Sep 2026· Journal of Clinical and Diagnostic Research· 0 citations
TL;DR
The CBCT imaging of the maxillary and sphenoidal sinuses provides valuable morphometric data that can aid in forensic identification, and demonstrate measurable differences across age and gender, supporting their utility as supplementary tools in forensic profiling.
Abstract
Introduction: Age and gender estimation are fundamental in forensic identification, especially in crime investigation, cases of mass disasters and unidentified body remains. Paranasal sinuses, especially maxillary and sphenoidal, are unique, durable, and sexually dimorphic and well-protected within skull, resistant to trauma and decomposition. Cone Beam Computed Tomography (CBCT) enables precise Three-dimensional (3D) morphometric analysis of these anatomical structures, making them valuable markers for forensic age and gender determination.
Aim: To evaluate the morphological (volumetric) characteristics of the maxillary and sphenoidal sinuses using CBCT to assess their potential in forensic age and gender estimation.
Materials and Methods: The present Institutional-based retrospective study was conducted between September 2025 to November 2025 on CBCT archives from Department of Oral Medicine and Radiology, K M Shah Dental College and Hospital, Sumandeep Vidyapeeth (Deemed to be University), Vadodara, Gujarat, India. CBCT Digital Imaging and Communications in Medicine (DICOM) files of maxilla/both arches covering maxillary and sphenoidal sinus was selected for analysis. Total CBCT scans of 142 individuals aged 21-75 years were analysed and volumetric measurements of bilateral maxillary and sphenoidal sinus were recorded by semi-automatic segmentation method using 3D Slicer software and statistically analysed to determine correlations with age and gender. Inclusion and exclusion criteria were strictly applied to ensure sample consistency. For statistical analysis Chi-square test, Mann-Whitney, KruskalWallis tests and Logistic regression analysis were done, p-values less than 0.05 were regarded as statistically significant.
Results: Significant variations in sinus dimensions were observed between different genders and age groups. The median volumes of the maxillary sinus (males: 13,574.75 mm³; females: 11,210.30 mm³) and the sphenoidal sinus (males: 4,918.71 mm³; females: 4,017.23 mm³) were significantly greater in males than in females, with p-values of 0.023 and 0.02, respectively. Correlation analysis revealed a statistically significant (p-value <0.05) negative association between age and sinus volume, with advancing age linked to reduced volumes in the bilateral maxillary sinuses and the right sphenoidal sinus.
Conclusion: The CBCT imaging of the maxillary and sphenoidal sinuses provides valuable morphometric data that can aid in forensic identification. These anatomical structures demonstrate measurable differences across age and gender, supporting their utility as supplementary tools in forensic profiling.
Among the paranasal sinuses, maxillary and sphenoid sinuses show considerable anatomical variation and sexual
dimorphism, making them useful structures in forensic identification. Cone Beam Computed Tomography (CBCT)
allows accurate three-dimensional evaluation of these structures with relatively low radiation exposure. The present
study aimed to assess the usefulness of linear and volumetric measurements of the maxillary and sphenoid sinuses
obtained from CBCT for age and sex estimation in a South Indian population. A retrospective observational study was
conducted using 70 archived CBCT scans comprising 35 males and 35 females between 20 and 70 years of age. Linear
measurements including height, width, and length, along with volumetric measurements of the bilateral maxillary and
sphenoid sinuses, were obtained using RadiAnt DICOM Viewer and ITK-SNAP software. Independent sample t-test
was used for sex comparison, while one-way ANOVA and linear regression analysis were used for age estimation.
Receiver operating characteristic (ROC) analysis was performed to evaluate predictive accuracy. Males generally
exhibited greater linear and volumetric sinus dimensions than females. Statistically significant differences were
observed in left maxillary sinus length (p = 0.04), bilateral maxillary sinus volumes (p = 0.01 and p = 0.04), and
bilateral sphenoid sinus volumes (p = 0.04 and p = 0.01). Among all evaluated parameters, right sphenoid sinus volume
demonstrated the highest predictive accuracy for sex estimation, with an accuracy of 80% for males and 68% for
females. Significant associations were also observed between sinus height, sinus volume, and age groups (p < 0.05).
Regression analysis demonstrated that selected maxillary and sphenoid sinus parameters contributed significantly to
age estimation.
D. V, Poongodi V, A. R et al.· International Journal of Dru...· 0 citations
Introduction: Age and gender estimation from skeletal remains is vital in forensic identification. The mandible, being strong, durable and sexually dimorphic, provides reliable information. Cone Beam Computed Tomography (CBCT) enables accurate Three-Dimensional (3D) evaluation of mandibular structures. Existing two-dimensional (2D) imaging methods are affected by image distortion, while population-specific variations influence mandibular morphology; therefore, CBCT-based reference standards are warranted. The present study focuses on establishing population-specific reference values for forensic age and gender determination.
