# Anatomical Evaluation of the Pterygomaxillary Complex Using Cone Beam Computed Tomography

## TL;DR

This study uses cone beam CT to analyze variations in the pterygomaxillary region, helping improve safety during facial surgery.

## Contribution

The study provides new morphometric data on the pterygomaxillary region based on age, sex, and laterality using CBCT.

## Key findings

- The distance between the piriform rim and descending palatine artery was greater on the left side.
- The lateral pterygoid lamina length increased with age, and the region's thickness varied by sex.
- CBCT evaluation can help prevent complications during Le Fort I surgery by identifying anatomical differences.

## Abstract

The pterygomaxillary region is a sensitive anatomical area that contains important vessels and nerves and may be at risk during Le Fort I surgery. In this study, cone-beam computed tomography (CBCT) images were used to evaluate how the shape, thickness, and width of this region differ according to age, sex, and side of the face. The results showed clear anatomical variations between individuals. Understanding these differences before surgery may help clinicians plan safer procedures, support more accurate radiological assessment, reduce the risk of complications, and provide valuable guidance for future studies in surgical planning and patient safety.

Background: The pterygomaxillary region is a complex anatomical area formed by the junction of the maxillary, palatine, and sphenoid bones and contains critical neurovascular structures. Accurate assessment of this region during Le Fort I osteotomy is essential, particularly to prevent hemorrhage and nerve injury that may occur during the pterygomaxillary separation phase. This study aims to investigate the morphometric characteristics of the pterygomaxillary region using cone-beam computed tomography (CBCT) and to evaluate the effects of age, sex, and laterality on these anatomical parameters. Materials and Methods: In this retrospective study, CBCT scans of 200 individuals (100 males and 100 females) aged 20–80 years were analyzed. Axial measurements included distances between the piriform rim, the descending palatine artery, the pterygomaxillary osteotomy line, and the pterygomaxillary fissure. Additionally, the thickness and width of the pterygomaxillary region and pterygoid process, lengths of the medial and lateral pterygoid laminae, and the distance between the greater palatine canal and the medial pterygoid lamina apex were recorded. Measurements were statistically evaluated by sex, age group, and laterality. Results: The following parameters demonstrated statistically significant differences based on the conducted measurements: The distance between the piriform rim and the descending palatine artery was significantly greater on the left side (p < 0.001). The length of the lateral pterygoid lamina increased with advancing age (p = 0.048). The thickness of the pterygomaxillary region was significantly greater in females (p = 0.014). Additionally, the distance between the greater palatine canal and the terminal point of the medial pterygoid lamina was significantly higher in males (p < 0.001). Conclusions: The pterygomaxillary region exhibits anatomical variations that may lead to serious complications during Le Fort I osteotomy. Detailed preoperative evaluation of this area using CBCT can guide surgical planning and help prevent potential vascular and neural complications.