|Year : 2018 | Volume
| Issue : 2 | Page : 57-61
Evaluation of gender based on the size of maxillary sinus and frontal sinus using paranasal sinus view radiographs in Maharashtra population, India
Nabila Nazz Sheikh1, SR Ashwinirani2, Girish Suragimath3, KM Shiva Kumar4
1 Intern, Bacheolr of Dental Surgeon, School of Dental Sciences, Karad, Maharashtra, India
2 Department Oral Medicine and Radiodiagnosis, School of Dental Sciences, Karad, Maharashtra, India
3 Department Periodontology, School of Dental Sciences, Karad, Maharashtra, India
4 Department Community Dentistry, School of Dental Sciences, Karad, Maharashtra, India
|Date of Web Publication||10-Sep-2018|
Dr Nabila Nazz Sheikh
Intern, Bacheolr of Dental Surgeon, Department of Oral Medicine and Radiology, School of Dental Sciences, Karad, Maharashtra
Source of Support: None, Conflict of Interest: None
Aim: The aim of the study was to analyze gender-based differences in frontal and maxillary sinuses.
Materials and Methods: A total of 100 patients which includes 50 males and 50 females were included in the study, and paranasal sinus (PNS) views were taken. All PNS views were exposed using MARS 50 machine using exposure parameters of 60–70 kVp, 35–40 mA. Height and width of maxillary and frontal sinuses were measured and compared between genders and between the sides.
Results: The side-wise comparison of maxillary sinus height showed higher values on left than right in both males and females, whereas when width was compared, right width was higher than left width in both males and females. The side-wise comparison of frontal sinus parameters both width and height showed higher values on the left side than the right side in both males and females, but the values of both the sinuses were statistically insignificant.
Conclusion: The width of left maxillary sinus and frontal sinus can be used as best discriminate parameter to study sexual dimorphism with an accuracy of 59% and 58% respectively.
Introduction: The basis for forensic identification of unknown deceased persons depends on uniqueness of anatomical structures. Individual identification is a subtle concept and often one of the important priorities in mass disasters, road accidents, air crashes, fires, and even in the investigation of criminal cases.
Keywords: Frontal sinus, maxillary sinus, paranasal sinus view
|How to cite this article:|
Sheikh NN, Ashwinirani S R, Suragimath G, Shiva Kumar K M. Evaluation of gender based on the size of maxillary sinus and frontal sinus using paranasal sinus view radiographs in Maharashtra population, India. J Oral Res Rev 2018;10:57-61
|How to cite this URL:|
Sheikh NN, Ashwinirani S R, Suragimath G, Shiva Kumar K M. Evaluation of gender based on the size of maxillary sinus and frontal sinus using paranasal sinus view radiographs in Maharashtra population, India. J Oral Res Rev [serial online] 2018 [cited 2019 Jun 20];10:57-61. Available from: http://www.jorr.org/text.asp?2018/10/2/57/240925
| Introduction|| |
The basis for forensic identification of unknown deceased persons depends on uniqueness of anatomical structures. Individual identification of person is important in several cases such as mass disasters, road accidents, air crashes, fires, and even in the investigation of criminal cases. Identification of an individual can be done using fingerprint analysis, DNA matching, lip prints, and anthropological methods.
During the 3rd–4th month of intrauterine life, the paranasal sinuses (PNS) develop as evagination or outpouching of the nasal epithelium into the bones surrounding the nasal cavity. Frontal sinus is paired lobulated cavities located posterior to the superciliary cavities in the frontal bone, and each frontal sinus opens into corresponding middle meatus through the infundibulum. They are not apparent at birth and development begins during the 2nd year of life. Frontal sinus is not visible radiographically until the age of 5 years. It is widely accepted that the development of the frontal sinus is completed by about 20 years of age and remains stable until further enlargement of the chambers which occurs as a result of bone resorption during advanced age., Schuller in 1921 first studied frontal sinus and revealed information about its uniqueness in shape, complexity, and individuals, which also included human identification in postmortem cases. Several studies have used frontal sinuses for forensic purposes.
