|Year : 2021 | Volume
| Issue : 3 | Page : 91-95
Importance of sexual dimorphism of the maxillary sinus and mandibular inter coronoid distance of Vijayawada City population in Andhra Pradesh: An original research
S Supraja1, A Anuradha2, Vijaysrinivas Guduru2, Mohammad Asif Kiresur2, Mohan Kumar Pasupuleti3, P Vignatha4
1 Department of Oral and Maxillofacial Pathology, Vishnu Dental College, Bhimavaram, Andhra Pradesh, India
2 Department of Oral and Maxillofacial Pathology, St. Joseph Dental College, Eluru, Andhra Pradesh, India
3 Department of Periodontics and Implantology, Vishnu Dental College, Bhimavaram, Andhra Pradesh, India
4 Private Practitioner, Vijayawada, Andhra Pradesh, India
|Date of Submission||24-May-2021|
|Date of Decision||23-Jul-2021|
|Date of Acceptance||20-Aug-2021|
|Date of Web Publication||27-Sep-2021|
Department of Oral and Maxillofacial Pathology, Vishnu Dental College, Bhimavaram, West Godavari District, Andhra Pradesh
Source of Support: None, Conflict of Interest: None
Background: Mass fatality incidents occur due to environmental, medical, vehicle, industrial, or terrorist events that can involve large numbers of victims. Identification of these victims is of utmost importance in these situations. Cone-beam computed tomography (CBCT) may be helpful in some forensic contexts, offering several advantages for postmortem forensic imaging. Aim: The research study aims to evaluate the sexual dimorphism of the maxillary sinus and inter coronoid distance to estimate sex by using CBCT. Materials and Methods: In 40 CBCT scans of 20 males and 20 females, maxillary sinuses height, width and inter coronoid distances of mandible were measured for forensic analysis. In high quality, reconstructed images of bilateral maxillary sinuses, height, and width were measured, and in mandible, inter coronoid was measured in axial view. Results were tabulated and analyzed using an unpaired t-test and discriminant function analysis used to compare differences in the measured parameters between males and females. Results: Mean values of inter coronoid in males and females are (♂ =88.1, ♀ =78.1). The maxillary sinus right side height and width (♂ =32.2, ♀ =24.6) (♂ =19.7, ♀ =19.6) left side height and width (♂ =32.7, ♀ =23.6) (♂ =18.1, ♀ =17.8), respectively. A statistically significant (P < 0.05) difference was found in maxillary sinus and inter coronoid distance between males and females. Results showed significantly larger dimensions of maxillary sinus and inter coronoid distance in males compared to females. The correct predictive accuracy rate of sex determination was 100% in females and 90% in males with overall accuracy of 95%. Conclusion: The present study showed the importance of maxillary sinus dimensions and inter coronoid distance in sex estimation using cone-beam computed tomography in forensic medicine.
Keywords: Cone-beam computed tomography, inter coronoid distance, maxillary sinus
|How to cite this article:|
Supraja S, Anuradha A, Guduru V, Kiresur MA, Pasupuleti MK, Vignatha P. Importance of sexual dimorphism of the maxillary sinus and mandibular inter coronoid distance of Vijayawada City population in Andhra Pradesh: An original research. J Forensic Sci Med 2021;7:91-5
|How to cite this URL:|
Supraja S, Anuradha A, Guduru V, Kiresur MA, Pasupuleti MK, Vignatha P. Importance of sexual dimorphism of the maxillary sinus and mandibular inter coronoid distance of Vijayawada City population in Andhra Pradesh: An original research. J Forensic Sci Med [serial online] 2021 [cited 2022 Oct 2];7:91-5. Available from: https://www.jfsmonline.com/text.asp?2021/7/3/91/326801
| Introduction|| |
Identification plays an important role in forensic science by which characteristic results can be framed to determine physical or chemical identity. Individual's identity can be established by traditional identification methods such as dactyloscopy, odontology, and molecular genetic analysis.
Forensic anthropology methods can be used as means of personal identification, particularly when there is limited applicability of traditional identification methods. The Board members of the Forensic Anthropology Society of Europe argue that forensic anthropology methods can be used as means of personal identification.
Thus, forensic anthropology is widely adopted as a guide in the management of the identification process for legal and medical professionals in mass fatalities. The difficulty of obtaining antemortem data on primary identification parameters was also encountered in few situations like the aftermath of the 2004 Indian Ocean Earthquake and Tsunami, Hurricane Katrina, and the Haiti earthquake, large scale disasters, and the Deaths at the Borders Database are the fewer challenges for primary identification which is extremely difficult without antemortem data.
