• Users Online: 69
  • Home
  • Print this page
  • Email this page
Home About us Editorial board Ahead of print Current issue Search Archives Submit article Instructions Subscribe Contacts Login 


 
 Table of Contents  
ORIGINAL ARTICLE
Year : 2016  |  Volume : 8  |  Issue : 4  |  Page : 193-198

To evaluate relationship between craniofacial structures and nose in Himachali ethnic population


1 Department of Orthodontics, Himachal Dental College, Sundernagar, Mandi, Himachal Pradesh, India
2 Department of Preventive and Pediatric Dentistry, Himachal Dental College, Sundernagar, Mandi, Himachal Pradesh, India

Date of Web Publication27-Dec-2016

Correspondence Address:
Gaurav Thakur
Department of Orthodontics, Himachal Dental College, Sundernagar, Mandi, Himachal Pradesh
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0976-4003.196815

Get Permissions

  Abstract 

Introduction: The Purpose of this study was to evaluate the relationship between craniofacial structures and nose in Himachali population. Materials and Methods: Sample included 100 Himachali adults (50 male, 50 female), aged 18 to 30 years. 27 parameters were measured on standardised lateral cephalometric radiographs. Which included 15 facial skeleton and 12 nasal parameters. Values of all the parameters obtained were statistically analyzed. Result: Nasal length and Nasal Depth showed positive correlation with the length of maxillary and mandibular jaws and facial height. Nasal hump, Nasolabial angle, Nasal base angle and Columella convexity showed no correlation with the underlying craniofacial structures. Conclusion: Nose, a prominent characterstic of the face, is related to underlying craniofacial structures in Himachali adult population. Himachali males have a longer protrusive nose with nasal tipped downwards and females have a shorter and lesser protrusive nose with nasal tip turned upwards.

Keywords: Cephalometrics and Himachali population, craniofacial structures, nasal parameters


How to cite this article:
Thakur G, Singla A, Jaj H S, Mahajan V, Negi P, Justa A. To evaluate relationship between craniofacial structures and nose in Himachali ethnic population. Indian J Dent Sci 2016;8:193-8

How to cite this URL:
Thakur G, Singla A, Jaj H S, Mahajan V, Negi P, Justa A. To evaluate relationship between craniofacial structures and nose in Himachali ethnic population. Indian J Dent Sci [serial online] 2016 [cited 2017 Jan 19];8:193-8. Available from: http://www.ijds.in/text.asp?2016/8/4/193/196815


  Introduction Top


Cephalometric analysis has long been used for assessment of the bony structures of the face. Craniofacial measurement [1] is an old diagnostic and evaluative tool used in orthodontics.

Cephalometrics has a wide range of application in the field of orthodontics. As orthodontic diagnosis and treatment planning have become more sophisticated and scientific, more attention is given to the skeletal pattern, the amount and direction of facial growth, soft tissue, and position of the dentition.[2] Craniofacial measurements are performed by measuring length and angles defined by craniofacial reference points on lateral cephalogram.

One of the primary goals of orthodontic treatment is to attain and preserve optimal facial attractiveness. To accomplish this, it is important that orthodontist conduct a thorough facial examination, as facial beauty is a function of harmonious balance among all parts of the face (forehead, orbits, zygomas, nose, lips, chin, and throat).[3],[4]

Facial esthetics [2],[3],[4],[5] have interested orthodontists for many years, and although opinions as to what constitutes an attractive face have come from many sources, there is still a considerable lack of information about the mode of longitudinal development of the nose, lips, and soft-tissue chin. This deficiency effectively precludes the development of any scientific-based diagnostic scheme.

Although cephalometric method had been used in numerous studies of the skeletal profile, there are surprisingly very few cephalometric investigations of soft-tissue profile and even less attention has been given to the specific region of the nose.[6]

Nose plays a dominant role in facial esthetics because of its location in the middle of face [4] and is the keystone to facial esthetics.[7] Facial appearance is influenced by form of the nose and its relationship to the other facial structures. Therefore, nasal form and its relationship to the other facial structures play an important part in the assessment of patients before orthognathic surgery,[8],[9] rhinoplasty,[7] and orthodontic treatment. Lateral cephalogram has been proved as a good tool for nasal shape analysis.[7]

Nasal features such as size, shape, and growth of nose vary from race to race along with the other facial characteristics and norms for one population may not fit well for others.[4] Nose can be evaluated by direct clinical examination, photography,[10] or radiography. The latter is the only method capable of simultaneously imaging the soft-tissue profile and the facial skeletal.[7] Lateral cephalometric radiographs have been used in studies of nasal growth and morphology.[4],[6],[11]

Hence, the purpose of this study was to find a relationship between craniofacial structures and nose in Himachali males and females.


