Development and validation of a formula based on maxillary sinus measurements as a tool for sex estimation: a cone beam computed tomography study



As sex estimation is an important step to delineate the biological profile, the development of tools employing anatomical structures which may maintain their integrity even after extreme events, such as the maxillary sinus, become useful for forensic identification. Thus, the aim in the present study was to develop and validate a formula for sex estimation through measurements in the maxillary sinuses in a Brazilian population, using cone beam computed tomography (CBCT) scans.

Material and methods

Linear and volumetric measurements in the maxillary sinus were performed bilaterally in 94 CBCT scans from 45 males (mean age 25.2 ± 0.79) and 49 females (mean age 23.7 ± 0.50). The OnDemand 3D software was employed for linear measurements (height, length and width of, and the largest distance between the right and left maxillary sinuses), while the ITK-SNAP 3.0 segmentation software was used to acquire the volume. The data obtained was applied to a mathematical model for sex estimation. To validate the developed formula, another sample composed of 60 CBCT images of Brazilian individuals was tested.


Overall, maxillary sinuses’ measurements were significantly higher in males, without statistically significant differences between the right and left sides within each group. The most dimorphic measurement was the height, with an accuracy of 77.7% regarding sex estimation. The formula created lead to a sex estimation of 87.8% for females and 80% for males, with an overall accuracy of 84%. When the formula validity was tested in another sample, it showed an accuracy of 82.4%.


The formula developed through measurements in the maxillary sinus using CBCT scans showed an accuracy of 84% for sex estimation and can be applied as a complementary method for human identification in the Brazilian population.

This is a preview of subscription content, log in to check access.

Fig. 1
Fig. 2
Fig. 3


  1. 1.

    Holobinko A (2012) Forensic human identification in the United States and Canada: a review of the law, admissible techniques, and the legal implications of their application in forensic cases. Forensic Sci Int 222(1–3):394.e1–394.13.

    Article  Google Scholar 

  2. 2.

    Leite T, Duailibi-Neto EF, Chilvarquer I, Melani RFH (2015) Human identification through frontal sinus 3D superimposition: pilot study with Cone Beam Computer Tomography. J Forensic Legal Med 36:63–69.

    Article  Google Scholar 

  3. 3.

    Molina D (2010) Forensic medicine and human identification. In: Senn D, Stimson P (eds) Forensic Dent, 2nd edn. CRC Press, Boca Raton, pp 61–77

    Google Scholar 

  4. 4.

    Angelakopoulos N, Franco A, Willems G, Fieuws S, Thevissen P (2016) Clinically detectable dental identifiers observed in intra-oral photographs and extra-oral radiographs, validated for human identification purposes. J Forensic Sci 62(2016):900–906.

    Article  PubMed  Google Scholar 

  5. 5.

    Tinoco RLR, Lima LNC, Delwing F, Francesquini L Jr, Daruge E Jr (2016) Dental anthropology of a Brazilian sample: frequency of nonmetric traits. J Forensic Sci 258(2016):102e1–102e5.

    Article  Google Scholar 

  6. 6.

    Gulhan O, Harrison K, Kiris A (2015) A new computer-tomography based method of sex estimation: development of Turkish population-specific standards. Forensic Sci Int 255:2–8.

    Article  PubMed  Google Scholar 

  7. 7.

    Uthman AT, Al-Rawi NH, Al-Naaimi AS, Al-Timimi JF (2011) Evaluation of maxillary sinus dimensions in gender determination using helical CT scanning. J Forensic Sci 56:403–408.

    Article  PubMed  Google Scholar 

  8. 8.

    Hamed SS, El-Badrawy AM, Abdel Fattah S (2014) Gender identification from frontal sinus using multi-detector computed tomography. J Forensic Radiol Imag 2:117–120.

    Article  Google Scholar 

  9. 9.

    Purkait R, Chandra H (2004) A study of sexual variation in Indian femur. Forensic Sci Int 146:25–33.