During challenging situations, forensic anthropological approaches, may render helping hand for the identification of the decedent and give enough evidentiary value for identification by its identification methods based on external morphological and skeletal features of the human body.,
Sex estimation is one of the important components to identify person's biological profile. Sex estimation can be done by using different regions of the human skeleton. Most of the forensic anthropologists use both quantitative and qualitative methods for sex estimation. Qualitative methods (23.9%) are most preferred when it comes to comparison with quantitative methods (12.5%).,
Many of the qualitative methods used for sex estimation are based on subjective interpretations of the skull and pelvic traits. According to the Klales (2013) survey, the most preferred traits for morphological cranial sex estimation are nuchal crest, mastoid process, supraorbital margin, glabella, and mental eminence.,, In this study, we used inter coronoid distance of mandible and dimensions of the maxillary sinus in sex estimation.
Disaster victim identification (DVI) is essential in many fatality incidents, irrespective of cause or number of casualties; victim identification is the first task. Human identification investigators should have a legal responsibility to identify every individual to be returned to their families. Mass fatality incidents generate many victims, often suddenly and unexpectedly, and victim identification is generally achieved by following DVI protocols.,
Identifying deceased individuals involved in the mass disaster is not always reliable or possible but depends on the availability and quality of antemortem information for each victim. Examining the deceased externally may reveal characteristics such as tattoos, scars, and fingerprints, which help confirm identity. Therefore, the credibility of information increases as the human identification expert passes from circumstantial evidence into physical evidence.
Sex has long been estimated from the skull, the pelvis, and the long bones with an epiphysis and a metaphysis in unknown skeletons. The aim of this study was to investigate whether the width, the height of the maxillary sinuses, and inter coronoid distance of the mandible could be used for the estimation of sex in forensic sciences.,,
| Materials and Methods|| |
All the necessary permissions from the institutional review board were obtained before starting the study. The human subjects ethics board approved under SJDC/Ethical/March/2016–18/OP/1 and this study was conducted by following the Helsinki Declaration of 1975, as revised in 2013.
Study design and subjects
The study was conducted in cone-beam computed tomography (CBCT) center attached to a dental clinic on 20 male patients and 20 female patients. Adults aged between 20 and 40 years of age population from Vijayawada city in Andhra Pradesh were included in the study. Identity proofs were taken from all the participants to confirm that the recruited participants belonged to the same region.
Only high-quality reconstructed images of bilateral maxillary sinuses, height, and width were measured, and in mandible, inter coronoid distance was measured in axial view in the same patients [Figure 1] and [Figure 2]. CBCT images analysis done on axial plane and images captured at 56–90Vp, 8–15 mA with time pulse 5–12 s. NewTom GiANO HR 2D CEPH-CBCT machine 0.5MM (68–300 micron voxel), India.
|Figure 1: The straight distance between most lateral points on two coronoids recorded in the axial view of cone-beam computed tomography image|
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|Figure 2: Maxillary sinus height: Measurement of the maximum distance from the lowest point of the maxillary sinus floor to the uppermost point of the roof defined as the height of left and right maxillary sinuses in coronal view of cone-beam computed tomography image. Maxillary sinus width: Measurement of width (the greatest distance from the most medial point of the sinus to the most lateral point of the sinus) of left and right maxillary sinuses in the axial view of cone-beam computed tomography image|
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Sample size calculation
Hundred samples analysis was done to include it into the study group. Calculations to determine the sample size were performed to measure inter coronoid distance and maxillary sinus dimensions as primary outcome measures using G*Power (Erdfelder, Faul, & Buchner,1996) designed as a general stand-alone power analysis program was used for statistical tests. The calculations were based on an effect size of 1.195, an alpha level of 0.05 with desired power of 80%.
The study group included regular patients without any abnormalities.
All the CBCT images were recorded by the principal investigator under the supervision of oral medicine and radiologist.
- The blurred images or artifacts caused by metallic objects were excluded and
- The scans that were not covering the entire extent of the maxillary sinus and inter coronoid process were excluded
- Scans with tumor, trauma, cleft, or any other disease within or in the vicinity of the sinus or previous surgery were excluded from this study.