Aim: To evaluate mandibular ramus dimensions using CBCT for forensic age estimation and gender determination.
Materials and Methods: This retrospective cross-sectional study was conducted in the Department of Oral Medicine and Radiology at Karpaga Vinayaga Institute of Dental Sciences from March 2025 to June 2025. A total of 100 CBCT scans that clearly visualised the mandible and met the primary inclusion criteria of individuals aged 7-58 years were selected using consecutive retrospective sampling. CBCT images (CS 9600, Carestream Dental LLC) were reviewed using Digital Imaging and Communications in Medicine (DICOM) software, and five mandibular ramus parameters-coronoid height, condylar height, ramus height, maximum ramus breadth, and minimum ramus breadth-were measured in millimetres (mm). Age and gender were recorded as demographic variables. Statistical analysis was performed using IBM Statistical Package for Social Sciences (SPSS) version 27.0. Student’s t-test/Welch’s t-test and Analysis of Variance (ANOVA) were used for group comparisons; Pearson correlation and linear regression were used for age association, and discriminant function analysis (Wilks’ Lambda) was applied for gender prediction. A significance level of p≤0.05 was considered statistically significant.
Results: Males showed higher mean coronoid height (61.51±4.42 mm) and condylar height (70.48±6.00 mm) compared to females (55.78±4.19 mm and 64.70±4.28 mm, respectively). Discriminant function analysis correctly classified 78% of individuals, with 34/40 females (85%) and 44/60 males (73.3%) correctly identified. Mandibular ramus height showed a weak and statistically non significant association with chronological age (R=0.206, p=0.121), indicating limited predictive value for age estimation in the studied population.
Conclusion: CBCT-derived mandibular ramus measurements showed significant sexual dimorphism with 78% accuracy for gender determination. However, ramus height demonstrated a weak, non significant association with age, limiting its value for age estimation. Further large-scale studies are warranted.
D. Bhairavi, Mahendra Raj, T. Saravanan et al.· Journal of Clinical and Diag...· 0 citations
Background/Objectives: This study aimed to characterize the three-dimensional morphology of the aerated maxillary sinus using CT-based air-cavity reconstruction and to evaluate its relationship with selected morphometric parameters, septa characteristics, bilateral symmetry, and dental root extension. Methods: This retrospective study included 125 paranasal computed tomography (CT) examinations from 61 males, 64 females (mean age 37.04 ± 15.37 years), corresponding to 250 maxillary sinuses. Three-dimensional air-cavity segmentation was performed using Mimics software following a standardized Hounsfield unit-based thresholding protocol. Morphological patterns of the aerated cavity were classified according to internal compartmentalization and associated morphological features. Morphometric measurements, including ostium-to-sinus-floor distance, axial sinus dimensions, multiplanar septal characteristics, and dental root extension, were recorded and statistically analyzed. Results: Unilocular morphology represented the predominant configuration on both sides (right: 55.2%; left: 53.6%), whereas bilocular and multilocular patterns were less common. Morphologically more complex configurations demonstrated a higher frequency of coronal and axial septa than simple unilocular cavities. Side-to-side differences were identified for ostium-to-sinus-floor distance (p = 0.050), axial longitudinal sinus length (p = 0.027), and pole measurements (p < 0.001). Dental root extension was more frequent on the left side (16.0%) than on the right (6.4%; p = 0.002). Male participants exhibited greater ostium-to-sinus-floor distances and larger axial sinus dimensions than females (all p < 0.05), whereas age showed only a weak negative correlation with left axial transverse sinus length (ρ = −0.191, p = 0.032). Inter-observer agreement for the proposed 18-category three-dimensional morphological classification was substantial (Cohen’s κ = 0.726 for the right side and κ = 0.717 for the left side; both p < 0.001). Conclusions: CT-based three-dimensional air-cavity reconstruction enabled detailed evaluation of the internal morphology of the aerated maxillary sinus. The observed variability in morphological patterns, septa distribution, and selected morphometric characteristics suggests that assessment of the aerated cavity may complement conventional morphometric evaluation of the maxillary sinus. These findings provide a descriptive anatomical reference that may support future radiological, anatomical, and computational investigations of maxillary sinus morphology.
