• Users Online: 571
  • Home
  • Print this page
  • Email this page
Home About us Editorial board Ahead of print Current issue Search Archives Submit article Instructions Subscribe Contacts Login 


 
 Table of Contents  
ORIGINAL ARTICLE
Year : 2022  |  Volume : 12  |  Issue : 1  |  Page : 38-41

A prospective study to determine and compare the sizes of the frontal sinus by age and gender


1 Department of Anatomy, Government Medical College, Pali, Rajasthan, India
2 Department of Biochemistry, Dr. S.N. Medical College, Jodhpur, Rajasthan, India

Date of Submission05-Jul-2021
Date of Decision18-Aug-2021
Date of Acceptance12-Sep-2021
Date of Web Publication31-Dec-2021

Correspondence Address:
Anoop Singh Gurjar
Department of Anatomy, Government Medical College, Pali, Rajasthan
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/aihb.aihb_101_21

Rights and Permissions
  Abstract 


Introduction: Determination of gender and estimation of stature from the skeleton is vital to medicolegal inquiries. CT scan measurements of maxillary and frontal sinuses are thought to be useful for gender determination. The aim of this study is to compare the frontal sinus dimensions and to assess their reliability and accuracy for gender determination using a CT scan. Materials and Methods: A comparative study included cranial Computerized tomography (CT) of 40 patients aged between 18 and 65 years who underwent CT examination of the head and neck for other medical problems that are not related to the frontal sinus. The measurements of the frontal sinus were done in axial and scout images. Results: Our study showed that the maximum depth of frontal sinus in males and females was 10.76 ± 2.12 and 9.23 ± 1.85, respectively, which showed a statistically significant P value (<0.05). The thickness of the anterior wall for males and females was 5.27 ± 1.46 and 5.62 ± 1.60, respectively. There was no statistical significance with respect to the thickness of the anterior wall of the frontal sinus. The maximal anteroposterior length of frontal sinus measured from scout image for males and females were 12.35 ± 3.11 and 10.52 ± 2.15, respectively, which showed a statistically significant P < 0.05. The frontal sinus dimensions were correlated with age subgroups, and there is no statistical significance. Conclusion: We concluded that the dimensions of the frontal sinus could be used for gender dimorphism. This study also proposes the reliability and accuracy of frontal sinus; hence the study proves vital in identifying the gender of a person in forensic anthropology.

Keywords: CT scan, frontal sinus, gender, skeletal


How to cite this article:
Gurjar AS, Gurjar M. A prospective study to determine and compare the sizes of the frontal sinus by age and gender. Adv Hum Biol 2022;12:38-41

How to cite this URL:
Gurjar AS, Gurjar M. A prospective study to determine and compare the sizes of the frontal sinus by age and gender. Adv Hum Biol [serial online] 2022 [cited 2022 Aug 15];12:38-41. Available from: https://www.aihbonline.com/text.asp?2022/12/1/38/334586




  Introduction Top


Human skeletal remains can be used for the identification of height, age, race and sex that are considered the four fundamental elements of forensic science and physical anthropology.[1],[2] It has been reported that maxillary and frontal sinuses stay intact in severely disfigured victims, whereas the skull and other bones maybe not.[3] Hence, it is of significance in forensic identification because of individual characteristics which make the frontal bone unique for every individual.[4]

Determination of gender and estimation of stature from the skeleton is vital to medicolegal inquiries.[5] Skull is composed of hard tissue and is the best-preserved part of skeleton after death,[6] hence, in many cases, it is the only available part for forensic examination.[7]

Craniometric features are included among these characteristics, which are closely related to forensic dentistry.[8] Sexual dimorphism refers to the systemic difference in the form (either in shape or size) between individuals of different sexes in the same species.[9] The frontal sinus is a Craniometric feature with significance in forensic identification due to its irregular shape[10],[11] and because of the individual characteristics which make the frontal bone unique for every individual, just as with fingerprints even for monozygotic twins.[10] Frontal sinus has great variability, and its structure does not change after the age of 18 years except for very rare occurrences as fractures, tumours or severe infections.[3],[10],[11],[12] The studies on the correlation of the morphology of the frontal sinus with gender showed that the frontal sinus is smaller in women, an aspect that points out its unique characteristic and importance in human identification, as well as in the determination of age.[13],[14]

