Gender Determination Based on CBCT Maxillary Sinus Analysis: A Systematic Review

Gender determination is an essential element for human identification in forensic medicine, to which the maxillary sinuses may contribute as they remain intact even after severe damage to the skull and other structures. Aim: To evaluate scientific evidence published over the last decade to determine whether maxillary sinus dimensions and volume may constitute useful parameters for forensic identification and gender determination, based only on cone-beam computed tomography images (CBCT). Methods: This review adhered to the PRISMA statement’s criteria. Four databases were searched for articles published between January 2010 and April 2023. Results: Initially, 1719 records were identified. After screening, there were 2475 participants in the included studies. Of the fifteen articles selected, five reported data assessing only volumetric measurements of the maxillary sinus, seven reported data calculating only linear measurements and three reported data by combining findings of both linear and volumetric measurements of the maxillary sinus. Maxillary sinus volume was significantly higher in male participants. Maxillary sinus height was the best discriminating parameter for forensic identification with an overall accuracy ranging from 70% to 80%. Conclusions: Maxillary sinus measurements revealed anatomic variability between genders, and this approach can be applied as a complementary method for human identification.