Health Science

Communication

Biosci. Biotech. Res. Comm. 10(2): 233-240 (2017)

Investigating the relationship between major

thalassemia diseases with anthropometric sizes

of head and facial soft tissue

Alireza Jafari Naimi,

Samaneh Bolourian,

Mahsa Mohammadzadeh,

Mona Farahmand,

Fatemeh Ghanbari

and Sadegh Samiee

Associate Professor Department of Orthodontic, Dental Branch, Islamic Azad University, Tehran, Iran

Dentist, Department of Orthodontic, Dental Branch, Islamic Azad University, Tehran, Iran

3,4,5,6

Orthodontic Assistant Department of Orthodontic, Dental Branch, Islamic Azad University, Tehran, Iran

ABSTRACT

Literature review and aim: according to increasing prevalence of beta thalassemia(thalassemia major) and based on raised concerns

about abnormal head and facial anthropometric besides recognized side effects and etiological importance of these disorders in these

sizes and considering that previous studies lacked investigations about relationship between anthropometric sizes of head and facial

heard tissues with major thalassemia we decided to perform a research aiming at analysis of the relationship between anthropometric

sizes of head and facial soft tissue with major thalassemia and comparing it with normal people.This research was performed by case

control method. Case group consisted 30 patients with thalassemia and control group also included 30 normal people who were approxi-

mately similar to case group considering their age, gender and BMI. Age range of both groups was from 17-35. Clinical examination,

interview, and measuring indicators in both patient and normal group before receiving any treatments including orthodonsy, trauma,

plastic operation in head and facial area. Anatomic points were marked with black oily pencil on meant areas of head and facial. Angle

sizes were recorded by 0/5-degree approximation and linear sizes were recorded by 0/5 approximation. In this research, anthropometric

standard tools for measuring head and face were sliding caliper, measuring tape, Spreading caliper. For comparing both groups, statisti-

cal ANOVA test was used and in order to determine statistical difference between groups, t test was used.Statistical results indicated that

anthropometric indicators of head and facial soft tissue are affected considering comparison of thalassemia and normal groups. In 20

indicators no signi cant difference was observed P<0/02 and in 11 indicators reduction happened (p<0.05) and in the next 10 indica-

tors an increase occurred (p<0.05).Due to anemia, patients with thalassemia are suffered from bone marrow hyperplasia in wide bones

of head and face such as maxilla, frontal, mandible ramus and other deformations, so transverse growth is happening in bones of these

people and consequently their covering soft tissue is growing transversely.

KEY WORDS: MAJOR THALASSEMIA, ANTHROPOMETRIC SIZES, HYPERPLASIA, HEAD AND FACIAL SOFT TISSUE, BONE MARROW

233

ARTICLE INFORMATION:

*Corresponding Author:

Received 2

Feb, 2017

Accepted after revision 12

June, 2017

BBRC Print ISSN: 0974-6455

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234 INVESTIGATING THE RELATIONSHIP BETWEEN MAJORTHALASSEMIA DISEASES BIOSCIENCE BIOTECHNOLOGY RESEARCH COMMUNICATIONS

Alireza Jafari Naimi et al.

INTRODUCTION

First time, in 1925, Thomas Cooley who was children

professor in Detroit, described this disease. Majorthalas-

semia diseases is an inherited blood disease which is

identi ed by producing abnormal hemoglobin products.

Major thalassemia in many countries is being considered

as serious risk for public health. Diagnosis and explana-

tion of oral, jaw and facial abnormalities in these patients

are dentists and oral disease professional’s tasks. Unfor-

tunately, there are few studies on effect of thalassemia

on anthropometric sizes. Clearly, in order to create more

accurate 3 dimensional descriptions from anthropometric

sizes abnormalities in thalassemia patients and to pro-

vide a general treatment there is needed to perform many

researches (Bassimitici 1996). Since bone marrow is main

and essential center for body hematopoiesis, thus during

anemia, this center is activated and make up anemia by

its activation. So due to increase of bone marrow activa-

tion slowly this hematopoiesis center is developed and its

size is increased. Since wide head and facial bones such as

maxilla all have the increase of activity in major thalas-

semia patients so, naturally, deformation of bones in this

area of head and face cause abnormalities in hard tissue

and consequently soft tissue (Karakas 2016).

One side effect of major thalassemia is increase of

upper jaw bone growth and also decrease of lower jaw

bone growth which  nally leads to class two malocculo-

sion (Pakshir, Abu Alhaija 2002, Einy 2016).Thalassemia

syndromes are distinct group of hereditary hematopoie-

sis which their sign was disorder in globin chain produc-

tion (Amini et al, 2016).

