Medicolegal Importance of the Foramen Ovale, in Determination of Sex, in Dried Adult Egyptians Human Skulls (Morphometric & Morphological Study)

Abstract

Anatomical variations of the skull foramens have been of interest for
anthropologists, forensic scientists and neuroanatomists. This study aimed to
determine the effectiveness of the morphometric measurements foramen ovale to
proof its anatomical variations for sex determination in Egyptian dried adult skulls.
This study included 25 dry adult human skulls (50 FO); 13 males and 12 females. A
digital caliper was used to measure the dimensions of the FO (Length and width);
these measurements were taken by two researchers separately. All measurements
were conducted bilaterally and repeated three times, the data were statistically
analyzed and a comparison between both sides (right and left) FO in skulls of both
sexes were done. It was found that there wane differences between the averages
meas ±SD length and the width of both sides of FO (left and right) in male skulls with
no statistical significance. The same results were found in female skulls. Based on the
gender, the linear metric measurements of F.O in skulls of both sexes showed
statistical significant difference on the average means ± SD in the length and width of
the right and left sides. Various shapes of the F.O were observed in the studied
skulls, and the most common shape was the oval shape followed by the almond
shape. It can be concluded that, the metric analysis of FO can be useful as a
supplement to other skeletal measurements aiming at establishing gender identity of
individuals. Also the foramen ovale has a great variation in different countries.

Full text

Mansoura J. Forens. Med. Clin. Toxicol., Vol. 26, No. 2, July. 2018
27
Medicolegal Importance of the Foramen Ovale, in
Determination of Sex, in Dried Adult Egyptians Human
Skulls (Morphometric & Morphological Study)
Ayman A. Nagy1, Nasr A.Y. 2, Abdel Moty Kabbash1
ABSTRACT
KEYWORDS
Identification,
Foramen ovale morphology
and morphometery,
Gender identification.
Anatomical variations of the skull foramens have been of interest for
anthropologists, forensic scientists and neuroanatomists. This study aimed to
determine the effectiveness of the morphometric measurements foramen ovale to
proof its anatomical variations for sex determination in Egyptian dried adult skulls.
This study included 25 dry adult human skulls (50 FO); 13 males and 12 females. A
digital caliper was used to measure the dimensions of the FO (Length and width);
these measurements were taken by two researchers separately. All measurements
were conducted bilaterally and repeated three times, the data were statistically
analyzed and a comparison between both sides (right and left) FO in skulls of both
sexes were done. It was found that there wane differences between the averages
meas ±SD length and the width of both sides of FO (left and right) in male skulls with
no statistical significance. The same results were found in female skulls. Based on the
gender, the linear metric measurements of F.O in skulls of both sexes showed
statistical significant difference on the average means ± SD in the length and width of
the right and left sides. Various shapes of the F.O were observed in the studied
skulls, and the most common shape was the oval shape followed by the almond
shape. It can be concluded that, the metric analysis of FO can be useful as a
supplement to other skeletal measurements aiming at establishing gender identity of
individuals. Also the foramen ovale has a great variation in different countries.
Introduction 
The anatomical variations of foramens of
the skull have been of interest for
anthropologists, forensic scientists and
neuroanatomists (Humphrey et al., 1999).
These variants between different populations
may be referred to socioeconomic factors,
_________________________________________
(1)Forensic Medicine and Clinical Toxicology
Department, Tanta University, Egypt.
(2)Anatomy Department, Faculty of Medicine, Zagazig
University, Zagazig, Egypt and King Abdul-Aziz
University, Jeddah, Kingdom of Saudi Arabia.
.
environmental, as well as genetic factors
(Saunders and Yang, 1999).
Craniometrical measurements of different
anatomical features of skulls enable us to
determine the sex as a part of complete
identification of body, which is an important
component both in criminal investigations and
in general preparedness for mass fatality
incidents (Rosing, 2007).
The differences in measurements and
shapes of foramina of skulls in different
genders are mainly determined by genetic
factors as well as nutrition, hormones, or
muscles (Gunay, 2000). The bones of skull

