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Related Experiment Video

Updated: Apr 4, 2026

Midface Hypoplasia and Cranial Base Morphology in Syndromic Craniosynostosis: A Comparative Analysis Study Using a Predictive Regression Model
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Sex Estimation Using Reproducible Craniometric Traits in a Modern Greek Population: A Pilot Craniofacial Study.

Michael Kostares1, Nikolaos Pantazis2, Panagiotis Papanagiotou3

  • 1Department of Anatomy, Faculty of Health Sciences, School of Medicine, National and Kapodistrian University of Athens.

The Journal of Craniofacial Surgery
|April 3, 2026
PubMed
Summary

This study introduces a new cranial base measurement, the Prosthion-Opisthion (PO) chord, for sex estimation in modern Greeks. While accuracy was moderate, the PO chord and Composite Bookstein Classification (CBC) improve reproducibility in forensic anthropology.

Keywords:
Computed tomographycraniofacial morphologycraniometric analysismeasurement reproducibilitypopulation specificitysex estimation

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Area of Science:

  • Forensic Anthropology
  • Biological Anthropology
  • Craniometry

Background:

  • Sex estimation is crucial in skeletal identification for forensic and medicolegal purposes.
  • Cranial metrics are widely used but accuracy varies with population and landmark reliability.
  • Limited craniometric reference data exists for the modern Greek population.

Purpose of the Study:

  • To provide population-specific pilot data for cranial sex estimation in modern Greeks.
  • To introduce and evaluate the Prosthion-Opisthion (PO) chord as a reproducible cranial base metric.
  • To assess the reliability of measurements using the Composite Bookstein Classification (CBC).

Main Methods:

  • Analysis of 100 adult Greek crania (51 male, 49 female) using 13 manual craniometric measurements.
  • Introduction of the Prosthion-Opisthion (PO) chord as an alternative to conventional cranial length.
  • Application of Composite Bookstein Classification (CBC) for landmark reliability and logistic regression for sex estimation models with 10-fold cross-validation.

Main Results:

  • High inter-rater reliability (ICC=0.864) observed, particularly for CBC Type I and II measurements.
  • Significant sexual dimorphism found for the PO chord, facial height, nasal height, and foramen magnum length.
  • Multivariable model achieved moderate cross-validated accuracy (68.0% AUROC=0.78), with higher apparent accuracy (77.7%).

Conclusions:

  • The PO chord is a reproducible metric for cranial sex estimation in modern Greeks.
  • The CBC framework enhances transparency in measurement reliability assessment.
  • Findings highlight the importance of reproducibility, internal validation, and population specificity in forensic craniometry, warranting larger studies.