A few studies have been performed, or at least

reported, on effect of thalassemia on three dimensional

growth of head and face so far. There are also different

reports on effect of thalassemia on hard tissue pro le

which can cause changes in soft tissue. Some research-

ers reported enlargement of upper jaw is due to over-

expansion of red bone marrow and increased bone vol-

ume which happen for making up healthy red globules

reduction. In contrast, some studies reported that this

disease reduces lower jaw growth. However, considering

different effects of thalassemia on upper jaw and lower

jaw and according to the relationship between changes

of hard tissue and soft tissue, this disease makes changes

in soft tissue pro le.

Based on popularity and increasing prevalence of

beta thalassemia, considering concerns for abnormal

anthropometric form of head and face and also for iden-

ti ed side effects and ethology of these disorders in these

sizes, and based on previous researches we performed a

study relationship between anthropometric sizes of head

and facial hard tissue with beta thalassemia and com-

pare differences of normal people in Iran professional

in rmary of adults thalassemia who were under treat-

ment and control group.

MATERIAL AND METHODS

Population under study included patients aged 17-35

with major thalassemia who were referred to the Iran

adults professional in rmary and they were under treat-

ment. As there were some restrictions and some patients

did not participate, this research was performed by case

control method. Both group are similar considering

age, gender based on BMI entry standards. They were

attended to the examination after providing information

and taking their written consent. Case group included

30 patients with tallassemia (14 females and 16 males

with average age of 29/7±4/2 and 30 normal people (15

females and 15 males with average age of 23/7±3/4).

41 linear and angle indicator in facial area were

measured by Farkas method. Regarded landmarks were

marked with black oily pencil in order not to error hap-

pens in measurement. Applied landmarks in this study

were standard indicators which are used in standard

study of head and facial anthropometric.

In this paper, accurate anthropometric standard tools

made in Insize company from Austria were used for

measurements which has a metric strip, digital sliding

colpier with long jaws, digital coulisse, Digital hook

depth gauge, Digital protractor and level. Tools were cal-

ibrated and their accuracy was 0.01 mm and 0.01 degree.

In general comparison of both groups, in order to deter-

mine statistical difference, t test was applied ( gure 1).

RESULTS AND DISCUSSION

The research was performed on 30 patients with major

thalassemia and 30 people in control group. Under study

population aged 17 to 35. Results are shown as below.

FIGURE 1. Digital sliding coliper with long jaws: A Dig-

ital sliding coliper : B

BIOSCIENCE BIOTECHNOLOGY RESEARCH COMMUNICATIONS INVESTIGATING THE RELATIONSHIP BETWEEN MAJORTHALASSEMIA DISEASES 235

Alireza Jafari Naimi et al.

Table 1. 41 linear and angular indices in face area

Millimeter/

degree

IndexMeasurement area

al-alNose width

sn-prn

Nose outgrowing rate

Nasal bridge

(degree)

Nose bridge inclination

Nasolabial

angle

(degree)

Nasolabial angle

ch-chMouth width

sn-stoUpper lip height

sn-ls

Height of cutaneous

upper lip

ls-sto

Height of upper lip

Vermillion

sn-ls

(degree)

upper lip inclination

sto-sllower lip height

li-sl

Height of cutaneous

lower lip

sto-li

Height of lower lip

Vermillion

sl-li (degree)lower lip inclination

sl-pg

Height of upper part of

chin

pg-gn

Height of lower part of

chin

sl-gnChin height

gn-cThroath length

Mentocer

vical angle

(degree)

Angle of chin/neck

Millimeter/degreeIndexMeasured area

g-op-gHead round

eu-euHead width

g-opHead length

v-nHead height

tr-nForehead height

Nose heightn-sn

Height of 1/3 of middle

face (nose)

n-gn

morphologic height of

face

tr-gn

physiognomic height

of face

n-sto

morphologic height of

upper face

tr-g

Height of 1/3 of upper

face (nose)

Nose heightg-sn

Height of 1/3 of middle

face (nose)

sn-gn

Height of lower 1third

of face

Height of lower

part of face

sto-gnMandible height

zy-zyFace width

go-goMandible width

t-snMaxilla depth

t-gnMandible depth

g-sn (degree)

Upper face pro le

inclination

sn-pg

(degree)

lower face pro le

inclination

pra-paEar width

sa-sbaEar height

en-en

innercorner of theeye

space

ex-exouter theeye space

en-exEye length (left)

In order to determine reliability of measurement

method, all 41 linear and angular indices were measured

for 10 women and 1- mean twice in order not to for-

get previous recorder numbers by project executive with

time intervals. Then correlation between three recorder

numbers were studied by intra class correlation. Finally,

collected data were analyzed in SPSS software for each

person. Shapiro- wilk test cleared that results have nor-

mal distribution. Then (mean±SD) was determined for

each indicator. After that, Con dence interval of each

indicator was estimated in Iranian community by 95%

con dence.