All the data were transferred to Microsoft Excel 2003 software and subjected to statistical analysis where the comparison between gender groups was made with the help of unpaired-”t” test and discriminant function analysis used to compare differences in the measured parameters between males and females. A statistically significant (P < 0.05) difference was found in the maxillary sinus and inter coronoid distance between males and females.
| Results|| |
In the present study, the parameters' overall values were significantly greater in males than females. [Table 1] shows the descriptive analysis of the parameters of the right and left maxillary sinuses' width, the height of right and left maxillary sinuses, and inter-coronoid distance. Significant mean differences were observed among all the three parameters between the two sexes [Figure 1] and [Figure 2].
|Table 1: Minimum and maximum values, the mean and standard deviation of maxillary sinus height, width, and inter coronoid distance in males and females|
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Mean values of inter coronoid distance in both males and females are (♂ =88.1, ♀ =78.1). The maxillary sinus right side height and width are (♂ =32.2, ♀ =24.6) (♂ =19.7, ♀ =19.6) and left side height and width are (♂ =32.7, ♀ =23.6) (♂ =18.1, ♀ =17.8), respectively. A statistically significant (P < 0.05) difference was found in maxillary sinus and intercoronoid distance between males and females. Results showed significantly larger dimensions of the maxillary sinus and inter coronoid distance in males compared to females.
[Table 1] shows the mean, standard deviation, and P value of all predictor variables for males and females. According to the Student's t-test, there was a statistically significant difference between males and females in the right maxillary sinus height, left maxillary sinus height, and the right maxillary sinus width, left maxillary sinus width, and inter coronoid distance.
Maxillary sinus height varied in both males and females when compared to their right and left sides. Maxillary sinus width does not vary in both males and females when compared to their right and left sides.
Based on the discriminant analysis, the most pronounced variable in the differentiation of sex groups in this study was the inter coronoid distance. The sex predictability was the highest for inter coronoid distance, followed by right side maxillary sinus height, left side maxillary sinus height, right side maxillary sinus width, and the lowest for left side maxillary sinus width. Sex assessment was established correctly with an accuracy of 100% for females and 90% for males with a mean of 95%.
For sex estimation, a discriminant function score was obtained from the measured variable:
D = ‒14.945+ (0.031 × ICD) + (‒0.097 × height Rt) + (0.392 × ht Lt) + (0.555 × Width Rt) + (‒0.344 × width Lt)
D score greater than zero indicates male and less than zero indicates female.
| Discussion|| |
The difference in the form of appearance between males and females of the same species which is called sexual dimorphism is the initial steps in a personal identification of the deceased, narrowing down the diagnosis toward a correct possibility. Most bones used for sex estimation are the pelvis, skull, and long bones, especially in catastrophes such as explosions, warfare, natural calamities, and other mass disasters like aircraft crashes. It has been reported in many research studies that zygomatic bones and maxillary sinus remain intact, although the other bones may be badly disfigured in incinerated victims.,,
The emerging imaging modality of CBCT provides images representing a series of continuous cross-sections like computerized tomography, thus providing three-dimensional (3-D) information of an entity within an object that can be studied in an integrated and interactive manner which permits multiplanar sectioning, virtual dissection. The scans of the specimen can later be compared to any possible variety of submitted antemortem.,
Specific studies on 3D reconstruction, bite-mark analysis, age estimation, person identification, and anthropological assessment have done using CBCT with promising results. It gives us a chance to use CBCT in forensic medicine. CBCT can be helpful in some forensic contexts, offering several advantages for postmortem forensic imaging, including good resolution for skeletal imaging, relatively low cost, portability, and simplicity.,
Teke et al. in 2007 studied width, length, and the height of the maxillary sinus in 127 adult patients by CT and observed that the measurements of the maxillary sinuses of males are larger than those of females. The mean estimated rate of sex was detected at 69.3%.
The study conducted by Kadam et al. on one hundred and 57 (male 84 and female 73) dry mandible of Maharashtra region showed a variation of shape in both sides' coronoid process and the inter coronoid distance. Results showed that mean inter coronoid distance among males was found to be 9.2000 and 9.100 in females.
According to Dr. Mrs. Doshi's (1989) study showed the distance was 9.41 cm, and the mean of inter coronoid distance was 9.23 cm in male and female mandibles.
A study conducted by Shahnaz S. Tambawala to quantify the measurement of the maxillary sinus in their showed that the maxillary sinus height is the most reliable discriminant parameter and can be used for sex estimation and reliability, usability, and accuracy of CBCT for evaluating maxillary sinus dimensions in the field of forensic science. Fernandes and Sahlstrand-Johnson et al. stated that the maxillary sinus volume's mean value was significantly more significant in males than in females.
