Sex estimation by maxillary sinus using computed tomography: a systematic review

Sex estimation is an important part of forensic human identification, and when primary methods cannot be applied, forensic anthropology becomes an important auxiliary method of identification. The maxillary sinus may remain intact even if the skull is severely damaged and could thus be used in forensic investigations. The objective of this study was to verify the effectiveness of the evaluation of the maxillary sinus as a technique for sex estimation. Articles published in the past 10 years were searched using PubMed, Web of Science, Scopus, and Cochrane databases, including those that used computed tomography to perform maxillary sinus measurements with the purpose of sex estimation. Studies that used radiographs to perform the measurements were excluded because they do not allow for a three-dimensional analysis. Studies that did not provide information regarding the origin of the analyzed population were also excluded. The selected articles were evaluated for methodological quality according to the indication of the objective, studied population, inclusion and exclusion criteria, parameters for obtaining the computed tomography image, measurements evaluated, bias discussion, and ethical authorization. From the 52 articles found, 18 were included. The populations studied included Indians, Iraqis, Iranians, Egyptians, Brazilians, French, Dutch, and Turkish. Height, width, length, and volume of the maxillary sinus were measured. The maxillary sinus can act as an auxiliary tool for sex estimation in forensic investigations.