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Mansoura J. Forens. Med. Clin. Toxicol., Vol. 26, No. 2, July. 2018
28
base are protected by its anatomical position
and surrounding soft tissues, which makes it
useful for identification in a case of destruction
of cranial and facial bones as in case of mass
disasters, explosion, or violence, that make it
difficult for identification or sex determination
(Graw, 2001).
Foraminen ovale (FO) are one of the
important foramina of the middle cranial fossa.
(Sharma et al, 2016). It lies close to the
posterior border of the pterygoid plate,
posterior to the foramen rotundum. The lesser
petrosal nerve, mandibular nerve and the
accessory meningeal artery, are its main
components (Standring, 2006).
Normally, the FO has a different linear
measurements and shapes. Very limited studies
had been done to determine those variants in
different populations.
This study aimed to determine the
effectiveness of the morphometric measure-
ments of FO to proof its anatomical variations
for sex determination in Egyptian dried adult
skulls.
Material and Methods
The material for the present study
included twenty five dry adult human skulls
(50 FO); 13 males and 12 females skulls. The
skulls were obtained from the Department of
Anatomy, Faculty of Medicine, University of
Tanta, Egypt. The approval of this study was
obtained from the Ethics committee, Quality
assurance Unit of Faculty of Medicine,
University of Tanta, Egypt. A digital caliper
(JOMARCA) of 0.1 mm was used to measure
the dimensions of the FO (length and width),
these measurements were taken three times by
two researchers separately, the averages mean
± SD of each researcher was calculated then
the averages mean ± SD of both results was
recorded. All measurements were conducted
bilaterally. Broken or fragmented skulls
especially at the pterygoid plate were excluded
and data were recorded and a comparison
between both foramina (Right and left) in both
sexes of skulls (Male and female skulls were
determined according to the anatomical
features.
Statistical Analysis
Statistical analysis of the present study
was conducted using the software of SPSS Inc.
Chicago, IL, USA, version 21.Quantitative data
was tabulated in mean ± SD for parametric
variables. Chi square test was used to examine
the association between categorical variables.
For parametric variables, Student t test was
used to compare the mean between two
independent groups. The level of significance
was adopted at the 5% and the significance
threshold (p value) was set at less than 0.05.
Results
Morphometric results:
It was found that the mean ± SD of the
length of FO on the left side in males skull was
7.7 ± 1.21 mm while on the right side it was
6.9 ± 1.13 mm with no statistical significant
difference p1> 0.05 (Table1). The average
mean ± SD of the width of the foramen ovale
in male skull was 5.63 ±1.26 mm and 5.58 ±
1.18 mm for left and right sides respectively,
these results were of no significant variance
(p1> 0.05) (Table2).
Regarding female skulls the average
mean ± SD of the length of F.O was 6.9 ± 1.13
mm and 7.02 ± 1.19 mm on the left and right
sides respectively. The average mean ± SD of
the width of F.O of the females skulls were 5.1

