Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Sanjay Gandhi institute of trauma and orthopedics,
On Aug 2018

Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".

Dr. Mamta Gupta
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018

Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.

Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
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Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
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Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
On May 11,2011

Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."

Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
On April 2011

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.

Dr. Anuradha
On Jan 2020

Important Notice

Year : 2022 | Month : December | Volume : 16 | Issue : 12 | Page : AE01 - AE05 Full Version

Mandibular Ramus as a Tool For Sexual Determination: A Systematic Review

Published: December 1, 2022 | DOI:
Kishore Chandra Thakur, Tarang Srivastava

1. Associate Professor, Department of Anatomy, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, Uttarakhand, India. 2. Associate Professor, Department of Physiotherapy, Shri Guru Ram Rai Institute of Medical and Health Sciences, Shri Guru Ram Rai University, Dehradun, Uttarakhand, India.

Correspondence Address :
Dr. Kishore Chandra Thakur,
Flat No-33, Ground Floor, Lane 2, Madhu Vihar, Haripur, Kanwali, GMS Road, Dehradun, Uttrakhand, India.


Introduction: Mandible being one of the sturdy bone resists damage and therefore its fragments are mostly available after mass disasters like explosions. After the pelvis, the mandible of the skull has significant sexual dimorphism. Many parameters of the mandible altogether make it suitable to identify sex from a given bone.

Aim: To determine sex with the help of parameters of the ramus of human mandible.

Materials and Methods: This systematic review included the articles from 2000 to 2020 and took one year duration. All studies were categorised under dry bone and radiological study. Only original articles of a cross-sectional study, cohort study and case-control study related to ramus and sex determinations were selected online by using available databases like Medline, Embase, and Google Scholar. All selected articles were then analysed for different types of ramus parameters studied. Studies that considered more than one parameter of ramus were included or otherwise rejected. Research articles that mentioned the efficacy of gender identification of bone by considering parameters of the ramus of the mandible, were tabulated.

Results: Commonly used ramus parameters by different researchers were maximum ramus breadth/width, minimum ramus breadth/width, ramus flexure and ramus height. In addition, coronoid height and projection height was also used by some. In most of the studies, parameters in males were higher than in females whereas gender predictive value was seen higher i.e, 70-83% when a combination of all ramus parameters was taken. In the case of consideration of a single parameter, gender predictive values ranged from 45-79%, and a higher sex predictive value was seen for males.

Conclusion: Only when the fragment of the mandible ramus is available, then it can be utilised for gender identification by using ramus width, ramus height along with other parameters based on availability. Ramus alone is a good tool for sex determination in the mandible.


Panoramic, Radiographies, Sex dimorphism

After the pelvis, the role of the mandible is considered significant in the identification of gender (1),(2). Being the strongest bone of the face, mandible is more resistant to degradation and has more possibility to get fragments as a piece of evidence. There is a number of metric and non metric traits of mandible utilised in gender determination due to their property of sexual dimorphism (3),(4),(5). Mandible shape and size help to determine sexual dimorphism but the condyle and ramus part of the mandible have higher scores in the determination of gender (6). The study of different parameters of the mandible showing relevant sexual dimorphism has an important role in the field of archeology, anthropology, and forensic science in relation to the identification of race, age, and gender. A combination of metric traits adds more reliability due to its measurable quantitative element. When sex determination of bone is done by osteometric or radiograph method, metric analysis by radiograph methods stands superior in terms of accuracy and reproducibility (7).

In anthropology, sex determination is one of the pillars among other components like age and population. Age-related changes include remodeling with the growth of an individual. Morphological changes in the mandible due to food habits have major effects on the dimension of parameters of the ramus and condyle of the mandible. Radiograph methods like Orthopantomography (OPG) and Digital Panoramic radiography (DPG) are common routine procedures in dental and medical clinical fields (5),(6). A large amount of data available due to these routine procedures can be easily utilised for gender identification after filtering specific parameter dimensions, which can be beneficial in the field of forensic anthropology and forensic investigation.

With the increasing incidence of mass disasters by explosions, natural calamities, air crashes, and crimes there has been increased demand for data, with the help of which, identification of an individual and their gender can be done from fragments of the bone that are available. In the present systematic review, an attempt was made to summarise the role of the ramus of the mandible as a fragment for gender determination.

