Mentolabial Angles Research Articles

Expert judgement of face profile

The aim of the study is to determinate the values of the parameters of the face profile that ensure the harmony of the architectonics of the facial composition, taking into account sexual dimorphism. 22 independent orthodontists were invited as experts (11 men, average age is 36.8±1.2 years; 11 women, average age is 35.3±2.2 years). Experts questioning implemented the preference vectors method using randomly arranged male and female face profile schemes with variable parameters. Male profile expert judgement average maximum was obtained for following indicator values: face convex angle 8°, nasolabial angle 105°, mentolabial angle - 135°, lip protrusion angle 130°, nasofacial angle 35°, projection nose length 17 mm and 19 mm, vertical ratio of upper lip height to lower lip with chin height 0.45 and 0.50. Female profile expert judgement average maximum was obtained for following indicator values: face convex angle 8° and 10°, nasolabial angle 95°, mentolabial angle 115°, lip protrusion angle 130°, nasofacial angle 35°, projection length nose - 17 mm, vertical ratio of upper lip height to lower lip with chin height 0.50. Facial profile attractiveness evaluation of Caucasian face profile showed gender dependence for face convex angle, nasolabial and mentolabial angles, projection nose length. Female profile compared to male profile is characterized by greater convexity, sharper nasolabial angle, marked supramental sulcus and shorter nose length. We have also determined that male face profile is characterized by wider range of indicators acceptable variations than female one.

Soft Tissue Treatment Goals for Orthodontic Patients- A Photogrammetric Analysis of Facial Profile for Soft Tissue Norms and Gender Variations in Young Adults, Hyderabad, India

Introduction: An average face is always more aesthetic than an atypical face, so setting soft tissue treatment goals for male and female orthodontic patients required local norms, like average measurements of local aesthetically pleasing profile is more important than adopting universal norms. Aim: To obtain angular and average measurements of softtissue facial profiles for males and females in young adults of Hyderabad, India. Materials and Methods: The cross-sectional study was conducted at the Department of Orthodontics and Dentofacial Orthopaedics, Government Dental College and Hospital, Hyderabad, India, from the December 2007 to January 2010. The study included 104 aesthetically pleasing individuals between the age group of 16 years to 25 years (42 male and 62 female) selected by Orthodontists and laypersons, facial profile photographs were taken with standardized photographic set up with camera using 100 mm macrolens. Photographs were traced and 12 angular measurements were taken. Descriptive statistical analysis was done using software MATLAB (Matrix Laboratory) mean, maximum, minimum value, standard deviation and confidence intervals were calculated. Student’s t-test was done to determine sexual dimorphism, and p-value ≤0.05 was considered statistically significant. Results: Total of 104 subjects (42 male subjects; mean age :21.4 years and 62 female subjects; mean age: 19.6 years) were analysed. There was a statistically (p-value <0.05) significant sexual dimorphism in seven of the angular measurements were noted. The nasofrontal (females-141o ±4.8o , males-137.86o ±5.2o ), nasal angle (females -84.4±9o , males-80.7o ±6.9o ), vertical nasal (males-32.08o ±3.3o , females-28.33o ±3.636o ), nasal dorsal angle (males-180.19o ±7.112o , females-174.43o ±6.648o ), cervicomental angle (females-98.41o ±5.4o , males-95.7o ±5.1o ), angle of facial convexity (females-173.2o ±4.4o , males-169.6o ±54.8o ), and angle of total facial convexity (females-149o ±4.6o , males144.4o ±5.2o ), showed sexual dimorphism. In the present study, large variability was observed with the nasolabial (p-value=0.314), and mentolabial (p-value=0.798) angles. Conclusion: Successful orthodontic treatment is mainly measured by patient appraisal only, this can be obtained by giving the locally more aesthetically pleasing facial profile to the patient, setting soft tissue facial profile treatment goals to native individuals is far more important than following universal norms in the total benefit of the patients.

