nasal bone is an important structure in the shape of entire nose . it is bordered superiorly by the frontal bone , laterally by the maxillary bones , and inferiorly by the pyriform aperture . the size and morphology of nasal bone vary between different races , ethnic groups , genders , and ages . nasal bone and pyriform aperture can be examined by a physical and x - ray examination and also the three - dimensional computed tomography [ 1 , 3 ] . objective data can not be obtained in this regard , since the result of physical examination can be different between clinicians . three - dimensional ( 3d ) ct is a perfect technique for obtaining objective data and can be used as a noninvasive preoperative examination [ 1 , 3 ] . this technique provides advanced information about the craniofacial anatomic anomalies , paranasal sinuses , and nasal cavity , as well as dental structures . nowadays , the use of three - dimensional radiographies ( like cone beam computed tomography ) is increasing for diagnosis and treatment in different fields of dentistry [ 4 , 5 ] , such as implant dentistry , maxillofacial surgery [ 6 , 7 ] , orthodontics , and endodontics , in comparing the craniofacial growth of patients with anomalies , and in planning reconstructive surgery on the craniofacial region . the normative data for the bony nasal pyramid dimension among ethnic and gender groups could provide credible references for the estimation of optimal thickness for nasal augmentation and determining the ideal sites for fix - device placement [ 1 , 3 ] . as rhinoplasty and osteotomies become more common , it is necessary to know the ethnic differences not only in nasal bone shape , but also in the bony structures . using an osteotome of an inappropriate size can contribute to excessive intranasal soft tissue trauma , resulting in destabilization , excessive hemorrhage , ecchymosis , and postrhinoplasty aesthetic deformity and asymmetry . proper selection of an osteotome preoperatively ( or having the option to change it intraoperatively ) increases the success of surgery and preserves the maximum amount of mucosa and periosteum . cbct was introduced to promise low - radiation doses with enough image quality , as well as fast processing and lower cost [ 11 , 12 ] . the reliability of linear measurements obtained by cbct was approved in previous researches , concluding that this measurement capability of cbct machine is reliable for structure closely associated with dentomaxillofacial imaging [ 13 , 14 ] . the aim of the present study was to have normative data of nasal bone thickness before reconstructive surgery and nasal augmentation , suggesting the guidelines for choosing the appropriate size of osteotome for the selected iranians through radiography analysis of nasal bone thickness , and to evaluate climate influence and gender on nasal bone shape and thickness . in the present descriptive - analytical study , a total of 74 cbct images of patients who underwent 3d maxillofacial cbct examination in 2012 - 2013 were randomly selected from the recorded archive . all cbct examinations were performed in the relevant conditions ( ma 10 to 42 according to patients ' size , effective radiation time between 2 to 6 seconds , voxel size 0.15  mm ) in isfahan university of medical sciences , oral and maxillofacial radiology department . patients with a history of nasal surgery , facial trauma , or known congenital anomaly were excluded from the study . 37 men ( with the age range of 1969 , mean age of 37 ) and 37 females ( with the age range of 2064 and average age of 34 ) were examined . images were taken by using galileous comfort 3d imaging system ( sirona dental system inc . , bensheim , germany ) , to provide standard radiography , and the patients were held in the image field through using occlusal bite block between their teeth ( according to the manufacturer 's instructions ) . imaging was performed at 7  ma ( 42  mas ) and 85  kvp , with 14-second scan time and 270 rotations . each scan produced 200 projections in a 15  15  15  cm field of view , a charge couple device detector , with 1024  1024 matrix and 0.15 voxel size . then axial , coronal , and sagittal images , as well as 3d model , were reviewed to determine the location of rhinion and nasion . the nasal bone thickness was measured at the sites of the lateral and medial osteotomy lines . a similar measurement was made at the point , halfway between the rhinion and nasomaxillary suture . we also measured the nasal bone length from the frontonasal suture to the end point of the nasal bone in the sagittal view ( figure 3 ) . the width of nasal bone aperture was measured at the widest points in coronal view too ( figure 4 ) . the distance measurements were done twice with one - month interval by the first observer and once by the second observer . intraclass correlation coefficient ( icc ) was used to analyze intraobserver and interobserver reliability of measurements (  = 0.05 ) . finally one sample t - test was performed for comparing dimensional characteristics of the selected iranians ' nasal bones with the acceptable 0.5  mm mean absolute error ( p value < 0.05 ) . according to icc value , the interobserver correlation was 0.966 ( p value < 0.001 ) between two intervals made by the first observer and the intraobserver correlation was 0.995 ( p value < 0.001 ) between the first and the second observer . the mean length of the nasal bone was 23.5 + 3.34  mm in females and 25.7  2.96  mm in males . the mean width of pyriform aperture was 23.77  2.58  mm in females and 25.67  1.79  mm in males ( table 1 ) . nasal bone length and width of pyriform aperture had no significant differences between the genders ( table 2 ) . the mean  sd lateral osteotomy nasal bone thickness was 1.92  0.29  mm in females and 1.73  0.32  mm in males . the medial osteotomy nasal bone thickness was 1.63  0.47  mm in females and 1.94  0.19  mm in males ( table 1 ) . the most frequent surgical procedures performed by plastic surgeons are nasal bone reconstruction and