Surg Radiol Anat (2007) 29:9–13
DOI 10.1007/s00276-006-0157-1
O R I G I N A L A RT I C L E
Determination of gender by measuring the size of the maxillary
sinuses in computerized tomography scans
Hacer Yasar Teke Æ Semra Duran Æ Nergis Canturk Æ
Gurol Canturk
Received: 13 February 2006 / Accepted: 20 September 2006 / Published online: 14 December 2006

Springer-Verlag 2006
Abstract
Background Identification of corpses is a difficult
forensic procedure and it is mandated by laws and
social rules. Comparison of ante mortem and post-
mortem medical records, such as dental documents,
plays an important role in the identification of corpses.
However, typical identification methods may be
inconclusive, especially when certain extreme post-
mortem changes have developed. Gender has long
been determined from the skull, the pelvis and the long
bones with an epiphysis and a metaphysis in unknown
skeletons. The aim of this study was to investigate
whether the width, the length and the height of the
maxillary sinuses could be used for determination of
gender.
Materials and Methods The width, the length and the
height of the maxillary sinuses were measured in 127
adult patients who were admitted to the Department of
Radiology for computed tomography scans of their
sinuses. Of 127 patients, 62 (48.8%) were females and
65 (51.2%) were males. The width, the length and the
H. Y. Teke
G. Canturk (&)
Forensic Medicine Department,
Ankara University School of Medicine,
Ankara 06340, Turkey
e-mail: gurolcanturk@yahoo.com;
canturk@medicine.ankara.edu.tr
S. Duran
Radiology Department, Ankara Numune Hospital,
Ankara, Turkey
N. Canturk
Institute of Forensic Medicine, Ministry of Justice,
Ankara, Turkey
height of the maxillary sinuses were measured in
Computerized Tomography scans (Hitachi Radix
Turbo computed tomography) when the patients were
in prone position without sedation or contrast medium.
The data were subjected to a discriminative analysis
using the SPSS package program (Version 11.5).
Results The discriminative analysis showed that the
accuracy of maxillary sinus measurements—i.e. the
ability of the maxillary sinus size to identify gen-
der—was 69.4% in females and 69.2% in males.
Conclusion Computerized Tomography measure-
ments of maxillary sinuses may be useful to support
gender determination in forensic medicine; however,
with a relatively low-accuracy rate (less than 70%).
Keywords Maxillary sinuses
Determination of
gender
Computerized tomography
Disaster victim
identification
Forensic medicine
Introduction
Post-mortem identification, a forensic procedure, is
difficult to perform and it is obligatory in terms of the
law and social norms. It is important to compare ante
mortem and post-mortem records for the identification
of corpses [2, 18]. However, commonly used forensic
procedures for identification may not help after
marked post-mortem changes have developed [20]. It
has been reported that the skull, the pelvis and the long
bones with an epiphysis and a metaphysis in skeletons
can be used for the determination of gender. The
length and the height of the head, the distance between
the basion and the nasion and the distance between the
basion and the prosthion, the circumference of the
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head, the length of the supraorbital edge, the mastoid
process and the mandibular ramus, the height of the
mandibular symphysis, the shape and the length of the
palate, the circumference of the occipital condyle, and
sizes of the teeth, the foramen magnum, the sphenoidal
sinus, the sella turcica and the frontal sinuses have also
been used recently to determine gender in unknown
human remains [2, 6, 7, 18, 21].
It has been reported that maxillary sinuses remain
intact although the skull and other bones may be badly
disfigured in victims who are incinerated and, there-
fore, that maxillary sinuses can be used for identifica-
tion [15]. Maxillary sinuses are two spaces, which are
filled with air, located in the maxillary bone and can be
in various sizes and shapes. Their walls are thin. The
apex of the sinuses can extend into the zygomatic
process and can occupy the zygomatic bone [17]. The
floor formed by the alveolar process, the first, the
second and the third molars and the roots of the ca-
nines may elevate the sinuses or may perforate their
floor [15].
The maxillary sinuses appear at the end of the
second embryonic month. They extend to the roof of
the permanent teeth when deciduous teeth fall off.
According to Jovanic [9], the maxillary sinuses reach
their mature sizes at the age of about 20 years, when
the permanent teeth fully develop. During adulthood,
their shapes and sizes change especially due to loss of
teeth. It has been reported that genetic diseases, post-
infections and environmental factors can affect the
sizes of maxillary sinuses [11]. Szilvassy [22] divided
the maxillary sinuses into four bases according to
their shapes: i.e. triangular, leaf, scapular and renal
shaped. It has been reported that triangular sinuses
were the most common in both females and males [6].
