Head Length

Gestational Head Circumference

Definition Maximum dimension of the sagittal axis of the skull. Landmarks Measure between the glabella (the most prominent point on the frontal bone above the root of the nose, between the eyebrows) and the opisthocranion (the most prominent portion of the occiput, close to the midline on the posterior rim of the foramen magnum) (Figs 7.1 and 7.4). These landmarks are also critical for measurement of head circumference. Figure 7.4 Measuring head length with calipers. Figure 7.4 Measuring head...

Palate

Cleft palate, with or without cleft lip, occurs about once in every 2500 births and is more common in females than males. A cleft may involve only the uvula, giving a fishtail appearance. It may extend through the soft palate, or it may extend all the way forward to the hard palate. The cleft may be overt or submucous. In severe cases associated with cleft lip, the cleft in the palate extends through the alveolar process and lip on both sides. The embryological basis of cleft palate is failure...

Info

Cri Chat Growth Curve

Figure 17.28 Cri du chat syndrome, head circumference, females, birth to 15 years. Normal growth curves (N) are included. Adapted from Marinescu et al. (2000). Figure 17.28 Cri du chat syndrome, head circumference, females, birth to 15 years. Normal growth curves (N) are included. Adapted from Marinescu et al. (2000).

Introduction

Disturbance of growth of the chest and trunk may lead to disproportion of the body in much the same way as disproportion can be produced by disturbance of limb growth. In addition, disturbed growth of the chest may affect the relationship between the sternum and ribs (sternocostal relationship), producing a variety of pectus deformities and possibly compromising respiratory function. The ribs develop from the mesenchymal costal processes of the thoracic vertebrae. They become cartilaginous...

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Biacromial Width

27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 Gestational age (weeks) Figure 9.15 Torso length, both sexes, at birth. From Sivan et al. (1983), by permission. Chapter 9 Chest and Trunk Biacromial Distance Definition Maximum distance between the right and left acromion (shoulder width). Landmarks The spine of the scapula projects laterally and superiorly over the shoulder joint to form the acromion. The acromion articulates anteriorly with the clavicle. The acromion is the most lateral bony...

Methods to Record and Analyze Dermatoglyphics

There are several ways to record the dermal ridge patterns of the hands and feet. The first way is to evaluate the patterns with a magnifying glass, preferably one that has an integrated lamp like an otoscope, or a device used by stamp collectors. For recording the dermal ridge patterns, prints can be made in several ways. Ink staining Ink can be used to stain the patient's hands and feet, applied with a roller on a pre-inked pad, and distributed as evenly as possible (Fig. 12.4). The print is...

Stages of Puberty Tanner Stages

To assess how far an individual has progressed through puberty, a rating scale that describes the successive stages of growth of the genitalia and pubic hair in boys and breast development and pubic hair development in girls was introduced by Tanner (Fig. 10.2). The stage of development in the individual is compared with visual standards which are referred to as G-1 to G-5 for male genitalia development, B-1 to B-5 for breast development, and PH-1 to PH-5 for pubic hair development. The...

Useful Parameters and Landmarks

Measurements of length, weight, and head circumference are standard measurements of a physical examination. These three measurements are the parameters against which all others are compared. They document growth and body proportions. They should be obtained routinely at every visit to a physician in order to be able to assess longitudinal growth and growth relative to an age- and sex-matched standard. Curves of normal standards of growth, weight, and head circumference are included in every...

Extensibility of Skin

The extensibility of the skin varies with age and is greatest in older people. There are also differences between the sexes, apparently dependent on hormonal variations. Female skin is more extensible at all ages. There is variable extensibility in different parts of the body the neck and elbow skin is looser than the skin on the forearms and hips. Extensibility depends on the collagen content of the skin. There are ways to measure precisely the extensibility of skin, which involve attaching a...

Ear Protrusion

Definition Protrusion of each ear is measured as the angle subtended from the posterior aspect of the pinna to the mastoid plane of the skull. Landmarks Measure between the posterior aspect of the pinna and the mastoid plane of the skull. The zero mark of the protractor is placed above the point of attachment of the helix in the temporal region, and its straight side is pressed against the subject's head. The extent of the protrusion is indicated on the curved side of the protractor (Fig....

