This was an observational type of study which was carried out from March 2018 to January 2020. After getting due approval from both the Institutes: Prakash Institute of Medical Sciences and Research, Urun-Islampur (Ref No.-PSM/PIMSR/24013/2018) and Sumandeep Vidyapeeth University, Vadodara, Gujarat, India (SVIEC/IN/MEDI/PHD/18004) the study was conducted. Total 1500 subjects including 535 males and 965 females from Kolhapur, Sangli, Karad, Satara and Islampur cities, 300 from each city were studied [Table/Fig-1]. The age group of participants was ranging between 18-20 years. After taking written consent from all the participants and No Objection Certificate (NOC) letter from Dean/Principal of respective College, the procedure and purpose of the study was explained to the participants.

[Table/Fig-1]:

Showing places of study in western Maharashtra.

Inclusion criteria: Individuals with normal craniofacial configuration were selected. It was confirmed that all the participants were residing in the respective city from their forefathers after taking personal and family history in brief.

Exclusion criteria: Students who were not resident of Western Maharashtra were excluded from the study and those who were having history genetically transmitted disorders like cleft lip, cleft palate were also excluded from the study.

Calibrated Standard digital Vernier caliper 30 centimeter length with accuracy of (0.01 mm) was used to take facial measurements. All the facial soft tissue landmarks were first marked with the help of skin marking pencil and then the measurements were taken by the author by standing in front of the participants. Keeping both the arms of the caliper on either side of alar of nose similarly on both corners of the mouth (chelion), nose width/alar width (al-al) and mouth width (ch-ch) was measured respectively [Table/Fig-2]. Participants were asked to remain quiet with erect neck with gently closed lips and avoid talking or laughing while taking measurements. All the facial measurements were taken in millimeters. The methodology adopted for the measurements was taken from the guidelines given by Farkas LG in his book-“Anthropometric facial proportions in Medicine” [7].

[Table/Fig-2]:

Showing facial landmarks and naso-oral canon.

Facial Measurements was checked by the validity of one horizontal neoclassical canon, the naso-oral canon in which ideal mouth width (ch-ch) should be equal to one and half times of nose width/alar width (al-al) i.e., (ch-ch)=1.5 (al-al).

Mouth width can be lesser than 1.5 times nose width i.e., (ch-ch) <1.5 (al-al) or mouth width can be greater than 1.5 times nose width i.e., (ch-ch) >1.5 (al-al).

For this the following facial measurements were taken:

1a) Width of Mouth (ch-ch)-distance between right and left chelion; 1b) Width of nose/alar width (al-al)-distance between right and left alar of nose.

All the collected data were subjected to appropriate statistical analysis (mean, standard deviation), p-value. It was analysed by using three way ANNOVA test with type III sum of squares. Software used was R statistical software with 3.5 version.

Nose width/Alar width (al-al)

Mean nose width/alar width in Western Maharashtrian males was found to be significant (p-value <0.001) at 5% level of significance. In general males were having significantly higher alar width as compared to females [Table/Fig-3]. [Table/Fig-4] shows place-wise mean alar width.

Mouth Width (ch-ch)-

Mean mouth width in Western Maharashtrian males was found to be significant. Mean width of mouth was higher for male than females [Table/Fig-5]. [Table/Fig-6] shows place-wise mean mouth width.

According to naso-oral canon, width of mouth (ch-ch) should be one and half times of nose width (al-al). Width of mouth could be lesser or greater than 1.5 times of nose width. In present study, total 68.33% subjects including males and females were having ch-ch <1.5 al-al. Remaining 31.67% subjects were having ch-ch >1.5 al-al. 78.32% males and 62.80% females were with ch-ch <1.5 al-al. Not any subject was found with mouth width equal to 1.5 times of alar width. More details are shown in [Table/Fig-7,8].

Naso-oral canon represents relationship between mouth width and nose width/alar width. According to this canon ideal mouth width (ch-ch) should be equal to 1.5 times of nose width (al-al). Mouth width can be greater or lesser than nose width.

In the present study, ch-ch=1.5 (al-al) was not found among Western Maharashtrian population similar to the results of another study done on Indian and Malaysian women by Kusuagal P et al., [8]. Other studies showed validity of this canon up to some extent by comparing of nose width and mouth width between different ethnicities/population is shown in [Table/Fig-9] [9,10]. Farkas LG et al found 21.7% validation in North American Caucasian [11]. Also it was found valid in 17% each of Turkish males and females by Karaca Sayagili O et al., in 5.9% males and 11.5% females of Southern China by Jayaratne YSN et al., 12.50% males and 12.26% females of Bulgaria by Sivkov S et al., in 0.9% African-American males by Jennifer PP et al., in 6% males and 3% females of Kenya by Virdi S et al. [12-16].

Mouth width less than 1.5 times of alar width was seen in 78.32% of males and 62.80% of females in the present study. Similar results were found in a study done on Singapore, Chinese, Vietnamese, Thais, but mouth width studied in Indian Women by Farkas LG and Christopher R, was significantly less than in present study [9]. Similar distribution was seen in Kenyan individuals, in Indian and Malaysian women, in Turkishand in Southern Chinese and in Bulgarians [Table/Fig-10] [8,12,13,14,16].

Mouth width greater than 1.5 times of nose width was seen in 21.68% of males and 37.20% in females of the present study.

As this study was focused only on five cities of Western Maharashtra, results of it cannot be generalised for Maharashtra as well as for India.

Very few studies are available which have checked the validity of neoclassical canons worldwide, amongst that only few showed conformity about some classical canons. Neoclassical canons can be used in facial aesthetic surgeries in the absence of anthropometric data but cannot be used as ideal proportions as they did not found valid in most of the ethnicities worldwide. Naso-oral neoclassical canon could not found valid in Western Maharashtrian young adults. In 78.32% male and 62.80% female population of Western Maharashtra, mouth width was found lesser than one and half times of nose width.

To generalise it, more extensive researches are required in this field in Maharashtra as well as in India in various ethnic groups. There is a need to study other neoclassical canons, both horizontal and vertical in Maharashtra as well as India.