Characterization of Pterygomaxillary Suture Morphology: A CBCT Study

Abstract

One of the most challenging procedures during maxillary osteotomy is pterygomaxillary suture (PMS) separation, due to the difficulty of directly inspecting this suture and the anatomical complexity of the adjacent structures. Knowing the precise anatomical dimensions and the position of the PMS, namely, the angle at which to approach this structure, may help in determining the proper osteotome. It will also help the oral and maxillofacial surgeon to perform this sensitive procedure more precisely and to minimize surgical complications (e.g., internal maxillary artery injury and unfavorable fracture during separation). The current study aimed to evaluate the morphology of PMS in an adult Israeli population using CBCT scans of the maxilla. Fifty CBCTs of healthy males (n = 27) and females (n = 23) were collected and analyzed. The vertical height, maximal thickness, and angulation of the PMS relative to the midsagittal plane of the skull were evaluated on both the right and left sides of the patient. An independent samples t-test was carried out to determine PMS morphological differences between males and females. A related samples t-test was conducted to determine the PMS morphological differences between the right and left sides. No significant differences in PMS parameters were found between sides in males and females (p > 0.225). Both males and females exhibited similar height and angulation of the PMS (p > 0.486). Interestingly, the PMS thickness was statistically greater in males (p = 0.029); however, this difference was clinically insignificant. The mean dimensions of the PMS in a healthy Israeli adult population are presented and discussed, as well as the clinical and methodological implications.