Many of the research studies have clearly showed that the maxillary sinus exhibited anatomic variability between sexes.,,, In the present study, while a significant sex difference was found in the height and width of the maxillary sinus. We also considered inter coronoid distance in which sex assessment was established correctly with an accuracy of 100% in males and 85% for females These results were in line with the findings reported by Fernandes.,,,,
In this study, among the measured parameters, the inter coronoid distance was the best discriminating variable for sexual dimorphism., Then, the maxillary sinus height and width showed as the discriminating variable which was consistent with the study done by Ahmed et al. indicated that maxillary sinus width was the best discriminant parameter.
| Conclusion|| |
Technology to produce 3-D images of your teeth, soft tissues, nerve pathways, and bone in a single scan and can be recorded for years. 3-D images of CBCT can be used to correlate between antemortem and postmortem records, which aids in the identification of the deceased. The overall parameters were significantly more in the males as compared to the females. The present study proposes the importance of sexual dimorphism of the maxillary sinus, in particular its height when all the methods used in the field of forensics seem to be inconclusive. It suggests the use of CBCT in forensics. Thus, this study has shown the importance of sexual dimorphism of maxillary sinus dimensions and inter coronoid distance in sex estimation by the use of CBCT in forensics.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Hans de Boer, Zuzana Obertová, Eugenia Cunha, Pascal Adalian, Eric Baccino, Tony Fracasso. Strengthening the role of forensic anthropology in personal identification: Position statement by the Board of the Forensic Anthropology Society of Europe (FASE). Forensic Sci Int 2020;315:110456.
Klales AR. MorphoPASSE: Morphological pelvis and skull sex estimation program. In: Klales AR, editor. Sex Estimation of the Human Skeleton. History Methods and Emerging Techniques. Academic Press: Elsevier Inc.,; 2020. p. 271-8.
Teke HY, Duran S, Canturk N, Canturk G. Determination of gender by measuring the size of the maxillary sinuses in computerized tomography scans. Surg Radiol Anat 2007;29:9-13.
Jaju PP, Jaju SP. Clinical utility of dental cone-beam computed tomography: current perspectives. Clin Cosmet Investig Dent 2014;6:29-43.
Lee KM, Lee WJ, Cho JH, Hwang HS. Three-dimensional prediction of the nose for facial reconstruction using cone-beam computed tomography. Forensic Sci Int 2014;236: 5.e1-5.
Amin MF, Hassan EI. Sex identification in Egyptian population using Multidetector Computed Tomography of the maxillary sinus. J Forensic Leg Med 2012;19:65-9.
Tambawala SS, Karjodkar FR, Sansare K, Prakash N. Sexual dimorphism of maxillary sinus using CBCT. Egypt J Forensic Sci 2016;6:120-5.
Kadam SD, Roy PP, Ambali MP, Doshi MA. Variation in the shape of coronoid process in drymandible of Maharashtra population. Int J Anat Res 2015;3:895-8.
Tapas S. Morphological variations of coronoid process in Dry adult Human Mandibles. Indian J Basic Appl Med Res 2014;3:401-5.
Fernandes CL. Forensic ethnic identification of crania: The role of the maxillary sinus – A new approach. Am J Forensic Med Pathol 2004;25:302-13.
Sahlstrand-Johnson P, Jannert M, Strömbeck A, Abul-Kasim K. Computed tomography measurements of different dimensions of maxillary and frontal sinuses. BMC Med Imaging 2011;11:8.
Farias Gomes A, de Oliveira Gamba T, Yamasaki MC, Groppo FC, Haiter Neto F, Possobon RF. Development and validation of a formula based on maxillary sinus measurements as a tool for sex estimation: A cone beam computed tomography study. Int J Legal Med 2019;133:1241-9.
Paknahad M, Shahidi S, Zarei Z. Sexual dimorphism of maxillary sinus dimensions using cone-beam computed tomography. J Forensic Sci 2017;62:395-8.
Przystańska A, Rewekant A, Sroka A, Gedrange T, Ekkert M, Jończyk-Potoczna K, et al.
Sexual dimorphism of maxillary sinuses in children and adolescents – A retrospective CT study. Ann Anat 2020;229:151437.
Brough AL, Morgan B, Rutty GN. Postmortem computed tomography (PMCT) and disaster victim identification. Radiol Med 2015;120:866-73.
Cohen O, Warman M, Fried M, Shoffel-Havakuk H, Adi M, Halperin D, et al.
Volumetric analysis of the maxillary, sphenoid and frontal sinuses: A comparative computerized tomography based study. Auris Nasus Larynx 2018;45:96-102.
Ahmed AG, Gataa IS, Fateh SM, Mohammed GN. CT scan images analysis of maxillary sinus dimensions as a forensic tool for sexual and racial detection in a sample of Kurdish population. Eur Sci J 2015;11:272-81.
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