Maxillary sinuses have also been classified into tri-
angular, oval, curved, rectangular and square shapes
[15].
Measurements of the maxillary sinuses in comput-
erized tomography (CT) scans can be used for
determination of age and gender when other methods
are inconclusive, though these measurements are not
error-free [15]. Anthropologically, CT has been ap-
plied in the study of fossil skulls [3, 19, 25, 26]. CT
scanning has also been used in a forensic context as
an aid in bite mark analysis [4, 19]. CT provides an
excellent method for examining maxillary sinuses.
Since the images represent a series of contiguous
cross-sections, they provide three-dimensional infor-
mation [19].
The aim of this study was to investigate whether the
width, the length and the height of maxillary sinuses
can be used for determination of gender.
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Surg Radiol Anat (2007) 29:9–13
Materials and methods
This study included 127 patients who had CT (Hitachi
radix Turbo, Milwaukee, WI, USA) of paranasal si-
nuses for various reasons between 1st April and 30th
May in 2005. The current study included patients who
had complaints of headaches and who were admitted
to the radiology clinic, with the pre-diagnosis of
sinusitis, to have CT scans in whom no pathological
findings were detected.
Of 127 adult patients, 62 (48.8%) were females and
65 (51.2%) were males. The gender with respect to age
distribution was similar. Table 1 shows the distribution
of patients by age and gender.
When CT was performed, the patients were in prone
position and they did not have sedation or contrast
medium. All the sections were coronal in planes. The
width and length measurements were made where the
maxillary sinus was in its widest position with the help
of the measurement equipment on the CT scan as the
measurement technique. The height of the maxillary
sinus was detected by marking the first and the last
scenes of the sinus in the CT scan, and the number of
the sections between them was determined. At last, the
number of the sections obtained was multiplied by 3 to
find the height of the sinus. The sections were 3 mm in
thickness and the reconstruction matrix was 120 kV,
150–175 mA and 512 · 512. The images obtained were
used to measure the width, the length and the height of
maxillary sinuses and t-test for independent samples
was used to compare these values in two groups. Dis-
criminative analysis was used to detect gender by using
data obtained from CT scans. The analyses were per-
formed by using the SPSS 11.5 package program.
Results
In the current study, the size of the maxillary sinuses of
the female was found to be smaller than those of men.
Table 2 shows the distribution of the mean width,
length and height of maxillary sinuses with their stan-
dard deviations according to gender. In the literature,
Table 1 Distribution of patients by age and gender
Age Male Female
n % n %
20–30 22 38.8 21 33.9
31–40 24 37.0 23 37.1
41–50 19 29.2 18 29.0
Total 65 100 62 100
Surg Radiol Anat (2007) 29:9–13 11

Table 2 Distribution of linear measurements of maxillary sinuses on CT and their standard deviations
Male (n = 65) Female (n = 62) p t
Mean XS Mean XS

The width of the right maxillary sinus 27.189 ±5.4636 24.445 ±3.6106 0.006 2.791
The height of the right maxillary sinus 42.588 ±7.9479 37.819 ±5.6941 0.034 2.140
The length of the right maxillary sinus 47.631 ±6.4410 45.113 ±4.6310 0.001 3.547
The width of the left maxillary sinus 26.892 ±5.5236 24.277 ±3.9886 0.002 3.179
The height of the left maxillary sinus 43.718 ±7.7821 37.603 ±6.0426 0.002 3.113
The length of the left maxillary sinus 47.215 ±6.5443 43.645 ±4.4023 0.000 3.983

the mean values of the maxillary sinus measurements Table 4 Gender determination from measurements of the left
were 32, 25 and 35 mm in length, width and height, maxillary sinus
respectively [24]. A discriminative analysis was per- Gender (real) Gender (predicted) Total
formed to determine whether the measurements of the
Male Female
maxillary sinuses could be used for gender determi-
nation. A significant difference was found in the width, Male 44 (67.7%) 21 (32.3%) 65
the height and the length of the sinuses between males Female 20 (40.3%) 42 (67.7%) 62
Total 64 63 127
and females.
The following formula can be used for gender
determination from measurements of the right maxil-
lary sinus: gender = –5.397 + 0.112 · the width of the Table 5 Gender determination from measurements of both
right maxillary sinus + 0.114 · the height of the right maxillary sinuses together
maxillary sinus –0.045 · the length of the right maxil- Gender (real) Gender (predicted) Total
lary sinus.