  Materials and Methods Top


A total of 100 lateral cephalograms (50 males, 50 females) were included in the study. All the subjects were of Himachal ethnic origin and were residents of Himachal Pradesh from the last two generations. Lateral cephalograms were selected from the records of the Orthodontic Department. All the subjects were viewed by a panel of orthodontists. Following were the inclusion and exclusion criteria for the sample selection in this study.

Inclusion criteria

  1. Well-balanced facial profile
  2. Age between 18 and 30 years
  3. Normal growth and development
  4. Well-aligned maxillary and mandibular dental arches with minor or no crowding
  5. Full complement of teeth present
  6. Good facial symmetry
  7. Himachali ethnic origin (nonmigrants).


Exclusion criteria

  1. Significant medical history
  2. History of trauma
  3. History of orthodontic treatment, maxillofacial or plastic surgery
  4. Facial asymmetry.


Cephalometric radiographs were taken with the patients made to stand in Natural Head Position.[12],[13] The Natural Head Position was recorded based on the method proposed by Cooke and Wei [14] in the year 1989. With Natural Head Position, patient positioning becomes quick, precise, easy, and minimizes the errors caused by incorrect positioning, one of the most frequent reasons for failed radiographs.

All lateral head films were traced on transparent cellulose acetate sheet of 54 µm. Similar conditions of the light box and general illumination were maintained during viewing and tracing of head films. All reference points were identified, located, and marked.

All cephalometric measurements were recorded on acetate paper with a 0.3-mm pencil. To test the reliability of the measurements, ten randomly selected cephalograms were retraced 2 weeks later by the same operator; all measurements were remeasured, and the reliabilities of the parameters were examined.

The following lateral cephalometric landmarks were used to assess the nose [Figure 1]:[9],[15]
Figure 1: Lateral cephalometric landmarks to assess nose.

Click here to view


  1. Glabella (G'): The most prominent point of the frontal bone
  2. Soft-tissue nasion (N): The point of greatest concavity in the midline between the forehead and the nose
  3. Midnasale (Mn): Midpoint N'-Pr
  4. Supratip (St): The point constructed between midnasal (Mn) and pronasal (Pr) on the lower third of the nasal dorsum
  5. Nasion (N): Skeletal nasion
  6. N1: The most concave point of the nasal bone
  7. N2: The most convex point of the nasal bone
  8. Rhinion (R): The most anterior and inferior point on the tip of the nasal bone
  9. Pronasale (Pr): The tip of nose
  10. Columella (Cm): The most convex point on the columellar-lobular junction
  11. Subnasale (Sn): The point at which the columella merges with the upper lip in the midsagittal plane
  12. Alar curvature point (Ac): The most convex point on the nasal alar curvature
  13. Labrale superior (Ls): The point indicating the mucocutaneous border of the upper lip
  14. Soft-tissue pogonion (Pg'): The most anterior point on the soft-tissue chin in the midsagittal plane.


The following reference planes and variables were used to assess the nose [Figure 2]:[4],[15]
Figure 2: Reference planes and variables used to assess nose.

