THE PARANASAL AIR SINUSES IN THE HUMAN: An Anatomical Assessment using Helical Multislice Computed Tomography. Applications to Human Forensic Identification.
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Introduction: Forensic pathologists may be asked to identify the race group or sex of a cranium of unknown origin. Race group refers to geographic ancestry and sex is biological sex. An analysis of the volumes and measurements of human paranasal sinuses, namely maxillary, ethmoid, sphenoid and frontal sinuses, in dried crania of different race and sex groups (European and Zulu male and female) was undertaken to search for a new improved approach of classifying crania according to race and sex. This anatomical assessment of the human paranasal sinuses identifies race and sex variations in the paranasal sinuses. Variations in paranasal sinus volumes and measurements may mean a variation in anatomical landmarks. The best combination of sinus measurements was selected to classify a cranium according to race group and sex making this research relevant to the field of forensic medicine. Objectives: To compare the paranasal sinus volumes and measurements of dried crania of European and Zulu descent with respect to race group and sex and to develop a method of classifying a cranium according to race group or sex by using dimensions of the paranasal sinuses. Methodology: Documented, cadaver derived, dried crania were obtained from the Raymond A. Dart Collection of Human Skeletons, housed at the School of Anatomical Sciences at the University of the Witwatersrand, Johannesburg, South Africa. Age, race and sex were recorded for each cranium within the collection and hence within the study sample. 26 Adult European crania; 13 male, 13 female. Age range 19-75yrs (mean 49.42yrs) and 27 Adult Zulu crania: 13 male, 14 female. Age range 16-90yrs (mean 40.16yrs) was selected for this study. An additional cranium of unknown origin was also analysed in the research. European crania were from descendants of Europe living in South Africa and Zulu crania were obtained from Zulu patients who were part of the Zulu tribe of South Africa. 53 crania with intact paranasal sinuses (106 individual sinuses for each of the maxillary, ethmoid, sphenoid and frontal sinuses) were studied. In addition, 2 sinuses from the unknown cranium were analysed. The dried crania of European and Zulu origin were assessed by helical, multislice computed tomography using 1mm coronal slices. The area for each slice was obtained by tracing the outline of each slice. A volume was calculated by the CT machine that totaled the slices for each sinus. Measurements of width, length and height were also assessed, as were other craniometrical measurements. Statistical analysis was performed for all European and Zulu male and female sinuses in respect of volumes and measurements. Further statistical analysis searched for classification patterns. In addition, forty patients’ scans from the European and Zulu male and female groups in Southern Africa were also assessed. CT scans of 10 adult European males, 10 adult European females, 10 adult Zulu males and 10 adult Zulu females provided 40 pairs of maxillary, ethmoid, sphenoid and frontal sinuses for analysis. Europeans were South African persons of European descent and Zulus were from the Zulu tribe of Kwa Zulu Natal in South Africa. Results: The aim of identifying race and sex differences in this anatomical region is achieved. Significant race and sex variations were found in the European and Zulu, male and female groups when analysing the volumes and measurements of the paranasal sinuses. The very best combinations of classifiable measurements were described and are being put forward as a new tool in human forensic identification studies. The significant sex classification figure of 91.8% by combining ethmoid, sphenoid and frontal paranasal sinus measurements, is a new discovery for using a combination of the sinuses. The significant race classification figure of 95.9 % is an excellent classification figure for classification according to race. This was done using the measurements of maxillary, ethmoid and total distance across the sinuses. All this was achieved by using the measurements of the paranasal sinuses in a European and Zulu, male and female population. Conclusion: Forensic race and sex identification of crania is now possible using a combination of measurements from the paranasal sinuses. A new approach to classifying a cranium into an race or sex group is revealed by way of using a new combination of paranasal sinus measurements. This discovery is of importance to forensic medicine in the realm of identification as it provides a measurable way of assigning race or sex to a cranium within a particular region. Other studies based on other race groups may add further value. What is clear is that the paranasal sinuses are now of established value when assessing race or sex group of a unknown cranium. A new tool for forensic race and sex identification is provided to the armamentarium of the forensic pathologist and associated disciplines.
AuthorsFernandes, Carmen Lee
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