Contributions of anatomy to forensic sex estimation: focus on head and neck bones.

This study sought to provide an up-to-date review of the importance of anatomy to human identification, focusing on the usefulness of anatomical knowledge about the head and neck bones and teeth to sex estimation in routine forensic anthropology methods. A detailed search of osteology applications in forensic sex estimation was conducted through the electronic databases for the 10 years prior to July 2020. Relevant articles and classic literature on the subject were gathered and are outlined in this review. Among the available literature, several metric analyses showed accuracy superior to 80% in sexual diagnosis. Angles measured from the inclination of glabellae and analysis of the external frontal bone surface through three-dimensional computer-aided design emerge as reliable cranial indexes for sex estimation. In the mandible, the condylar and coronoid height, bigonial width, and coronion-gonion distance express significant sexual dimorphism. Measurements of the canine are the best option for sex estimation using teeth, as well as the thickness of the dentine or enamel of incisors. The axis vertebra surpasses other neck bones for sex estimation due to its atypical shape and the presence of the odontoid process. Metric analyses based on anatomy can provide reliable accuracy in sexual diagnosis. Adequate training and anatomical knowledge can reduce bias and interobserver differences, and the use of three-dimensional models and computed tomography images can enhance the accuracy of these methods for sex estimation. However, every method should be validated before being applied to a different population. Key Points• Anatomy-based metric analyses can provide reliable accuracy in forensic sex estimation. • Glabellae inclination, external frontal bone surface, mandible, and canine teeth measurements can reach accuracies superior to 80% in sexual diagnosis.• The use of three-dimensional models and computed tomography images can enhance accuracy in sex estimation.• Every method should be validated before being applied to a different population.