Click here to view


  1. The axis of dorsum: The line constructed through the depth of the soft-tissue nasion to the supratip point
  2. Nasal length: (N'-Pr)
  3. Nasal depth 1: The perpendicular distance between Pr and the line drawn through N' to Sn
  4. Nasal depth 2: The distance between points Ac and Pr
  5. Hump: The perpendicular distance between the axis of the dorsum and the most superior point of the upper part of the nasal dorsum
  6. Nasolabial angle (NLA): The angle formed by the intersection of the Cm tangent and the tangent to the upper lip (Ls)
  7. Nasal-base angle (NBA): The inclination of the nasal base (angle between the G'-Sn line and the long axis of the nostril)
  8. Nasomental angle (NMA): The angle constructed by the axis of the dorsum and the Pr-to-Pg' line
  9. Soft-tissue facial convexity (SFC): The angle between the G'-Sn' line and the Sn'-Pg' line
  10. Lower dorsum convexity (Dconv): The perpendicular distance from the most convex point of the lower nasal dorsum to the Mn-Pr line
  11. Columella convexity (Cconv): The perpendicular distance from the most convex point of columella to the line drawn from Pr to Sn
  12. Nasal bone length (NboneL): The distance from N to R
  13. Nasal bone angle (NboneA): The posterior angle formed between the Nl-N2 line and the N2-R line.


The following parameters were used to assess the facial skeletal framework:[15]

  • Maxillary anteroposterior position
    1. SNA: The angular anteroposterior position of the maxilla to the cranial base
    2. Nperp-A: The linear anteroposterior position of the maxilla to the cranium.
  • Maxillary length
    1. Co-A: The effective maxillary length.
  • Mandibular anteroposterior position
    1. SNB: The angular anteroposterior position of the mandible to the cranial base
    2. Facial angle: The posteroinferior angle between the Frankfort horizontal plane and N-Pg line angle
    3. Nperp-Pg: The linear anteroposterior position of the mandible to the cranium.
  • Mandibular length
    1. Co-Pg: The effective mandibular length.
  • Maxilla to mandible
    1. ANB: The angular anteroposterior position of the jaws to each other used in skeletal classification
    2. Facial convexity: The angle between the N-point A line and point A-Pg line.
  • Facial height
    1. S-PNS: Posterior maxillary height
    2. S-Go: Posterior facial height
    3. N-ANS: Anterior maxillary height
    4. N-Me: Anterior facial height
    5. SNPP: The maxillary inclination to the cranium
    6. GoGnSN: The mandibular plane inclination to the cranium.


Values of all the parameters thus obtained were statistically analyzed.


  Results Top


The present study consisting of fifty males and fifty females was conducted based on 27 parameters. The Pearson correlation coefficient test was used to evaluate the relationship between nasal parameters and craniofacial structures [Table 1].
Table 1: Correlation between nasal parameters and craniofacial structures in Himachali population

Click here to view


Correlation analysis: Correlation of nasal parameters and craniofacial structures in Himachali population

Nasal length showed a moderate positive correlation with the maxillary length (0.296), mandibular length (0.362), posterior facial height (0.394), and low positive correlation with posterior maxillary height (0.255) and anterior maxillary height (0.242).

Nasal depth 1 showed no significant correlation. Nasal depth 2 showed a moderate positive correlation with the maxillary length (0.318), mandibular length (0.351), posterior maxillary height (0.418), and posterior facial height (0.399).

Hump showed no significant correlation.

NLA showed a moderate positive correlation with the angular anteroposterior position of the jaws (0.282) and low positive correlation with the facial convexity (0.237) but low negative correlation with the anteroposterior position of the mandible to the cranium (−0.253).

NBA showed a moderate positive correlation with posterior maxillary height (0.264) but moderate negative correlation with the linear anteroposterior position of the maxilla to cranium (−0.317) and low negative correlation to facial angle (−0.222), linear anteroposterior position of the mandible to cranium (−0.232) and facial convexity (−0.242).

NMA showed a low positive correlation with facial angle (0.209) but moderate negative correlations with the angular anteroposterior position of jaws (−0.403) and facial convexity (−0.242).

SFC showed a moderate positive correlation with angular anteroposterior position of jaws (0.518), facial convexity (0.601), and maxillary inclination to cranium (0.268) but low negative correlation with angular anteroposterior position of the mandible to cranial base (−0.215) and facial angle (−0.199).

Lower dorsum convexity showed a low positive correlation with the maxillary length (0.245).

Columella convexity showed a low positive correlation with maxillary inclination to the cranium (0.214) and moderate negative correlation with angular anteroposterior position of jaws (−0.261).

