIPD (mm)
P5
Diff-F/N (mm)
P5
C-I
P5
C-II
P5

Parameters*

1012
n 5 335
Mean 6 SD

79
n 5 389
Mean 6 SD

TABLE 5 Anthropometric Variation Pattern for Fronto-Occipital Circumference, Inner Canthal Distance, Outer Canthal Distance, Near Interpupillary Distance, Distant
Interpupillary Distance, the Difference Between Distant and Near Interpupillary Distance, Canthal Index, and Circumference-Interorbital Index With Advancing Age from 7 through
40 Years in Male and Female Subjects

Evereklioglu et al., ANTHROPOMETRIC STUDY OF CRANIOFACIAL PARAMETERS

215

216

Cleft PalateCraniofacial Journal, March 2002, Vol. 39 No. 2

TABLE 6 Comparison of Inner and Outer Canthal Distance, Near and Distant Interpupillary Distance, Canthal Index, and
Circumference-Interorbital Index of This Study With Other Populations Available in the Literature
Mean 6 SD

Investigator

Population

Parameter*

Age (mean)

Quant and Woo (1992)

Juberg et al. (1975)
Present study
Juberg et al. (1975)
Present study
Juberg et al. (1975)
Present study
Juberg et al. (1975)
Present study
Osuobeni and Al-Musa (1993)
Present study
Osuobeni and Al-Musa (1993)
Present study
Osuobeni and Al-Musa (1993)
Present study
Fledelius and Stubgaard (1986)
Present study
Osuobeni and Al-Musa (1993)
Present study
Singh and Banerjee (1983)
Present study
Lucas and Pryor (1935)
Pryor (1969)
Present study
Pryor (1969)
Pryor (1969)
Present study
Osuobeni and Al-Musa (1993)
Present study
Quant and Woo (1992)
Present study

Hong Kong Chinese

African American
Turkish
African American
Turkish
African American
Turkish
African American
Turkish
Arabs
Turkish
Arabs
Turkish
Arabs
Turkish
European Caucasian
Turkish
Arabs
Turkish
Indian
Turkish
Whites
Mexican
Turkish
Japanese
Whites
Turkish
Arabs
Turkish
Hong Kong Chinese
Turkish

ICD
ICD
ICD
OCD
OCD
C-I
C-I
C-II
C-II
NIPD
NIPD
NIPD
NIPD
NIPD
NIPD
FIPD
FIPD
FIPD
FIPD
FIPD
FIPD
FIPD
FIPD
FIPD
FIPD
FIPD
FIPD
FIPD
FIPD
FIPD
FIPD

Male Subjects
7
7
7
7
7
7
7
7
7
515 ()
715 (10.93)
1625 ()
1625 (20.70)
2655 ()
1625 (30.85)
1119 ()
1119 (14.48)
515 ()
715 (10.93)
13.515 ()
1315 (14.01)
15
15
15
1624 ()
1624 ()
1624 (20.14)
1625 ()
1625 (20.70)
25
25

24
96
169
96
144
96
169
96
169
310
1104
272
582
418
166
71
843
310
1104
48
404
270
49
129
47
391
515
272
582
120
67

33.30
30.60
28.33
79.80
81.74
38.38
34.67
5.89
5.49
55.68
56.07
60.18
60.20
62.07
60.91
62.70
61.33
57.96
58.83
58.00
61.14
59.00
65.00
61.92
66.00
62.00
63.52
63.25
63.60
64.59
64.21

6
6
6
6
6
6
6
6
6
6
6
6
6
6
6
6
6
6
6
6
6
6
6
6
6
6
6
6
6
6
6

0.26
2.01
0.47
3.31
2.66
2.21
0.48
0.37
2.52
3.32
2.67
2.54
2.57
3.04
3.99
3.13
2.63
3.48
3.20
2.74
5.20
2.00
2.73
3.40
3.50
2.63
2.94
2.60
2.87
2.45

Quant and Woo (1992)

Juberg et al. (1975)
Present study
Juberg et al. (1975)
Present study
Juberg et al. (1975)
Present study
Juberg et al. (1975)
Present study
Osuobeni and Faden (1993)
Present study
Osuobeni and Faden (1993)
Present study
Osuobeni and Faden (1993)
Present study
Osuobeni and Faden (993)
Present study
Singh and Banerjee (1983)
Present study
Lucas and Pryor (1935)
Pryor (1969)
Present study
Fledelius and Stubgaard (1986)
Present study
Pryor (1969)
Pryor (1969)
Present study
Osuobeni and Faden (1993)
Present study
Osuobeni and Faden (1993)
Present study