Material and Methods

This systematic review included the articles from 2000 to 2020 and analysis was done in one year duration (March 2021 to February 2022). An online search was done on available databases like Medline, Embase and Google Scholar. Related literature of the last 20 years from 2000 to 2020, was searched that included keywords like dry mandible, ramus, gender determination, radiological, orthopantomography osteologic, anthropology, forensic, and sexual dimorphism. In order to get more related articles, Boolean operators such as AND/OR/NOT were utilised. A combination of the mandible and sexual dimorphism, dry mandible or osteological study, the panoramic study of the mandible, ramus and gender determination and ramus not gonial width were utilised to search more titles, abstracts and original articles. References of the related articles were searched to extract more data. For the purpose of collecting relevant articles, certain inclusion and exclusion criteria were formulated.

Inclusion criteria: Articles included were only those that came under the category of observational studies, cross-sectional studies, prospective and retrospective studies. Original articles, abstracts and full-text articles based on radiological and osteometric studies of the ramus of the mandible, with aim of study for sexual dimorphism were only included in the study.

Exclusion criteria: Case report and review article were not included in the study. Any article on mandibles, but not based on gender determination or not on human mandibles was excluded. Articles about the growing mandible, irrespective of the aim for sexual dimorphism were also excluded from the study.

After the screening, 126 relevant articles were collected. After the application of inclusion and exclusion criteria, 34 articles were finalised for systemic review (Table/Fig 1).

All included materials were categorised into the radiological and osteological study, in relation to parameters of the ramus of the mandible and tabulated along with needful data. All the articles finalised were individually screened and analysed by the authors. Tabulation of studies with their population, parameters used, study tool, and conclusions were done.

Study of Risk of Bias

In case of any doubt in relation to exclusion or inclusion, the article was discussed among authors to reach a common consensus on excluding or including the article. A checklist for qualitative research by Munn Z et al., was used to assess the quality of articles. This tool assessment was based on review question clarity, inclusion criteria, appropriateness of the extent of use of resources, criteria of appraising studies, methods used to minimise errors, the combination of different studies, publication bias, and any directive for new ideas given or not (8). Any disagreement over any article was tried to finalise following the above leading questions to reach common consensus of exclusion and inclusion. This reduced bias of selection, but still selection bias could not be totally neglected .


Considering all Indian studies, Max RB was 38.2 mm in males and 35.8 mm in females whereas Min RB ranged from 27.7 mm to 30.11 mm in males and 20.2 mm to 30.11 mm in females with overall accuracy 83.9% (5),(6),(7),(9),(10),(11),(12),(13),(14),(15),(16),(17) (Table/Fig 2),(Table/Fig 3). In (Table/Fig 3), the study on the population of Thailand shows that the Min RB in them was closer to the lower value of Min RB of the Indian population. Among all other countries,ramus height in Indians was in the range of 60.1 mm to 67.9 mm for males and 40.9 mm to 55.7 mm for females (11),(12),(17),(18),(19),(20),(21),(22),(23),(24),(25),(26),(27),(28) (Table/Fig 4),(Table/Fig 5). The ramus height of Thailand people (Table/Fig 5) was closer to the lower value of the ramus height range observed in the Indian population and it was a much lower value range from 44.18 to 49.94 mm seen in the population of Tanzania (28). The overall accuracy of sex determination was seen higher with parameter ramus breadth. There was a big range of accuracy of gender identification for ramus flexure noticed, ranging from 32 to 92%, but it was found that the percentage of accuracy was higher in males in comparison to females (29),(30),(31),(32),(34),(35),(36),(37) (Table/Fig 6),(Table/Fig 7).


Many related articles showed that more than 22 parameters were studied in the mandible to understand their correlation with sexual dimorphism. The total article reviewed in the last 20 years showed that the most common parameters utilised for gender determination in the mandible were a gonial angle, ramus height, ramus breadth, ramus flexure, and bigonial width. Among these, correlations of parameters like gonial angle, ramus flexure and ramus breadth were more in accuracy alone or in combination, for sex determination through the mandible. Kharoshah MA et al., in their radiological study with a sample of 330 people in Egypt population concluded that, the overall predictive accuracy of sex prediction was 83.9% by using parameters bicondylar breadth, gonial angle, and minimum ramus breadth whereas it was 83.6% in males and 84.2% in females (13).