rhinoplasty , while osteotomy was performed blindly with only physical examinations . information concerning the nasal bone and pyriform aperture is quite important , and we ensure better performance during surgery by preoperative evaluation of nasal bone anatomy [ 15 , 16 ] . hwang et al . studied 88 dried skulls from korean adults and measured the height and width of pyriform aperture . height of nasal bone was 25.9 + 3.8  mm in males and 24.5 + 3.7  mm in females . the width of pyriform aperture was 25.7 + 1.7  mm in males and 25.4 + 2.1  mm in females . lang and baumeister reported that german nasal bone length was 24.9 + 3.2  mm and width of pyriform aperture was 23.6 + 1.8  mm . ofodie has studied 20 skulls , 6 skulls from ashant tribe in west africa , 5 black american skulls , 5 austrians in northern europe , and 4 american indian people . ofodie reported that the mean nasal bone length of the ashantis was 21.8  mm , 30.2  mm for austrians , 30  mm for american indians , and 27.9  mm for black americans . the width of pyriform aperture of the ashantis was 26.5  mm , 21.6  mm for austrians , 25.2  mm for american indians , and 23.4  mm for black americans . ofodie concluded that austrians ' nasal bones were the longest and the ashantis had the widest pyriform aperture ( oval shape ) . studied 80 anatolian patients and reported the mean nasal bone length of 30.6  mm in males and 29.01  mm in females . the mean width of pyriform aperture was 18.83  mm in males and 18.19  mm in females . it is concluded that the mean length of nasal bone is longer and the width of pyriform aperture is smaller in anatolian people than in koreans , austrians , and germans . based on comparing various relevant studies , anatolian widths of pyriform apertures were the narrowest whilst the ashantis ' were the widest . the width of pyriform apertures of iranian people was narrower than the ashantis ' and american indians ' and somewhat equal to the koreans ' and germans ' and was wider than the black americans ' , austrians ' , and anatolians ' . the height of iranians ' nasal bones in this study was shown to be shorter than anatolians ' , austrians ' , american indians ' , and black americans ' and somewhat equal to the koreans ' and germans ' and longer than the ashantis . since rhinoplasty is performed more frequently , it is essential to measure the average shape of the nose . this information can be helpful in the clinical field of ent specialists , for anthropological researches . excessive damage can lead to postoperative destabilization , aesthetic deformity , and excessive narrowing [ 18 , 19 ] . it is not necessary for the osteotome blade to cut the entire thickness of nasal bone , because partial thickness fractures produce microfractures [ 20 , 21 ] , so osteotome is to be smaller than the patient nasal bone thickness . greenstick fracture mobilizes nasal bones to narrow the lateral wall and enable correction of deviated noses . however , thick nasal bones make greenstick fractures difficult , so full thickness fractures are required . lee and yang studied 75 korean people and measured nasal bone thicknesses in medial and lateral osteotomy lines . the mean thickness of lateral osteotomy point was 2.06 + 0.36  mm in males and 1.93 + 0.3 in females . the medial point was 1.75 + 0.38  mm in males and 1.78 + 0.35  mm in females . the mere difference in this study as compared to others was only 0.28  mm . the mean lateral osteotomy nasal bone thickness was 2.39 + 0.68  mm and medial point was 1.18 + 0.3  mm . the average bony thickness along lateral osteotomy line at middle level was 2.75 + 0.76  mm and was 2.54 + 0.31  mm along the medial osteotomy point . this study showed that trauma to soft tissues in asian bodies can be minimized by using 2.5 or 3  mm osteotomes . studied 80 patients , whose mean nasal bone thicknesses were 1.85 + 0.32  mm in lateral and 2.08 + 0.17  mm in medial osteotomy line in males and the values showed 2.04 + 0.17  mm in lateral and 1.091 + 0.46  mm in the medial osteotomy point . the mean nasal bone thickness in the present study was 1.79  mm and equal power in both points is needed . there were no significant differences in nasal bone thickness , width of pyriform aperture , and length of nasal bone between the genders in the present research and the data was consistent with other studies . these results can provide a guideline for choosing appropriate size of osteotome contributed to the reduction of postoperative complication associated with osteotomy .
background . 
 the aim of the present study was to have normative data of nasal bone thickness for use before reconstructive surgery and nasal augmentation through radiography analysis . 
 methods and materials . in this descriptive - analytical study , 
 74 patients were selected from people referred to radiology department of isfahan university for cbct examination in 2012 . 
 patients with a history of nasal surgery or facial trauma and known congenital anomaly were excluded from the study . 
 height of nasal bone and width of pyriform aperture and nasal bone thickness in lateral and medial osteotomy line were measured . 
 all these measurements were repeated by two radiologists ; finally one sample t - test was performed . 
 results . 
 the mean thickness of nasal bone on the lateral osteotomy line was 1.92  0.29  mm in females and 1.73  0.32  mm in males ( p value = 0.39 ) . 
 the mean thickness of medial osteotomy line was 1.63  0.47  mm in females and 1.94  0.19  mm in males ( p value = 0.31 ) . 
 the mean length of nasal bone was 23.5  3.34  mm in females and 25.7  2.96  mm in males ( p value = 0.11 ) . 
 the mean width of pyriform aperture was 23.77  2.58  mm in females and 25.67  1.79  mm in males ( p value = 0.25 ) . 
 conclusions . 
 the dimensions of nasal pyramid are known to be significant in choosing suitable osteotome size for reducing surgery side effect . 
 our results can be used for preoperative estimation of nasal bone dimension of people undergoing reconstructive surgery and augmentation .