Age determination complete

Undergraduate Forensic Medicine Class on Age Determination.

1. Demonstration class Age Determination Dr. Salam Bitam singh Senior Resident

2. MLC. No.: .......... Police Station: .... Requisition from: ..................... 1. Name : .......................... 2. Age: ......... 3. Sex : ........... 4. S/O : ............................. 5. Caste: ............. 6. Occupation : .................. 7. Address:.......................... 8.Marital status .................. 9. Aged as alleged by: Individual to be examined..... Police:....... 9. Brought and identified by :- ( i ) Police Constable: ..................................... (II) Accompanying Person: ........................................ 10. Date and Time................. Place of Examination:......................... 11. Identification marks (I).......................................................................................................... (II)......................................................................................................... 12. Consent with signature for examination: ............................................................................................................. In case of minor: Consent of the Guardian and his/her signature or left thumb impression 13. Name of the female attendant/ Nurse present: .................. 

3. Examination Height : ...... , Weight: ........ Chest measurement at the level of nipple: ........... General build and appearances: .................. Hair : Scalp: ........., Beard: ..............,Moustache : .................. Chest:................, Pubic:............, Axilla : .......................   Dental formulae: S: Spacing, T: Temporary, P: Permanent (S) 87654321 12345678(S) (S) 87654321 12345678(S) Development of Breast:........................................ Date of Menarche: ..... Regularity of Menses : .................. Development of genitalia: .......................................

4. Report of Radiological examination with date: X-Ray of both elbow joint : fused X-Ray of both the Knee joints: Fused X-Ray of both Pelvis: not fused. Opinion: Based on the above, Physical, Dental, and radiological examination findings, I am of the opinion that the, age of the subject is above: 18yrs and below 20 yrs

5. Time line 1. Inta - uterine age : 0-7/10 days: ovum 1 st wk – 8 th wks: embryo 8 th wks – delivery : foetus 2. Post delivery Neonate: Delivery -28 th day Infant : 0-1yrs Child : 1-12 yrs Adolescent/ tenache : 12-18 yrs Adult : more than 18yrs Minor : Less than 18 yrs Major: more than 18 yrs

6. Hair & Breast Growth Age (Yrs) Male Female 13 Breast begins to develop Vulva begins more horizontal Labia minora develops 14 Pubic hair starts Testis become larger firmer 15 Axillary hair begins Pubic and axillary hair begins 16 External Genital adult appearance 16-18 Voice become hoarse Facial hair begins

7. Development & Eruption of Teeth Mottle Teeth Hutchinson’s Teeth Fourneirs teeth Pink Teeth

8. Pink Teeth Hutchinsons Teeth Mottle Teeth

9. Temporary Permanent Size Smaller,Longer,Narrower,Except Temporary Molars Heigher,Broader except permanent premolars replacing Temporary Molar which are smaller. Crown Colour China White Ivory Neck constriction More Lesser Root of Molar Ridges Smaller more divergent Larger and less divergent Ridges Present between crown and fangs Absent Eruption : Lower earlier than the upper except lateral incisor which erupt earlier in upper jaw. Wisdom : lower left earlier Female Dental age = skeletal age one year ahead.

10. China White Vs Ivory white

11. Dentition Temporary Permanent: Permanent M1 erupt behind 2 nd tempt. Molar I(C) I(L) M1 C M2 Teeth 0.5 0.8 1 1.5 2 Years M1 I(C) I(L) P1 P2 C M2 M3 Teeth 6 7 8 9 10 11 12 17 Years

12. Period of Mixed dentition 6-12 yrs Age (yrs) Total Teeth Tempt. Total Permanent Total 6-12 24 20 I8 C4 M(1)4 M(2)4 4 M1 9 24 12 I0 C4 M(1)4 M(2)4 12 M(1)4 I 8 10 24 8 I0 C4 M(1)0 M(2)4 16 M(1)4 I8 PM(1)4 11 24 4 I0 C4 M(1)0 M(2)0 20 M(1)4 I8 PM(1)4 PM(2)4 14 28 28 M(1)4 I8 PM(1)4 PM(2)4 M(2)4

13. Figure 1: Photograph of a 9-year-old girl at the time of presentation shows the absence of the left maxillary central incisor. The right maxillary central incisor and both maxillary lateral incisors are fully erupted. Left Maxilary Incisor

14. At What Stage of Development Is Her Dentition in the clinical photographs? She is in the early permanent dentition. The second permanent molars are unerupted , with the exception of the LL7, which is partially erupted.

