Is lateral cephalometric analysis useful to sex estimation in forensic science? A cross-sectional study

The objective of this study was to investigate whether linear, angular, and area measurements derived from lateral cephalometric radiographs can serve as an additional method for determining sex in a sample of Greek population.

The study sample comprised digital lateral cephalometric radiographs from 150 Greek individuals aged 18-65 years, who sought orthodontic treatment at the School of Dentistry, National and Kapodistrian University of Athens, Greece. Patient records were screened based on eligibility criteria for inclusion in the study. The sample was categorized by sex and age, with age intervals of 5 years. An equal number of lateral cephalometric radiographs for males and females were distributed within each age group. Twelve cephalometric points visible on lateral cephalometric radiographs were digitally traced using ViewBox software, including glabella, nasion, orbitale, sella, basion, porion, anterior nasal spine, posterior nasal spine, anterior, superior, posterior and inferior points of sinus. The present cross-sectional study used a binary logistic regression (BLR) model.

Sex was predicted with an overall accuracy of 74.7 %. A value lower than 0.41 identified a male participant, and a value higher than 0.41 a female participant. The estimated sensitivity and specificity are 85.3 % and 64.0 %, respectively, indicating that the model has satisfactory adjustment. The area under the Receiver Operating Characteristic (ROC) curve (area under the curve - AUC) was 0.80, indicating good discriminative ability.

Cephalometric analysis using radiographs for sex estimation could be useful as a complementary method to conventional sex estimation approaches and may serve as a reliable sex predictor in the Greek population, particularly when alternative techniques cannot be used to estimate sex.