A Comparative Analysis of Mandibular Ramus and Maxillary Sinus in Sex Determination among the Population of West Godavari, India: A Tool in Forensic Identification
Correspondence Address :
Dr. Alapati Naga Supriya,
Associate Professor, Department of Oral Pathology, Vishnu Dental College, Bhimavaram-534202, Andhra Pradesh, India.
E-mail: nagasupriya.a@vdc.edu.in
Introduction: The application of dental principles to legal issues is known as forensic dentistry. Among the skull’s various bones, mandible is the strongest and most diverse bone and is crucial in determining sex. It has been reported in many studies that maxillary sinus seems to be intact, although other bones may be severely deformed and can be applied to determine sex.
Aim: To assess, analyse and compare the morphometric analysis of maxillary sinus and ramus of mandible for gender determination using digital Orthopantamograph (OPG).
Materials and Methods: A cross-sectional study was conducted in Department of Oral Medicine, Radiology and Oral Pathology, Vishnu Dental College, Bhimavaram, Andhra Pradesh, India. The study comprising of 64 individual radiographs (32 men and 32 women) were measured for mandibular ramus (maximum ramus width, condylar and coronoid height) and maxillary sinus length, width and compared bilaterally. The results were tabulated and statistically analysed using discriminant functional analysis after the mean values were calculated.
Results: The mean age of study population was 34.67±5.78 years. In the present study, the overall measurements of mandibular ramus were more in males than females whereas maxillary sinus measurements were more in females when compared to males. Condylar length (right and left), width of ramus (right) and width of maxillary sinus (left) were found to have statistical significance in determining the gender (p-value <0.001, 0.024, 0.024). Length of the condyle showed highest accuracy of 73.8% in gender determination.
Conclusion: The present study suggests that the mandibular ramus and maxillary sinus measurements using OPG are helpful in dealing forensics, with condylar height being the most accurate indicator for gender determination.
Digital orthopantamograph, Forensic dentistry, Gender determination
Forensic odontology is a multidisciplinary field of study that deals with issues of jurisdiction and the victim identification in large-scale disasters and analysing natural disasters with dental records. In criminal justice cases, Forensic Odontology also known as Forensic Dentistry, handles, examines, and evaluates dental evidence. Forensic dentistry plays a crucial role when other human identification techniques are either not indicated or not appropriate. Gender identification is the first step in the identification procedure for adult skeletons. All human populations have different sized and shaped adult male and female skeletons (1),(2).
Sex identification depends mainly on the sections of the skeleton that are still present in cases of large-scale disasters where fragmented bones are typically discovered. The most frequently used part of the skeleton for gender identification is the skull, followed by the pelvis (1). The mandible, the most dimorphic bone in the skull, may be crucial in determining sex in situations where the whole skull is not present. The largest thick, compact bone and sturdiest bone in the face is the mandible making it exceptionally resilient and well preserved for personnel identification in large-scale disasters (2). In victims who are incinerated, the maxilla remains still intact and radiographic pictures offer sufficient measures of the maxillary sinus that can be used to determine sex (3),(4).
Interpreting OPGs is a simple, non-invasive, economical, and reliable method for determining the un-identified. The OPG is routinely used in dentistry to obtain a complete overview of the maxillofacial complex which can be utilised to measure the mandibular ramus and maxillary sinus effectively (5). The OPG can be used to determine gender from mandibular ramus and maxillary sinus measurements.
Several research have been done to determine the sex of dry adult mandibles (1),(2),(6), but a literature search found very few studies (6),(7) that measured the mandibular ramus using digital panoramic radiograph. This is one of the first kind of study, attempted to determine the sex of an individual where numerous measurements of the maxillary sinus and mandibular ramus were measured, compared, and evaluated using digital OPG’s in West Godavari population.
A cross-sectional study was done on 64 OPG’s (32 males, 32 females) in Department of Oral Medicine, Radiology and Oral Pathology, Vishnu Dental College, Bhimavaram, Andhra Pradesh, India. The study protocol was approved by Institutional Ethical Committee (IECVDC/22/UG01/OP/IVV/76), Vishnu Dental College, Andhra Pradesh for a period of four months, August 2022 to November 2022.
Inclusion criteria: Male and female patient radiographs with age group of 25-40 years without any pathologies, completely developed maxillary sinus, mandibular ramus and radiographs with adequate density, contrast and clarity were included in the study.
Exclusion criteria: Radiographs with blurred images and artifacts caused by metallic objects, not covering entire maxillary sinus and mandibular ramus and any pathologies were excluded from the study.
Sample size calculation: Using the G power 3.1 software, sample size was calculated based on a desired power of 0.80, an alpha level of 0.05, and an accuracy of mandibular ramus and maxillary sinus for determination of sex was 84% and 90% (1). The estimated sample size was 64.
Study Procedure
The OPG’s of both male and female patients were conducted. Sex determination was done as per the measurement of the mandibular ramus (maximum ramus width, condylar and coronoid height) and maxillary sinus length and width. Description of measurements were recorded as follows [Table/Fig-1,2]:
Mandibular ramus
Maximum width of ramus: The distance between the anterior point of mandibular ramus to the posterior point of condyle and angle of jaw.
Condylar height: Most superior point on the mandibular condyle to lower border of ramus.
Coronoid height: Distance between coronion to lower border of bone.
Maxillary sinus
Sinus width: Anterior part of sinus to most posterior part of sinus
Sinus length: Superior to inferior wall of sinus (1),(3),(4),(6),(7)
Measurements were made bilaterally, values obtained were entered in the Microsoft Excel sheet, average values were determined, the results tabulated, and statistical analysis was performed.