In the last years of the 20th century and the first decade of the 21st century, the use of radiological techniques has improved and became widespread after the introduction of computed tomography (CT) by Godfrey Hounsfield in 1972.[15] Today, forensic scientists are regularly using radiographic images as part of the autopsy procedures and forensic identification. The value of radiography has become well established in the criminal and medicolegal work of police officers and medical examiners (Cornwell, 1956). Anthropologically, CT has been applied in the study of a fossil skull and bite mark analysis.[16]

Computed tomography (CT) scans are an excellent imaging modality used to evaluate the paranasal sinuses, craniofacial bones, as well as the extent of pneumatization of the sinuses and provides detailed information that is not available from standard radiographs.[17] Hence, CT measurements of maxillary and frontal sinuses are useful to estimate gender.[10] The aim of this study is to compare the frontal sinus dimensions and to assess their reliability and accuracy for gender determination using a CT scan.

Aim

The aim of the study is to determine and compare the sizes of the frontal sinus by age and gender using a CT scan.


  Materials and Methods Top


Subject selection

Forty systemically healthy patients in the age group of 18–65 years were selected for this study. Amongst these, 23 were males, and the remaining were females. They were undergoing periodontal treatment in the Department of Oral Medicine and Radiology. This study was conducted from January 2020 to April 2020. Patients were made aware of the study protocol, and written consents were obtained at the beginning of the study. Ethical clearance was obtained in December 2019 from the research and review board committee (ETD/2019/290). This study was conducted in accordance with the Declaration of Helsinki. The following formula was used to determine the sample size. n = (Zα/2 + Zβ)2 × 2 × σ2/d2

(Where Z α/2 is the critical value of the normal distribution at α/2).

The patients underwent CT examination of the head and neck for other medical problems that are not related to the frontal sinus. Patients included were admitted for CT evaluation of the head and neck region. CT images with facial trauma, evidence of previous sinus surgery, pathological lesions involving maxillary and frontal sinus were excluded from our study.

Procedure

The evident pneumatization was accepted as the presence of the sinus. The longest diameter was recorded after going through different slices in axial sections. Considering the fact that the frontal sinus reaches its maximum dimension at the age of 18 years, our study means the age of the subject was chosen. The measurements of the frontal sinus were done in axial and scout images. The measurement will be based on confirmed anatomical landmarks. The measurements were performed as follows:

  1. The maximum mediolateral diameter (width [mm]) corresponds to the width that was measured as the longest perpendicular distance from the medial wall of the sinus to the outermost point of the lateral wall of the lateral process. The anterior wall thickness is measured at the level of the orbital roof from axial sections
  2. Maximum anteroposterior diameter (length [mm]) corresponds to the length measured as the longest distance anteroposteriorly along the nasal floor on the right and left side
  3. Total distance is the distance from the outermost point of one maxillary sinus to the outermost point of the opposite sinus


CT scans of those subjects included in the study were further divided into three age groups as 18–35, 36–50 and 51–65 years and each measurement parameter was compared amongst the subgroups. The measurement obtained was subjected to discriminate analysis. All the measurements were recorded by a single observer.

Statistical analysis

The paired t-test was done for the comparison of the means of the dimensions measured for the two groups, and P < 0.05 was taken as statistically significant. The data were analysed using SPSS software. (v22 for windows, Philadelphia, PA, USA). The Canonical discriminant functional analysis was performed to assess whether the maxillary, and frontal sinus measurements could be used for gender determination. MANOVA test was carried out to find the difference between the two groups.


  Results Top


Our study showed that the maximum depth of frontal sinus in males and females was 10.76 ± 2.12 and 9.23 ± 1.85, respectively, which showed a statistically significant P value (<0.05). The thickness of the anterior wall for males and females was 5.27 ± 1.46 and 5.62 ± 1.60, respectively. There was no statistical significance with respect to the thickness of the anterior wall of the frontal sinus. The maximal anteroposterior length of frontal sinus measured from scout image for males and females were 12.35 ± 3.11 and 10.52 ± 2.15, respectively, which showed a statistically significant P value < 0.05 [Table 1].
Table 1: Comparison of different parameters (mm) of frontal sinus

Click here to view


When compared with the age subgroups, the highest value for frontal sinus is observed in the 18–35 age group. The lowest value is observed in the 51–65 age group. The frontal sinus dimensions were correlated with age subgroups. There was no statistical significance [Table 2].
Table 2: Comparisons of measurements of frontal sinus in age subgroups

