CBCT-Based Analysis of Medial and Lateral Pterygoid Plates: Cross-Sectional Study of Saudi Subpopulation

Background: The pterygoid plates serve as crucial reference points for posterior maxillary surgery and the placement of pterygoid implants; however, population-specific morphometric reference values remain underexplored for adults of Asir region (Abha city) of Saudi Arabia. Methods: This retrospective cross-sectional cone beam computed tomography (CBCT) study analyzed the archived scans obtained at King Khalid University Dental Hospital. Of 100 randomly selected adult CBCT scans collected between June and October 2025, 50 images met the eligibility criteria. The analyses were conducted using OnDemand3D software to measure the bilateral pterygoid plates' length, thickness at the maximum diameter, and medial-lateral divergence angle. Styloid process length was measured as an exploratory variable. Three calibrated examiners performed the measurements, and the reliability was assessed using interclass correlation coefficients. Results: Fifty CBCT scans met the inclusion criteria (30 males, 20 females). The mean lateral pterygoid plate length was 14.61 ± 3.69 mm on the right and 13.83 ± 3.93 mm on the left, while the mean medial plate length was 11.27 ± 3.52 mm (right) and 11.98 ± 3.82 mm (left). Side to side paired comparisons showed no significant right-left differences in lateral plate length (mean R-L 0.79 mm, 95% CI -0.48 to 2.06), lateral thickness (mean 0.04 mm, 95% CI -0.14 to 0.22), medial thickness (mean 0.01 mm, 95% CI -0.19 to 0.21), or pterygoid angulation (mean 1.99°, 95% CI -1.07 to 5.05), supporting bilateral symmetry. Bilateral correlations were strong for medial plate length (r = 0.729, p < 0.001) and angulation (r = 0.632, p < 0.001). Males had a longer right lateral plate than females (15.74 ± 3.55 mm vs. 12.93 ± 3.31 mm; mean difference 2.81 mm, 95% CI 0.80-4.82; p = 0.007), whereas other measurements did not differ by sex. Plate thickness ranged from approximately 1.33 to 1.46 mm and left medial plate thickness correlated negatively with left medial plate length (r = -0.399, p = 0.004). Styloid process length averaged 22.99 ± 9.76 mm and showed no significant association with pterygoid plate measures. Conclusions: CBCT-derived findings demonstrated overall bilateral symmetry and limited dimorphism in relation to sex. These region-specific morphometries support individualized preoperative posterior maxillary surgery and pterygoid implant planning.