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± 0.97 mm and 5.02 ± 1.08 mm in the left and
right sides respectively. There was no
significant variance between the length of both
sides as well as the width of both sides in the
female skulls (p1> 0.05) (Tables1& 2).
Based on the gender, the linear metric
measurements of F.O in male and female skulls
showed statistical significant difference of the
average means ± SD in the length and width.
As the length of the left side was 7.7 ± 1.21
mm and 6.9 ± 1.13 mm in males and females
respectively (p< 0.05) while on the right side it
was 7.68 ± 1.32 mm and 7.02 ± 1.19 mm in
males and females respectively (p< 0.05) as
shown in (Table 1).
While the averages mean ± SD of width
of the foramen oval on left side, it was 5.63 ±
1.26 mm and 5.1 ± 0.97 mm in males and
females respectively (p> 0.05) as shown in
(Table 2). The results showed statistical
significance (p< 0.05) between the averages
mean ± SD of the width on the right side 5.58 ±
1.18 mm and 5.02 ± 1.08 mm of males and
females respectively.
Morphological Study
Various shapes of the F.O were observed
in studied skulls. The results showed typical
foramina oval (Fig.1a & b) in 58% (30 on the,
right side, 28 on the left), almond shape in 33%
(Fig.2) (16 and 17 right and left foramina
respectively), other forms such as slit like and
bizarre shapes (Fig.3, 4) 9% (4 right, 5 left)
and there was no statistical difference between
different shapes on both sides (p> 0.05)
(Table 3).
Table (1): The length of the left and right foramen ovale, in both male and female skulls.
Length in mm
(Mean ± SD)
Males
(n=13)
Females
(n=12) t. test p. value
Left FO 7.7 ± 1.21 6.9 ± 1.13 3.423 0.001*
Right FO 7.68 ± 1.32 7.02 ± 1.19 2.632 0.001*
t. test 0.082 0.523
p1. value 0.937 0.606
SD: standard deviation, mm: millimeter, n: number, F.O: foramen ovale, t: Independent samples test, *means
significant, p = difference between males & females and p1=difference between left and right FO.

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Table (2): The width of the left and right foramen ovale, in both male and female skulls.
Width in mm
(Mean ± SD)
Males
(n=13)
Females
(n=12) t. test p value
Left 5.63 ± 1.26 5.1 ± 0.97 2.362 0.020*
Right 5.58 ± 1.18 5.02 ± 1.08 2.483 0.015*
t. test 0.203 0.394
p1. value 0.838 0.698
SD: standard deviation, mm: millimeter, n: number, F.O: foramen ovale, t: Independent samples test, *means
significant, p= difference between males & females and p1=difference between left and right FO.
Table (3): Morphology of the foramen ovale on the right and left sides of the studied skulls.
Rt side Lt side Total
n % n % n %
Oval shape 30 60 28 56 58 58
Almond shape 16 32 17 34 33 33
Other forms 4 8 5 10 9 9
Total 50 100 50 100 100 100
2 0.213
Chi-square p-value 0.901
Rt: Right side; Lt: left side; n: number; %: percentage; 2 : Pearson's Chi Square test.
Fig. (1 a): Showing oval shape of foramen ovale
bilaterally (arrow).
Fig. (1 b): Showing oval shape of foramen ovale
bilaterally (arrow).

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Fig. (2): A photograph showing almond shape
of foramen ovale on the right side
(arrow).
Fig. (3): A photograph showing slit like shape of
foramen ovale on left side (arrow).
Fig. (4): A photograph showing bizarre shape
like (due to projection of spine) of
foramen ovale on left side (arrow).

