Sexual dimorphism of cranial fossae in forensic anthropology: A systematic review

Objectives: Sex estimation is an essential step in forensic anthropology because it significantly narrows the identification pool. Traditional approaches emphasize extracranial traits but cranial fossa structures (CFS) have gained attention due to their potential roles in sex determination. This review summarizes the current methods and classification accuracies associated with CFS. Methods: Systematic search was conducted using PubMed, Scopus, and Web of Science, adhering to PRISMA guidelines. Studies published from 2000 to 2024 on sexual dimorphism in CFS were included, excluding those utilizing plain radiographs. The risk of bias was evaluated using a modified methodology quality score. Data extraction followed the PICO framework: population (origin of skulls), intervention (various materials and methods), comparison (male versus female differences), and outcome (accuracy of classification, size, and shape). Results: Sex classification using CFS yielded accuracy rates ranging from 77.9% to 92%. Crista galli length was most sexually dimorphic in the anterior cranial fossa, with 83.7% accuracy (male: 14.50-21.26 mm; female: 11.06-21.24 mm). In the middle cranial fossa, the distance between the foramina ovale had a sex classification accuracy of 63.9%, with mean measurements of 57.3-62.5 mm in males and 55.6-60.1 mm in females. The clivus length was the most sexually dimorphic structure within the posterior cranial fossa, where the sex classification accuracy was 67%, with mean values of 43.99-44.79 mm in males and 41.39-42.53 mm in females. Conclusion: Measurable sexual dimorphism traits are found in the CFS, particularly the crista galli, and can be used as indicators in forensic sex estimation.