As Pvalue higher than 0/05 indicates that the differ-

ence is not considerable and it is not identi able by eyes

so it is no clinically signi cant. Therefore, in this study

p<0.05 is signi cant. Considering that normality limit

of each indicator is considered as mean±2SD so this was

considered as normal rate for Iranian people and it was

identi ed that what percent of the population are out of

Iranian adult population.

Case group included 30 patients with thalassemia (14

females and 16 males with average age of 29/7±4/2 and

30 normal people (15 females and 15 males with aver-

age age of 23/7±3/4). Both group are similar considering

age, gender, trauma record- head and facial operation-

orthodonsy treatment, and BMI entry standards and

their difference was not signi cant p<0.2.

236 INVESTIGATING THE RELATIONSHIP BETWEEN MAJORTHALASSEMIA DISEASES BIOSCIENCE BIOTECHNOLOGY RESEARCH COMMUNICATIONS

Alireza Jafari Naimi et al.

Head and facial anthropometric indicators of head

and neck anatomic points of under study group are pro-

vided at the following table and they show that:

1. Out of measured indicators in head area which

are provided in table 3, head height index (v-n)

showed maximum difference in compare to thalas-

semia group (thalassemia: 96/99±7/28 and control

group: 5/7±105/3 and head width index (eu-eu)

represented minimum changes. In addition, out of

these indices, head width (p<0.4) was not signi -

cant statistically.

2. Measured indicators in ear area indicated that

out of ear indices, there is no signi cant differ-

ence in earlobe width (par-pa) (thalassemia group:

35/152/7 and control group 35/7±2/6 and earlobe

length (sa-sba) (thalassemia group: 59/95±3/136

and control group 61/4±4/1.

3. Out of eye indices, other than both inner corner

of the eye (en-en) which do not show signi cant

difference with control group. Other parameters

including space between both outer corners of the

eye (ex-ex) and eye gap length (en-ex) showed

signi cant difference and space of both outer

corners of the eye indicated maximum difference

(thalassemia group: 97/29±2/65 and control group

93/5±2/75) in addition, eye gap length of patients

with thalassemia (34/72± 2/04) was more that

control group (31/39±1/8).

4. From anthropometric indices of nose, nose tip

photogene (sn-prn) represented maximum differ-

ence which is signi cant statistically (thalassemia

group: 11/80±1/58 and control group 19/6±2/4).

While nose bridge inclination showed minimum

changes which is not signi cant statistically. In

nose height index (n-sn) there was signi cant re-

lationship between experiment and control group

which illustrated that nose height in patients with

thalassemia is shorter while in other nose indices

such as nose width (al-al) there was no signi -

cant difference. Although nasolabial angle showed

considerable difference (3 degree) in thalassemia

people, it was not signi cant statistically.

5. From facial indices, mandible height (sto-gn)

showed maximum difference in compare to thalas-

semia groups which shows higher heath of mandi-

ble was signi cant statistically among thalassemia

patients (thalassemia group: 48/7±3/25 and con-

trol group 5/125±41/74) and facial morphologic

height indices (n-gn) and physiognomic height of

upper part of face were reduced which indicates

reduction of middle part of face. In addition, man-

dible depth (t-gn) and maxilla depth (t-sn) was not

signi cant statistically p<0.1. Mandible width in-

Table 2. characteristics of people under study in terms of major thalassemia and control groups

Intervening

variable

Major

thalassemia

AgegenderTrauma

Manipulation by

head and face

surgery

orthodonsy

treatment

Another disease

other that

thalassemia

which cause

change of soft

and hard tissues

BMI

Femalemalenormalsufferednormalsufferednormalsufferednormalsuffered

Normal

N=30

23/7±3/4

50%

100%

022/56±3/4

suffered N=3029/7±4/2

46/6%

53/3%

100%

020/12±2/1

BIOSCIENCE BIOTECHNOLOGY RESEARCH COMMUNICATIONS INVESTIGATING THE RELATIONSHIP BETWEEN MAJORTHALASSEMIA DISEASES 237

Alireza Jafari Naimi et al.

