Forensic application of CT-based frontal sinus and mandibular ramus measurements for sex and age estimation in a Turkish population: A retrospective analytical cross-sectional study

Frontal sinus (FS) and mandibular ramus morphology are valuable components of forensic identification because these structures are resilient to trauma, fire, decomposition, and fragmentation, and they exhibit high individual variability. This study aimed to evaluate the diagnostic performance of computed tomography (CT)-based FS morphology and mandibular ramus length (MRL) for sex estimation and age-group classification. CT scans of 150 adults (75 males and 75 females) aged 20 to 72 years were retrospectively analyzed. Measurements included frontal sinus height, width, depth, volume, and MRL. Participants were stratified into 5 age groups. The individual and combined discriminative power of these parameters was assessed using multivariate statistical analysis, including discriminant analysis and receiver operating characteristic curve evaluation. All FS and mandibular ramus parameters were significantly higher in males than females (P < .001). Frontal sinus volume and MRL were the strongest sex predictors. The combined model demonstrated superior diagnostic performance (area under the curve = 0.91) compared with single-parameter analyses (area under the curve = 0.84-0.85), achieving 88% sensitivity, 85% specificity, and an overall accuracy of 86.5%. Frontal sinus depth increased with age (P = .031), whereas MRL decreased in older individuals (P = .012). Age classification accuracy was highest in the 20 to 29 (76.7%) and ≥60 (83.3%) age groups, with an overall accuracy of 72.0%. CT-based FS and mandibular ramus measurements provide reliable indicators for sex determination and offer moderate discriminative potential for age-group estimation. The integrated multivariate approach enhances classification accuracy and may be particularly useful in forensic scenarios where conventional skeletal markers are unavailable.