Angular Photogrammetric Analysis of Nasiolabial and Mentolabial Angle in Pakistani Adults

Objective: The objective of the study was to determine the range of nasiolabial and mentolabial angles in normal Pakistani adult and to establish any sexual dimorphism if present. Method: Five hundred objects 500 were selected from the indoor of the de’Mont morency College of dentistry, Lahore. Written consent was obtained from all the participants and were guaranteed that secrecy of all the data was kept up. They were selected using following criteria 1)subjects aged between 18-30 years both males and females 2)skeletal class 1,2 and 3 using ANB of Stenier’s analysis with no or minor crowding, good facial asymmetry and full dentition irrespective of third molar. Gender wise difference was found using independent sample t test. Results: The results of Independent sample t test revealed that there was a significant gender wise difference with regards to nasiolabial (t= 3.827, P<.001) and mentolabial angle (t= -2.733, P<.007). Conclusion: The results showed wider nasiolabial angle in males while no significant difference in terms of skeletal classes. However, mentolabial angle was less in males than females and highest in class 3 than class 1 which was greater than class 2.The impact of sex was significant in both angles Keywords: Nasiolabial angel, Mentolabial angle, Sexual Dimorphism, Angular photogrammetric analysis

Middle and Lower Facial Soft Tissue Changes after Maxillary Advancement through Conventional or High Le Fort I Osteotomy: A Case Series Study

Introduction Maxillary advancementis applied extensively for malocclusion class III correction.This procedure is done using one of the two methods, Conventional or High. Maxilla moves in both vertical and horizontal and only in the horizontal directions in Conventional and High method respectively, so expecting a difference in facialsoft tissue changes. In present study is a case series that describes this issue. Materials and Methods: The cases included 30 patients with class III malocclusion due to maxillary deficiency, whom underwent Le Fort I osteotomy for maxillary advancement in Shahid Beheshti Hospital in Babol, Iran during 1995 to 1995. According to surgical technique, the cases were placed in group 1 (Conventional) or group 2 (High). Maxillary advancement and changes in hard and soft tissue of the middle and lower facial regions where measured through tracing on the lateral cephalometry. Intra-group and inter-group statistical comparisons were done using SPSS20 software at significance level as 0.05. Result: The pre-surgical mean size of SNA, SNB, nasolabial and mentolabial angles was similar in two groups. In all patients, after surgery, SNA angle size was increased and SNB، nasolabial and Mentolabial angles size were decreased. The mean value of these change was similar in two groups. In group 2, the displacement of point A ‘(mean difference: 1.30 mm) and Labrale Superius (mean difference: 1.40 mm) were significantly more than group 1. The amount of displacement of SN (mean difference: 1.30 mm), Labrale Inferius (mean difference: 0.88 mm) and Pogonion (mean difference: 0.23 mm) points in group 2 was higher than that of group 1, but this difference was not statistically significant. Conclusion: It is needed strong evidence for decision about selecting High or Conventional approach maxillary advancement in terms of facial aesthetic aspects. So, further studies with larger sample sizes and cohort or quasi-experimental design is suggested

INVESTIGATE THE LATERAL MORPHOLOGY FEATURES OF THE SOFT TISSUES FACIAL PROFILE OF STUDENTS AT HUE UNIVERSITY OF MEDICINE AND PHARMACY

Background: To survey the lateral morphology features of the soft tissues facial profile and identify some indicators, size of facial soft tissue of students at Hue University of Medicine and Pharmacy. Materials and methods: Cross-sectional description research on 183 students of Hue University of Medicine and Pharmacy, including 81 males and 102 females. The subjects were taken a photogrammetric to determine the lateral morphology features of the soft tissues facial profile. Results: Most of the lateral soft tissue angles in male were smaller than in females, with the exception of the cervicomental and two lips angles. The difference between men and women was statistically significant (p < 0.05) in the total facial convexity, cervicomental, nasofrontal and mentolabial angles. The convex form was 94.0%. Conclusion: Most of the lateral soft tissue angles in male were smaller than in females, with the exception of the cervicomental and two lips angles.The convex form was majority. Key words: anthropometry, lateral morphology of the soft tissues facial profile, digital photo

