Sex determination based on the evaluation of frontal sinus dimensions and volume using cone-beam computed tomography

Objective: The aim of this study was to evaluate the reliability of sex determination based on the linear and volumetric measurements of the frontal sinus using cone-beam computed tomography (CBCT) data. The study also aimed to demonstrate the potential applicability of frontal sinus morphometry as a complementary method in forensic identification. Method: This retrospective study was conducted using CBCT images obtained for diagnostic purposes from the archives of the Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Pamukkale University. The scans were acquired with a NewTom 5G XL (Cefla, Imola, Italy) device at 110 kV, 3.00–8.73 mA, with an exposure time of 3.6–5.4 seconds and a voxel size ranging from 0.125 to 0.250 mm, using a 21×19 cm field of view (FOV). A total of 250 individuals (125 females and 125 males), aged between 20 and 89 years, with fully developed frontal sinuses and no evidence of sinus pathology were included. Linear measurements (anteroposterior depth, height, and width) were performed according to defined anatomical boundaries, while volumetric measurements were obtained using the 3D Slicer 5.6.2 software with a semi-automatic segmentation method. Results: Significant differences were found between males and females in all linear (depth, height, and width) and volumetric parameters of the frontal sinus (p<0.001). The mean values of all parameters were higher in males than in females. Logistic regression analysis revealed that right depth, left depth, and right width were the strongest predictors for sex estimation. According to ROC analysis, the right depth parameter provided 78.4% sensitivity and 83.2% specificity at a cutoff value of 11.35 mm Conclusion: Frontal sinus measurements obtained from CBCT images provide high accuracy in sex determination. Among these, right and left depth and right width parameters were found to be the most discriminative variables. The findings indicate that frontal sinus morphometry can serve as a reliable and complementary tool in forensic identification. Key words: frontal sinus, cone-beam computed tomography, sex determination