Nasal bone length showed moderate positive correlation with the anterior maxillary height (0.398), maxillary inclination to cranial base (0.323) and low positive correlation to posterior maxillary height (0.221) and mandibular plane inclination to cranium (0.217) but moderate negative correlation to angular anteroposterior position of maxilla to cranial base (−0.441) and angular anteroposterior position of mandible to cranium (−0.413) and low negative correlation to linear anteroposterior position of maxilla to cranium (−0.230) and facial angle (−0.208).

Nasal bone angle showed no significant correlation.


  Discussion Top


The diagnosis and treatment of malocclusion depend on the knowledge of the form and growth of the human face. The improvement of facial form has always been recognized as one of the prime requisites of satisfactory orthodontic therapy.[12]

The differential growth of skeletal and soft-tissue components within total craniofacial complex has an influence on facial appearance. There have been surprisingly few cephalometric investigations of the soft-tissue profile, and even less attention has been given to the specific region of the nose.[6] Czarnecki et al.[16] reported that the perception of facial appearance was influenced by the form of the nose and its relationship to other parts of soft-tissue profile. Therefore, evaluation of nasal form and its position relative to other facial structures should play an important part in assessment of patients before orthognathic surgery, rhinoplasty, or orthodontic treatment.

Nasal characteristics are related to the person's race, sex, and other facial features.[4] The “ideal” nose is one that is in harmony with the other favorable features of an individual's face. The present study was conducted to evaluate the relationship between craniofacial structures and nose in Himachali population.

The age group was limited to 18–30 years because active nasal development is seen up to 18 years of age and the distinct growth differences between males and females can be discerned after 18 years.[2]

The relationship of nasal features with underlying hard-tissue structures

Enlow [17] reported that the nose of the leptoprosopic face and dolichocephalic skull was quite protrusive, with a convex contour and a tipped-down point. On the other hand, in the brachycephalic skull and euryprosopic facial type, a less protrusive nose tended to be straighter and frequently tipped up. The present study also showed that nasal characteristics were related to facial characteristics.

Pearson correlation coefficient test was conducted to determine the relationship between craniofacial structures and nose. The results [Table 1] showed that the nasal length has a positive correlation with maxillary length (0.296), mandibular length (0.362), posterior facial height (0.394), posterior maxillary height (0.255), and anterior maxillary height (0.242). Nasal depth 2 showed a positive correlation with maxillary length (0.318), posterior maxillary height (0.418), and posterior facial height (0.399). Therefore, nasal length and nasal depth 2 had tendencies to increase with the increase in the length of maxillary and mandibular jaws and facial height. According to Gulsen et al.,[4] it is natural to expect a long nose with an increased prominence (nasal depth) in a long face with long upper and lower jaws. On the contrary, a normal or short nose with decreased nasal depth can be seen in normal or short faces with decreased jaw lengths. Similar findings were reported in the present study. Binder syndrome,[18] a congenital malformation characterized by nasomaxillary hypoplasia due to an underdevelopment of the mid-facial skeleton, also supports our finding that a normal maxillary height will have normal nasal height and decreased maxillary length will have decreased nasal prominence.

Nasal hump showed no significant correlation [Table 1]. This can be attributed to the fact that sample selected in this study had well-balanced facial proportions and had Class I skeletal relationship.[2]

NLA showed a positive correlation with angular anteroposterior position of jaws (0.282) and facial convexity (0.237) and negative correlation to the anteroposterior position of mandible to cranium (−0.253) [Table 1]. This indicates that as angular anteroposterior position of jaws and facial convexity increases, NLA also increases. This is supported by Gulsen et al.,[4] who had similar values but contrary to studies done by Mommaerts et al.[19] and Louis et al.,[20] who reported slight or no change in NLA after surgical advancement of the maxilla. This might be the result of the upward movement of nasal tip and the thinning of upper lip.

NBA showed a negative correlation with linear anteroposterior position of maxilla (−0.317) and mandible (−0.232) to cranium, facial angle (−0.222), and facial convexity (−0.242) [Table 1]. Hence, nasal base inclination (upward facing nostrils) becomes more prominent in retrusive jaw bases. Similar findings were observed in the study done by Gulsen et al.;[4] they reported that a short and protrusive maxilla more often accompanies a shorter and straighter nose than does a long and retrusive maxilla.