Mentolabial sulcus and malocclusion: Facial esthetics in ethnic Tamil population

Aim: The aim of this study was to evaluate the soft-tissue parameter that is depth and angle of mentolabial sulcus and to correlate this parameter with type of malocclusion present in an ethnic Tamilian population. Objective: The objective of the study was to evaluate the depth and angle of the mentolabial sulcus, to determine the type of malocclusion, and to correlate the soft-tissue parameter and malocclusion. Materials and Methods: This study was conducted in 260 university students (65 males and 95 females) between April and September 2018. Photographs of all the students were taken using a digital camera. Mentolabial sulcus depth and angles were measured from the lateral photographs using an angle instrument along with the molar and canine relation. The type of mentolabial sulcus was also taken into account. The data were analyzed using the SPSS software version 22. The comparison of sulcus between males and females was performed using two-sample t-test at 95% confidence interval. Results: The mean mentolabial sulcus angle in the Tamilian population was 117.18° ± 9.24° (males: 118.19° ± 12.28° and females: 116.19° ± 12.28°). There was no statistically significant difference of sulcus angle between males and females (P = 0.078). The sulcus was classified as deep, average, and shallow in males and females. In total students, the average was more predominant followed by deep and shallow. Conclusion: The mean mentolabial sulcus angle in the Tamilian population was 117.18° ± 9.24°, in males was 118.19° ± 12.28°, and in females was 116.19° ± 12.28°. The sulcus was classified as deep, average, and shallow. There was no statistically significant difference of sulcus angle between males and females. The average type of sulcus was more predominant in the Tamilian population.

Correlation in changes in the upper and lower incisor inclinations toward the nasolabial angle and mentolabial angle in non-extraction Class I malocclusion orthodontic treatment

Non-extraction orthodontic treatment in borderline cases is reported, according to some authors, to lead to upper and lower incisor inclination changes affecting patients’ soft tissue profiles. Here, we aim to determine the correlation, in non-extraction Class I malocclusion cases, between the upper and lower incisor inclination changes toward the nasolabial angle and the mentolabial angle before and after orthodontic treatment. (We took before and after lateral cephalometric radiographs on 26 patients with non-extraction Class I malocclusion orthodontic treatment.) We measured the I-SN, IMP, nasolabial, and mentolabial angles. For statistical analysis, we used the non-parametric Wilcoxon test and the Spearmen correlation test. There was no significant difference between the I-SN and nasolabial angles, but a significant difference between the IMP and mentolabial angles, before and after treatment. The correlation test showed very weak negative and positive correlations between the change in the I-SN angle and the change in the nasolabial angle, and the change in the IMP angle and the change in the mentolabial angle, respectively. The decrease in the I-SN angle was followed by an increase in the nasolabial angle, even though the correlation was very weak. The increase in the IMP angle was followed by an increase in the mentolabial angle, which was also very weakly correlated.

Proposition of two cephalometric angles for assessing lip position

The present study was conducted in order to propose two angles for the assessment of the anteroposterior position of the upper and lower lips, taking as a reference stable bone structures thus avoiding soft tissue reference points that vary according to age such as the nose and chin. Material and methods: 114 lateral headfi lms from skeletal class I, II and III patients were traced. The proposed angles were measured. For the upper lip (LSMx), the palatal plane and the anterior nasal spine-upper stomion plane formed the angle. For the lower lip (LIMd) the angle was formed by the mandibular plane and the pogonion-lower stomion plane. Both angles were compared with the nasolabial (NSL) and the mentolabial angles (MTL) respectively. Results: A statistical t-Student test was conducted. The proposed angles for the upper and lower lip had lower standard deviations from the mean in comparison to similar angles in all three classes, especially skeletal class I: LSMx: 105.5o ± 5.5, LIMd: 88o ± 5.5, NSL: 104.1o ± 11.3 and MTL: 136.9o ± 12.4. The angle proposed for the lower lip showed a smaller standard deviation and a statistically significant difference compared to the mentolabial angle in the ANOVA test (p ˂ 0.05). Conclusions: The proposed angles for assessing lip position indicate that they have smaller deviations from the mean, in addition if there is an increase they show lip protrusion and a decrease indicates lip retrusion.

Repeatability Study of Angular and Linear Measurements on Facial Morphology Analysis by Means of Stereophotogrammetry.