Table 3. head parameters

P-valuesufferedNormal

thalassemia

landmark

Parameter name

P<0.00196.99±7.28105.3±5.7(v-n)Head height

P<0.01560.23±2.73562.5±3.45(g-op)Head round

P<0.001185.46±4.86190.55±5.85Cirum (g-op)Head length

P<0.4154.41±2.92155.25±4.65(eu-eu)Head width

Table 4. ear parameters

P-valuesufferedNormal

thalassemia

landmark

Parameter name

P<0.435.15±2.7035.7±2.6(pra-pa)Earlobe width

P<0.0159.95±3.13661.4±4.15(sa-sba)Earlobe length

Table 5. eye parameters

P-valueSufferedNormal

thalassemia

landmark

Parameter name

P<0.431.98±2.37532.5±2.8(en-en)

both inner corners of

the eye

P<0.00197.29±2.6593.5±2.75(ex-ex)

both outer corners of

the eye

P<0.00134.72±2.0431.39±1.8(en-ex)Eye gap length

Table 6. nose parameters

P-valuesufferedNormal

thalassemia

landmark

Parameter name

P<0.133.85±2.3534.75±2.35(al-al)nose width

P<0.0111.80±1.5819.6±2.4(sn-prn)Nose tip photogene

P<0.00150.154±3.0957.6±3.55(n-sn)Nose height

P<0.832.15±5.932.45±5.85(bridge inc)Nose bridge height

P<0.198.55±9.1195.8±9.7Nasolabial angleNasolabial angle

Table 7. facial parameters

P-valuesufferedNormal

thalassemia

landmark

Parameter name

P<0.1107.40±2.86104.45±5.8(go-go)Mandible width

P<0.001118.37±6.51123.75±4.7(n-gn)

Face morphologic

height

P<0.00174.106±3.0877.65±4(n-sto)

Physiognomic height of

upper part

P<0.1125.39±6.78127.9±5.2(t-sn)Maxilla depth

P<0.1142.21±5.69144.4±5.95(t-gn)Mandible depth

P<0.00148.7±3.2541.74±5.125(sto-gn)Mandible height

P<0.001148.11±6.43136.35±4.85(zy-zy)Face width

Alireza Jafari Naimi et al.

238 INVESTIGATING THE RELATIONSHIP BETWEEN MAJORTHALASSEMIA DISEASES BIOSCIENCE BIOTECHNOLOGY RESEARCH COMMUNICATIONS

Table 8. on third of facial area

P-valuesufferedNormal

thalassemia

landmark

Parameter name

P<0.1180.08±10.2183.5±9.7(tr-gn)Physiognomic height of face

P<0.557.32±4.4556.55±6.35(tr-g)Forehead height

P<0.00157.31±6.1466±4.35(g.sn)

Space between glabella and

subnasal

P<0.168.55±4.266.83±5.7(sn-gn)Lower height of face

P<0.0018.67±6.0372.55±3.4(g-sn) inclination

Upper face pro le

inclination

P<0.810.65±7.4610.3±7.25(sn-pg) inclinationlower face pro le

Table 9. upper lip parameter

P-valueSufferedNormal

thalassemia

landmark

Parameter name

P<0.848.86±2.5548.75±3.3(ch-ch)Mouth width

P<0.0223.40±5.2421.1±2.4(sn-sto)Upper lip height

P<0.00121.73±3.7514.1±2.55(sn-ls)

height of cutaneous

upper lip

P<0.26.8±1.427.3±1.6(ls-sto)

Height of upper

vermilion

P<0.0512.03±9.3027.25±8.95(sn-ls) inclinationUpper lip inclination

Table 10. lower lip parameters

P-valuesufferedNormal

thalassemia

landmark

Parameter name

P<0.217.27±2.8418.05±2.05(sto-sl)lower lip height

P<0.59.61±2.899.25±1.85(li-sl)cutaneouslowerlip height

P<0.0018.23±2.089.95±1.65(sto-li)lower vermilion height

P<0.152.34±9.6348.85±8.85(sl-li) inclinationlower lip inclination

dicator (go-go) was increased, it was not signi -

cant statistically (thalassemia group: 107/40±2/86

and control group 5/8±104/45). However facial

width indicator was increased in these patients

and showed signi cant difference in compare to

control group.

