Evaluation of frontal, maxillary, and sphenoid sinus dimensions using computed tomography for sex estimation in adult Turkish population sample

Background: Establishing the identity of human remains is one of the most critical issues of forensic science. The first of two aspects in identifying unknown corpses; is to create a biological profile that allows assigning the deceased to one of the primary groups such as gender, age group, race, and height. Sex is the crucial component of establishing a biological profile. One of the most critical problems of biological profile establishment from the skeleton is the fragmented bones. The fact that the paranasal sinuses are sheltered within the skull bones and are more robust, dense, and minor in structure increases their resistance to external effects and allows more accurate measurements. In this study, gender differences will be investigated by measuring the frontal sinus (FS), maxillary sinus (MS), and sphenoid sinus (SS) on Paranasal Sinus Computed Tomography (CT) images and the discrimination power of paranasal sinus sizes will be compared with each other in terms of sex determination. Materials and Methods: Cases aged 20-49 years who underwent Paranasal Sinus CT for clinical purposes were included in this study. Right and left FS height, depth, width, and distance of both frontal sinus peaks to each other, both MS height, depth, width, midpoint width, intermaxillary length, both SS height, depth, and width of each case were measured twice by two different operators. Inter/Intra Class Correlation Test was applied to test the reliability between observations and observers. R software was used in the statistical analysis of the data. Continuous variables were expressed as mean ± standard deviation, and categorical variables as % (percent). Descriptive statistics are presented with frequency, percentage, mean, median, and standard deviation values. Each sinus measurement in sex determination was analyzed by Receiver Operating Characteristics (ROC) curve analysis. Pearson Correlation or Spearman Rank Correlation coefficients were calculated to examine the relationships between continuous variables. In multivariate analysis, logistic regression analysis was performed using all sinus parameters. The Hosmer-Lemeshow test was used for model fit. A p<0.05 was accepted as a criterion for statistical significance in all tests. Results: In this study, the mean age of men was 30.85±9.06 (min: 20, max: 49), and of women was 32.84±8.74 (min: 20, max: 49). The intraclass correlation coefficient was found to be>0.99. It was determined that 19 of the 22 paranasal sinus sizes measured in the study were larger in men than in women. Bilateral MS height, depth, width, intermaxillary distance, and width of right MS midpoint, right SS height, left SS height, depth, width, and all FS dimensions were significantly more prominent in males than females. Specificity, sensitivity, cut-off value, positive predictive value, negative predictive value, and accuracy rate were calculated for sex determination, and ROC graphs were created. The measurements with the highest accuracy in sex determination were left FS depth (73.5%), right FS depth (73.2%), and right MS height. Logistic regression analysis was performed to determine the usability of paranasal sinus measurements in sex determination. An equation formulated by using the parameters of right FS depth, left FS depth, left FS width, right MS height, right MS depth, right MS width, left MS depth, left MS midpoint width, and left SS height in logistic regression analysis, obtained 75.9% accuracy. Conclusion: Using the formula produced by multiple logistic regression analyses using the dimensions of the three paranasal sinuses, an accurate sex determination could be made with a rate of 75.9%. The study shows that paranasal sinus dimensions can be used in sex determination. Multicenter national studies are required for its use in daily practice.