The forensic importance of frontal sinus radiographs

doi:10.1016/j.jflm.2008.05.016

Journal of Forensic and Legal Medicine

Volume 16, Issue 1, January 2009, Pages 18-23

https://doi.org/10.1016/j.jflm.2008.05.016 Get rights and content

Abstract

The identification of unidentified human remains through the comparison of antemortem and postmortem radiographs has found wide acceptance in recent years. Reported here is the forensic case of an unidentified adult male who had died as the result of a traffic accident, after which the body was identified by matching images of ante- and postmortem radiographs of the frontal sinus. A general discussion on identification using frontal sinus radiographs is presented, highlighting the reliability of this method, in reference to the uniqueness of the frontal sinus in humans. However, it also notes a few difficulties, especially in reference to the X-ray technique in cases where antemortem radiographs are available and a potentially larger number of anatomical, pathological or traumatic features are present. The comparison of frontal sinus outlines is recommended when it may become necessary to provide quantitative substantiation for forensic identification based on these structures.

Introduction

The use of imaging exams in legal matters has been described in forensic literature both in cases of lawsuits against healthcare professionals¹ and in cases of human identification. In the latter, computerized tomography (CT) scans² and X-rays performed with medical ³ or dental referral 4, 5, 6 can be useful tools in forensic investigations, as these examinations display different singularities of the anatomical structures analyzed.

Specifically in the skull, several types of radiographs can be taken by using particular models of panoramic or medical X-ray machines. Medical or dental referrals for skull radiography allow for the analysis of numerous anatomical structures, such as the cranium, paranasal sinuses, zygomatic process and nasal cavity. Moreover, radiographic analysis makes it possible to identify any foreign objects or intracranial calcification, evaluate symmetry or identify craniofacial bone fractures, in addition to assisting in the planning of specific treatments, such as orthodontic tracing and orthognathic or implant surgery.

The anatomical complexity of the facial skeleton has prompted the development of several types of radiographic techniques. Among those more commonly used is the posteroanterior (PA) view of the skull, also known as the Caldwell view. Its application is normally associated with the radiographic evaluation of frontal and ethmoidal sinus morphology, making it also possible to identify calvarial bone fractures.

Knowing that in addition to having clinical purposes, PA skull radiographs can also be used for legal purposes, the aim of the present study was to demonstrate, by means of a case report, the importance of frontal sinus radiographs for human identification in forensic investigations.

Section snippets

Case report

In June 2005, an unidentified adult male was killed as the result of a traffic accident. The body was taken to the local coroner’s office for a routine autopsy, in order to determine the cause and circumstances of his death, as well as the instrument that ultimately caused his demise. After 30 days, the victim remained unidentified, without matching any missing-person report. Therefore, prior to routine burial procedures, postmortem facial photographs, fingerprints and DNA material were

Discussion

Anatomically, the frontal sinuses can be defined as pneumatic cavities covered by mucosa, located between the internal and external cortical bones of the frontal bone.¹⁰ Although these cavities are not visible at birth and at the start of their development during the second year of life, they are radiologically evident structures at five or six years of age, developing during the later stages of puberty and becoming completely developed by approximately 20 years of age.11, 12 In relation to its

Final considerations

Although DNA analysis is precise and provides reliable results, this type of testing is not yet used routinely in forensic investigations performed by almost any forensic medicine departments in Brazil, including the unit where the present research was conducted. Therefore, the methods of human identification using anthropological and dental forensic parameters continue to be used, due to their relative low cost and processing time, allowing for precise and reliable results.

Within this context,

Conflict of interest

None declared.