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Discussion
The FO can be seen as an oval ring in
the sphenoid bone in its greater wings, during
the 7th month of the intrauterine life. The
sphenoid bone has developed from
endochondral and intramembranous ossi-
fication centers which give the lesser and
great wings as well as body of the sphenoid
bone. Anatomically FO lies close to the upper
border of lateral pterygoid body, between the
foramen rotundum and foramen spinosum
(Standring, 2006). A large number of studies
have been done worldwide on the
morphometric measurements of FO giving
insight into association between its
morphology and its neurovascular anatomy
(Jyothsna et al., 2013).
In this study, it was found that the
average mean of antero-posterior measure of
FO on the right and left side in both males
and females were different. This difference
between both sides of FO in males and
females was found to be statistically
insignificant. Regarding the width of FO in
this study, the average meas of width of FO of
the right and left side in both males and
females were different. This was insignificant
in both sexes. Even though the left side was
longer than the right side in both sexes.
Similarly in previous studies on different
populations, carried out on Nepal populations,
there was insignificant difference between the
metric length and width of both sides, as
reported by Biswabina et al. (2005). As the
mean length was 7.46 ± 1.41 mm, 7.01 ± 1.41
mm and the mean width was 3.21 ± 0.02mm,
3.29 ± 0.58mm on the right and left side
respectively. Another study was carried out
on Indian populations by Someshet al. (2011)
showing that the mean length was 7.64 ± 1.19
mm, 7.561 ± 1.123 mm while the mean width of
the FO of the right and left side respectively was
5.128 ± 0.827 mm, and 5.244 ± 0.950 which
were of no significant difference. In Japanese
population a comparison of the length of FO in
adults, fetus and juvenile skulls, in a study by
Yanagi (1987) showed that the average maximal
length of FO was 7.48 in adults. Studying the
postnatal enlargement of foramen ovale in living
German populations it was reported that the
average length of FO was 7.2 mm while the
width was 3.7 mm as reported by Lang et al.
(1984). This difference in dimensions was
giving evidence that the skulls are bilaterally
asymmetrical.
In the present study, it was found that there
is a statistical significant difference in metric
measurement of the FO in dried human adult
skulls between males and females in the
measurements of the dimensions of the right and
left sides respectively. In a study done by
Burdan et al. (2011) on skulls in adults from the
Lublin region (Poland), comparative metric
measurements of FO in males and females
through examination by computed tomography,
they reported insignificant higher length and
width measurement of FO in males than females.
This difference in results may be attributed to
different methods of measurement and different
type of skulls (dry and living skulls and
bilaterally asymmetrical skull development).
Analyzing the variation in the shape of the
FO, it was found that the oval shape is the
common shape as it represents 60% of the right
side and 56% of the left side foramina, while the
almond shape was the second variant as it
represents 32% and 34% of the right and left
foramina respectively. Other forms represent 4-
5%. This comes in accordance with previous
studies done by Yanagi (1987) and Somesh et