The aim of this study was to analyze the repeatability in a stereophotogrammetry digital system used for the evaluation of facial morphology. Thirty healthy Brazilian, 18 to 45 years old (26.71 ± 6.53), had 11 reference landmarks marked on their faces by the same examiner and were photographed with an interval of 1 week by the VECTRA M3. Nine angular measurements (nasolabial, mentolabial, nasofrontal, maxillofacial, nasal, maxillary, mandibular, facial convexity, full facial convexity) and 2 linear measurements (middle facial height and lower facial height) were taken. Repeatability was analyzed by the mean absolute differences, relative error of magnitude, technical error of measurement, intraclass correlation coefficient, and Bland-Altman analysis. Paired t test sought any systematic errors between the acquisitions. Associations among body mass index, age, and the error in the measurements were made using the Pearson correlation coefficient. For the technical error of measurement, the nasolabial and mentolabial angles showed values >2° (clinical limit set for this study). For the relative error of measurement, most of the measures were rated between good and excellent. The maxillofacial angle was only moderate. There was a systematic error for middle facial height. The nasolabial, mentolabial, facial convexity, full facial convexity, maxillofacial, and nasofrontal angles presented intraclass correlation coefficient values rated as excellent. The relationship between age/body mass index and the error found between measurements was not confirmed. The nasolabial and mentolabial angles should be interpreted with caution due to the variability showed. The results found stereophotogrammetry to be repeatable, giving accurate measures within the references established for this study.

Age-related and sex-related changes in the normal soft tissue profile of native Northern Sudanese subjects: a cross-sectional study

Information about age-related and sex-related normative measurements of the nasolabial region in native Northern Sudanese subjects is scanty. We have therefore used a hand-held laser scanner to measure nasolabial angles and distances, and collected the 3-dimensional coordinates of seven landmarks on the facial soft tissues from 654 healthy native Northern Sudanese subjects (327 male and 327 female, aged 4-30 years). From these we calculated five angles and two linear distances and took the mean (SD) for age and sex, and compared them using factorial analysis of variance. All measurements analysed were significantly modified by age in both sexes (p < 0.01) except for the distance from the lower lip to Ricketts’ E-line. Sex had a significant effect on the mentolabial and maxillary prominence angles and both distances (p < 0.005). Nasal convexity and the interlabial angle became more obtuse with growth, while the nasolabial and mentolabial angles reduced progressively with female subjects having significantly more obtuse mentolabial angles (p < 0.001). The maxillary prominence angle progressively decreased during childhood, and increased after adolescence, with larger values in male subjects. The upper and lower lip distances from Ricketts’ E-line were also significantly larger in male subjects (p < 0.003), but the difference reduced with age. Overall, there were several differences when we compared our data with published data for African and white subjects, which points to the need for ethnic-specific data. Measurements collected in the current study could be used for the quantitative description of facial morphology in native Northern Sudanese children, adolescents, and young adults.

Comparison of soft-tissue profiles in Le Fort I osteotomy patients with Dolphin and Maxilim softwares

To correct dentofacial deformities, a combination of orthodontic treatment and orthognathic surgery is needed. Prediction software packages are beneficial in treatment planning and achieving improved outcomes, but before using any software, its reliability and reproducibility must be assessed. The aim of this study was to evaluate the accuracy of 2-dimensional Dolphin (version 10; Dolphin Imaging & Management Solutions, Chatsworth, Calif) and 3-dimensional Maxilim (Medicim, Sint-Niklaas, Belgium) softwares in predicting the soft-tissue profiles of patients who had Le Fort I osteotomies. The presurgical and postsurgical cone-beam computed tomography synthesized lateral cephalograms of 13 patients were collected. Using the Dolphin and Maxilim softwares, the postsurgical profiles were predicted. The positions of the soft-tissue landmarks in profile views were compared with landmarks in the postsurgical photographs. The data were analyzed with the coefficient of reliability and paired-sample t tests. The alpha values of the interclass correlations for each landmark in the x and y planes were between 0.96 and 0.99, except for stomion superior in Maxilim (0.83). The 95% confidence interval and the absolute mean of the error showed that errors in the Dolphin software were greater than those in the Maxilim software, but the differences were not significant (P>0.05), except for soft-tissue A-point. The greatest errors were seen in the chin region. The prediction errors of the nasolabial and mentolabial angles were greater; the prediction error in the Dolphin software was 9°, which has clinical significance. The Dolphin and Maxilim softwares are both appropriate for clinical use. Their inaccuracies in the prediction of the chin region should be considered in complicated surgical planning.

