|Year : 2014 | Volume
| Issue : 1 | Page : 12-15
A study of morphometric evaluation of the maxillary sinuses in normal subjects using computer tomography images
Lakshmi N. Kiruba1, Chandni Gupta1, Sandeep Kumar2, Antony S. D'Souza1
1 Department of Anatomy, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
2 Department of Radiodiagnosis, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
|Date of Web Publication||4-Jun-2014|
Department of Anatomy, Kasturba Medical College, Manipal - 576 104, Karnataka
Source of Support: None, Conflict of Interest: None
Objectives: The paranasal sinuses are complex anatomical structures with a significant inter-individual variation. The dimensions of maxillary sinuses are particularly significant when considering endoscopic sinus surgery . The aims of this study were to estimate different dimensions of the maxillary sinuses measured on head CT, and their relations to sex of the individuals. Materials and Methods: Cranial computerized tomographic images (CT) of 200 normal subjects between the age groups of 18 and 80 years were observed in this study. The height, width, and depth of the maxillary sinuses were measured with a Philips Brilliance 64 CT. The statistical analysis for sex and age comparison for all the parameters was done. Results: The mean width, height, and depth of maxillary sinus in male on both right and left side were 27.8, 28.2, 39.9, 39.6, and 40.0, 39.7 mm but in females were 26.6, 26.7, 36.8, 37.1, and 36.6, 37.4 mm. The discriminative analysis showed that the accuracy of maxillary sinus measurements i.e. the ability of the maxillary sinus size to identify gender was 55% in females and 69.5% in males. Conclusion: This study on CT dimensions of maxillary sinuses may be beneficial for the ENT surgeons when planning for endoscopic sinus surgery and to support gender determination.
Keywords: CT scan, maxillary sinus, measurements
|How to cite this article:|
Kiruba LN, Gupta C, Kumar S, D'Souza AS. A study of morphometric evaluation of the maxillary sinuses in normal subjects using computer tomography images. Arch Med Health Sci 2014;2:12-5
|How to cite this URL:|
Kiruba LN, Gupta C, Kumar S, D'Souza AS. A study of morphometric evaluation of the maxillary sinuses in normal subjects using computer tomography images. Arch Med Health Sci [serial online] 2014 [cited 2019 Dec 14];2:12-5. Available from: http://www.amhsjournal.org/text.asp?2014/2/1/12/133782
| Introduction|| |
Maxillary sinuses are two spaces, which are occupied with air, situated in the maxillary bone, and can be in several sizes and shapes. Their walls are thin. The tip of the sinuses can extend into the zygomatic process and can occupy the zygomatic bone. The base formed by the alveolar process, the first, the second, and the third molars, and the roots of the canines may raise the sinuses or may pierce their base.  It drains into the middle meatus (hiatus semilunaris) of nose. 
The maxillary sinuses appear at the end of the second embryonic month. They extend to the roof of the permanent teeth when deciduous teeth fall off. The maxillary sinuses originate as invagination of the nasal mucosa into maxilla bone. This unique development describes the massive quantity of anatomical variation. 
Computed tomography (CT) is an outstanding means of providing anatomical information of this area; thus, it has been used to determine the anatomic variations of the nose and paranasal sinuses. 
It has been reported that maxillary sinuses stay intact though the skull and other bones may be severely disfigured in victims who are incinerated and hence, that maxillary sinuses can be used for identification. 
The aim of this study was to investigate whether the width, the depth, and the height of maxillary sinuses can be used for determination of gender.
| Materials and Methods|| |
This study included cranial computerized tomographic images (CT) of 200 (M = 120, F = 80) normal subjects between the age groups of 18 and 80 years, for which ethical clearance has been taken from the local ethical committee. The Width, height, and depth measurements were made where the maxillary sinus was in its widest position with the help of the measurement equipment on Philips Brilliance 64 CT scan, as the measurement technique. Whereas width is measured in axial section [Figure 1] and height, depth in sagittal section [Figure 2].
|Figure 2: Showing the height and depth of maxillary sinus as measured on CT images|
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The statistical analysis for sex and age comparison for all parameters was done using t-test for independent samples to compare these values in two groups. Discriminative analysis was done to detect gender by using data obtained from CT scans. The analyses were performed by using the SPSS 14 package program.
| Results|| |
In the current study, the size of the maxillary sinuses of the female was found to be smaller than those of men. [Table 1] shows the distribution of the mean width, depth, and height of maxillary sinuses with their standard deviations according to gender.
|Table 1: Distribution of linear measurements of maxillary sinuses on CT and their standard deviations |
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A significant difference was found in the width, the height, and the depth of the sinuses between males and females, except the width of the right maxillary sinus which is not significant.
This formula can be used for gender determination from measurements of the left (Lt) and the right (Rt) maxillary sinuses together:
Gender = -8.424 - 0.118 X height of Rt MS - 0.120 X depth of Rt MS - 0.039 X width Lt MS + 0.088 X height Lt MS + 0.096 X depth Lt MS.
The accuracy rate of gender identification from the right and left maxillary sinus measurements together was 55% in females and 69.5% in males, with a mean of 63.6% [Table 2].
|Table 2: Gender determination from measurements of both maxillary sinuses together |
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| Discussion|| |
Identification from remnants of human skeletons is a significant forensic procedure. Determination of age and gender is an essential part of identification. Gender determination is certainly significant for identification. It has been stated that the precision rate of gender determination is 100% from a skeleton, 98% from both the pelvis and the skull, 95% from the pelvis only or the pelvis and the long bones, 90-95% from both the skull and the long bones, and 80-90% from the long bones only. ,,
It has been reported that the maxillary sinuses are significantly larger in males than in females. ,, The left maxillary sinus has been reported to be larger than the right sinus in both genders. 