References (28)

J.C. Montovani et al.
Surgery of frontal sinus fractures: epidemiologic study and evaluation of techniques
Rev Bras Otorrinolaringol
(2006)
G. Quatrehomme et al.
Identification by frontal sinus pattern in forensic anthropology
Forensic Sci Int
(1996)
R.E. Wood
Forensic aspects of maxillofacial radiology
Forensic Sci Int
(2006)
K.J. Reichs
Quantified comparison of frontal sinus patterns by means of computed tomography
Forensic Sci Int
(1993)
M. Pfaeffli et al.
Post-mortem radiological CT identification based on classical ante-mortem X-ray examinations
J Forensic Sci
(2007)
E. Tatlisumak et al.
Identification of unknown bodies by using CT images of frontal sinus
Forensic Sci Int
(2007)
M. Yoshino et al.
Classification system of frontal sinus patterns by radiography. Its application to identification of unknown skeletal remains
Forensic Sci Int
(1987)
T. Riepert et al.
Identification of unknown dead bodies by X-ray image comparison of the skull using the X-ray simulation program FoXSIS
Forensic Sci Int
(2001)
D.I.A. Ramos
Tooth transposition and its ethical and legal implications
Rev ADM
(2005)
W.D. Haglund et al.
Confirmation of human identification using computerized tomography (CT)
J Forensic Sci
(1993)

M. Angyal et al.

Personal identification on the basis of antemortem and postmortem radiographs

J Forensic Sci

(1998)

S.L. Fischman

The use of medical and dental radiographs in identification

Int Dent J

(1985)

R.F. Silva et al.

The importance of dental documentation in human identification: report of a case

Acta Odontol Venez

(2005)

R.F. Silva et al.

Dental radiographs: source of information for human identification

Odontol Clin-Cientif

(2006)

Cited by (46)