    Article  PubMed  Google Scholar 

  10. 10.

    Shehri FA, Soliman KEA (2015) Determination of sex from radiographic measurements of the humerus by discriminant function analysis in Saudi population, Qassim region, KSA. Forensic Sci Int 253:138.e1–138.e6.

    Article  Google Scholar 

  11. 11.

    Teke HY, Duran S, Canturk N, Canturk G (2007) Determination of gender by measuring the size of the maxillary sinuses in computerized tomography scans. Surg Radiol Anat 29:9–13.

    Article  PubMed  Google Scholar 

  12. 12.

    Amin MF, Hassan EI (2012) Sex identification in Egyptian population using Multidetector Computed Tomography of the maxillary sinus. J Forensic Legal Med 19:65–69.

    Article  Google Scholar 

  13. 13.

    Akhlaghi M, Bakhtavar K, Kamali A, Maarefdoost J, Sheikhazadi A, Mousavi F, Sabery Anary SH, Sheikhazadi E (2017) The diagnostic value of anthropometric indices of maxillary sinuses for sex determination using CT-scan images in Iranian adults: a cross-sectional study. J Forensic Legal Med 49:94–100.

    Article  Google Scholar 

  14. 14.

    Gamba TO, Yamasaki MC, Groppo FC, Silveira HLD, Boscolo SMA, Sanderik GCH, Berkhout WER (2017) Validation study of a new method for sexual prediction based on CBCT analysis of maxillary sinus and mandibular canal. Arch Oral Biol 83:118–123.

    Article  PubMed  Google Scholar 

  15. 15.

    Sarment DP, Christensen AM (2014) The use of cone beam computed tomography in forensic radiology. J Forensic Radiol Imag 2:173–181.

    Article  Google Scholar 

  16. 16.

    Tambawala SS, Karjodkar FR, Sansare K, Prakash N (2015) Sexual dimorphism of maxillary sinus using cone beam computed tomography. Egypt J Forensic Sci 6:120–125.

    Article  Google Scholar 

  17. 17.

    Cicchetti DV (1994) Guidelines, criteria, and rules of thumb for evaluating normed and standardized assessment instruments in psychology. Psychol Assess 6:284–290.

    Article  Google Scholar 

  18. 18.

    Paknahad Z, Shahidi M, Zarei S (2016) Sexual dimorphism of maxillary sinus dimensions using cone-beam computed tomography. J Forensic Sci 62(2016):395–398.

    Article  PubMed  Google Scholar 

  19. 19.

    van den Bergh JPA, ten Bruggenkate CM, Krekeler G, Tuinzing DB (1998) Sinus floor elevation and grafting with autogenous iliac crest bone. Clin Oral Implants Res 9:429–435.

    Article  PubMed  Google Scholar 

  20. 20.

    Galindo-Moreno P, Ávila G, Fernández-Barbero JE, Aguilar M, Sánchez-Fernández E, Cutando A, Wang HL (2007) Evaluation of sinus floor elevation using a composite bone graft mixture. Clin Oral Implants Res 18:376–382.

    Article  PubMed  Google Scholar 

  21. 21.

    Möhlhenrich SC, Heussen N, Peters F, Steiner T, Hölzle F, Modabber A (2015) Is the maxillary sinus really suitable in sex determination? A three-dimensional analysis of maxillary sinus volume and surface depending on sex and dentition. J Craniofac Surg 26:e723–e726.

    Article  PubMed  Google Scholar 

  22. 22.

    Kanthem RK, Guttikonda VR, Yeluri S, Kumari G (2015) Sex determination using maxillary sinus. J Forensic Dent Sci 7:163–167.

    Article  PubMed  PubMed Central  Google Scholar 

  23. 23.

    Ekizoglu O, Inci E, Hocaoglu E, Sayin I, Kayhan FT, Can IO (2014) The use of maxillary sinus dimensions in gender determination. J Craniofac Surg 25:957–960.

    Article  PubMed  Google Scholar 

  24. 24.