15. A 9-year-old female presented in the mixed dentition

16. Mamelons A  mamelon  (from  French   mamelon , "nipple") is one of three rounded protuberances which are present on the cutting edge of an  incisor  tooth when it first erupts through the gum. Mamelons ' appearance can be smoothed by a dentist if they have not been worn down naturally by biting and eating foods.  [1] Mamelons are present on permanent central and lateral incisors

17. Tanner stages  or  Sexual Maturity Rating (SMR) Scale of  physical development in children ,  adolescents  and  adults . The scale defines physical measurements of development based on external  primary  and  secondary sex characteristics , such as the size of the  breasts ,  genitals , testicular volume and development of  pubic hair . This scale was first identified in 1969 by  James Tanner , a British pediatrician , after a two-decade-long study following the physical changes in girls undergoing puberty.

18. Stages Pubic Hair Scale (both males and females) Female Breast Development Scale Male External Genitalia Scale Stage 1: No hair No glandular breast tissue palpable  Testicular volume < 4 ml or long axis < 2.5 cm Stage 2: Downy hair Breast bud palpable under the areola (1st pubertal sign in females) 4 ml-8 ml (or 2.5 to 3.3 cm long), 1st pubertal sign in males Stage 3: Scant terminal hair Breast tissue palpable outside areola; no areolar development 9 ml-12 ml (or 3.4 to 4.0 cm long) Stage 4: Terminal hair that fills the entire triangle overlying the pubic region Areola elevated above the contour of the breast, forming a “double scoop” appearance 15-20 ml (or 4.1 to 4.5 cm long) Stage 5: Terminal hair that extends beyond the inguinal crease onto the thigh Areolar mound recedes into single breast contour with areolar hyperpigmentation, papillae development, and nipple protrusion > 20 ml (or > 4.5 cm long) Tanner stages  or  Sexual Maturity Rating (SMR)

19. Tanner stages  or  Sexual Maturity Rating (SMR)

20. Bony Development Age (IU) Appearance Centre of ossification 1.5 Month (IU) Clavicle 2 Months Each half of Mandible 3 Months Ischuim 4 Month Sacral segment ( Upper, Mid), Middle Ear Bone 5 Month Calcaneum 6 Month Sternum 7 Month Talus 8 Month Sacral Segment (Lower) 9 Month Femur (Lower End) 10 Month Cuboid , Upper end Tibia

21. Thumb side

22. Thumb Side

23. Carpel bones on X-Ray at the end of 1 yrs = 2 Carpel bones on X-Ray between 2-6yrs =Age in years.

24. Ossification centres of the foot Primary ossification centres present at birth Visible on x-ray from birth: calcaneus : 6 months in utero talus: 7 months in utero cuboid : 9 months in utero metatarsals: 9 weeks in utero phalanges: 3-10 months (proximal to distal) Primary ossification centres developing after birth Become visible on x-ray from: lateral cuneiform: 1 st  year medial cuneiform: 3 rd  year intermediate cuneiforms and navicular : 4 th  year Secondary ossification centres At the age of 3 years, secondary ossification centres of the navicular , metatarsals and phalanges should all be present. The last secondary ossification center to develop is the calcaneus appearing at 5 years.

25. TIPS Aging more accurate with the appearance of Ossification Centre than fusion Head of humerus : Last long bone epiphysis to be united. Upper limbs: elbow union earlier than wrist Lower limbs: Hip and Ankle union earlier than Knees. X-Ray union is 6 months earlier than the anatomical union.