Technical Note: Individuals identified by radiographic comparison: A sample of demographics and the region of body used for identification in Clark County, Nevada, USA (2017–2020)
2024, Forensic Science International
Radiographs regularly aid in identifications by comparing antemortem and postmortem images. The forensic community has widely accepted this method because radiographic images are low in cost, easily transferable, and generally believed to be uncomplicated to assess. However, there is a dearth of diverse, modern radiographic datasets as well as a deficiency in assessing population frequencies of nonmetric traits via radiographs. Further, radiographic comparisons, although typically required as a core competency of practicing forensic anthropologists, do not have standard training and education requirements. To understand the diversity and representation within an opportunistic dataset, we provide a case study of the demographics of decedents identified via radiographic comparison at the Clark County Office of the Coroner/Medical Examiner (CCOCME) in Las Vegas, NV, USA from 2017 to 2020. Additionally, we examined each region of the body used to make radiographic identifications. The sample was majority Caucasian and male, with a mean and median age at death of 64.9 years and 67.0 years, respectively. Our results indicated that this sample was not representative of the greater Clark County population. The most common body region used for comparisons was the chest, followed by the head and neck, pelvis, dentition, and the extremities. Thus, large generalizations made from these types of datasets must be implemented with caution due to the relative lack of diversity and representation. As well, current discussions regarding training and education of forensic anthropologists as they relate to radiographic comparisons are explored.
Maxillary sinuses’ height/width/depth of Brazilian subjects and influence of sex, age, skin color, and nutritional status: A CBCT study
2022, Forensic Imaging
The purpose of this study was to perform linear (two-dimensional) measurements of maxillary sinuses (MS) using cone-beam computed tomography (CBCT) images, analyze the influence of sex, age, skin color, and nutritional status, and verify differences between the right and left sides. The sample consisted of CBCT images of 238 living Brazilian subjects (139 women and 99 men). Linear measurements of maximal height, width, and depth of the right and left MS were performed with the DDS-Pro® 2.12.0_2021 software (DPP Systems, Czestochowa, Poland). All data were submitted to the statistical analysis to validate potential significant differences (p > 0.05) for sex and age and correlation to skin color and BMI. The TEM, rTEM, and R were used for intra- and inter-examiner assessments. There were differences between the sides, with significantly higher measurements on the right side for MS height and on the left side for width and depth. The MS width was only greater (p > 0.05) in men. Adult individuals (18 years or older) had higher MS height measurements than the other age groups. The measurements for skin color and BMI did not show significant differences, and it was impossible to confirm a relationship between the parameters measured. The measurements of MS height and width showed significant differences between the right and left sides and anatomic variability between the sexes for MS width, which can help analyze sexual dimorphism. There were also significant differences between the age groups. There was no significant difference in the measurements for skin color and nutritional status.
Pott's puffy tumor in a 23-month-old: Youngest known case of a rare disease
2022, Auris Nasus Larynx
Citation Excerpt :
This case is remarkable for the presentation of a disease process that is rare in young children, but also remarkable for the presence of frontal sinuses seen radiographically and clinically in a 23-month-old child. The frontal sinus is absent at birth and typically does not begin developing until the age of 2 years [5,8,10–12]. It begins as two small air pockets above the orbits that grows through puberty until about the age of 20 years [10].
This case report describes a child who developed Pott's puffy tumor and was treated at the Children's Mercy Hospital in Kansas City. In addition to a discussion of a case, a review of the literature was completed on this topic describing the typical embryology and development of the frontal sinus, and the epidemiology, diagnosis, and treatment of Pott's puffy tumor. The patient was a 23-month-old boy who developed Pott's puffy tumor after recovery from influenza. The patient presented to the hospital with progressing edema of the unilateral eye that spread bilaterally within a few days. A CT scan demonstrated pansinusitis, developed frontal sinuses, right periorbital cellulitis, and medial forehead subperiosteal abscess. Functional endoscopic sinus surgery and transcutaneous abscess drainage were urgently performed and the patient made a full recovery following a course of ertapenem and levofloxacin. The presence of a developed frontal sinus in a 23-month-old is an unexpected radiologic finding. This case represents the youngest patient reported in the literature to develop this rare complication of frontal sinusitis.
Three-dimensional analysis of the maxillary sinus according to sex, age, skin color, and nutritional status: A study with live Brazilian subjects using cone-beam computed tomography
2022, Archives of Oral Biology
Citation Excerpt :
Considering the particularities of their contours, analyzing paranasal sinuses is valuable for human identification for providing information and reducing the risk of errors by forensic professionals during investigations (Barros, Serra, Kuhnen, Matos, Fernandes, 2021; Gioster-Ramos, Silva, Nascimento, Fernandes, & Serra, 2021; Musse, 2009). Several studies have evaluated maxillary sinus, frontal sinuses, and sphenoid sinuses to identify individuals (Musse, 2009; Perella, Rocha, & Cavalcanti, 2003; Tatlisumak et al., 2008; Uthman, Al-Rawi, Al-Naaimi, Tawfeeq, & Suhail, 2010), using extraoral radiographs (Pfaefflli et al., 2007; Riepert, Ulmcke, Schweden, & Nafe, 2001; Silva et al., 2009) and CT scans (Perella et al., 2003; Pfaeffli et al., 2007; Tatlisumak et al., 2008; Uthman et al., 2010). Such structures were also studied to analyze sexual dimorphism, age, and ancestry (Araújo et al., 2015; Camargo, 2000; Demiralp et al., 2019; Etemadi, Seylavi, & Yadegari, 2017; Farias Gomes et al., 2019; Garcia, 2014; Moore & Ross, 2017; Najem, Safwat, Elaziz, & Gaweesh, 2020; Özer, Atalar, Öz, Toprak, & Barut, 2018; Rani et al., 2017; Robles, Rando, & Morgan, 2020; Saccucci et al., 2015; Sidhu et al., 2014), among others.
