{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T07:42:00Z","timestamp":1760168520973,"version":"build-2065373602"},"reference-count":50,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2021,9,8]],"date-time":"2021-09-08T00:00:00Z","timestamp":1631059200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Symmetry"],"abstract":"<jats:p>The evaluation of the symmetry of orbital and ear soft tissues is important for aesthetic and reconstructive surgery. However, little information is available for these facial regions, especially in children. We analyzed the orbital and auricular symmetry in 418 Italian and 206 Sudanese subadult males divided into three age groups (8\u201311, 12\u201315, and 16\u201319 years old). Orbital and auricular height and width were measured for calculating fluctuating and directional asymmetry indices. Differences in asymmetry indices according to ethnicity and age group were assessed through the two-way ANOVA test (p &lt; 0.01), while differences in the prevalence of right or left asymmetry according to ethnicity were assessed through the chi-square test. On average, directional asymmetry indices ranged from \u22122.1% to 1.1%, while fluctuating asymmetry indices ranged between 2.9% and 5.4%, corresponding to a small effect size and to 1.06\u20132.34 mm actual dimensions. Sudanese subjects showed a greater asymmetry for all the indices except for the fluctuating asymmetry of orbital height (p &lt; 0.01). The directional asymmetry of auricular width increased with age. A prevalent right-side asymmetry was found for all the orbital indices (p &lt; 0.001) in both populations, although significantly more prevalent in Sudanese individuals (over 83% for both measures), while auricular measures showed a prevalent left asymmetry exclusively in the Sudanese but with lower percentages. Aside from the limited effect size, the results proved the ethnic variability of asymmetry of orbital and auricle regions in children and suggest the need to collect more population data.<\/jats:p>","DOI":"10.3390\/sym13091657","type":"journal-article","created":{"date-parts":[[2021,9,8]],"date-time":"2021-09-08T21:28:45Z","timestamp":1631136525000},"page":"1657","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Assessment of the Orbital and Auricular Asymmetry in Italian and Sudanese Children: A Three-Dimensional Study"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3060-4097","authenticated-orcid":false,"given":"Claudia","family":"Dolci","sequence":"first","affiliation":[{"name":"Department of Biomedical Sciences for Health, Universit\u00e0 degli Studi di Milano, 20133 Milano, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fadil","family":"Elamin","sequence":"additional","affiliation":[{"name":"Khartoum Centre for Research and Medical Training, Khartoum 11111, Sudan"},{"name":"Institute of Dentistry, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London E1 2AD, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4527-4203","authenticated-orcid":false,"given":"Annalisa","family":"Cappella","sequence":"additional","affiliation":[{"name":"Department of Biomedical Sciences for Health, Universit\u00e0 degli Studi di Milano, 20133 Milano, Italy"},{"name":"U.O. Laboratorio di Morfologia Umana Applicata, IRCCS Policlinico San Donato, 20097 San Donato Milanese, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luisa","family":"Barni","sequence":"additional","affiliation":[{"name":"Department of Biomedical Sciences for Health, Universit\u00e0 degli Studi di Milano, 20133 Milano, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniele M.","family":"Gibelli","sequence":"additional","affiliation":[{"name":"Department of Biomedical Sciences for Health, Universit\u00e0 degli Studi di Milano, 20133 Milano, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6532-6464","authenticated-orcid":false,"given":"Chiarella","family":"Sforza","sequence":"additional","affiliation":[{"name":"Department of Biomedical Sciences for Health, Universit\u00e0 degli Studi di Milano, 20133 Milano, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2021,9,8]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"380e","DOI":"10.1097\/PRS.0000000000004114","article-title":"Quantifying Normal Craniofacial Form and Baseline Craniofacial Asymmetry in the Pediatric Population","volume":"141","author":"Cho","year":"2018","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Chou, P.Y., Denadai, R., Chen, S.H., Tseng, H.J., Hsu, C.K., Wang, S.W., Hallac, R., Chen, C.H., Kane, A.A., and Lo, L.J. (2019). Identifying Three-Dimensional Facial Fluctuating Asymmetry in Normal Pediatric Individuals: A Panel Assessment Outcome Study of Clinicians and Observers. J. Clin. Med., 8.","DOI":"10.3390\/jcm8050648"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1016\/S0901-5027(00)80117-4","article-title":"Laser scanning of the ear identifying the shape and position in subjects with normal facial asymmetry","volume":"29","author":"Coward","year":"2000","journal-title":"Int. J. Oral Maxillofac. Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"244","DOI":"10.1054\/ijom.2001.0152","article-title":"Identifying the position of an ear from a laser scan: The significance for planning rehabilitation","volume":"31","author":"Coward","year":"2000","journal-title":"Int. J. Oral Maxillofac. Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1169","DOI":"10.1016\/S0165-5876(03)00221-0","article-title":"Anthropometric growth study of normal human auricle","volume":"67","author":"Kalcioglu","year":"2003","journal-title":"Int. J. Pediatr. Otorhinolaryngol."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Sajid, M., Shafique, T., Riaz, I., Imran, M., Jabbar Aziz Baig, M., Baig, S., and Manzoor, S. (2018). Facial asymmetry-based anthropometric differences between gender and ethnicity. Symmetry, 10.","DOI":"10.3390\/sym10070232"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"2398","DOI":"10.1097\/01.PRS.0000060995.99380.DE","article-title":"Morphometry of the adult human earlobe: A study of 547 subjects and clinical application","volume":"111","author":"Azaria","year":"2003","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"647","DOI":"10.1097\/01.PRS.0000070979.20679.1F","article-title":"A morphometric study of the external ear: Age and sex-related differences","volume":"112","author":"Brucker","year":"2003","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"20141639","DOI":"10.1098\/rspb.2014.1639","article-title":"Facial fluctuating asymmetry is not associated with childhood ill-health in a large British cohort study","volume":"281","author":"Pound","year":"2014","journal-title":"Proc. R. Soc. B"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"663","DOI":"10.1111\/j.1469-7580.2008.01002.x","article-title":"Facial asymmetry in young healthy subjects evaluated by statistical shape analysis","volume":"213","author":"Ercan","year":"2008","journal-title":"J. Anat."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1016\/j.bandc.2004.08.056","article-title":"Appearance of symmetry, beauty, and health in human faces","volume":"57","author":"Zaidel","year":"2005","journal-title":"Brain Cogn."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Van Dongen, S., Ekrami, O., and Claes, P. (2020). Lack of Correlation between Facial Sexual Dimorphism, Fluctuating Asymmetry and Self-Perceived Attractiveness in Men and Women. Symmetry, 12.","DOI":"10.3390\/sym12020236"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"103311","DOI":"10.1016\/j.actpsy.2021.103311","article-title":"Normality mediates the effect of symmetry on facial attractiveness","volume":"217","author":"Zheng","year":"2021","journal-title":"Acta Psychol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1331","DOI":"10.1007\/s00266-018-1151-9","article-title":"Three-Dimensional Imaging in Rhinoplasty: A Comparison of the Simulated versus Actual Result","volume":"42","author":"Persing","year":"2018","journal-title":"Aesthetic Plast. Surg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"761","DOI":"10.1097\/PRS.0000000000003146","article-title":"The Evolution of Photography and Three-Dimensional Imaging in Plastic Surgery","volume":"139","author":"Weissler","year":"2017","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Ekrami, O., Claes, P., White, J.D., Weinberg, S.M., Marazita, M.L., Walsh, S., Shriver, M.D., and van Dongen, S. (2020). A Multivariate Approach to Determine the Dimensionality of Human Facial Asymmetry. Symmetry, 12.","DOI":"10.3390\/sym12030348"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Ekrami, O., Claes, P., van Assche, E., Shriver, M.D., Weinberg, S.M., Marazita, M.L., Walsh, S., and van Dongen, S. (2021). Fluctuating Asymmetry and Sexual Dimorphism in Human Facial Morphology: A Multi-Variate Study. Symmetry, 13.","DOI":"10.3390\/sym13020304"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"56","DOI":"10.3389\/fevo.2019.00056","article-title":"Phenotypic Plasticity, Developmental Instability, and Robustness: The Concepts and How They Are Connected","volume":"7","author":"Klingenberg","year":"2019","journal-title":"Front. Ecol. Evol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1007\/s00435-007-0028-2","article-title":"Directional asymmetry and correlation of tail injury with left-side dominance occur in Serpentes (Sauropsida)","volume":"126","author":"Razzetti","year":"2007","journal-title":"Zoomorphology"},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Graham, J.H., and \u00d6zener, B. (2016). Fluctuating Asymmetry of Human Populations: A Review. Symmetry, 8.","DOI":"10.3390\/sym8120154"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"125","DOI":"10.2307\/2406192","article-title":"A study of fluctuating asymmetry","volume":"16","year":"1962","journal-title":"Evolution"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Quinto-Sanchez, M., Cintas, C., Silva de Cerqueira, C.C., Ramallo, V., Acu\u00f1a-Alonzo, V., Adhikari, K., Castillo, L., Gomez-Vald\u00e8s, J., Everardo, P., and de Avila, F. (2017). Socioeconomic status is not related with facial fluctuating asymmetry: Evidence from Latin-American populations. PLoS ONE, 12.","DOI":"10.1371\/journal.pone.0172418"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1486","DOI":"10.1002\/jmor.10499","article-title":"Eye Size in Geckos: Asymmetry, Allometry, Sexual Dimorphism, and Behavioral Correlates","volume":"267","author":"Werner","year":"2006","journal-title":"J. Morphol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1111\/j.1469-7998.1998.tb00088.x","article-title":"Evidence that minor directional asymmetry is functional in lizard hindlimbs","volume":"245","author":"Seligmann","year":"1998","journal-title":"J. Zool."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1080\/13576500244000067","article-title":"Behavioral and morphological asymmetries in hindlimbs of Hoplodactylus duvaucelii (Lucertilia: Gekkon-omorpha: Gekkota: Diplodactylinae)","volume":"7","author":"Seligmann","year":"2002","journal-title":"Laterality"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"110.e1","DOI":"10.1016\/j.forsciint.2009.02.019","article-title":"Age- and sex-related changes in the normal human ear","volume":"187","author":"Sforza","year":"2009","journal-title":"Forensic Sci. Int."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"115.e1","DOI":"10.1016\/j.forsciint.2008.12.010","article-title":"Age- and sex-related changes in the soft tissues of the orbital region","volume":"185","author":"Sforza","year":"2009","journal-title":"Forensic Sci. Int."},{"key":"ref_28","unstructured":"Farkas, L.G. (1994). Craniofacial norms in North American Caucasians from birth (one year) to young adulthood. Anthropometry of the Head and Face, Raven Press."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"881","DOI":"10.1097\/00005537-200105000-00023","article-title":"A morphological study of age changes in adult human auricular cartilage with special emphasis on elastic fibers","volume":"111","author":"Ito","year":"2001","journal-title":"Laryngoscope"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1111\/joa.12252","article-title":"An investigation of matching symmetry in the human pinnae with possible implications for 3D ear recognition and sound localization","volume":"226","author":"Claes","year":"2015","journal-title":"J. Anat."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Launonen, A.M., Vuollo, V., Aarnivale, H., Heikkinen, T., Pirttiniemi, P., Valkama, A.M., and Harila, V. (2020). Craniofacial asymmetry from one to three years of age: A prospective cohort study with 3D imaging. J. Clin. Med., 9.","DOI":"10.3390\/jcm9010070"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"275","DOI":"10.29252\/wjps.7.3.275","article-title":"What Is the Role of Plastic Surgery in Global Health? A Review","volume":"7","author":"Borrelli","year":"2018","journal-title":"World J. Plast. Surg."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"421","DOI":"10.2319\/022107-85.1","article-title":"Asymmetry of the face in orthodontic patients","volume":"78","author":"Haraguchi","year":"2008","journal-title":"Angle Orthod."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1092","DOI":"10.1016\/j.ijom.2019.10.019","article-title":"Reliability of optical devices for three-dimensional facial anatomy description: A systematic review and meta-analysis","volume":"49","author":"Gibelli","year":"2020","journal-title":"Int. J. Oral Maxillofac. Surg."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"180.e1-11","DOI":"10.1016\/j.forsciint.2013.02.003","article-title":"Morphometry of the soft tissues of the orbital region in Northern Sudanese persons","volume":"228","author":"Sforza","year":"2013","journal-title":"Forensic Sci. Int."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"2129","DOI":"10.1016\/j.joms.2009.09.036","article-title":"Accuracy and reproducibility of a 3-dimensional stereophotogrammetric imaging system","volume":"68","author":"Rosati","year":"2010","journal-title":"J. Oral Maxillofac Surg."