In forensic identification, it is often necessary to use bones that are recovered intact such as the maxillary sinus. The maxillary sinus remains intact even when the skull and other bones may be badly disfigured in victims who are incinerated; thus, it can be used for identification. The first PNS to develop is maxillary sinus which is located in the left and right maxillary bones and consists of two pyramidal-shaped air-filled cavities lined with mucosa. The maxillary sinus tends to appear at the end of the second embryonic month and complete by the age of 18–20 years. The shape and size of the maxillary sinus vary among individuals, between genders, and in various populations. The maxillary sinus stabilizes after the second decade of life, and thus, reliable measurements can be achieved by radiographic images.
Various studies for gender determination have been done in the different parts of the world using radiographs such as PNS view, anteroposterior, cephalometric views, computed tomography (CT), and cone-beam CT. The data regarding the Western part of Maharashtra population were not available; with this background, the present study was designed to analyze gender-based differences in the maxillary sinus and frontal sinus dimensions.
| Materials and Methods|| |
- Patients aged above 18 years
- Patients who were willing to undergo PNS radiograph.
- Patients with a known history of trauma to the maxillofacial region
- Patients with developmental maxillofacial anomaly
- Mentally disabled patients
- Pregnant patients
- Any surgery of the skull
- History or clinical characteristics of endocrine disturbances, nutritional diseases, hereditary facial asymmetries, acromegaly, and Paget's disease
- Radiograph without a well-defined septum in the frontal sinus region.
The study was conducted at Krishna Institute of Medical Sciences, Deemed to be University in Collaboration with School of Dental Sciences, Karad. The ethical clearance was obtained from the institution before the commencement of the study. The consent form was obtained before enrolling the patients in the study. A total of 100 patients which includes 50 males and 50 females were included in the study. All PNS views were exposed using multivariate adaptive regression splines 50 machine using exposure parameters of 60–70 kVp, 35–40 mA.
The following parameters were measured: frontal sinus right height (FRH), frontal sinus right width (FRW), frontal sinus left height (FLH), and frontal sinus left width (FLW). The frontal sinus septum is the partition between the left and right sinuses, and it determines the extent of the width on both sides. The frontal sinus height on each side (FLH and FRH) was measured as maximum distance between the lowest and highest extents of frontal sinus, whereas the width (FRW and FLW) of the frontal sinus was measured as the distance between the medial and lateral most extents of the right and left sides of the frontal sinus [Figure 1]. Maxillary sinus measurements, height and width of the right and left sides, were measured and tabulated [Figure 2]. All measurements were measured in centimeter using a measuring scale in the software. The data were entered in MS Excel sheet and subjected to statistical analysis.
|Figure 1: Paranasal sinus radiograph showing measurements of frontal sinus|
Click here to view
|Figure 2: Paranasal sinus radiograph showing measurements of maxillary sinus|
Click here to view
Statistical analysis was done by calculating the mean and standard deviation of both maxillary and frontal sinus measurements which were calculated and compared. All the measured parameters were subjected to appropriate statistical analysis and then analyzed for unpaired t-test using SPSS version 21.0 Armonk, NY: IBM corp.
| Results|| |
A total of 100 patients (50 males and 50 females) with their age group between 20 and 40 years were considered for the study.
Gender-wise comparison of maxillary sinus height showed higher values on the left side than the right side, whereas width-wise comparison showed higher values on the right side than the left side in both males and females. Overall, the height and width were larger in females than males which was statistically insignificant (P > 0.05) [Table 1].
Classification function coefficients and accuracy level for each parameter in determining gender were done, and the left maxillary sinus width was found to be the best discriminant parameter that could be used to study sexual dimorphism with an overall accuracy of 59% [Table 2].
The frontal sinus parameters (width and height) were measured and compared between males and females. The males had higher values than females, which was statistically insignificant (P > 0.05) [Table 3].
The side-wise comparison of frontal sinus parameters (width and height) showed left side larger values than the right side in both males and females. However, differences in mean values of the parameters were statistically not significant (P > 0.05) [Table 3].