Photogrammetric Analysis of Nasolabial Angle and Mentolabial Angle norm in Malaysian Adults

Introduction: While measurement of nasolabial angle and mentolabial angle is an important clinical examination in pre-orthognathic surgery assessment, data on non-western population is limited. This study was therefore conducted to determine the range of nasolabial angle and mentolabial angle in normal Malaysian adult with comparison of males and females. Materials and Methods: A total of 50 Class I males and 52 Class I females aged 19-30 years from three main ethnic groups were randomly selected from dental students, medical students and staffs in dental clinic of Hospital Universiti Sains Malaysia (HUSM). The photographic set-up consisted of a 50mm Nikon DAT camera held in position by a tripod. The photos taken in JPEG format were digitalized and analysed using ProVixwin software. Independent t-test was used to compare any possible gender difference in nasolabial and mentolabial angles. Results: The mean of nasolabial angle and mentolabial angle for male was 92.99? and 130.44? whereas for females it was 95.04? and 130.73? respectively. Gender differences were found to be insignificant for both nasolabial angle and mentolabial angle. Conclusion: Despite having great variation in our population, the nasolabial angle and mentolabial angle are gender independent. Bangladesh Journal of Medical Science Vol. 12 No. 02 April’13 Page 209-214 DOI: http://dx.doi.org/10.3329/bjms.v12i2.14951

Soft Tissue Facial Morphometry Before and After Total Oral Rehabilitation With Implant-Supported Prostheses

The objective of the current study was to assess a low-cost, noninvasive facial morphometric digitizer to assist the practitioner in three-dimensional soft-tissue changes before and after oral rehabilitation. Twenty-two patients aged 45 to 82 years, all with edentulous maxilla and mandible, were assessed both before and after receiving their definitive complete implant-supported prostheses (each received 4-11 implants in each dental arch; full-arch fixed prostheses were made). The three-dimensional coordinates of 50 soft-tissue facial landmarks were collected with a noninvasive digitizer; labial and facial areas, volumes, angles, and distances were compared without and with the prostheses. Dental prostheses induced significant reductions in the nasolabial, mentolabial, and interlabial angles, with increased labial prominence (P < 0.05, Wilcoxon test). Lip vermilion area and volume significantly increased; significant increments were found in the vertical and anteroposterior labial dimensions. The presence of the dental prostheses significantly (P < 0.001) modified the three-dimensional positions of several soft-tissue facial landmarks. In conclusion, the current approach enabled quantitative evaluation of the final soft-tissue results of oral rehabilitation with implant-supported prostheses, without submitting the patients to invasive procedures. The method could assess the three-dimensional appearance of the facial soft tissues of the patient while planning the provisional prosthetic restoration, providing quantitative information to prepare the best definitive prosthesis.

Three-dimensional facial morphometry in patients rehabilitated with implant-supported prostheses

The aim of the present study was to assess a low-cost, non-invasive facial morphometric digitizer to assist the practitioner in three-dimensional soft-tissue changes before and after oral rehabilitation. The method should provide quantitative data to support an objective assessment of the facial esthetic outcome [1]. Twenty-two patients aged 45-82 years, all with edentulous maxilla and mandible, were assessed both before and after receiving their definitive complete implant-supported prostheses (each received 4-11 implants in each dental arch; full-arch fixed prostheses were made). The three-dimensional coordinates of 50 soft-tissue facial landmarks were collected with a non-invasive digitizer; labial and facial areas, volumes, angles and distances were compared without/ with the prostheses [2]. Dental prostheses induced significant reductions in the nasolabial, mentolabial and interlabial angles, with increased labial prominence (p<0.05, Wilcoxon test). Lip vermilion area and volume significantly increased; significant increments were found in the vertical and anteroposterior labial dimensions. The presence of the dental prostheses significantly (p<0.001) modified the three-dimensional positions of several soft-tissue facial landmarks. The current approach enabled quantitative evaluation of the final soft-tissue results of oral rehabilitation with implant-supported prostheses, without submitting the patients to invasive procedures. The method could assess the three-dimensional appearance of the facial soft tissues of the patient while planning the provisional prosthetic restoration, providing quantitative information to prepare the best definitive prosthesis. Dote ricerca: FSE, Regione Lombardia

Angular Photogrammetric Comparison of the Soft-Tissue Facial Profile of Kenyans and Chinese