Statistical Analysis
The values obtained were entered in the Microsoft excel sheet and the tabulated data was analysed using Statistical Package for Social Sciences (SPSS) version 20 (International Business Management (IBM) version 20.0). Discriminate functional analysis was used to assess the morphometric analysis of maxillary sinus and mandibular ramus for gender determination with a 0.05 or lower p-value was found to be statistically significant.
The mean age of study population was 34.67±5.78 years with 50% males and 50% females (32 males and 32 females). Descriptive statistical analysis of all the odontometrical variables on OPG is shown in (Table/Fig 3). Condylar length (right and left), width of ramus (right) and width of maxillary sinus (left) showed statistically significance (p-value <0.001, 0.024, 0.024) in determining gender. Other parameters like coronoid length (right and left), width of ramus (left), length of maxillary sinus (right and left), and width of maxillary sinus (right) were not statistically significant. All the above variables showed higher measurements in males than females except width of maxillary sinus which was higher in females than in males.
The sex could be determined from calculations using the equations given below:
D Male : -459.295+3.584 (width of max. sinus right-side)+0.146 (width of max. sinus left-side) -0.973 (length of max. sinus right-side)+5.213 (length of max. sinus left-side)+3.535 (condylar length on right-side)+0.925 (condylar length on left-side) -0.842 (coronoid length on right-side)+1.593 (coronoid length on left-side)+0.939 (width of ramus on right-side)+2.654 (width of ramus on left-side)
D Female : -434.533+3.449 (width of max. sinus right-side)+0.343 (width of max. sinus left-side) -1.084 (length of max. sinus right-side)+5.217 (length of max. sinus left-side)+3.360 (condylar length on right-side)+0.778 (condylar length on left-side) -0.718 (coronoid length on right-side)+1.587 (coronoid length on left-side)+0.820 (width of ramus on right-side)+2.632 (width of ramus on left-side)
In the present study, the cut-off point was found to be -0.749. values greater than this sectioning point indicate male and values lesser than this point indicate female. Accuracy was calculated using discriminant functional analysis for gender determination using different odontometrical variables and depicted in (Table/Fig 4). Length of the condyle showed highest overall accuracy in determining gender (73.8%) followed by width of ramus (right- 69.2%), width of maxillary sinus (left- 67.7%), while length of maxillary sinus (right- 46.2%) showed least accuracy.
In forensic anthropology and medicine, particularly in criminal investigations, the hunt for the missing, and attempts to reconstruct the lives of ancient populations, the ability to determine sex from human remains is crucial. The first most important step in a forensic investigation is the identification of skeletal remains. At the scene of a crime, accident, or major disaster, human remains are partially recovered where sex determination is dependent on these fragmented skeletal remains only (8),(9). The pelvis is the most sexually dimorphic part of the human skeleton, which exhibits significant sex differentiation. The reliability of the human skull for sex determination is 92%, making it also an essential part of forensic examination (10),(11). Although the other bones suffer severe disfigurement in explosions, combat, and other mass tragedies like aeroplane accidents, the maxillary sinuses have been seen to be intact (3),(4). The biggest and toughest bone of the face, the mandible, may be the only remaining bone at these incidents that can be used to help determine the sex (12),(13), with the above mentioned benefits of the mandibular ramus and maxillary sinus in the current study, the authors utilised various parameters in sex determination.
In the present research, measures of the maxillary sinus and mandibular ramus were analysed using discriminant functional analysis. Three measurements from the mandibular ramus and one from the maxillary sinus assessed from OPG showed statistically significant gender differences (p-value 0.05), indicating that condylar length exhibited good sexual dimorphism which was in accordance with the results of Indira AP et al., Shakya T et al., Giles E, Humphrey LT et al., (1),(6),(11),(14). The present study revealed that men had larger mandibular ramus measurements than women, which was consistent with research by Indira AP et al., Mehta H et al., Shakya T et al., More CB et al., and Verma P et al., (1),(2),(6),(7),(15). Comparison of the data for present study with similar studies from the literature has been done in (Table/Fig 5) (1),(2),(6),(7),(15).
In the present study, the maxillary sinus was measured on both sides to determine gender. The width of the left-side’s maxillary sinus was found to be the best variable for gender discrimination and was statistically significant. In contrast, Uthman AT et al., found that the best variable for determining gender was the height of the left maxillary sinus (16). The results of a different study performed by de Queiroz CL et al., suggested that the height and width of the right and left maxillary sinuses were significant for sex discrimination (3).
It has been shown that socio-environmental elements like diet, food, climate, etc., affect the development and appearance of bones. Numerous research have found that each population’s skeletal characteristics vary, emphasising the need for population-specific osteometric standards for sex determination (1),(6),(7),(11),(15). The mandible and maxillary sinus measurements can be recorded using the OPG, which is a reliable and accurate tool.
Limitation(s)
All the digital OPG’s were interpreted by only one observer.
The mandibular ramus has significant sexual dimorphic characteristics when compared to the maxillary sinus. According to the present research, the most important factor in determining sex is condylar height followed by width of mandibular ramus and width of maxillary sinus. Therefore, the authors strongly advise using the mandibular ramus and maxillary sinus as a tool for forensic examination to help in gender determination. Further research on more diverse populations is advised in considering the results to determine the importance of these characteristics.
DOI: 10.7860/JCDR/2023/62858.18164
Date of Submission: Jan 12, 2023
Date of Peer Review: Jan 30, 2023
Date of Acceptance: Feb 18, 2023
Date of Publishing: Jul 01, 2023
AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. Yes
PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Jan 13, 2023
• Manual Googling: Feb 14, 2023
• iThenticate Software: Feb 14, 2023 (11%)
ETYMOLOGY: Author Origin
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