Umbrella review: CT of frontal, maxillary and sphenoidal sinuses for sexual dimorphism

Abstract

Purpose

This study aimed to synthesize evidence on the use of computed tomography (CT) for sexual dimorphism based on the frontal (FS), maxillary (MS) and sphenoidal (SS) sinuses.

Methods

An umbrella review was designed following the Preferred Reporting Items for Overviews of Reviews (PRIOR) and considered the Enhancing the Quality and Transparency of Health Research (EQUATOR) network. The study protocol was registered in Open science framework (OSF, https://doi.org/10.17605/OSF.IO/5XWJU). Systematic reviews and meta-analyses examining FS, MS and SS through CT imaging were included. The search was performed across PubMed, SciELO, LILACS and Open Grey.

Results

Six eligible systematic reviews published between 2021 and 2024 were identified. These reviews analyzed the sinuses for parameters such as height, width, length, area, and volume. The studies predominantly focused on adults with age range spanning 13–97 years. The findings indicated accuracy rates for sexual dimorphism typically ranging between 60 % and 80 %, with MS generally being more dimorphic than the others. Two systematic reviews included meta-analyses, reporting sensitivity and specificity rates for MS of up to 72.3 % and 69 %, respectively. Cone beam CT yielded higher accuracy compared to multislice CT. However, the quality of studies was critically low or moderate based on AMSTAR-2 and ROBIS assessments – highlighting methodological inconsistencies and biases.

Conclusion

The studied sinuses were considered adjuvant tools for sexual dimorphism. Better results might come from MS visualized by means of CBCT. Primary studies remain necessary for stronger evidence.