Male Female
The accuracy rate of the right maxillary sinus mea-
surements was 59.7% in females and 67.7% in males, Male 45 (69.2%) 20 (30.8%) 65
with a mean of 63.8% (Table 3). Female 19 (30.6%) 43 (69.4%) 62
Total 64 63 127
The following formula can be used for gender
determination from measurements of the left maxillary
sinus: gender = –6.484–0.037 · the width of the left maxillary sinus + 0.077 · the length of the left maxil-
maxillary sinus + 0.137 · the height of the left maxil- lary sinus. The accuracy rate of the right and left
lary sinus + 0.041 · the length of the left maxillary maxillary sinus measurements together was 69.4% in
sinus. The accuracy rate of the left maxillary sinus females and 69.3% in males, with a mean of 69.3%
measurements was 67.7% in both females and males (Table 5).
(Table 4).
The following formula can be used for gender
determination from measurements of the left and the Discussion
right maxillary sinuses together: gender = –5.616 +
0.133 · the width of the right maxillary sinus –0.020 · Identification from remains of human skeletons is an
the height of the right maxillary sinus –0.078 · the important forensic procedure. Determination of age
length of the right maxillary sinus–0.114 · the width of and gender is an integral part of identification. Gender
the left maxillary sinus + 0.148 · the height of the left determination is really important for identification. It
has been reported that the accuracy rate of gender
determination is 100% from a skeleton, 98% from both
Table 3 Gender determination from measurements of the right the pelvis and the skull, 95% from the pelvis only or
maxillary sinus the pelvis and the long bones, 90–95% from both the
Gender (real) Gender (predicted) Total skull and the long bones and 80–90% from the long
bones only [7, 8, 13].
Male Female
It has been reported that the maxillary sinuses are
Male 44 (67.7%) 21 (32.3%) 65 significantly larger in males than in females [5, 12, 22].
Female 20 (40.3%) 42 (67.7%) 62 The left maxillary sinus has been reported to be larger
Total 64 63 127
than the right sinus in both genders [23].

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In a study about gender determination, the accuracy
rate of the thickness of the skull was found to be 74.7%
in males and 67.6% in females [10]. In another study
using nine parameters of the skull for gender deter-
mination, the accuracy rate was 71.4% in females and
84.0% in males [6]. In one study related with gender
determination from the radius and ulna, the accuracy
rate was 90.0% in males and 93.6% in females [1].
In a study about gender determination in which the
width of the wrist was measured, the accuracy rate was
74.8% in females and 88.0% in males [16]. In another
study, from the measurements of the foramen mag-
num, the accuracy rate was found to be 64.0% in fe-
males and 64.5% in males [7].
Today, CT scans are being performed for an
expanding number of medical and dental reasons, thus
ensuring their increasing availability in cases requiring
personal identification. CT scanning equipment is
available in most hospitals [19].
In a study about gender determination from mea-
surements of the maxillary sinuses, it has been noted
that the volume of the maxillary sinuses was larger in
males than in females and that the accuracy rate was
79.0%. Moreover, the maxillary sinuses of males were
found to be wider when compared with those of fe-
males in Europe, but narrower in males than in females
in Zululand [14].
In the present study, the measurements of the
maxillary sinuses of females were lower than those of
males. The mean estimation rate of gender was de-
tected as 69.3%. The finding of the maxillary sinuses of
males being wider than those of females was similar as
in European males.
Conclusion
Gender determination is an important step in identifi-
cation in forensic medicine. CT measurements of
maxillary sinuses may be useful to support gender
determination in forensic medicine; however, with a
relatively low-accuracy rate (less than 70%). We sug-
gest that the length, the width and the height of the
maxillary sinuses together with other bones can be
used for gender determination when the whole skele-
ton is not available. However, further studies on gen-
der determination from the maxillary sinuses are
needed.
Acknowledgments The authors would like to thank Prof. Dr.
Ayla Sevim for her assistance. This study was presented at the
fourth Meeting of the Anatolian Forensic Sciences, 2005 Denizli,
Turkey, as a poster. This study was performed according to the
current laws, which are in practice in Turkey.