    Ariji Y, Kuroki T, Moriguchi S, Ariji E, Kanda S (1994) Age changes in the volume of the human maxillary sinus: a study using computed tomography. Dentomaxillofacial Radiol 23:163–168.

    CAS  Article  Google Scholar 

  25. 25.

    Fernandes CL (2004) Forensic ethnic identification of crania: the role of the maxillary sinus—a new approach. Am J Forensic Med Pathol 25:302–313.

    Article  PubMed  Google Scholar 

  26. 26.

    Yushkevich PA, Piven J, Hazlett HC, Smith RG, Ho S, Gee JC, Gerig G (2006) User-guided 3D active contour segmentation of anatomical structures: significantly improved efficiency and reliability. Neuroimage 31:1116–1128.

    Article  PubMed  Google Scholar 

  27. 27.

    Weissheimer A, Menezes LM, Sameshima GT, Enciso R, Pham J, Grauer D (2012) Imaging software accuracy for 3-dimensional analysis of the upper airway. Am J Orthod Dentofac Orthop 142:801–813.

    Article  Google Scholar 

  28. 28.

    Saccucci M, Cipriani F, Carderi S, Carlo G, D'Attilio M, Rodolfino D et al (2015) Gender assessment through three-dimensional analysis of maxillary sinuses by means of cone beam computed tomography. Eur Rev Med Pharmacol Sci 19:185–193

    CAS  PubMed  Google Scholar 

  29. 29.

    Sidhu R, Chandra S, Devi P, Taneja N, Sah K, Kaur N (2014) Forensic importance of maxillary sinus in gender determination: a morphometric analysis from Western Uttar Pradesh, India. Eur J Gen Dent 3:53.

    Article  Google Scholar 

  30. 30.

    Sahlstrand-Johnson P, Jannert M, Strömbeck A, Abul-Kasim K (2011) Computed tomography measurements of different dimensions of maxillary and frontal sinuses. BMC Med Imaging 11:8.

    Article  PubMed  PubMed Central  Google Scholar 

  31. 31.

    Vidya CS, Shamasundar NM, Manjunatha B, Raichurkar K (2013) Evaluation of size and volume of maxillary sinus to determine gender by 3D computerized tomography scan method using dry skulls of South Indian origin. Int J Curr Res Rev 5:97–100

    Google Scholar 

  32. 32.

    Sharma SK, Jehan M, Kumar A (2014) Measurements of maxillary sinus volume and dimensions by computed tomography scan for gender determination. J Anat Soc India 63:36–42.

    Article  Google Scholar 

  33. 33.

    Ahmed AG, Gataa IS, Fateh SM, Mohammed GN (2015) 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 11:272–281

    Google Scholar 

  34. 34.

    Kiruba LN, Gupta C, Kumar S, D’Souza AS (2014) A study of morphometric evaluation of the maxillary sinuses in normal subjects using computer tomography images. Arch Med Heal Sci 2:12.

    Article  Google Scholar 

  35. 35.

    Iscan MY (2005) Forensic anthropology of sex and body size. Forensic Sci Int 147(2015):107–112.

    Article  Google Scholar 

Download references

Author information



Corresponding author

Correspondence to Amanda Farias Gomes.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The Research Ethics Committee of the Piracicaba Dental School—State University of Campinas (FOP/UNICAMP) approved this study without restrictions (CAAE: 46141815.0.0000.5418).

Informed consent

This is a retrospective study. For this type of study, formal consent is not required.



Table 4 Sensitivity, specificity, and accuracy of the measurements for sexual prediction

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Farias Gomes, A., de Oliveira Gamba, T., Yamasaki, M.C. et al. Development and validation of a formula based on maxillary sinus measurements as a tool for sex estimation: a cone beam computed tomography study. Int J Legal Med 133, 1241–1249 (2019).

Download citation


  • Sex characteristics
  • Forensic anthropology
  • Maxillary sinus
  • Cone beam computed tomography
  • Forensic dentistry