Abstract
BACKGROUND: The skull is highly durable and plays a significant role in sex determination as one of the most dimorphic bones. The facial canal (FC), a clinically significant canal within the temporal bone, houses the facial nerve. This study aims to estimate sex using morphometric measurements from the FC through machine learning (ML) and artificial neural networks (ANNs). MATERIALS AND METHODS: The study utilized Computed Tomography (CT) images of 200 individuals (100 females, 100 males) aged 19-65 years. These images were retrospectively retrieved from the Picture Archiving and Communication Systems (PACS) at Düzce University Faculty of Medicine, Department of Radiology, covering 2021-2024. Bilateral measurements of nine temporal bone parameters were performed in axial, coronal, and sagittal planes. ML algorithms including Quadratic Discriminant Analysis (QDA), Linear Discriminant Analysis (LDA), Decision Tree (DT), Extra Tree Classifier (ETC), Random Forest (RF), Logistic Regression (LR), Gaussian Naive Bayes (GaussianNB), and k-Nearest Neighbors (k-NN) were used, alongside a multilayer perceptron classifier (MLPC) from ANN algorithms. RESULTS: Except for QDA (Acc 0.93), all algorithms achieved an accuracy rate of 0.97. SHapley Additive exPlanations (SHAP) analysis revealed the five most impactful parameters: right SGAs, left SGAs, right TSWs, left TSWs and, the inner mouth width of the left FN, respectively. CONCLUSIONS: FN-centered morphometric measurements show high accuracy in sex determination and may aid in understanding FN positioning across sexes and populations. These findings may support rapid and reliable sex estimation in forensic investigations-especially in cases with fragmented craniofacial remains-and provide auxiliary diagnostic data for preoperative planning in otologic and skull base surgeries. They are thus relevant for surgeons, anthropologists, and forensic experts. CLINICAL TRIAL NUMBER: Not applicable.