Utility of the morphometry of the maxillary sinuses for gender determination by using computed tomography

Background. It is impossible to use the routine skeletal parts for gender identification if the skeleton of unknown human remains is obtained in a fragmented and incomplete state. The alternative is to use other parts of the skeleton for gender identification. Objectives. The objective of this study was to assess the utility of the morphometry of the maxillary sinuses using computed tomography (CT) for gender determination. Material and methods. The study, approved by the institutional ethics committee, analyzed CT scans of 200 patients (100 males, 100 females). The measurement of the mediolateral (ML), superoinferior (SI) and anteroposterior (AP) dimensions, as well as of the volume and the antero-lateral (AL) angle of both the maxillary sinuses, was performed using a CT scan. Head circumference and head area were also measured on an axial image in order to evaluate the correlation between the sinus volume and the head circumference and head area. Results. The mean of the mediolateral, superoinferior and anteroposterior dimensions, volume and AL angle of the right and left maxillary sinuses showed a statistically significant difference between males and females. Head circumference as well as head area were observed to be greater in males than in females, with a statistically significant difference. A positive correlation was observed between the volume of maxillary sinuses and the head circumference and head area on both sides and in both genders; however, it was not significant. Amongst all the parameters, the left AL angle with a 78.5% accuracy was found to be the best discriminative parameter, followed by the right AL angle with a 73% accuracy. The overall accuracy of the maxillary sinus parameters to identify gender was 86%. Conclusions. The maxillary sinus measurements, as well as head circumference and head area are valuable parameters for sex determination in forensic medicine, with a relatively good accuracy rate. However, the prediction rate can be increased by including the AL angle of the maxillary sinus.