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Zygomatic arch Mastoid process Ramus of mandible (bizygomatic) I Mandibular width (bigonial) Zygomatic arch Mastoid process Ramus of mandible Figure 7.1 Palpable landmarks of craniofacies. cephalostats used today are much less obstructive and expensive than Broadbent's research instrument, the positioning of the head and the distance between the X-ray unit and the head-holder remain the same. The head is held in the cephalostat, which restrains the head in a precise manner. Adjustable ear rods...

Palate Height

Landmarks Measure the shortest distance between the midline of the junction of the hard and soft palates and the plane established by other reference points as outlined in palate length and palate width (Fig. 7.84). Instruments A palatal measuring device is necessary (Shapiro et al., 1963). Figure 7.84 Measuring palate height. Remarks Palate height for ages 6-16 years is shown in Fig. 7.85. This measurement point, the fovea palatinus, is not always the highest dimension of the palatal vault....

Directions For Administration

Try to get child to smile by smiling, talking or waving. Do not touch him her. 2. Child must stare at hand several seconds. 3. Parent may help guide toothbrush and put toothpaste on brush. 4. Child does not have to be able to tie shoes or button zip in the back. 5. Move yarn slowly in an arc from one side to the other, about 8 above child's face. 6. Pass if child grasps rattle when it is touched to the backs or tips of fingers. 7. Pass if child tries to see where yarn went. Yarn should be...

Tongue

Around the end of the fourth week of gestation, a median, somewhat triangular elevation appears in the floor of the pharynx just rostral to the foramen caecum. This elevation, the median tongue bud, gives the first indication of tongue development. Soon, two oval distal tongue buds (lateral lingual swellings) develop on each side of the median tongue bud. These elevations result from proliferation of mesenchyme in the ventromedial parts of the first pair of branchial arches. The distal tongue...

Which Of The Following Landmarks Is Not Used When Measuring Head Circumference

Disturbance of limb growth generally leads to disproportion of the body, as the normal proportions of the body reflect changes in the relative size of the limbs at different ages. The limb buds emerge as identifiable structures at about four weeks of embryonic development. Normal development depends on the interactions of developing vascular, nerve, muscle, and bony tissues. All are interdependent and have changing patterns and relationships during development. Initially, the limb is paddle...

Why Measurements Are Useful

Foot Anatomy Landmarks

Growth is the essence of the developing organism. Physical growth starts shortly after fertilization and continues throughout pregnancy, childhood, and adolescence. It may even occur in the adult. Growth of different parts of the body follows a predictable schedule during normal development and maturation. This timetable of development is influenced and controlled by many genetic and environmental factors. Any disturbance in the normal sequence of development and growth may lead to...

Ears

The ear consists of three anatomical parts-external, middle, and internal. The external and middle parts are concerned mainly with transferring sound waves from the exterior to the internal ear. The internal ear contains the vestibulocochlear organ, which is concerned with equilibrium and hearing. The internal ear is the first of the three anatomical divisions of the ear to appear, early in the fourth week of gestation. At that time, surface ectoderm gives rise to the otic vesicle which becomes...

Internipple Distance

Areola Circumference

Definition Distance between the centers of both nipples. Landmarks Measure between the centers of both nipples (Fig. 9.5). Instruments Tape-measure. Position The patient stands upright, with the arms down at the sides measure during mid-expiration. Infants should be measured lying supine during mid-expiration. Remarks Internipple distance cannot be measured from pictures. With inspiration and expiration the value will change, so two measurements, both taken during mid-expiration, are desirable....

Measurements in Dysmorphology and Clinical Genetics

The human body is expected to grow predictably and proportionately. The relationship of measurements to each other is expected to be constant at specific ages. These relationships can be expressed as ratios, as an index, or by the use of regression techniques. Those in common use are the relationship between height and weight. They are mainly corrected with the chronological age or the bone age of the patient. These proportions and relationships change dramatically from the fetal period through...