6. Out of 1 third of facial indices, space between gla-

bella and subnasal showed maximum difference

in compare to thalassemia groups (thalassemia

group: 57/31±6/14 and control group 66±4/35)

which is indicator of decrease in one third of facial

part in patients. Forehead height and lower height

of face is indicator of decrease and physiognomic

height of face was indicator of increase in patients

with thalassemia but that was not signi cant sta-

tistically upper pro le inclination indicated ex-

crescence of subnasal in thalassemia patents and

it was signi cant statistically. Moreover, difference

in lower pro le inclination of face was not sig-

ni cant in thalassemia patients and control group

statistically P<0/8.

Indicators of mouth width (ch-ch) and height of

upper vermilion (ls-sto) did not show signi cant dif-

ference in compare to control group. However, height

of cutaneousupper lip (sn-ls) and upper lip height (sn-

sto) indicated increased difference which were signi -

cant statistically. Out of them height of cutaneousupper

lip showed maximum difference (thalassemia group:

21/73±3/75 and control group 14/1±2/55).

7. Out of lower lip indices, lower lip inclination (sl-

li inclination) showed maximum difference and

it was increased in patients but it was signi cant

statistically (thalassemia group: 52/34±9/63 and

control group 48/85±8/85) indices of lower vermil-

ion height (sto-li) and height of lower lip was de-

creased out of these two difference, vermilion was

signi cant p<0.001 (thalassemia group: 8/23±2/8

Alireza Jafari Naimi et al.

BIOSCIENCE BIOTECHNOLOGY RESEARCH COMMUNICATIONS INVESTIGATING THE RELATIONSHIP BETWEEN MAJORTHALASSEMIA DISEASES 239

and control group 9/95±1/65). And height of cuta-

neouslower lip (li-sl) indicated signi cant differ-

ence between patients and control group.

8. Out of chin and neck indicators, chin indicators

were all signi cant and they were increased from

which upper height of chin (sl-pg) showed max-

imum difference (thalassemia group: 52/34±9/63

and control group 48/85±8/85) and also throat

length (gn-c) was reduced in this indicators and

that was signi cant and mentocervical angle was

also ncreased however its statistical difference

with control group was not signi cant p<0.5.

One main issue in treatment of jaw and facial abnor-

malities is accessing to anthropometric indicators of

patients in a race group. This study aimed at analysis

of the relationship between anthropometric sizes of

head and facial soft tissue with major thalassemia and

comparing them with Iranian adult’s population. Previ-

ous studies mostly were performed on photography and

cefalometry which were two dimensional documents of a

three dimensional bodies and performed on hard tissue.

In addition, there are many studies performed on iden-

tifying thalassemia effects on anthropometric sizes of

head and facial soft tissue. Results of the study showed

that anthropometric sizes of head and facial soft tis-

sue in patient with control group (healthy people) were

different. It is clear that obtained results can provide

more accurate anticipation in changes of head tissue and

so head and facial soft tissue and cause more precise

orthodonsy of these people. At the following, we provide

parameters of this abnormalities and obtained results.

37 linear indicators and 7 angle index were measured

based on Method F directly on head and facial area. This

study indicated that comparing both groups (control and

thalassemia) proved that in one third of facial indicator

signi cant difference happens. One of these changes is

related to one third of lower part of face which includes

increased mandible and chin height that is derived from

vertical growth of mandible. In addition, in indica-

tors related to one third of facial change we can have

mentioned to space between glabella to subnosal and

physiognomic height of upper part of face was decreased

which generally shows size decrease of this part. Max-

illa had anteriorrotation which is anti-clock wise. Sule

bassimitici researches of Dr Alavai et al and Dr Amini

was compatible with our research results. In addition,

in this study changes rate in indicators of ear were so

inconsiderable which shows that effect of this disease is

not considerable on cartilaginous tissue.

One other difference in head and facial area is related

to nasal area that in these patients photogene of nose tip

is was decreased. Nose height was reduced a lot too. As

it is expected saddle form nose or in other words this rat

looking face was justi ed with decrease of face middle

third part and maxilla protogene. Results of this research

were compatible with Mina and Pakshir.

In compare to control group, some angle change of

face such as pro le inclination of upper face and incli-

nation of upper lip had been increased signi cantly

(p<0/001). One of the most popular changes that hap-

pens in head and facial area of patients is pre maxilla

excess which can be explained in relation with hyper-

plasia of bone marrow. According to this excess which

is along with mandible vertical growth, rat looking face

or leptospirosis with decrease on can be interpreted. Dr

Amini researches also approved those results.