Click here to view



  Discussion Top


The gender determination can be done with 100% accuracy if the skeleton exists completely. However, victim identification in mass disasters like aircraft crashes, terrorist attacks, landslides, earthquakes, explosions and warfare, the gender determination rate is 98% when there is the existence of pelvis and cranium, 95% with the only pelvis and long bones and 80%–90% with only long bones. The skull is the most reliable part of the skeleton next to the pelvis for gender determination, but it is not reliable until after puberty.[18]

The uniqueness and interindividual variation in size, shape, symmetry, permanence of anatomical landmarks provide scientific information in forensic anthropology. There are currently many techniques used in forensic science to identify an unknown person, the most reliable being DNA analysis. However, this method is time-consuming as well as expensive and may not be possible if the remains are extremely degraded or exposed to extreme environmental conditions. In such cases, other methods can be used, like radiographic evaluation of maxillary and frontal sinus, especially in cases where only skull remains are available.

In the present study showed that the maximum depth of frontal sinus in males and females was 10.76 ± 2.12 and 9.23 ± 1.85, respectively, which showed a statistically significant P value (<0.05). The studies by Pernilla et al.[6] stated the maximum depth of frontal sinus for males and females is 10 ± 3 and 9.6 ± 3, respectively, with a significant P = 0.034. The mean depth of the frontal sinus by Matthew K. Lee et al.[7] stated that it was 8.0–9.3 mm and did not vary significantly at any distance from midline. The results were consistent with the previous report by Matthew et al.[7] and Sahlstrand-Johnson.[18]

In present study showed that the thickness of the anterior wall for males and females was 5.27 ± 1.46 and 5.62 ± 1.60, respectively. There was no statistical significance with respect to the thickness of the anterior wall of the frontal sinus. The thickness of the anterior wall of FS as determined by Pernilla et al.[18] was 2.1 ± 1 and 2.1 ± 0.8 for males and females with no significant P = 0.824. In Matthew K Lee et al.[7] the mean anterior table thickness ranged from 2.6 to 4.1 mm. Furthermore, in their study, it was stated, males were found to have greater dimensions in most frontal sinus measurements. This was supported by the fact that the male forehead was marked by a more acute nasofrontal angle (119.9° versus 133.5°) and a steeper posterior forehead inclination (−7.2° vs. −3.5°). There are only limited studies where the anterior wall thickness of the frontal sinus was estimated; therefore, future research can be done to validate this parameter.

In the present study, the maximal anteroposterior length of frontal sinus measured from scout image for males and females were 12.35 ± 3.11 and 10.52 ± 2.15, respectively, which showed a statistically significant P < 0.05. In previous studies by Tatlisumak et al.,[19] the anteroposterior length of FS for males and females was calculated as 13.15 ± 5.23 and 10.80 ± 4.10. Uthman et al.[20] conducted a study on frontal sinus to identify unknown individuals, and the anteroposterior length was measured from scout image, which was 18.24 ± 8.92 in males and 12.22 ± 6.96 in females. The results of the present study were similar to Tatlisumak et al.[19] and Uthman et al.[20]

In the present study, the anteroposterior length and the depth of FS showed statistical significance, but when compared with age subgroups, the ANOVA test results did not show a significant association with age. Previous studies have demonstrated that frontal sinus dimensions changes due to pneumatization. However, in certain diseases such as sinusitis and in the elderly, FS may enlarge due to bone loss.[21]There are, however, limitations in the use of the frontal sinus in personal identification because they are affected by craniofacial configurations, hormonal levels and pathological conditions and the influence of genetic and environmental factors on the size of the frontal sinus.