Hong Kong Chinese

African American
Turkish
African American
Turkish
African American
Turkish
African American
Turkish
Arabs
Turkish
Arabs
Turkish
Arabs
Turkish
Arabs
Turkish
Indian
Turkish
Whites
Mexican
Turkish
European Caucasian
Turkish
Japanese
Whites
Turkish
Arabs
Turkish
Arabs
Turkish

ICD
ICD
ICD
OCD
OCD
C-I
C-I
C-II
C-II
NIPD
NIPD
NIPD
NIPD
NIPD
NIPD
FIPD
FIPD
FIPD
FIPD
FIPD
FIPD
FIPD
FIPD
FIPD
FIPD
FIPD
FIPD
FIPD
FIPD
FIPD
FIPD

19
111
144
111
144
111
144
96
169
352
955
311
521
353
135
352
955
48
274
270
49
108
77
705
83
391
469
311
521
353
135

34.00
30.50
28.14
79.60
81.17
38.50
34.66
5.98
5.59
55.32
55.27
58.03
58.41
58.70
59.17
57.55
57.99
54.90
60.67
59.00
64.00
60.90
60.90
60.29
64.00
60.00
61.30
60.27
61.30
60.90
62.25

6
6
6
6
6
6
6
6
6
6
6
6
6
6
6
6
6
6
6
6
6
6
6
6
6
6
6
6
6
6
6

2.20
1.93
6.00
3.18
3.05
1.83
0.39
0.37
3.29
3.25
2.78
2.61
3.01
2.55
3.29
3.28
2.70
2.59
4.40
1.80
2.62
3.23
2.84
3.40
3.40
2.63
2.80
2.67
3.03
2.66

Female Subjects
7
7
7
7
7
7
7
715 ()
715 (10.78)
1625 ()
1625 (20.43)
2640 ()
2640 (30.90)
715 ()
715 (10.78)

13.515 ()
1315 (14.06)
15
15
15
1119 ()
1119 (14.30)
1624 ()
1624 ()
1624 (19.93)
1625 ()
1625 (20.43)
2640 ()
2640 (30.90)

Range

Method

28.538.1

2334

7592

28.7542.50

4.346.46
4860
4666
5672
5267
5670
52.571

5371
5164
4869

5369
5265
5968
5669
5975
5875
5571
5875
5571
5771.5
5869

Sliding caliper
Sliding caliper
Ruler
Sliding caliper
Ruler
Sliding caliper
Ruler
Sliding caliper
Ruler
Ruler
Ruler
Ruler
Ruler
Ruler
Ruler
Ruler
Ruler
Ruler
Ruler
Calculation
Ruler
Calculation
Calculation
Ruler
Calculation
Calculation
Ruler
Ruler
Ruler
CRP
Ruler

29.039.0

7588
30.6739.03
4.516.54
4765
4665
5268
5166
5069
5065
4968
4969

5569
4364
6269
5669

5269
5574
5472
5369
5471
5369
5271
5368

Sliding caliper
Sliding caliper
Ruler
Sliding caliper
Ruler
Sliding caliper
Ruler
Sliding caliper
Ruler
Sliding caliper
Ruler
Ruler
Ruler
Ruler
Ruler
Ruler
Ruler
Calculation
Ruler
Calculation
Calculation
Ruler
Ruler
Ruler
Calculation
Calculation
Ruler
Ruler
Ruler
Ruler
Ruler

* ICD 5 inner canthal distance; OCD 5 outer canthal distance; C-I 5 canthal index; C-II 5 circumference-interorbital index; NIPD 5 near interpupillary distance; FIPD 5 distant (far) interpupillary
distance; CRP 5 corneal reflex pupillometer.
In mm except both indexes.
Data not available.