Classification function coefficients and accuracy level for each parameter in determining gender were done, and the left frontal sinus width was found to be the best discriminant parameter that could be used to study sexual dimorphism with an overall accuracy of 58%.[Table 4].
| Discussion|| |
For forensic identification, the frontal sinus morphology makes it a very convenient part because of its typical features. First, it presents a highly variable nature and shows variation even among monozygotic twins., The second feature is its relatively stable structure during adult life. Third, the resiliency of the frontal sinus makes it useful for forensic purposes. It has very strong walls and is preserved intact in human remains as its internal bony structure and arched nature protect it from damage and decomposition. Fourth, most of the times PNS radiographs are commonly taken for diagnostic purposes in many people.,
Identification of gender from remains of human skeletons is an important forensic procedure. The gender can be determined with an accuracy of 100% if the entire skeleton is available. A total of 98% accuracy can be achieved from both the pelvis and the skull. Maxillary sinus continues to pneumatize after birth into the developing alveolar ridge as the permanent teeth erupt. The pneumatization of the sinus ends at the age of 20, with the completion of the eruption of the third molars. It has been reported that genetic diseases, postinfections, and environmental factors can affect the sizes of maxillary sinus. Considering this factor, the patients with disease conditions were excluded from the study.
The current study was designed to analyze gender-based differences in frontal sinus and maxillary sinus dimensions. Comparison of maxillary sinus parameters (height and width) between male and female groups showed higher values in females than males with statistically insignificant differences. The results of our study were in accordance with Urooge and Patil study. The results of our study were contradictory to studies done by Prabhat et al., Fernandes, and Sahlstrand-Johnason et al.
Saccucci et al. conducted a study on gender determination using maxillary sinus by means of PNS. No statistical difference was found in patient's maxillary sinus volumes between genders, and they concluded that it is not possible to use the maxillary sinus to discern sexual difference in corpse identification. Similarly, our results also did not reveal any significant difference between males and females.
Side-wise comparison of maxillary sinus height showed higher values on the left side than the right side, and width-wise comparison showed greater values on the right side than the left side in both males and females without a statistically significant difference. The results were in accordance with Urooge and Patil study.
In our study, accuracy level for each parameter in determining gender was done, and the left maxillary sinus width was found to be the best discriminant parameter that could be used to study sexual dimorphism with an overall accuracy of 59%. Studies done by Urooge and Patil showed that accuracy level for the left maxillary sinus width was 60% which was found to be nearer to the present study. A discriminating analysis performed by Sharma et al. on maxillary sinus measurements showed that the left maxillary sinus width was the best discriminate parameter with an overall accuracy of 61.3% which was slightly higher than our study, whereas study done by Azhar et al. showed that maxillary sinus length was the best discriminant parameter with an overall accuracy of 69.81% in determination of gender.
In the present study, the dimensions of frontal sinus were higher in males than females, which was statistically insignificant. The results were in accordance with Belaldavar et al. study and Sidhu et al. study.
Side-wise comparison of frontal sinus height and width showed higher values on the left side than the right side in both males and females without statistically significant differences. The results were contradictory to Belaldavar et al., Camargo et al., and Jose Marcos et al. studies where they showed that the right side was bigger than the left. The differences in the size of frontal sinus can be attributed to the fact that the morphological differences in the cranium between the two sex are determined mainly by genetic factors, nutritional, hormonal, or muscular factors.,
In our study, accuracy level for each parameter in determining gender was done, and the left frontal sinus width was found to be the best discriminant parameter that could be used to study sexual dimorphism with an overall accuracy of 58%. Similar study on Brazilian population by Camargo et al. found an accuracy of 79.7% in sex determination on the left side. Uthman et al., on Iraqi population using CT scan for the evaluation of frontal sinus and skull measurement in sex determination, found an accuracy of 76.9% in determining the sex by frontal sinus using discriminant functional analysis. However, when they combined skull measurement and frontal sinus measurement, they obtained an accuracy of 85.9% in sex identification.
| Conclusion|| |
Based on results of our study, maxillary sinus and frontal sinus height and width exhibit anatomic variability between genders but without any significant difference. The width of the left maxillary sinus and frontal sinus can be used as the best discriminate parameter to study sexual dimorphism with an accuracy of 59% and 58%, respectively.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Patil N, Karjodkar FR, Sontakke S, Sansare K, Salvi R. Uniqueness of radiographic patterns of the frontal sinus for personal identification. Imaging Sci Dent 2012;42:213-7.