The purpose of this study was to determine the average angular dimensions that define the normal soft-tissue facial profiles of black Kenyans and Chinese and compare them with each other and with values proposed for whites. Standardized facial profile photographs, taken in natural head position, of 177 black Kenyans and 156 Chinese with normal occlusion and well-balanced faces were analyzed for 12 angular parameters. Two-sample t-tests were used to determine sex and racial differences. Kenyan and Chinese averages were compared with proposed white values using 1-sample t-tests. Eight parameters in Kenyans and 7 in Chinese showed sex differences. All angles, except for facial convexity, nasal dorsum, and inferior facial height, were different between Kenyans and Chinese. Kenyan and Chinese averages for all parameters were different from proposed white average, except for facial convexity. Nasolabial and mentolabial angles showed large individual variability and racial differences. The study demonstrated many differences in average angular measurements of the facial profiles of black Kenyans, Chinese, and white standards. Orthodontists, maxillofacial and plastic surgeons, and other clinicians working in the craniofacial region should bear these in mind when setting aesthetic treatment goals for patients of different races. Mean values from this study can be used for comparison with similar records of subjects with same ethnicity.

Angular photogrammetric analysis of the soft tissue facial profile.

All medical specialties interested in improving facial appearance need to measure the face to quantify the desired facial changes. The purpose of this investigation was to obtain objective average measurements of the soft tissue facial profile to use them as a guide for aesthetic treatment goals. The analysis of the soft tissue facial profile from photographic records provides information on the morphology of the profile and its relationship with the underlying dentoskeletal tissues. In this investigation the soft tissue facial profile of a young adult European Caucasian population (212 individual, 50 males and 162 females, 18-20 years of age) was studied by means of standardized photographic records taken in the natural head position (NHP). Angular measurements were analysed digitally. Sexual dimorphism was found for several angles: nasofrontal (G-N-Prn: P < 0.01), vertical nasal (Cm-Sn/N-Prn: P < 0.01), nasal (N-Prn/TV: P < 0.01), nasal dorsum (N-Mn-Prn: P < 0.05), and mandibular contour (C-Me/G-Pg: P < 0.01). Wide individual variations in nasolabial and mentolabial angles were also observed.

Digitized three-dimensional analysis of normal dento-labial relationships

The lips and their relationship with the positions of anterior teeth considerably affect a person's smile and facial esthetics in general. In this study, the changes in lip dimensions and position in three-dimensions during the period between adolescence (12 boys and 12 girls aged 13–15 years) and young adulthood (10 men and 11 women aged 20–24 years) in normal, untreated subjects were measured, along with the age-related modifications in the clinical crown dimensions of maxillary and mandibular anterior teeth. The three-dimensional coordinates of selected soft-tissue facial and dental landmarks were directly digitized on the subjects using a non-invasive electromagnetic instrument. From the landmark coordinates, the total vermilion and upper lip heights; mouth width; intercanine and interincisor distances; clinical crown heights and widths of anterior teeth; interlabial, nasolabial, mentolabial, dentolabial and inciso-occlusal angles were calculated. Mean values for each sex and age group were computed and compared using two-way factorial analysis of variance. Results have shown that soft-tissue growth in the lip area has not subdued in adolescent males, while it has slowed in females; moreover, there was some degree of eruption of the maxillary anterior teeth in adolescent males, thus modifying dento-labial relationships. On average, males have a tendency toward a wider, thinner, and flatter lip area with growth. The various growth phenomena still to take place in adolescent males should be taken into consideration when commencing treatment: enucleation of four premolars may for example enhance a natural tendency toward a flatter lip area.

Analysis of soft tissue facial profile in white males

Three of the integumental variables, namely, the total facial convexity, upper lip to esthetic plane, and lower lip length, showed significant measurement errors in the preadolescent boys. Large standard deviations were also found for several variables in both age groups. This suggests that a range of values, rather than means, should be used in clinical cephalometric evaluations. A table of means, standard deviations, and ranges for the variables evaluated is provided. The nasolabial and the mentolabial angles did not differ significantly between the younger and the older age groups. The total soft tissue facial convexity was noted to have a marginally significant difference between the adults and children. Other variables were significantly different between the two age groups, and indicated that the adults had a relatively straighter facial profile than the children. In addition, the upper and lower lips were more retrusive relative to the esthetic plane in adults. Sagittal proportions relating nasal depth/nose to most protrusive lip/chin to most protrusive lip were found to have a ratio of 2.1:1.0:1.2 in children and 1.8:1.0:0.3 in adults.