In study of Lee Fernandes, (2004) about gender determination from measurement of the maxillary sinuses, it has been noted that maxillary sinuses was larger in males than in females and that the accuracy rate was 79.0%. 
According to Hacer Yasar T et al. (2007), the determination of gender based on measurements of maxillary sinus was found to be accurate in 69.4% in females and 69.2% in males. 
In the present study, the measurements of the maxillary sinuses of females were lower than those of males. The estimation rate of gender was detected in male 69.5% and female 55% whereas mean 63.6%.
Johnson PS et al. (2011) found the depth and width of maxillary sinus in males on right and left side as 36, 35 and 25, 25 mm while in females as 35, 34 and 23, 23 mm while in our study, we got 40, 39.7 and 27.8, 28.2 in males and in females 36.6, 37.4 and 26.6, 26.7 mm. 
Shahbazian M et al. (2010) have done the CT measurements of maxillary sinus in dentate patients and on edentulous patients. They found the depth and width of maxillary sinus on right and left side in dentate patient as 37.4, 37 and 24.8, 25.1 mm while in edentulous patients as 38, 36.8 and 25.5, 23.5 mm. 
Hacer Yasar T et al. (2007) has got the following formula, which can be used for gender determination from measurements of the left and the right maxillary sinuses together. 
Gender = -5.616 + 0.133· the width of the right maxillary sinus -0.020· the height of the right maxillary sinus -0.078· the length of the right maxillary sinus-0.114· the width of the left maxillary sinus + 0.148· the height of the left maxillary sinus + 0.077· the length of the left maxillary sinus.
While in our study, we got the formula as- Gender = -8.424 - 0.118 X height of right maxillary sinus - 0.120 X depth of right maxillary sinus -0.039 X width left maxillary sinus + 0.088 X height left maxillary sinus + 0.096 X depth left maxillary sinus. This may be due to racial differences in the population in which the studies were done.
Uthman AT et al. (2011) found that the maxillary sinus height was the best discriminant parameter that could be used to study sexual dimorphism with an overall accuracy of 71.6%. They found using multivariate analysis, 74.4% of male sinuses and 73.3% of female sinuses were sexed correctly and the overall percentage for sexing maxillary sinuses correctly was 73.9%. 
Fernandes CL gender determination from measurement of the maxillary sinuses was 79.0% while in our study, it was 63.6%. 
CT measurements of maxillary sinuses may be beneficial to support gender determination in forensic medicine; however, with fairly low-accuracy rate (less than 70%). We advise that the depth, the width, and the height of the maxillary sinuses together with other bones can be used for gender determination when the complete skeleton is not available. This information can also be useful for ENT surgeons while performing surgery in this region.
| References|| |
|1.||Teke HY, Duran S, Canturk N, Canturk G. Determination of gender by measuring the size of the maxillary sinuses in CT scans. Surg Radiol Anat 2007;29:9-13. |
|2.||Asim KD. Nose and para-nasal sinuses. In: Datta AK, editor. Essentials of Human Anatomy (Head and Neck), 4 th ed. Kolkata: Current Books International Publishers; 2000. p. 271. |
|3.||Amusa YB, Eziyi JA, Akinlade O, Famurewa OC, Adewole SA, Nwoha PU, et al. Volumetric measurements and anatomical variants of paranasal sinuses of Africans (Nigerians) using dry crania. Int J Med Med Sci 2011;3:299-303. |
|4.||Gunay Y, Altinkok MC, Agdir S, Sari H. Is foremen magnum size useful for gender determination (in Turkish). Bull Legal Med 1998;3:41-5. |
|5.||Hauser G, De Stefeno GF. Epigenetic variants of the human skull. E. Stuttgart: Schweizerbart'sche Verlagsbuchhandlung; 1989. p. 38-40. |
|6.||Krogman WM, Iscan MY. The human skeleton in forensic medicine, 2 nd ed. Springfield: Charles Thomas Publisher; 1986. p. 189-243. |
|7.||Fernandes CL. Volumetric analysis of maxillary sinuses of Zulu and Europen crania by helical, multislice computed tomography. J Laryngol Otol 2004;118:877-81. |
|8.||Kim HJ, Yoon HR, Kim KD, Kang MK, Kwak HH, Park HD et al. Personal computer based three dimensional reconstruction and simulation of maxillary sinus. Surg Radiol Anat 2002;24:393-9. |
|9.||Szýlvssy J. New methods about the intraserial analysis of the excavation areas. Mitt Berliner Ges Anthrop Ethnol Urgesc 1986;7:49-62. |
|10.||Szýlvassy J. The importance of the rontgenologic methods for the prehistoric and recent history excavation areas. In: Up-to-date problems of the fominit evolution- Vero¨ ff. U¨ berse-Mus Bremen 1987;9:79-128. |
|11.||Sahlstrand-Johnson P, Jannert M, Strömbeck A, Abul-Kasim K. Computed tomography measurements of different dimensions of maxillary and frontal sinuses. BMC Med Imaging 2011;11:8. |
|12.||Shahbazian M, Xue D, Hu Y, Cleynenbreugel JV, Jacobs R. Spiral Computed Tomography based maxillary sinus imaging in relation to tooth loss, implant placement and potential grafting procedure. J Oral Maxillofac Res 2010;1:.e7 |
|13.||Uthman AT, Al-Rawi NH, Al-Naaimi AS, Al-Timimi JF. Evaluation of maxillary sinus dimensions in gender determination using helical CT scanning. J Forensic Sci 2011;56:403-8. |
|14.||Fernandes CL. Forensic ethnic identification of crania. The role of the maxillary sinus - a new approach. Am J Forensic Med Pathol 2004;25:302-13. |
[Figure 1], [Figure 2]
[Table 1], [Table 2]
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