Morphological Variations of the Pterygomaxillary Suture According to Skeletal Patterns

Background: The posterosuperior maxillary region poses a challenge in orthognathic surgery due to its complex three-dimensional anatomy. The pterygomaxillary suture (PMS) is a key landmark for various procedures. Understanding its anatomical relationships is essential to improving surgical precision. Methods: A retrospective analysis of CBCT images from 120 patients aged 18-70 years at Ankara Medipol University was conducted. Patients were categorized into skeletal Classes I, II, and III according to the ANB angle. Linear and angular measurements of the PMS and adjacent structures were performed. The statistical analysis included the Shapiro-Wilk, Independent t-test, Mann-Whitney U test, and regression analysis (p < 0.05). Results: There were clear differences between the skeletal groups. Class II and III patients had a lesser lateral PMS-baseline intersection distance (IV-VI) and Class II had a lesser medial PMS-baseline perpendicular distance (VV') compared to Class I (p < 0.05). Additionally, the angle V-IV-VI was significantly narrower in Class II and III groups, indicating altered PMS orientation in these skeletal patterns. Conclusions: PMS morphology, including thickness, width, and angulation, is influenced by skeletal pattern. A preoperative CBCT assessment and individualized surgical planning are essential to ensure the safety and accuracy of Le Fort I osteotomies, especially in Class II and III patients.