Saini V et al., took 116 mandibles of north Indian origin for their osteometric study over the different parameters of ramus only that included condylar height, projected height, coronoid height, minimum, and maximum ramus breadth. They found significant sexual dimorphism with an overall accuracy of 80.2% (32). Lin C et al., did a study of 240 mandibles of the Korean population to determine sex from ramus flexure parameters only, and found that, sex determination accuracy ranges from 50.4 to 77.1% by using discrimination functional analysis. They further added that accuracy increases up to 88.8%, if all variables of mandibular flexure were input in stepwise discriminant analysis (31).

Ercan I et al., took 415 samples of Turkish origin, to study of virtual assessment of sex by a linear and angular trait of mandibular ramus, using three-dimensional CT concluding an accuracy range of 51-95.6% in sex determination by using mandibular ramus. They further pointed out that accuracy increased to 89.7-98.6% if mandibular flexure upper border and max ramus breadth was utilised by applying bivariate analysis (38). A 99% accuracy rate was noticed by them when stepwise discrimination analysis was done. Saloni et al., in their study of ramus and gender determination by the radiological method using digital panoramic film of 200 Indian origin samples found significant differences and thus were able to get overall accuracy of sex determination by ramus parameters upto 77.6%, which was individually up to 78.4% in male and 76.8% in female respectively (5).

Kaur R et al., did a digital radiological study on 100 samples of the Indian Haryana region to find mandibular ramus and sex determination using ramus parameters like minimum and maximum ramus width, condylar height, and projection height of ramus. They found significant differences between male and female parameters (39). Indira AP et al., their radiographic study of 100 mandibles of Indian origin concluded that the mandibular ramus was a strong parameter for sex determination (22).

The above study was supported by a similar study done by Damera A et al., (40). Loth SR and Henneberg M, found mandibular ramus flexure help to determine the sex of the mandible with an accuracy of up to 91% due to a significant difference (3). Pokhrel R and Bhatnagar R 2013 (16) concluded that, a fragment of a mandible having a ramus can be used for gender determination when they found significant differences in the parameter of the ramus and were able to determine the sex of the mandible with an overall accuracy of 82.9% with help of ramus breadth and 70.9% with condylar length and breadth by using discriminate functional analysis method (16). For this study, they took 158 rami of 79 mandibles of Indian origin. Kronoiti EF et al., found significant differences and sexual dimorphism in the ramus of the mandible by using discriminate functional analysis by taking 70 adult Greek population mandibles (1).

The collection of huge data over years on different parameters related to the ramus of the mandible enables anthropologists to identify the gender of an individual with the help of fragments of the mandible. Predictive accuracy increases as parameters like ramus height, ramus width, and ramus flexure, when combined all together to identify gender through the ramus of the mandible. In addition to gender identification, these parameters data could be utilised in the field of cosmetic surgery like reconstruction of the face. Comparative study over parameters of different populations and ethnicity would help to understand anthropological connections among them, if any or to evaluate factors, that lead to changes in morphometric dimensions of the mandible. The development of more aesthetic prostheses could be possible, if the compilation of all related parameters was done and analysed based on age, population, and gender.


The non availability of sufficient data, based on a cadaveric study was a big limitation and could not be well-blended, with studies based on radiological and osteometric studies.


Different parameters like ramus breadth, ramus height and ramus flexure all together play a significant role in sexual dimorphism identification of the mandible and can be utilised in combination to identify the sex of fragment of ramus of the mandible with predictive accuracy, ranging from 64-84%. Considering the fact that, most of the studies included were on the Indian population which showed the same trend as those of another geographical area i.e most parameters were on the higher side in males. The parameters like ramus breadth, were comparatively lower in people of Thailand and ramus height of Tanzania population was toward the lower end of the range seen in the Indian population. Validated measurements based on different gender, ethnic patterns, and populations should be kept in mind during anthropological studies, forensic applications, and surgical reconstruction of faces.


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DOI and Others

DOI: 10.7860/JCDR/2022/59582.17242

Date of Submission: Aug 09, 2022
Date of Peer Review: Sep 19, 2022
Date of Acceptance: Nov 20, 2022
Date of Publishing: Dec 01, 2022

• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? No
• Was informed consent obtained from the subjects involved in the study? NA
• For any images presented appropriate consent has been obtained from the subjects. NA

• Plagiarism X-checker: Aug 22, 2022
• Manual Googling: Nov 15, 2022
• iThenticate Software: Nov 17, 2022 (7%)

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