NMA showed negative correlation with anteroposterior positioning of maxillary and mandibular jaw bases (−0.403) and facial convexity angle (−0.242) [Table 1], thus confirming the fact that the convexity of the soft-tissue profile is also governed by the position of nose tip. This is in accordance with the study conducted by Gulsen et al.;[4] they concluded that the convexity of the soft-tissue profile is also governed by the position of nose tip.

SFC showed a negative correlation to anteroposterior positioning of mandible (−0.215) and facial angle (−0.199) and positive correlation to anteroposterior positioning of maxillary and mandibular jaw bases (0.518) [Table 1], thus suggesting that more retrusive is mandibular position, more pronounced is SFC. This is proved by the fact that angles Class II malocclusion patients have more pronounced SFC as compared to patients having Class I malocclusion.

Lower dorsum convexity showed a positive correlation with maxillary length (0.245). Buschang et al.[21] conducted a longitudinal examination of the form of the nasal dorsum and divided it into two parts, upper and lower. They reported that the lower nasal dorsum was responsible for the angular changes. This resulted from the downward/backward or upward/forward movements of the pronasal point (this was explained by the relationship between pronasal movement and Anterior nasal spine movement). The parameters of the present study were different from the parameters used by Buschang et al.[21] However, the findings observed in both the studies are similar.

Columella convexity shows a negative correlation to anteroposterior positioning of maxillary and mandibular jaw bases (−0.261) [Table 1]. No significant correlation was seen with the underlying maxilla. This is in accordance with the study conducted by Fitzgerald et al.,[22] who revealed that no significant relationship exists between the soft-tissue profile of the nasolabial region and underlying skeletal structures. Although the parameters used in Fitzgerald et al.'s [22] study were different, they supported the findings obtained in the present study.

Nasal bone length showed a positive correlation to anterior maxillary height (0.398) and posterior maxillary height (0.221) [Table 1]. Therefore, as vertical dimensions are increased, nasal bone length increases which is in accordance with the study done by Enlow,[17] who stated that leptoprosopic face and dolichocephalic skull is long and narrow.

Nasal bone angle showed no significant correlation to underlying facial structures which is in accordance to the study conducted by Gulsen et al.[4]

Following conclusion were drawn from the above-citied findings – increase in nasal length and nasal depth (prominence) was associated with an increase in maxillary length, mandibular length, anterior facial height, and posterior facial height. Nasal hump and NLA showed no relationship with underlying skeletal structures. Nasal base inclination was more in patients having retrusive maxilla and increased inclination was as a result of soft-tissue compensation to deficient underlying skeletal structures. NMA and soft-tissue convexity were related to pronasal (nasal tip) and mandibular position. Lower dorsum convexity depended on underlying maxillary position. Columella convexity showed no relationship to underlying skeletal structures. Nasal bone length was increased with increase in anterior and posterior maxillary height. Nasal bone angle showed no relationship to underlying craniofacial structures.

Hence, from above discussion, it is concluded that all the parts of nose do not follow underlying craniofacial structures. This is further supported by the findings observed in a study done by Subtelny et al.,[23] who stated that all parts of the soft-tissue profile do not directly follow the underlying skeletal profile.


  Conclusion Top


The present study was conducted on 100 adults (50 males, 50 females) of Himachal ethnic origin to investigate the relationship of craniofacial structures and nose. The following conclusions were obtained from the study:

  • Nose, a prominent characteristic of the face, is related to underlying craniofacial structures in Himachali adult population
  • Himachali males have larger protrusive nose with nasal tip tipped downward and females have shorter, lesser protrusive nose with nasal tip turned upward
  • Results of relationship between craniofacial structures and nose in the present study were comparable to the studies done in other population.


Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Steiner CC. Cephalometrics in clinical practice. Am J Orthod 1956;29:8-30.  Back to cited text no. 1
    
2.
Genecov JS, Sinclair PM, Dechow PC. Development of the nose and soft tissue profile. Angle Orthod 1990;60:191-8.  Back to cited text no. 2
    
3.
Peck H, Peck S. A concept of facial esthetics. Angle Orthod 1970;40:284-318.  Back to cited text no. 3
    
4.
Gulsen A, Okay C, Aslan BI, Uner O, Yavuzer R. The relationship between craniofacial structures and the nose in Anatolian Turkish adults: A cephalometric evaluation. Am J Orthod Dentofacial Orthop 2006;130:131.e15-25.  Back to cited text no. 4
    