Ear Length

Head Circumference Gestational Age

Definition Maximum distance from the superior aspect to the inferior aspect of the external ear (pinna). Landmarks Measure from the superior aspect of the outer rim of the helix to the most inferior border of the earlobe or pinna (Fig. 7.55). Instruments Tape-measure or transparent calibrated ruler. Position The head should be held erect (in the resting position) with the eyes facing forward. The head should not be tilted forward or backward. The facial profile should be vertical and the...

Anal Diameter

Hentai Accidental Anal

A serious anal stenosis can be excluded by determining the anal diameter. This is done either by placing a gloved little finger into the anal opening or by the use of graduated sounding instruments (Hegar sounds). In the newborn, there is a correlation between anal diameter and weight (Fig. 10.15). Incomplete development and separation of the cloaca into the urogenital sinus and the rectum will result in various anorectal anomalies. An international classification of anorectal anomalies is...

Chest Circumference

Chest Circumference

Landmarks Measure horizontally around the upper body at the level of the nipples or at the level just below the scapular angles Fig. 9.2. In the postpubertal female, measure just below the breasts. Figure 9.2 Measuring chest circumference. Position The patient should stand upright with the arms down at the sides. The measurement should be made during mid-expiration. Infants should be measured lying supine, in mid-expiration. Alternative Measure at the nipple line, or in adults 10 cm down from...

Range of Movement

Range Movement

Normal joints allow a range of purposeful movements as well as easy shifting from one position to another. They have active and passive ranges of movement or motion (ROM). In a healthy joint the active range of motion is almost as full as passive. If there are no major complaints or apparent limitations of movement, checking four important positions will provide rough estimates of the range of movement of the major joints (Fig. 8.59-8.62). Neutral position (general) (Fig. 8.59) The patient...

Spondyloepiphyseal Growth Chart

Russell Silver Syndrome Birth

0123456789 10 11 12 13 14 15 16 17 18 19 20 Age (years) 0123456789 10 11 12 13 14 15 16 17 18 19 20 Age (years) Figure 17.69 Russell-Silver syndrome, height, females, birth to 20 years. From Wollmann et al. (1995). 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Age (years) Figure 17.70 Spondyloepiphysial dysplasia congenita, height, birth to 16 years. From Horton et al. (1982), by permission. 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Age (years) Figure 17.70 Spondyloepiphysial dysplasia congenita,...

Expected Increments

Brachial Vein Fetal Pig

There is a predictable height increase for each specific time interval. This increment changes with age. Males and females have the same incremental height increases for the first 48 months of life, then sex differences are noted. Expected height increase increment charts can be found in Fig. 4.26. Figure 4.26 Expected increments in height, both sexes, birth to 16 years. From Lowrey (1986), by permission. Figure 4.26 Expected increments in height, both sexes, birth to 16 years. From Lowrey...

Head Circumference Down Syndrome Cronk

Down Syndrome Head Circumference

0 2 4 6 8 10 12 14 16 18 20 22 24 26 28 30 32 34 36 Age (months) Figure 17.35 Down syndrome, weight, North American females, birth to three years. Adapted from Cronk et al. (1988) and http www.growthcharts.com . Figure 17.36 Down syndrome, weight, North American females, 2 to 18 years. Adapted from Cronk et al. (1988) and http www.growthcharts.com . Figure 17.36 Down syndrome, weight, North American females, 2 to 18 years. Adapted from Cronk et al. (1988) and http www.growthcharts.com . 0 2 4 6...

Head Width

Anthropometer Basic Set

Definition Maximal biparietal diameter. Landmarks Measure between the most lateral points of the parietal bones (eurion) on each side of the head (Fig. 7.7). Instruments Spreading calipers give most accurate measurements. A tape-measure held above the head, avoiding the natural curve of the cranial vault, may be substituted. Position The head should be held erect (in the resting position) with the eyes looking straight ahead. Alternative Viewing the skull from in front or behind may allow...