  Conclusion Top


We concluded that the dimensions of the frontal sinus could be used for gender dimorphism. This study also proposes the reliability and accuracy of frontal sinus; hence the study proves vital in identifying the gender of a person in forensic anthropology.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Nagare SP, Chaudhari RS, Birangane RS, Parkarwar PC. Sex determination in forensic identification, a review. J Forensic Dent Sci 2018;10:61-6.  Back to cited text no. 1
[PUBMED]  [Full text]  
2.
Warrier V, Krishan K, Shedge R, Kanchan T. Height Assessment. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2021 Available from: http://www.ncbi.nlm.nih.gov/books/NBK551524/. [Last accessed on 2021 Jul 05].  Back to cited text no. 2
    
3.
Cappello ZJ, Minutello K, Dublin AB. Anatomy, Head and Neck, Nose Paranasal Sinuses. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2021. Available from: http://www.ncbi.nlm.nih.gov/books/NBK499826/. [Last accessed on 2021 Jul 05].  Back to cited text no. 3
    
4.
Shireen A, Goel S, Ahmed IM, Sabeh AM, Mahmoud W. Radiomorphometric evaluation of the frontal sinus in relation to age and gender in Saudi population. J Int Soc Prev Community Dent 2019;9:584-96.  Back to cited text no. 4
    
5.
Gul H, Mansor Nizami S, Khan MA. Estimation of body stature using the percutaneous length of ulna of an individual. Cureus 2020;12:e6599.  Back to cited text no. 5
    
6.
Pernilla Sahlstrand-Johnson , Magnus Jannert, Anita Strömbeck and Kasim Abul-Kasim. Computed tomography measurements of different dimensions of maxillary and frontal sinuses. BMC Medical Imaging 2011,11:8.  Back to cited text no. 6
    
7.
Latham KE, Miller JJ. DNA recovery and analysis from skeletal material in modern forensic contexts. Forensic Sci Res 2019;4:51-9.  Back to cited text no. 7
    
8.
Lee MK, Sakai O, Spiegel JH. CT measurement of the frontal sinus- gender differences and implications for frontal cranioplasty. J cranimaxillofac surg 2010;38:494-500.  Back to cited text no. 8
    
9.
McLean CJ, Garwood RJ, Brassey CA. Sexual dimorphism in the Arachnid orders. PeerJ 2018;6:e5751.  Back to cited text no. 9
    
10.
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.  Back to cited text no. 10
[PUBMED]  [Full text]  
11.
Garhia P, Saxena S, Gupta A. Frontal sinus variability as a tool in forensic identification – A pilot study using radiographic images and software analysis. Int J Curr Res Rev 2019;11:08-12.  Back to cited text no. 11
    
12.
Özdemir M, Kavak RP, Öcal B, Soysal H. A novel anatomical classification of the frontal sinus: Can it be useful in clinical approach to frontal sinusitis? Egypt J Otolaryngol 2021;37:34.  Back to cited text no. 12
    
13.
da Silva RF, Pinto RN, Ferreira GM, Daruge E Jr. Importance of frontal sinus radiographs for human identification. Braz J Otorhinolaryngol 2008;74:798.  Back to cited text no. 13
    
14.
Alijani S, Farhadian N, Alafchi B, Najafi M. Relationship of frontal sinus size and maturation of cervical vertebrae for assessment of skeletal maturity. Front Dent 2020;17:1-6.  Back to cited text no. 14
    
15.
Bhattacharyya KB. Godfrey newbold hounsfield (1919-2004): The man who revolutionized neuroimaging. Ann Indian Acad Neurol 2016;19:448-50.  Back to cited text no. 15
[PUBMED]  [Full text]  
16.
Campbell RM, Vinas G, Henneberg M. Towards the restoration of ancient hominid craniofacial anatomy: Chimpanzee morphology reveals covariation between craniometrics and facial soft tissue thickness. PLoS One 2021;16:e0245760.  Back to cited text no. 16
    
17.
Bangi BB, Ginjupally U, Nadendla LK, Vadla B. 3D evaluation of maxillary sinus using computed tomography: A sexual dimorphic study. Int J Dent 2017;2017:170-78.  Back to cited text no. 17
    
18.
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.  Back to cited text no. 18
    
19.
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.  Back to cited text no. 19
    
20.
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.  Back to cited text no. 20
    
21.
Charakorn N, Snidvongs K. Chronic sphenoid rhinosinusitis: Management challenge. J Asthma Allergy 2016;9:199-205.  Back to cited text no. 21
    



 
 
    Tables

  [Table 1], [Table 2]



 

Top
 
 
  Search
 
Similar in PUBMED
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

  Materials and Me...
  In this article
Abstract
Introduction
Results
Discussion
Conclusion
References
Article Tables

 Article Access Statistics
    Viewed703    
    Printed38    
    Emailed0    
    PDF Downloaded62    
    Comments [Add]    

Recommend this journal


[TAG2]
[TAG3]
[TAG4]