Reliability Assessment of Cone-Beam Computed Tomography Images of Maxillary and Frontal Sinuses for Age Estimation and Sex Determination: A Cross-sectional Study

Background: Sex determination and age estimation in forensic medicine are important for identification. In this study, the volume and dimensions of the maxillary and frontal sinuses (FS) derived from cone-beam computed tomography (CBCT) images were measured, and their reliability in gender identification and age estimation underwent evaluation. Methods: The CBCT of 240 patients, including 112 males and 128 females, was performed at 18–51 years old. The images were converted to DICOM format and entered the semi-automated segmentation software ITK-SNAP 3.6.0 beta that measured the volume, length, width, and height of the FS, right maxillary sinus (RMS), and left maxillary sinus (LMS). Discriminant analysis was used to assess the reliability of the dimensions and volume of frontal and maxillary sinuses for determining gender and age estimation. In addition, the Pearson correlation coefficient was utilized to evaluate the relationship between quantitative and age variables. Results: The dimension and volume of FS, RMS, and LMS were significantly higher in males than in females (P<0.05). By measuring the volume and dimensions of these sinuses, it is possible to correctly identify individuals with an overall accuracy of 80%. These parameters do not significantly differ at different ages. Conclusion: The volume and dimensions of FS, RMS, and LMS derived from CBCT images have a high ability to determine gender. Therefore, these variables can be employed to identify the gender of cadavers that are not known in forensic medicine. Using these parameters cannot estimate the age with a high confidence level.