Thoracic Index

Lateral Diameter Chest

Definition Ratio of the anteroposterior diameter of the chest to the lateral diameter (chest width) multiplied by 100. Landmarks Anteroposterior diameter is measured (Fig. 9.8a) from the sternum, at the level of the nipples, to the vertebrae, at the same level, while at rest. Lateral diameter is measured between the midaxillary lines at the level of the nipples (Fig. 9.8b) Position The patient should be standing with the arms hanging loosely at the sides the measurement is made during...

Nasal Height

Head Circumference

Definition The distance from the nasal root (nasion) to the nasal base (subnasion). Landmarks Measure from the deepest depression at the root of the nose to the deepest concavity at the base of the nose, in a vertical axis (Fig. 7.66). Instruments Spreading calipers are most accurate. A tape-measure could be used if held straight in a vertical plane, avoiding the contours of the face. Position Frankfort horizontal, with the facial profile in the vertical. The patient can be observed from the...

Length of Columella

Definition Length of the inferior-most aspect of the nasal septum. Landmarks Measure along the crest of the columella from the base of the nose (subnasion) to the most anterior point of the columella at the level of the tip of each nostril (Fig. 7.68). Instruments Tape-measure or sliding calipers. Position The patient should recline with the midfacial plane in the vertical. Remarks Normal columella length for children age 6-16 years is shown in Fig. 7.69. It is important to note that this...

Testicular Volume

Landmarks The length and width of the testis can be measured along a vertical axis between the upper and lower pole of the testis and at the broadest width. Position The individual should be standing upright or lying supine. Instruments The size of the elliptical shaped testis is most easily estimated by palpation and comparison with standardized graded ellipsoid models of different volume sizes (Fig. 10.8). Since Prader developed and standardized these...

Breast and Nipple Size and Shape

The mammary gland develops from the mammary crest, which is of ectodermal origin. The mammary crest (milk line) extends from the axilla to the inguinal area on the developing trunk (see Fig. 9.1 in Chapter 9) but disappears in humans except in the pectoral area. During prenatal life the primary mammary bud is formed. From the deeper surface layers of the bud, 15-20 solid cellular cords, the secondary epithelial buds, proliferate into the mesenchyme. These subdivide and develop into a system of...

Trichoglyphics Introduction and Embryology

The patterning of hair follicles is called trichoglyphics. The hair shaft directional slope is secondary to the plane of the stretch exerted on the skin when the hair follicles are forming. During the first two months of gestation, the embryo is completely hairless. Then the primary hair, called lanugo, starts to grow. The origin of the hair directional patterning is the original sloping angulation of the hair follicle. The hair follicles start to push downward into the underlying mesenchyme at...

Guws Medical Skull

Head Bangings Early Skull Closure

The skull develops from mesenchyme around the developing brain. It consists of two parts the neurocranium (the protection for the brain) and the viscerocranium (the main skeleton of the jaws). The neurocra-nium is further divided into cartilaginous and membranous portion. The cartilaginous neurocranium (or chondrocranium) consists initially of the cartilaginous base of the developing skull which forms by fusion of several cartilages. Later endochondral ossification of the chondrocranium forms...

Patterns Reflected by the Skin

Nervus Peroneus Sensory Innervation

Because the human embryo is originally segmental, various structures reflect a segmental pattern that can be appreciated on the surface of the body. The melanin-producing cells are of neural crest origin and apparently migrate embryologically in a predictable pattern. The pattern was first described by Blaschko. When pigmented streaks reflecting that migration are seen, they are called Blaschko lines Fig. 11.1 . Disorders of pigmentation and mosaicism for two or more genetically different cell...

Eyes

Eyelid Marginal Notching

The eyes develop from three sources the neural ectoderm of the forebrain, the surface ectoderm of the head, and the mesoderm between the two aforementioned layers. Eye formation is first evident at about 22 days gestation, when a pair of grooves called optic sulci appear in the neural folds at the cranial end of the embryo. Soon these sulci form a pair of optic vesicles on each side of the forebrain. The optic vesicles contact the surface ectoderm and induce development of the lens placodes,...