26. Stages of union of Epiphysis with Diaphysis Stage 0 – Non-union: The diaphyseal and epiphyseal bones are adjacent to each other but not yet in intimate relationship. The epiphysis is separate from the diaphysis due to the presence of the cartilaginous growth plate . This should be apparent in at least one view on the radiograph, as a continuous radiolucent gap between the epiphysis and diaphysis . Stage 1 – Beginning union: The epiphyseal and diaphyseal surfaces closely move towards each other. There is a narrow radiolucent strip between adjacent surfaces of the epiphysis and diaphysis when compared to the state of non-union. There is a radiolucent gap which is not continuous from anterior to posterior or medial to lateral, indicating that union has begun centrally, but has not yet commenced on the remainder of the growth plate. In radiographic views, the later stage should be selected. Stage 2 – Active union: The epiphysis and diaphysis cap each other, the epiphysis overlapping the metaphysis . The terminal plate of the epiphysis can no longer be distinguished. A fusion line or zone of greater density than the adjacent bone replaces the epiphyseal cartilage . There is a radiodense region indicating that fusion is actively occurring.

27. Stage 3 Recent union: The epiphysis and diaphysis now form a single unit of bone; there is complete capping. The position of the former epiphysis and diaphysis can still be observed. There may be a fine line of fusion of greater density between the epiphysis and diaphysis , and a discontinuity of trabeculae between these. A slight notch at the margin of the growth plate (less than 2 mm) can be observed that is not yet completely calcified .These indicate that the bone has recently united. Stage 4 – Complete union: The epiphysis and diaphysis are united as a single unit of bone. There is continuity of trabeculae from shaft to former epiphysis. This is presented as a uniformity of internal bone pattern throughout the length of the long bone up to the articular surface. All traces of epiphyseal differentiation have been lost. The growth plate has now completely ossified and the bone is fused in its entirety; there are no radiolucent notches evident at the peripheral margin of the bone .

28. Appearance of the Ossification centres X-Ray between 6-12 years Elbow & Wrist ( Appearences of O.C) 6years 9years 9-11 years 10-11years 11years Ulna (Lower End) Medial Epicondyle of Humerus Olecranon Trochlea of Humerus Pissiform Lateral epicondyle of Humerus Between 13-16 years X-Ray Elbow and Pelvis 13 years 12-14 years 14 years 15 years 16 years TriRadiate cartilage of acetabulum Separate Centres Femur lesser trochanter Fussion of Medial Epicondyle , lateral epicondyle with Trochea Fusion of Triradiate cartilage of acetabulum Ischial tuberosity Fusion of lower end of Humerus Olecranon to ulna Fusion of upper end of radius

29. Fusion of the X-Ray joints 16 yrs 16-17 yrs 17-18 yrs 18-19 yrs 20-21 yrs Elbow Ankle Hip Knee Shoulder Wrist Iliac Crest Ischial tuberosity Inner end of Clavicle

30. GALSTAUN’S CHART Accepted in Calcutta High court Bone Male Female Appearance Fusion with Appearance Fusion Elbow joint Humerus M.EC L.EC Trochlear 7yrs 12yrs 11yrs 16yrs(Shaft) 14-16yrs( capitulum ) 11-15yrs( Capitulum ) 5yrs 10yrs 10yrs 14yrs 12yrs 10-13yrs( Capitulum ) Head of Radius 8yrs 16yrs 6yrs 14yrs Tip of olecranon 11-13 yrs 17yrs 9-12yrs 15yrs Wrist Joint Lower end of Radius 1yr 16-17yrs 1yr 17-18yrs Lower end of Ulna 10-11yrs 18yrs 8-10yrs 17yrs Pisiform 12-17yrs 9-12yrs

31. Bone Male Female Appearance Fusion with Appearance Fusion Pelvis joint Iliac Crest 17yrs 19-20yrs 14yrs 17-19yrs Ischial tuberosity 16-18yrs 20yrs 14-16yrs 20yrs Head of Femur 1yrs 16-17yrs 1yr 14-15yrs Greater Trochanter 17yrs 14yrs Lesser Trochanter 15-17yrs 15-17yrs Acetabulum Disappearnce of the triradiate cartilage 15-16yrs 14yrs Knee Joint Lower end of Femur At or just before birth 14-17yrs At or just before birth 14-17yrs Upper end of tibia At or just before birth 15-17yrs At or just before birth 14-15yrs Upper end of Fibula 11-16yrs 9-12yrs 14-16yrs Patella 3-7yrs 4yrs