Evereklioglu et al., ANTHROPOMETRIC STUDY OF CRANIOFACIAL PARAMETERS

increments for NIPD and FIPD from 7 through 35 years were

8.66 and 9.31 mm, respectively. In girls and women, these
increments averaged 7.61 and 7.96 mm, respectively. In addition, the difference between NIPD and FIPD slowly increased with age in either sex. Across all subjects, the average
difference between the NIPD and FIPD was 2.98 mm for men
and 2.80 mm for women. Overall, male subjects have NIPD
and FIPD an average 1.12 and 2.01 mm larger than those for
women, respectively.
The overall FIPD obtained in our study was 60.75 6 4.03
mm for men and boys and 59.45 6 3.51 mm for girls and
women. These values were similar to results of Lucas and Pryor
(1935; 59 6 4.4 mm for boys and men; 59 6 5.2 mm for girls
and women) and lower than those for a mixed European population investigated by Waardenberg (1951; 65.3 mm and 62.7
mm for men and women, respectively). In the 7- to 11-year-old
age group, the average interpupillary distance was greater in our
population (54.5 to 59 mm) than reported averages for Chinese
(52 mm; Liu et al., 1986), Black (53.1 to 57.5 mm; Lucas and
Pryor, 1935), and Caucasian children (52 to 56 mm; Pryor,
1969). Our values are very similar to those reported for Hong
Kong (54 to 59 mm; Quant and Woo, 1992) and British children
(55 to 60 mm; Kaye and Obsfeld, 1989). In the 7- to 15-yearold girls, our FIPD and NIPD values (58.03 6 3.31 and 55.31
6 3.29 mm, respectively) were quite similar with those of Osuobeni and Faden (1993) for Arabian children (57.55 6 3.29
and 55.32 6 3.29 mm, respectively; Table 6). In Osuobeni and
Fadens investigation of female subjects, the normal FIPD values were 60.27 6 2.80 and 60.90 6 3.03 mm in 16- to 25- and
26- to 40-year-old groups, respectively. In our study, these values (61.30 6 2.66 and 62.24 6 2.65 mm, respectively) were
generally higher (Table 2).
This study found the fronto-occipital circumference and outer
canthal distance of men and boys to be larger than those of girls
and women, and for the group as a whole, the differences were
significant (p , .001; Table 1). On the other hand, inner canthal
distance of men and boys is larger than that for girls and women
in all age groups but only significant in the 16- to 25-year-old
age group (p , .001). The average total increments for inner
canthal width achieved between ages 7 and 25 years were 2.8
mm in the men and boys and 2.2 mm in the girls and women.
On the other hand, outer canthal distance of men and boys is
significantly wider than that for girls and women in all age
groups (for all, p , .001). The outer canthal width showed
significantly greater increments with advancing age from 7
through 25 years, and the values were 7.5 mm for men and
boys and 5.3 mm for girls and women. For the overall group
in our study, the mean inner canthal distance was 30.19 6 2.47
mm for men and boys and 29.89 6 2.38 mm for girls and
women. These values were similar to the results of Laestadius
et al. (1979; 30 6 2.5 mm and 30 6 3.0 mm on the average
for men and boys and girls and women, respectively) and lower
than those of a mixed European population (33.5 and 32.5 mm
on the average, respectively; Waardenburg, 1951). In a study of
a mixed population, Feingold and Bossert (1974) found the
overall inner canthal distance to be 35 mm. Freihofer (1980)

217

and Murphy and Laskin (1990) found the overall inner canthal
distance in the black population to be 31.2 6 2.5 mm and 33.9
6 3.0 mm, respectively. Our overall result was lower than all
these studies.
In conclusion, the present study documents the anthropometric variation pattern of the orbit and fronto-occipital circumference with advancing age and presents normative data
for the measured parameters, including canthal index and circumference-interorbital index, specific for age and sex. When
making the clinical assessment of telecanthus and ocular hypoor hypertelorism in some craniofacial malformations and various syndromes, one should not rely only on the impressions
of physical features of the face but measure the canthal distances and the NIPD and FIPD. The common measures used
by dysmorphologists, the canthal index and circumference-interorbital index, should also be provided in each population.
Acknowledgments. The authors wish to thank the principals of eight public
schools and colleges in our region, the students of the university, the staff of
our hospital, and the principals of the police academy for their understanding
and assistance. It is also a pleasure to thank Assistant Prof. Saim Yologlu, PhD.,
from the Department of Biostatistics for his patient assistance in the statistical
analysis of this study.

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