Bibliography

Growth dynamics of low-birth-weight infants with emphasis on the prenatal period. In Human growth. A comprehensive treatise, Vol. 1. ed. F. Falkner and J. M. Tanner , pp. 415-475. Plenum, New Yo rk. Brooke, O. G., Butters, F., Wood, C., Bailay, P., and Tu dkmachi, F. 1981 . Size at birth from 31-41 weeks gestation ethnic standards for British infants of both sexes. Journal of Human Nutrition, 35, 415-430. Georgi, M., Schaefer, F., Wuehi, E. and Schaerer, K. 1996 . Heidelberger...

Ear Width

Definition Width of external ear pinna . Landmarks Measure transversely from the anterior base of the tragus, which can be palpated, through the region of the external auditory canal to the margin of the helical rim, at the widest point Fig. 7.58 . Instruments Tape-measure, calibrated transparent ruler, or calipers may be used. Position The head should be held erect in the resting position with the eyes facing forward. Alternative The infant or young child may be lying prone with the head...

Upper Facial Height Nasal Height

Nasal Spine Measurement With Caliper

Definition Distance from the root of the nose nasion to the base of the nose subnasion . Landmarks Measure from the deepest part of the nasal root nasion to the deepest point of concavity at the base of the nose subnasion , in a vertical plane Figs 7.1 and 7.13 . Instruments Sliding calipers are most accurate. A tape-measure could be used, avoiding the natural curve of the midface. Position Frankfort horizontal, with the facial profile in the vertical. Alternative If the nasal tip is long or...

Ear Position

Ear Position Head

Definition Location of the superior attachment of the pinna. Note the size and rotation of the external ear are not relevant. Landmarks Four methods to determine the position of attachment of the ear are outlined. 1. Draw an imaginary line between the outer canthus of the eye and the most prominent part of the occiput. The superior attachment of the pinna should be on or above this line Fig. 7.62a . 2. Draw an imaginary line through the inner and outer canthi and extend that line posteriorly....

Bony Interobital Distance Cephalometric

Graduated Ruler

Definition The distance between the medial margins of the bony orbit Fig. 7.43 . Landmarks Measure between the medial walls of the orbits, at approximately the level of the junction between the medial angular process of the frontal bone and the maxillary and lacrimal bones the dacrion . Instruments Spreading calipers or a graduated ruler can be used. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Age from birth years Figure 7.43 Bony interorbital distance, birth to 16 years. From Hansman 1966 and...

Normal and Abnormal Hair Patterns

The normal location of the parietal hair whorl is several centimeters anterior to the posterior fontanelle, the majority 56 percent being located slightly to the left of the midline. Thirty percent of hair whorls in normal individuals are right sided, and 14 percent have a midline location. Five percent of individuals have bilateral hair whorls posteriorly. Ninety-four percent of hair whorls are clockwise and 5 percent are counter-clockwise. From the posterior hair whorl, the hair sweeps...

Joint Rom Chart

Normal Range Joint Motion

Measurements of ROM for specific joints are made from the neutral reference position. Obtain this position, then measure ROM of the various specific joints Figs 8.63-8.68 . Instruments A goniometer for measuring angles accurately see Fig. 8.70 . Remarks Newborns have mild limitation of ROM of most joints. Normally during infancy and childhood the ROM increases and is 5-10 degrees greater by puberty. With aging, the ROM of all joints decreases. Hyperextensible joints are found in many conditions...

Interpupillary Distance

Definition The distance between the centers of the pupils of the two eyes. Landmarks Measure between the centers of both pupils Fig. 7.39 . Instruments A graduated transparent ruler is most accurate. A tape-measure can be used stretched in a straight line to avoid curvature of the face. Position The head should be held erect in the resting position with the eyes facing straight forward. This is easiest when the patient is reclining, the eye fissures are horizontal, and the eyes are gazing...

Interalar Distance Nasal Width

Definition Distance between the most lateral aspects of the alae nasi. Landmarks Measure from the lateral-most aspect of one ala nasi to the lateral-most aspect of the ala nasi Fig. 7.72 . Instruments Spreading calipers are the most accurate instruments, although a transparent calibrated ruler or tape-measure can be substituted. Position The patient should be reclining, with the vertical. Remarks Values for nasal width from birth to age 16 years are shown in Fig. 7.73. There is tremendous...