5.
Shaw WC. The influence of children's dentofacial appearance on their social attractiveness as judged by peers and lay adults. Am J Orthod 1981;79:399-415.  Back to cited text no. 5
    
6.
Chaconas SJ. A statistical evaluation of nasal growth. Am J Orthod 1969;55:403-14.  Back to cited text no. 6
    
7.
Begg RJ, Harkness M. A lateral cephalometric analysis of the adult nose. J Oral Maxillofac Surg 1995;53:1268-74.  Back to cited text no. 7
    
8.
Schendel SA, Carlotti AE Jr. Nasal considerations in orthognathic surgery. Am J Orthod Dentofacial Orthop 1991;100:197-208.  Back to cited text no. 8
    
9.
Connor AM, Moshiri F. Orthognathic surgery norms for American black patients. Am J Orthod 1985;87:119-34.  Back to cited text no. 9
    
10.
Neger M. A quantitative method for evaluation of soft tissue facial profile. Am J Orthod 1959;45:738.  Back to cited text no. 10
    
11.
Robison JM, Rinchuse DJ, Zullo TG. Relationship of skeletal pattern and nasal form. Am J Orthod 1986;89:499-506.  Back to cited text no. 11
    
12.
Coben SE. The integration of facial skeletal variants. Am J Orthod 1955;41:407-34.  Back to cited text no. 12
    
13.
Lundström F, Lundström A. Natural head position as a basis for cephalometric analysis. Am J Orthod Dentofacial Orthop 1992;101:244-7.  Back to cited text no. 13
    
14.
Cooke MS, Wei SH. A comparative study of southern Chinese and British Caucasian cephalometric standards. Angle Orthod 1989;59:131-8.  Back to cited text no. 14
    
15.
Jacobson A. Radiographic Cephalometrics; From Basics to Video Imaging. Chicago: Quintessence; 1995.  Back to cited text no. 15
    
16.
Czarnecki ST, Nanda RS, Currier GF. Perceptions of a balanced facial profile. Am J Orthod Dentofacial Orthop 1986;89:180-7.  Back to cited text no. 16
    
17.
Enlow DH. Facial Growth. 3rd ed. W.B. Saunders Company; 1990.  Back to cited text no. 17
    
18.
Bhatt YC, Vyas KA, Tandale MS, Panse NS, Bakshi HS, Srivastava RK. Maxillonasal dysplasia (Binder's syndrome) and its treatment with costal cartilage graft: A follow-up study. Indian J Plast Surg 2008;41:151-9.  Back to cited text no. 18
[PUBMED]  Medknow Journal  
19.
Mommaerts MY, Lippens F, Abeloos JV, Neyt LF. Nasal profile changes after maxillary impaction and advancement surgery. J Oral Maxillofac Surg 2000;58:470-5.  Back to cited text no. 19
    
20.
Louis PJ, Austin RB, Waite PD, Mathews CS. Soft tissue changes of the upper lip associated with maxillary advancement in obstructive sleep apnea patients. J Oral Maxillofac Surg 2001;59:151-6.  Back to cited text no. 20
    
21.
Buschang PH, Viazis AD, Delacruz R, Oakes C. Horizontal growth of the soft-tissue nose relative to maxillary growth. J Clin Orthod 1992;26:111-8.  Back to cited text no. 21
    
22.
Fitzgerald JP, Nanda RS, Currier GF. An evaluation of the nasolabial angle and the relative inclinations of the nose and upper lip. Am J Orthod Dentofacial Orthop 1992;102:328-34.  Back to cited text no. 22
    
23.
Subtelny JD. A longitudinal study of soft tissue facial structures and their profile characteristics, defined in relation to underlying skeletal structures. Am J Orthod 1959;45:481-506.  Back to cited text no. 23
    


    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1]



 

Top
 
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
Abstract
Introduction
Materials and Me...
Results
Discussion
Conclusion
References
Article Figures
Article Tables

 Article Access Statistics
    Viewed74    
    Printed3    
    Emailed0    
    PDF Downloaded30    
    Comments [Add]    

Recommend this journal


[TAG2]
[TAG3]
[TAG4]