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Surg Radiol Anat (2007) 29:9–13
References
1. Agritmis H, Celbis O (2002) Body length and gender
determination from radius and ulna (in Turkish). J Forensic
Med 16(1):7–17
2. Cameriere R, Ferrante L, Mirtella D, Rollo UF, Cingolani M
(2005) Frontal sinuses for identification: quality of classifi-
cations, possible error and potential corrections. J Forensic
Sci 50(4):1–4
3. Conroy GC, Vannier MW (1987) Dental development of the
Taung skull from computerized tomography. Nature
329:625–627
4. Farrell WL, Rawson RD, Steffens RS, Stephens CRT (1987)
Computerized axial tomography as an aid in bite mark
analysis: a case report. J Forensic Sci 32:266–272
5. Fernandes CL (2004) Volumetric analysis of maxillary si-
nuses of Zulu and Europen crania by helical, multislice
computed tomography. J Laryngol Otol 118(11):877–881
computerized tomography
6. Gunay Y, Altinkok M, Çagdir S, Kirangil B (1997) Gender
determination with skull measurements (in Turkish). J
Forensic Med 13:13–19
7. Gunay Y, Altinkok M, Çagdir S, Sari H (1998) Is foremen
magnum size useful for gender determination (in Turkish).
Bull Legal Med 3(2):41–45
8. Hauser G, De Stefeno GF (1989) Epigenetic variants of the
human skull. E. Schweizerbart’sche Verlagsbuchhandlung.
Stuttgart, pp 38–40
9. Jovanic S, Jelicic N, Kargovska-Klısarova A (1984) Le
développement post-natal et les rapports du sinus maxillaire.
Acta Anat 118:122–128
10. Kaptanoglu K, Ozdemir B (2001) Gender dimorphism from
skull tickness: a preliminary study (in Turkish). In: Annual
_
forensic medicine meeting proceeding, Istanbul, pp 153–156
11. Karakas S, Kavaklı A (2005) Morphometric examination of
the paranasal sinuses and mastoid air cells using computed
tomography. Ann Saudi Med 25(1):41–45
12. Kim HJ, Yoon HR, Kim KD, Kang MK, Kwak HH, Park
HD, Han SH, Park CS (2002) Personal computer based three
dimensional reconstruction and simulation of maxillary si-
nus. Surg Radiol Anat 24:393–399
13. Krogman WM, Iscan MY (1986) The human skeleton in
forensic medicine, 2nd edn. Charles Thomas Publisher,
Springfield, IL, pp 189–243
14. Lee Fernandes C (2004) Forensic ethnic identification of
crania. The role of the maxillary sinus—a new approach. Am
J Forensic Med Pathol 25(4):302–313
15. Lerno P (1983) Identification par le sinus maxillaire. Odontol
Leg 216:39–40
16. Ozaslan A, Iscan MY, Ozaslan I, Tugcu H, Koc S (2002)
Gender determination from hand measurements (in Turk-
ish). In: Annual forensic medicine meeting proceeding, An-
talya, pp 114–118
17. Plenk JR, Tschabıtscher M (1986) Entwicklung, makro und
mikromorphologie der kieferhöhle. In: Watzek G, Matejka
M (eds) Erkrankungen der Kieferhöhle. Springer-Verlag,
Wien, New York, pp 1–12
18. Quatrehomme G, Fronty P, Sapanet M, Grevin G, Bailet P,
Olier A (1996) Identification by frontal sinus pattern in
forensic anthropology. Forensic Sci Int 83:147–153
19. Reichs KJ (1993) Quantified comparison of frontal sinus
patterns by means of computed tomography. Forensic Sci Int
61:141–168
20. Riepert T, Ulmcke D, Schweden F, Nafe B (2001) Identifi-
cation of unknown dead bodies by X-ray image comparison
Surg Radiol Anat (2007) 29:9–13
of the skull using the X-ray simulaton program FoXSIS.
Forensic Sci Int 117:89–98
21. Rogers LT (2005) Determining the sex of human remains
through cranial morphology. J Forensic Sci 50(3):1–7
22. Szılvssy J (1986) New methods about the intraserial analysis
of the excavation areas. Mitt Berliner Ges Anthrop Ethnol
Urgesc 7:49–62; In: Hermann B (ed) Innovatory tendencies
in prehistoric anthropology. Proceedings of the Contr
_
International Symposium, Berlin-West, 26 February–1
March 1986
23. Szılvassy J (1987) The importance of the rontgenologic
methods fort he prehistoric and recent history excavation
13
areas. In: Up-to-date problems of the fominit evolution-
Veröff. Überse-Mus Bremen 9:79–128
24. Williams PL, Bannister LH, Berry MM, Collins P, Dyson M,
Dussek JE, Ferguson MWJ (1995) Gray’s anatomy, 38th edn.
Churchill Livingstone, Edinburgh, pp 1637
25. Wind J (1984) Computerized X-ray tomography of fosil
hominid skulls. Am J Phys Anthropol 63:265–282
26. Wind J, Zonneveld FW (1989) Computed tomography of an
Australopithecus skull (Mrs. Ples): a new technique. Natur-
wissenschaften 76:325–327
123