Length of the Philtrum

Definition Distance between the base of the nose and the border of the upper lip, in the midline. Landmarks Measure from the base of the nose subnasion to the superior aspect of the vermilion border of the lip, in the midline Fig. 7.74 . Instruments Ideally the philtral length is measured with spreading calipers however, a calibrated transparent ruler could be used. Position The head should be held in the resting position erect with the eyes facing forward. The observer should be lateral to the...

Analysis of Flexion Creases

Head Circumference

The flexion creases of fingers reflect flexion at the interphalangeal joint those of the palm reflect movement of the hand and the digits against the palm during early in utero development. The flexion creases usually evaluated include those of the fingers and the major flexion creases of the palm. Each finger usually has three transverse Figure 12.8 Normal flexion crease patterns. From Martin and Saller 1962 , by permission. Figure 12.8 Normal flexion crease patterns. From Martin and Saller...

Trigonocephaly And Angels Kisses

Accessory nipple Additional nipple, unilateral or bilateral, on the trunk, lying on the milk linewhich runs caudally from the normal position of the nipples and cranially toward the axilla. acrocephaly Tall or high skull the top of the head is pointed, peaked, or conical in shape usually involving premature closure of the lambdoid and coronal sutures, with a vertical index above 77 also referred to as oxycephaly, turricephaly, and tower skull. acromelic Referring to the distal portion of the...

Orbital Protrusion

Normal Head Circumference Adult

Definition Degree of protrusion of the eye exophthalmos . Landmarks The calibrated end of a Luedde exophthalmometer is held firmly against the lateral margin of the orbit. The long axis of the instrument is held parallel to the long axis of the eyeball. The examiner sights the anterior margin of the cornea through the calibrated scale and reads the distance in millimeters Fig. 7.50 . Instruments A Luedde exophthalmometer for details, see Gerber et al. 1972 . A transparent calibrated ruler could...

Anthropometry

Anthropometry is the study of comparative measurement of the human body. A number of precision instruments are available for accurate anthropometric studies. A decision to use these instruments will depend upon the degree of precision that is desired or required. The pediatrician, physician, medical geneticist, dysmorphologist, or clinician interested in taking precise physical measurements may want to use anthropometric instruments. However, adequate training is necessary to use these devices...

Limb Circumference

Head Circumference Measurements

Definition Circumference of a particular area of a limb, usually at the widest, largest, or maximum point. Landmarks Circumference measurements are taken at the widest or largest diameter of the limb Fig. 8.57 or from a fixed bony point e.g., 10 cm distal to lower edge of the patella . In the upper arm the widest point is at the middle of the biceps, just below the insertion of the deltoid. Position When measuring for maximum circumference, the arm is slightly bent and the lower arm is...

Measurement of Breast Volume

A variety of methods may be used to define the breast volume 1. weighing the breast on a scale, which can be done with pendulous breasts 2. using a water-filled container placed over the breast and into which the breast is placed. Since the volume of water in the container is known, the breast size can be calculated from the amount of water displaced 3. making a cast of the breast, and the volume of the breast is measured from the cast 4. measuring the breast size with a special...

Facial Height

Lower Facial Height

Definition Distance from the root of the nose nasion to the lowest median landmark on the lower border of the mandible menton or gnathion . Lower two-thirds of craniofacies Fig. 7.17 . Landmarks Measure from the root of the nose nasion to the inferior border of the mandible menton or gnathion in a vertical plane Figs. 7.1 and 7.17 . Instruments Spreading calipers give the most reliable measurements. A tape-measure can be used but should be held parallel to the sagittal axis of the face, in...

Analysis of Ridge Patterns

Total Ridge Finger Count

Dermal ridge count To count the dermal ridges of a particular pattern, a line is drawn from the middle or center of the pattern to a triradius a point at which three converging patterns meet Fig. 12.5 . The number of ridges which are crossed by this line or touch the line is counted. The total dermal ridge count for the individual is the sum of the ridge count of the 10 digits. If there are two triradii, as in a whorl, the line is drawn to the most distal triradius. Arch patterns have no ridge...