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33
al. (2011), as the oval shape was the common,
then the almond shape.
The exact cause of the observed
variation in different studies is difficult to be
determined. It could be related to genetic,
racial, developmental, nutritional or other
unknown factors (Sigh and Pathak, 2013).
Conclusions
There is a statistical insignificant
difference in linear metric measurements of
FO on both sides. The left side of the FO is
longer and wider than the right side. There is
a statistical significant difference in linear
metric measurement (length and width of the
FO) on both sides between males and females
adult dried skulls. However, from forensic
point of view, the metric analysis of FO could
be useful as a supplement to other skeletal
measurements aiming to establishing the
gender of individuals. The foramen ovale has
a great variation in different countries. The
knowledge of morphometric analysis in
different population is necessary for forensic
anthropologist and clinicians as neuro-
surgeons.
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ﺔﻀﯿﺑ ﺐﻘﺛ نﻮﺴﻤﺧ ﻞﻤﺸﺗ .( ﺟﺮﻔﻟا مﺪﺨﺘﺳأ ﺬﺧأ ﻢﺗ ﺪﻗو ، ﺔﻀﯿﺒﻟا ﺐﻘﺜﻟ ضﺮﻌﻟاو لﻮﻄﻟا تﺎﺳﺎﯿﻗ ءاﺮﺟﻹ ﻲﻤﻗﺮﻟا رﺎ
ةﺪﺣ ﻰﻠﻋ ﻞﻛ ﻦﯿﺜﺣﺎﺒﻟا ﻦﻣ ﻦﯿﻨﺛإ ﻞﺒﻗ ﻦﻣ تﺎﺳﺎﯿﻘﻟا)ﻟ تﺎﺳﺎﯿﻗ ﺔﺛﻼﺛﺎﻤﮭﻨﻣ ﻞﻜ (ﺐﻘﺛ ﻞﻜﻟ . ﻊﯿﻤﺟ ﻞﯿﻠﺤﺗو ﻞﯿﺠﺴﺗ ﻢﺗو
ﻦﯿﺒﻘﺜﻟا ﻼﻛ ﻦﯿﺑ ﺔﻧرﺎﻘﻤﻟاو ﺎﯿﺋﺎﺼﺣإ تﺎﺳﺎﯿﻘﻟا) ﺮﺴﯾﻷاو ﻦﻤﯾﻷا ﺐﻘﺜﻟا ( ثﺎﻧﻹاو رﻮﻛﺬﻟا ﻢﺟﺎﻤﺟ ﻦﻣ ﻞﻛ ﻲﻓ .
ﺔﻀﯿﺒﻟا ﺐﻘﺛ لﻮﻃو ضﺮﻋ سﺎﯿﻗ ﻲﻓ ﺔﯾرﺎﺒﺘﻋإ ﺔﻤﯿﻗ تاذ ﺮﯿﻏ تﺎﻓﻼﺘﺧإ دﻮﺟو ﺚﺤﺒﻟا ﻦﻣ ﺖﺒﺛ ﻦﻤﯾﻷاو ﺮﺴﯾﻷا
رﻮﻛﺬﻟا ﻢﺟﺎﻤﺟ ﻲﻓ . و ﺪﻗو ﺒﺗ ﺪﻘﻓ ،ﺲﻨﺠﻠﻟ ﺔﺒﺴﻨﻟﺎﺑو ثﺎﻧﻹا ﻢﺟﺎﻤﺟ ﻲﻓ ﺎﮭﺴﻔﻧ ﺞﺋﺎﺘﻨﻟا تﺪﺟﯿ تاذ تﺎﻓﻼﺘﺧإ دﻮﺟو ﻦ
ﺔﻀﯿﺒﻟا ﺐﻘﺛ لﻮﻃو عﺎﺴﺗإ سﺎﯿﻗ ﻲﻓ ﺔﯾرﺎﺒﺘﻋإ ﺔﻤﯿﻗﻦﻤﯾﻷاو ﺮﺴﯾﻷا ثﺎﻧﻹاو رﻮﻛﺬﻟا ﺔﻋﻮﻤﺠﻣ ﻦﯿﺑ.
ﻀﯿﺒﻟا ﻞﻜﺸﻟا نأ ﻦﯿﺒﺗ ﺔﺳارﺪﻟا ﻞﺤﻣ ﻢﺟﺎﻤﺠﻟا ﺲﻔﻧ ﻰﻓ ﺔﻀﯿﺒﻟا ﺐﻘﺛ ﻞﻜﺷ ﺔﺳارد ﺪﻨﻋووﺎﻟا ﻮھ ي ﻞﻜﺸ
ﻊﺋﺎﺸﻟا يزﻮﻠﻟا ﻞﻜﺸﻟا ﮫﻌﺒﺗو . تﺎﺳﺎﯿﻘﻟ ﺔﻠﻤﻜﻣ ﺔﺟرﺪﺑ ﻢﮭﻣ ﺔﻀﯿﺒﻟا ﺐﻘﺜﻟ يﺮﺘﻤﻟا ﻞﯿﻠﺤﺘﻟا نأ ﻰﻟإ ﺺﻠﺨﻧ نأ ﻦﻜﻤﯾو
ىﺮﺧﻷا ﻲﻤﻈﻌﻟا ﻞﻜﯿﮭﻟا داﺮﻓﻷا ﺲﻨﺟ ﺪﯾﺪﺤﺗ ﻰﻟإ فﺪﮭﺗ ﻲﺘﻟاو . ﺐﻘﺛ تﺎﺳﺎﯿﻗو لﺎﻜﺷأ ﻦﯾﺎﺒﺗ ﺔﺳارﺪﻟا ﻦﻣ ﺖﺒﺛو
ناﺪﻠﺒﻟا ﻒﻠﺘﺨﻣ ﻲﻓ ﺔﻀﯿﺒﻟا.