Cone-beam computed tomography-based morphometric assessment of the pterygomaxillary region: implications for Le Fort I osteotomy

The pterygomaxillary region (PMR) is of critical importance in Le Fort I osteotomy due to its complex anatomy and close relationship with vital neurovascular structures. The aim of this study was to evaluate the anatomical characteristics of the PMR and the localization of the greater palatine canal (GPC) using cone-beam computed tomography (CBCT). In this retrospective, single-center study, CBCT images of 140 patients (70 males and 70 females), aged 20–68 years, were analyzed. Demographic data and radiological findings were recorded. Various morphometric parameters of the PMR were evaluated according to sex and side, with age included as a covariate. After adjusting for age, the most prominent sex-related differences were observed for the bilateral transverse parameters, with males exhibiting significantly greater values for the distance between the bilateral greater palatine canals (BGPC) (32.85 ± 2.51 vs. 29.97 ± 2.08 mm), the distance between the terminal points of the bilateral lateral plates (BLP) (54.27 ± 4.45 vs. 49.28 ± 4.03 mm) and the distance between the terminal points of the bilateral medial plates (BMP) (31.49 ± 2.28 vs. 29.63 ± 2.39 mm; all p < 0.001). A significant side-related difference was identified for anterior length (AL), with higher values on the right side (39.70 ± 2.53 vs. 39.10 ± 2.67 mm; p < 0.001). Additional significant sex-related differences were observed for medial plate length (MPL) and pterygomaxillary region thickness (PMRTh) (greater in females; adjusted p < 0.001 and adjusted p = 0.030, respectively) and the distance between the pterygomaxillary fissure and greater palatine canal (PMF–GPC) (greater in males; adjusted p = 0.012). No significant sex, side, or sex × side interaction effects were found for lateral plate length (LPL) or pterygoid process thickness (PPTh). Significant sex-related differences were observed in several morphometric parameters of the PMR, while AL showed a significant side-related difference, with greater values on the right side. These findings demonstrate sex- and side-related morphometric variability in the PMR and may provide useful anatomical information for preoperative assessment. However, prospective studies correlating these morphometric findings with actual surgical outcomes are needed to determine their clinical significance.