Sr A, Suragimath G, Sande AR, Kulkarni P, Nimbal A, Shankar T, et al.
Comparison of lip print patterns in two Indian subpopulations and its correlation in ABO blood groups. J Clin Diagn Res 2014;8:ZC40-3.
Tatlisumak E, Ovali GY, Asirdizer M, Aslan A, Ozyurt B, Bayindir P, et al.
CT study on morphometry of frontal sinus. Clin Anat 2008;21:287-93.
Cristiane RR, Nader N. Anatomo-radiological and morphometrical study of the frontal sinus in humans. Braz J Morphol Sci 2004;21:53-6.
Camargo JR, Daruge E, Prado FB, Caria PH, Alves MC, Silva RF, et al
. The frontal sinus morphology in radiographs of Brazilian subjects; its forensic importance. Braz J Morphol Sci 2007;24:239-43.
Prabhat M, Rai S, Kaur M, Prabhat K, Bhatnagar P, Panjwani S. Computed tomography based forensic gender determination by measuring the size and volume of the maxillary sinuses. J Forensic Dent Sci 2016;8:40-6.
] [Full text]
Tang JP, Hu DY, Jiang FH, Yu XJ. Assessing forensic applications of the frontal sinus in a Chinese Han population. Forensic Sci Int 2009;183:104.e1-3.
Cox M, Malcolm M, Fairgrieve SI. A new digital method for the objective comparison of frontal sinuses for identification. J Forensic Sci 2009;54 761-72.
Nambiar P, Naidu MD, Subramaniam K. Anatomical variability of the frontal sinuses and their application in forensic identification. Clin Anat 1999;12:16-9.
Naeem TA, Nadia K, Saluja SA, Taseer B, Akhtar H. Evaluation of gender by measuring the size of maxillary sinus using computed tomographic scan in Indian Population. J Int Oral Health 2015;7:88-92.
Urooge A, Patil BA. Sexual dimorphism of maxillary sinus: A morphometric analysis using cone beam computed tomography. J Clin Diagn Res 2017;11:ZC67-70.
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.
Saccucci M, Cipriani F, Carderi S, Di Carlo G, D'Attilio M, Rodolfino D, et al.
Gender assessment through three-dimensional analysis of maxillary sinuses by means of cone beam computed tomography. Eur Rev Med Pharmacol Sci 2015;19:185-93.
Sharma SK, Jehan M, Kumar A. Measurements of maxillary sinus volume and dimensions by computed tomography scan for gender determination. JASI 2014;63:36-42.
Azhar A, Ibrahim G, Salah F. 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;11:271-81.
Belaldavar C, Kotrashetti VS, Hallikerimath SR, Kale AD. Assessment of frontal sinus dimensions to determine sexual dimorphism among Indian adults. J Forensic Dent Sci 2014;6:25-30.
] [Full text]
Sidhu R, Chandra S, Devi P, Taneja N, Sah K, Kaur N. Forensic importance of maxillary sinus in gender determination: A morphometric analysis from Western Uttar Pradesh, India. Eur J Gen Dent 2014;3:53-6. [Full text]
Jose Marcos P, Ralmundo Nonato A, Jose Maldonado V, Patick M, Ana Clara T. Anatomoical variations of the frontal sinus. Int J Morphol 2008;26:803-8.
Verma S, Mahima VG, Patil K. Radiomorphometric analysis of frontal sinus for sex determination. J Forensic Dent Sci 2014;6:177-82.
] [Full text]
Uthman AT, Al-Rawi NH, Al-Naaimi AS, Tawfeeq AS, Suhail EH. Evaluation of frontal sinus and skull measurements using spiral CT scanning: An aid in unknown person identification. Forensic Sci Int 2010;197:124.e1-7.
[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3], [Table 4]