To perform three-dimensional measurements (volume and area) of the maxillary sinus, from cone-beam computed tomography (CBCT) images, and to assess potential differences between the left and right sides and a correlation of the measurements to sex, age, skin color, and nutritional status.
CBCT images of 161 living Brazilian subjects of both sexes (89 women and 72 men) were used, and three-dimensional measurements of volume and area were made with the beta version of the DDS-Pro™ 2.14.2_2022 software (DPP Systems, Czestochowa, Poland). The inter- and intra-examiner reproducibility of measurements was evaluated with TEM, rTEM, and R.
Both maxillary sinus volume and area did not show significant differences between the left and right sides and between the sexes. Volume and area were significantly lower in the age group from 6 to 11 years than in the other two groups (p < 0.05). The measurements obtained for maxillary sinus volume and area were significantly higher in white individuals (p < 0.05), but they did not show significant differences (p > 0.05) regarding nutritional status (considering the body mass index - BMI).
There were no statistically significant differences between the sexes, which does not allow recommending the use of maxillary sinus volume and area measurements to analyze sexual dimorphism, and the same occurs for BMI. However, such measures can help to estimate the age and skin color of individuals.
Sexual Dimorphism of Frontal Sinus: A 2-Dimensional Geometric Morphometric Analysis on Lateral Skull Radiographs
2022, Forensic Imaging
Sex identification is vital in establishing biological identity of unknown remains. In cases of fragmented skeletons, the resiliency of the frontal sinus suggests its potential in establishing biological identity. The traditionally used linear measurement has low reliability and is size-oriented, whereas geometric morphometrics is efficient as being reliable in characterising the shape. However, the frontal sinus approach for sex identification among Malaysians is yet to be explored.
This study aims to evaluate sexual dimorphism of frontal sinus among Malaysians using the two-dimensional (2D) geometric morphometrics method.
Lateral skull radiographs of 453 adult Malaysian, comprising 228 males and 225 females, were retrieved retrospectively. Eight 2D landmarks were applied to the lateral skull radiographs using TPSDig2 software. 2D geometric morphometric analysis was performed by MorphoJ software.
The Principal Component Analysis (PCA) showed that the first three Principal Component (PCs) exhibit 83.0% of the total variance of the frontal sinus shape. Procrustes analysis of variance (ANOVA) revealed significant differences in centroid size and shape (p-value < 0.05) of frontal sinus between sexes. Discriminant Function Analysis (DFA) after cross-validation demonstrated a classification accuracy of 78.5% in males and 82.7% in females, with an average of 80.6%.
High classification accuracy suggests that frontal sinus is a valuable tool for sex identification using 2D geometric morphometrics. The significant sexual dimorphism of the frontal sinus shape indicates its capability to aid in forensic investigation. To the best of our knowledge, this is the first study which showed such findings among Malaysian population.
Deep architectures for the segmentation of frontal sinuses in X-ray images: Towards an automatic forensic identification system in comparative radiography
2021, Neurocomputing
Comparative radiography (CR) is the forensic anthropology technique in which ante-mortem (AM) and post-mortem (PM) radiographic materials (e.g., X-ray images or CTs) are compared in order to determine the identity of a human being (either by providing a positive identification or by reducing the number of candidates). One of the most commonly used anatomical structures in CR are the frontal sinuses, which are used in forensic human identification tasks due to their singularity and high identification power. In order to automate the comparison of frontal sinuses in AM and PM materials, we need to perform their segmentation and registration. However, these tasks are time-consuming, subjective, and complex. This paper presents the first CR-based identification system for the comparison of frontal sinuses and supporting the forensic expert’s decision. The proposed system comprises two building blocks. First, a frontal sinus segmentation method in X-ray images using deep convolutional neural networks. Different convolutional architectures are compared in solving the segmentation problem, obtaining an average Dice Similarity Coefficient of the frontal sinuses of 0.823 on a dataset composed of 234 skull radiographs. Second, an evolutionary-based 2D-3D IR method, that searches for the best alignment of segmented AM and PM images using a real-coded evolutionary algorithm. The proposed system is evaluated on a real multiple-comparison identification scenario including 10 X-ray images and 10 CTs, where manual and automatic segmentation approaches are compared. The global results shows that the proposed system is able to filter 50% of the sample. These preliminary results suggest that our system can reliably keep the true positive identity in the first half of the sample, allowing for a significant reduction of forensic experts’ workload and shortening identification times.

View all citing articles on Scopus

View full text

Case ReportThe forensic importance of frontal sinus radiographs

Abstract

Introduction

Section snippets

Case report

Discussion

Final considerations

Conflict of interest

Rev Bras Otorrinolaringol

Forensic Sci Int

Forensic Sci Int

Forensic Sci Int

J Forensic Sci

Forensic Sci Int

Forensic Sci Int

Forensic Sci Int

Tooth transposition and its ethical and legal implications

Rev ADM

Confirmation of human identification using computerized tomography (CT)

J Forensic Sci

Personal identification on the basis of antemortem and postmortem radiographs

J Forensic Sci

The use of medical and dental radiographs in identification

Int Dent J

The importance of dental documentation in human identification: report of a case

Acta Odontol Venez

Dental radiographs: source of information for human identification

Odontol Clin-Cientif

Case Report
The forensic importance of frontal sinus radiographs