This study is a quantitative evaluation of the influence of the lower component of the nasofrontal angle on perceived attractiveness and threshold values of desire for rhinoplasty. The nasofrontal angle of an idealized silhouette male Caucasian profile image was altered incrementally between 106 and 148 degrees. Images were rated on a Likert scale by pretreatment patients (n = 75), laypeople (n = 75), and clinicians (n = 35). The results demonstrated that a nasofrontal angle of approximately 130 degrees is ideal, corresponding to a lower component of 60 degrees, with a range of 127 to 142 degrees deemed acceptable. Angles above or below this range are perceived as unattractive, and anything outside the range of 118 to 145 degrees is deemed very unattractive. Reduced nasofrontal angles, simulating a nasal hump deformity, of less than 115 degrees were deemed the least attractive. In terms of threshold values of desire for surgery, for all groups a threshold value of 148 degrees indicated a preference for surgery: for patients, the threshold value was 121 degrees or less; for lay people, the threshold value was 124 degrees or less; and similarly for clinicians, the threshold value was 118 degrees or less. Clinicians were the least critical, and patients appeared to be less critical than lay people. This stresses the importance of using patients as observers, as well as laypeople and clinicians, in facial attractiveness research. From the results of this study, it is recommended that in rhinoplasty planning, the range of normal variability of the nasofrontal angle, in terms of observer acceptance, is taken into account as well as the threshold values of desire for surgery.
In this article, the advantages, disadvantages and pitfalls of three-dimensional virtual surgical planning (3D-VSP) compared to traditional two-dimensional (2D) planning methods in orthognathic surgery are discussed, alongside a standardised protocol that can be utilised. A skeletal Class II, skeletal Class III and an anterior open bite clinical case along with their 3D-VSP management are presented, highlighting modifications that can be made to computer-aided design/computer-aided manufacture (CAD/CAM) cutting guide and plate designs.
Congratulations should be extended to Sharma and Minhas for their interesting article debating evidence in medicine.1 Unfortunately, the article contains a factual error, albeit unintentional, which requires elaboration. The authors state, ‘Arabic physician Ibn Sina (known as Avicenna in the West) is the first physician to recommend that practice should be evidence based and to set out a summary of current evidence in his “Canon of Medicine”.’1 The statement regarding the Canon is correct; however, Avicenna was a Persian physician and polymath.2
Pur Sina, or Ibn Sina (meaning ‘son of Sina’), known in the West by his Latinized name Avicenna, was born c. 980 in Bukhara and died in 1037 in Hamadan, both in Persia. Avicenna spent his entire life in the eastern and central regions of Iran; his lifetime coincided with one of the most tumultuous periods in Iranian history. The turbulent politics of the time and Avicenna's secular nature kept him permanently unsettled. Other than brief periods of relative tranquillity, it led to a life of wandering and turmoil, which was to last to the end of his days.2 However, his powers of concentration were such that he was able to continue his scientific work with remarkable consistency. Avicenna wrote a number of works, including The Book of Healing, a vast philosophical and scientific encyclopaedia. However, in the West his fame is above all based on The Canon of Medicine.3 This vast tome, consisting of more than a million words, surveyed the entire field of medical knowledge from ancient times to the most up-to-date techniques. Its comprehensive and systematic approach meant that when it was translated into Latin in the 12th century, it became the standard medical textbook for seven centuries throughout Europe.4 Sir William Osler described Avicenna as the ‘author of the most famous medical textbook ever written,’ noting that Avicenna's Canon of Medicine remained ‘a medical bible for a longer time than any other work.’4
The reason for Sharma and Minhas's error is to an extent understandable, though not acceptable. The Canon was written in Arabic, as it was unlawful, and dangerous, for Persians to write in their native language while under Arab rule. Despite this, Persian polymaths of the time, such as Avicenna, Biruni, Razi (Latin Rhazes) and Khayyam wrote many of their works in Persian.
Clearly, the great men and women of history belong to all mankind. The unsurpassed beauty of Shakespeare's Sonnets are as inspiring to a German as they are to us, and Leonardo da Vinci's paintings and notebooks are as enlightening to the French as to the Italians; yet, Shakespeare was not German and Leonardo was not French. This is not an issue of nationalizm, which Einstein rightly noted was ‘an infantile disease’ and ‘the measles of mankind’.5 Medicine rises above such conceptions. This is simply a point of historical accuracy.
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