Lower Facial Height

Definition Length of the lower one-third of the craniofacies Fig. 7.15 . Landmarks Measure from the base of the nose subnasion to the lowest median landmark on the lower border of the mandible menton or gnathion . The menton is identified by palpation and is identical to the bony gnathion. Figs 7.1 and 7.15a . Instruments Tape-measure or spreading calipers. Position Frankfort horizontal, with facial profile in the vertical. The mouth should be closed, with the teeth in occlusion. Remarks This...

Ear Rotation

Outer Canthus Xray

Definition Angulation or rotation of the median longitudinal axis of the external auricle pinna . Landmarks Inclination of the medial longitudinal axis of the ear from the vertical is measured by placing the long side of an angle-meter along the line connecting the two most remote points of the medial axis of the ear see section on measurement of ear length . The vertical axis is then established in one of two ways. 1. The most accurate measurement of the vertical is a line perpendicular to the...

Scalp and Facial Hair Patterning

Hair directional slope is secondary to the plane of stretch exerted on the skin by the growth of underlying tissues during the period of down-growth of the hair follicles at around 10-12 weeks gestation. The posterior parietal hair whorl is interpreted as the focal point from which the growth stretch is exerted by the dome-like out-growth of the brain during the time of hair follicle development. Malformations that antedate hair follicle development, such as encephalocele, produce aberrations...

Bizygomatic Distance Facial Width

Bizygomatic Width

Definition The maximal distance between the most lateral points on the zygomatic arches zygion Fig. 7.19 . Landmarks Measure between the most lateral points of the zygomatic arches zygion , localized by palpation Figs 7.1 and 7.19 . Instruments Spreading calipers will give the most precise results. A tape-measure can be used, but should be held in a straight line parallel to the zygomatic arches avoiding the curves of the zygomata. Position The head should be held erect in the resting position...

Skull Height Forehead Height

Head Circumference And Height

Definition Distance from the root of the nose nasion to the highest point of the head vertex . Landmarks Measure from the depth of the nasal root to the superior-most point of the skull in the vertical plane Figs. 7.1 and 7.11 . Instruments Spreading calipers are most accurate. A tape-measure could be used, being held vertically and avoiding the natural curve of the head. Position The head should be held erect in the resting position with the eyes looking straight forward. The patient should...

Perzentilwerte Hansmann

Growth dynamics of low-birth-weight infants with emphasis on the prenatal period. In Human growth. A comprehensive treatise, Vol. 1, ed. F. Falkner and J. M. Tanner , pp. 415-475. Plenum, New Yo rk. Brooke, O. G., Butters, F.,Wood, C., Bailay, P., and Tudkmachi, F. 1981 . Size at birth from 31-41 weeks gestation ethnic standards for British infants of both sexes. Journal of Human Nutrition, 35,415-430. Hohenauer, L. 1980 . Intrauterine Wachtumskurven fuer den Deutschen...

Outer Canthal Distance

Definition The distance between the outer canthi of the two eyes. Landmarks Measure from the most lateral corner of one eye to the most lateral corner of the other eye, in a straight line avoiding the curvature of the face Fig. 7.36 . Instruments A graduated transparent ruler is most accurate however, a tape-measure or blunt calipers can be used. Position The head should be held erect in the resting position with the eyes open and facing forward. Remarks As with any other measurement, the outer...

Upperto Lower Segment Ratio

Upper Lower Segment Ratio

Definition The ratio of the length of the upper part of the body to the length of the lower part of the body. Landmarks The lower segment is measured from the top of the middle part of the public bone to the sole of the foot Fig. 8.52 . The upper segment is measured from the top of the middle part of the pubic bone to the top of the head. Upper segment and lower segment together equal total height. Instruments Tape-measure or calipers Position The individual is standing upright, and the top of...