Pelin Ismailoglu, Alp Bayramoğlu, Tuğba Yemiş et al.· Journal of Clinical Medicine· 0 citations
Reliable personal identification remains a major challenge in forensic medicine, particularly in cases involving decomposition, thermal injury, or absence of DNA and dental records. In this context, anatomically protected and morphologically unique structures such as the sphenoid sinus may serve as valuable biometric markers. The aim of this study was to evaluate the forensic applicability of sphenoid sinus morphology using computed tomography (CT), automated segmentation, and three-dimensional (3D) computational analysis. The proposed framework integrates CT-based image preprocessing, automated 3D segmentation using nnU-Net architecture, and geometric comparison of reconstructed sphenoid sinus models through point cloud analysis and deep learning approaches. Morphological variability, spatial configuration, and structural stability of the sphenoid sinus were analyzed as discriminative biometric features. The GSA-Net–based identification model demonstrated high recognition performance, achieving Top-1 accuracies exceeding 97.8% and Top-3 accuracies up to 100% in controlled datasets. The results support the concept that the sphenoid sinus possesses sufficient individuality and anatomical preservation to enable reliable ante-mortem and post-mortem identification. The study highlights the potential of integrating automated segmentation and AI-driven 3D analysis into forensic workflows and emphasizes the importance of standardized imaging protocols and larger annotated datasets for future clinical and forensic implementation.
V. Alekseeva, Marcus Krüger, Florian Zwicker et al.· Electronics· 0 citations
The present study aimed to evaluate the developmental morphometry of the paranasal sinuses using computed tomography (CT) in subjects aged 1-25 years and to characterize age-related changes in sinus dimensions, volume, and surface area throughout childhood, adolescence, and young adulthood. This retrospective CT-based study included 250 subjects (125 females and 125 males) without radiologic evidence of sinonasal pathology. Bilateral morphometric analyses of the frontal, sphenoid, maxillary, and ethmoid sinuses were performed using multiplanar CT images and three-dimensional reconstructions. Measurements included anteroposterior, mediolateral, and superoinferior diameters, sinus volume, and sinus surface area. Significant age-related differences were identified for all morphometric parameters of the frontal, sphenoid, maxillary, and ethmoid sinuses (all p < 0.05). The frontal sinus demonstrated the latest developmental onset, with no measurable pneumatization during infancy and first detectable development at 5 years of age. In contrast, the maxillary and ethmoid sinuses were identifiable in most subjects during infancy, whereas sphenoid sinus pneumatization was identifiable at 2 years of age. Progressive enlargement of sinus dimensions, volume, and surface area was observed throughout childhood and adolescence, with relative stabilization of most morphometric measurements between the postpubescent and young adult groups. Paranasal sinus morphology demonstrates substantial age-related developmental variation from infancy to young adulthood. These findings provide comprehensive morphometric reference data regarding paranasal sinus maturation and may contribute to improved radiologic interpretation, developmental assessment, and safer surgical planning in pediatric and young adult populations.
Ceyda Şevval Çetin, A. Artaş, Ali Atadağ et al.· Clinical anatomy (New York,...· 0 citations
Abstract Objectives To provide clinical and distributional evidence on the prevalence, demographic patterns, laterality distribution, and symptom profiles of maxillary pathologies with secondary maxillary sinus involvement, and to identify statistically significant associations that may refine clinical assessment and interdisciplinary management. Materials and Methods A retrospective observational study was conducted on 400 consecutive patients surgically treated for maxillary pathologies between 2018 and 2022 at a tertiary referral center. Among them, 165 cases demonstrated radiologically and clinically confirmed maxillary sinus involvement based on OPG, CT, CBCT, and intraoperative assessment when applicable. Demographic characteristics (age and sex), pathology type, laterality of sinus extension, and clinical manifestations (pain, dental involvement, voice alteration, and oral malodor) were systematically recorded. Statistical Analysis Associations between pathology type and categorical variables were evaluated using the chi-square test. Fisher's exact test and Monte Carlo simulation (10,000 resamples; 99% confidence intervals) were applied when appropriate. Effect size was determined using Cramér's V. Statistical significance was set at p < 0.05. Results Maxillary sinus involvement was identified in 41.25% of surgically treated maxillary lesions. Odontogenic sinus pathology predominated (27.9%), followed by maxillary cysts (21.2%) and trauma-related lesions (20.0%). Significant associations were observed between pathology type and age (χ 2 (21, N = 165) = 75.55, p < 0.001; V = 0.391), sex (χ 2 (7) = 22.23, p = 0.002; V = 0.367), and laterality (χ 2 (14) = 131.998, p < 0.001; V = 0.632), indicating condition-specific epidemiological patterns. Unilateral involvement was predominant (78.2%). Clinical manifestations demonstrated strong diagnostic associations (all p < 0.001; large effect sizes), particularly for pain, voice alteration, and oral malodor, whereas dental involvement, despite high prevalence (90.3%), showed limited discriminatory value. Conclusions Maxillary sinus involvement follows pathology-specific epidemiological and clinical patterns rather than random distribution. Odontogenic and inflammatory conditions predominated and were commonly associated with unilateral presentation and distinct symptom patterns. These findings provide clinically relevant insights that may contribute to improved diagnostic assessment and interdisciplinary treatment planning in maxillofacial and dental practice.
Algen Isufi, Irina Isufi, A. Meto et al.· European Journal of Dentistr...· 0 citations
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