Simple Summary Frontal sinus patterns are unique amongst individuals. When faced with an unknown decedent, investigators can compare the frontal sinus pattern observed in postmortem radiographs to antemortem radiographs of the suspected individual to make a positive identification. Ideally, the antemortem and postmortem radiographs are oriented in the same exact position, but this can be challenging. This study investigates how slight variations in radiographic orientation affect sinus outlines and potentially impact identification. Frontal sinus models were created from CT scans (21 individuals) and digitally oriented across three clinically relevant views. From each standard orientation (looking straight ahead), eight 5 degrees deviations were obtained in horizontal (left/right), vertical (up/down), and diagonal (e.g., left-up vs. right-down) directions. Within and between individual differences in sinus size and outline shape were assessed. Sinus breadth remained relatively stable across deviations, while sinus height was affected by small vertical deviations. Although radiographic vertical deviations resulted in statistical differences, impacts on outline matches were minimal. However, practitioners need to take particular care in matching radiographic orientation for smaller and/or discontinuous (right and left sides separated) sinuses, which are more likely to lose part of the sinus in more inferiorly oriented views and, thus, could affect various methods of sinus identification. The utility of frontal sinuses for personal identification is widely recognized, but potential factors affecting its reliability remain uncertain. Deviations in cranial position between antemortem and postmortem radiographs may affect sinus appearance. This study investigates how slight deviations in orientations affect sinus size and outline shape and potentially impact identification. Frontal sinus models were created from CT scans of 21 individuals and digitally oriented to represent three clinically relevant radiographic views. From each standard view, model orientations were deviated at 5 degrees intervals in horizontal, vertical, and diagonal (e.g., left-up) directions (27 orientations per individual). For each orientation, sinus dimensions were obtained, and outline shape was assessed by elliptical Fourier analyses and principal component (PC) analyses. Wilcoxon sign rank tests indicated that sinus breadth remained relatively stable (p > 0.05), while sinus height was significantly affected with vertical deviations (p < 0.006). Mann-Whitney U tests on Euclidean distances from the PC scores indicated consistently lower intra- versus inter-individual distances (p < 0.05). Two of the three orientations maintained perfect (100%) outline identification matches, while the third had a 98% match rate. Smaller and/or discontinuous sinuses were most problematic, and although match rates are high, practitioners should be aware of possible alterations in sinus variables when conducting frontal sinus identifications.