Many studies approve these  ndings; Including

Seyedi and Nabavi Zadehin 2001 who studied jaw and

oral and facial signs. These studies showed that 60/5%

of lower jaw protrusionand 5% had saddle form nose.

Mina and Pakshir also indicated that in patients with

thalassemia some considerable changes such as skeleton

relation class 2 and vertical growth of jaw happened.

In chin and neck zone, neck length throat (gn-c) hap-

pened signi cantly. In case of (g-op) index, head size

has similar change which is approved by Mina and

Pakshir studies. In addition, mandible and Zygomatic

width are increased signi cantly which is approved by

Alavi studies.

CONCLUSION

In patients with thalassemia, hyperplasia of bone mar-

row happens due to anemia so  at bones of face and

head such as maxilla, Frontal and ramus mandible have

lateral growth and change their involved soft tissue .

Table 11. chin and neck parameters

P-valueSufferednormal

thalassemia

landmark

Parameter name

P<0.0116.17±4.58013.5±3.25(sl-pg)Upper height of chin

P<0.00120.55±2.75119.3±2.9(pg-gn)lower height of chin

P<0.0229.55±2.12126.01±2.9(sl-gn)height of chin

P<0.0238.56±6.36742.15±6.4(gn-c)Neck length

P<0.584.01±11.1282.65±13.75Mento cervicalMentocervical angle

Alireza Jafari Naimi et al.

240 INVESTIGATING THE RELATIONSHIP BETWEEN MAJORTHALASSEMIA DISEASES BIOSCIENCE BIOTECHNOLOGY RESEARCH COMMUNICATIONS

REFERENCE

Abu Alhaija ESJ, Hattab FN, Alomari MA, (2002). Cephalo-

metric measurements and facial deformities in subjects with

-thalassemia major. Eur J Orthod 24: 9-19.

Amini F., Jafari A.R., Eslamian L. (2007). “A Cephalometric

study of craniofacial morphology of Iranian children whit B

thalassemia major”. Ortod craniofacial Res 10, 36-44. Postal M.

Amirtouri M. (2012).Soft tissue pro le characteristics in chil-

dren with beta thalassemia major”.Acta Odonatological Scan-

d inavia

Angel EH, (1899). Classi cation of malocclusion. D Cosmos

41:284-264,350-357.

Bassimitici S., Yucel-Eroglu E., Akalar M. (1996). “Effects of

thalassemia major on components of the craniofacial complex.

Br J Ortod, 1996; 23: 157-161.

Caffcy J, (1957). Cooley`s anemia:a review of the congeno-

graphic  nding in the skeleton

Einy S, Hazan-Molina H, Ben-Barak A, Aizenbud D. (2016).

Orthodontic Consideration in Patients with Beta-Thalassemia

Major: Case Report and Literature Review. Journal of Clinical

Pediatric Dentistry. 40(3):241-6.

F.Shahsavari, M. Eslami, M.H. Farhoosh, (2007). Investigating

malocculasionrelationship with beta major thalassemia, scien-

ti c journal of medical scienc university of Semnan, volume 8:4.

H.R. Pakshir, Kh. Mina, (2002). Cephalometric study of skeleton

dimension of head and face in patient with thalassemia under

regular treatments and comparing with patient with thalas-

semia under irregular treatment and normal people. Denstistry

department journal, Shahid Behashti Medical Science Univer-

sity, 548:4-561

Karakas S, Tellioglu AM, Bilgin M, Omurlu IK, Caliskan S,

Coskun S. (2016). Craniofacial Characteristics of Thalassemia

Major Patients. The Eurasian Journal of Medicine. 48(3):204.

M. Vahedi, H. Mortazavi, B. Lati an, Sh. Abdollahzadeh,

(2009). Prevalence of oral facial side effects of patients with

major thalassemia in Ghazvin thalassemia center, journal

of Medical Science University of Iran Islamic Republican of

Army, 7th years: number 3: 217-221

Poyton H.C. and Davey K.W, (1968). Thalassemia: changes vis-

ible in radiographs used in dentistry. oral surgery. Oral medi-

cine & oral pathology, v25, 564-576

Postel, M.C., (1989). No evidence for a defect in growth hor-

mone binding to liver membranes in thalassemia major.

Journal of clinical endocrinology and metabolism, 68(1):

94-98.

Sh. Alavi, A. Eshagh, (2003). comparative study of anthropo-

metric dimensions of craniofacial area of patients with major

thalassemia aged between 17-21 and healthy people in Esfa-

han province. Dentistry journal, 13th volume, number 4.