Assessment of the skull base, pterygomaxillary junction, and its association with the orbit in skeletal malocclusion and cleft lip/palate implications for Le fort I osteotomy

Significant variations in PMJ morphology were observed among the study groups. The mean anterior length was significantly greater in patients with CLP (p = 0.000), whereas the posterior length was greater in Class III patients (p = 0.042). The thinnest pterygomaxillary region was found in Class III patients (p = 0.002). The width of the maxillary tuberosity, the distance from the superior orbital fissure (SOF)-PMJ and the orbital canal (OC)-PMJ, and the distance between the medial and lateral pterygoid plates on both sides were the lowest in the CLP group (p < 0.05). The angle of the PMJ was the highest in the Class II group (p = 0.014), whereas the distance between the lateral plates at the hamulus level was the lowest in the Class II group. (p = 0.005) CONCLUSION: Our study highlights notable anatomical differences in the PMJ among individuals with skeletal malocclusion and CLP. These variations are clinically relevant for preoperative planning in Le Fort I osteotomy, particularly in reducing the risk of unfavorable fractures and ophthalmic complications. These findings underscore the importance of individualized surgical approaches based on anatomical assessments.