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1772","DOI":"10.1016\/j.joms.2018.01.021","article-title":"Are Portable Stereophotogrammetric Devices Reliable in Facial Imaging? A Validation Study of VECTRA H1 Device","volume":"76","author":"Gibelli","year":"2018","journal-title":"J. Oral Maxillofac Surg."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"109","DOI":"10.2319\/042510-222.1","article-title":"Three-dimensional assessment of nose and lip morphology in north Sudanese subjects with Down\u2019s syndrome","volume":"81","author":"Sforza","year":"2011","journal-title":"Angle Orthod."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"551Y558","DOI":"10.1016\/0007-1226(95)90043-8","article-title":"Evaluation of the laser scanner as a surface measuring tool and its accuracy compared with direct facial anthropometric measurements","volume":"48","author":"Aung","year":"1995","journal-title":"Br. J. Plast. Surg."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"507Y514","DOI":"10.1016\/S0006-3223(01)01327-0","article-title":"3D laser surface scanning and geometric morphometric analysis of craniofacial shape as an index of cerebro-craniofacial morphogenesis: Initial application to sexual dimorphism","volume":"51","author":"Hennessy","year":"2002","journal-title":"Biol. Psychiatry"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"2853","DOI":"10.1007\/s00784-019-03150-1","article-title":"Validity and reproducibility of the 3D VECTRA photogrammetric surface imaging system for the maxillofacial anthropometric measurement on cleft patients","volume":"24","author":"Othman","year":"2020","journal-title":"Clin. Oral Investig."},{"key":"ref_42","unstructured":"Farkas, L.G. (1994). Anthropometry of the Head and Face, Raven Press."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"514e","DOI":"10.1097\/PRS.0000000000006555","article-title":"A Simple Standardized Three-Dimensional Anthropometry for the Periocular Region in a European Population","volume":"145","author":"Guo","year":"2020","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"545","DOI":"10.1055\/s-2000-8479","article-title":"Physiological correlates of bilateral symmetry in humans","volume":"21","author":"Tomkinson","year":"2000","journal-title":"Int. J. Sports Med."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"2815","DOI":"10.21105\/joss.02815","article-title":"Effect size: Estimation of effect size indices and standardized parameters","volume":"5","author":"Makowski","year":"2020","journal-title":"J. Open Source Softw"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1201","DOI":"10.1016\/j.anbehav.2003.11.024","article-title":"Aggression in females is also lateralized: Left-eye bias during aggressive courtship rejection in lizards","volume":"68","author":"Hews","year":"2004","journal-title":"Anim. Behav."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1016\/j.beproc.2013.08.002","article-title":"Lateralization of visually guided detour behavior in the common chameleon, (Chamaeleo chameleon): A reptile with highly independent eye movements","volume":"100","author":"Lusting","year":"2013","journal-title":"Behav. Process."},{"key":"ref_48","doi-asserted-by":"crossref","unstructured":"Sion, G., Tal, R., and Meiri, S. (2020). Asymmetric behavior in Ptyodactylus guttatus: Can a digit ratio reflect brain laterality?. Symmetry, 12.","DOI":"10.3390\/sym12091490"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"228","DOI":"10.1002\/ajmg.a.30275","article-title":"Nasal dimensions in normal subjects: Conventional anthropometry versus computerized anthropometry","volume":"130A","author":"Sforza","year":"2004","journal-title":"Am. J. Med. Genet. A"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"1807","DOI":"10.1016\/j.jcms.2018.07.008","article-title":"Three-dimensional facial anatomy evaluation: Reliability of laser scanner consecutive scans procedure in comparison with stereophotogrammetry","volume":"46","author":"Gibelli","year":"2018","journal-title":"J. Craniomaxillofac. Surg."}],"container-title":["Symmetry"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2073-8994\/13\/9\/1657\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T06:58:42Z","timestamp":1760165922000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2073-8994\/13\/9\/1657"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,9,8]]},"references-count":50,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2021,9]]}},"alternative-id":["sym13091657"],"URL":"https:\/\/doi.org\/10.3390\/sym13091657","relation":{},"ISSN":["2073-8994"],"issn-type":[{"type":"electronic","value":"2073-8994"}],"subject":[],"published":{"date-parts":[[2021,9,8]]}}}