Posterior Fontanelle Size

Fontanelle Size

Definition Length of the posterior fontanelle Fig. 7.29 . Landmarks The posterior fontanelle is a triangular structure. Measure from the anterior corner A to the midpoint B on a line connecting the two posterolateral margins created by the occipital bone Fig. 7.29 . Instruments Spreading calipers or a tape-measure can be used. Position The head should be held erect with the eyes facing forward. Alternative The neonate may lie prone. Remarks The posterior fontanelle is usually closed in neonates...

Intercommissural Distance Mouth Width

Head Circumference Measurements

Landmarks Measure from one cheilion corner of the mouth to the other cheilion Fig. 7.78 . Instruments Spreading calipers are best. A tape-measure held straight or a calibrated transparent ruler may be substituted. Position The head should be held erect in the resting position with the eyes facing forward and the mouth held close and in a neutral position. Alternative The young infant or child may lie supine. Remarks The intercommissural distance has been estimated by several authors in spite of...

Nose Classification System

Nasal Shape

The nose is remarkable in its variability, in profile, frontal plane, and from the undersurface. Details and definitions of the soft tissue and bony landmarks are available in references at the end of this chapter and are illustrated in Fig. 7.65a. A qualitative assessment of the nose should include 1. the nasofrontal angle is it normal, flat, or deep 2. the nasal root protrusion is it average, high, or low 3. the nasal bridge is it high, low, broad, beaky, or bulbous 4. the nasal tip is it...

Obliquity Inclination or Slant of the Palpebral Fissure

Palpebral Fissure Slant

Definition Angle of slant of the palpebral fissure from the horizontal Fig. 7.48 . Landmarks A comparison between two lines is necessary. One line connects the inner canthus and outer canthus of the eye. The second line is defined by the Frankfort horizontal FH , a line connecting the lowest point on the lower margin of each orbit, identified by palpation the orbitale , and the highest point on the upper margin of the cutaneous external auditory meatus the porion The slant of the palpebral...

Anterior Fontanelle Size

How Measure Size Anterior Fontanel

Definition The sum of the longitudinal and transverse diameters of the anterior fontanelle along the sagittal and coronal sutures Figs. 7.24-7.28 . Landmarks The index finger should be placed as far as possible into each of the four corners of the anterior fontanelle. These four positions may be marked with a dot immediately distal to the fingertip. The longitudinal and transverse diameters may be measured directly, or a piece of white paper can be firmly pressed over the fontanelle to transfer...

Fontanelles

Fetal Head Fontanelles

Examination of the fontanelles provides evidence of altered intracranial pressure and, less commonly, is an index of the rate of development and ossification of the calvaria, which may be altered in a wide variety of disorders. In order to utilize fontanelle size and patency as a clue to altered morphogenesis, it is necessary to have normal age-related standards. Figs. 7.22 and 7.23 outline the constant and accessory fontanelles present at birth. The most common accessory fontanelle is the...

Sitting Height

Crown Rump Length

Definition Sitting height is the distance from the top of the head to the buttocks when a sitting position. Landmarks Measure from the top of the head to the bottom of the thighs surface on which the patient is sitting Fig. 4.15b,c . Instruments Sitting height table or stadiometer. Position The patients sits straight, eyes looking straight ahead Frankfort horizontal plane . The back of the head, back, buttocks, and the shoulders are in contact with the vertical board. A moveable headboard is...

Head Circumference OFC

Head Circumference Lubchenco

Definition Maximum circumference of the head. Landmarks The maximum head circumference usually horizontal just above the eyebrow ridges , is measured from just above the glabella area to the area near the top of the occipital bone opisthocranion Fig. 6.1 . Position The patient should look straight ahead Fig. 6.1 . Alternative It is often easier, in young infants, to have them stay seated on an adult's lap while measuring the head circumference, and to do the measurement from behind. Remarks The...

Total Body Length

Supine Length Measurement Child

Definition Length of the supine body. Landmarks Measure from the top of the head to the sole of the foot with the patient lying on the back with hips and knees extended Fig. 4.1a, b . Instruments Ideally, measuring table with engraved measurements, a firm headblock, and a moveable footblock Fig. 4.1a . Position For this measurement, ideally, two persons work together. One holds the head of the child, while the other straightens the legs of the child with one hand and moves the footblock toward...