Pilot CBCT-Based Volumetric and Morphometric Analysis of the Pterygopalatine Fossa in a Romanian Cohort: A...

Background: The pterygopalatine fossa (PPF) is a complex anatomical region containing critical neurovascular structures and serving as an important surgical landmark for endoscopic and transmaxillary approaches. Quantitative data on its volumetric and linear morphology remain limited. Objectives: This study aimed to evaluate bilateral PPF volumes and linear dimensions using CBCT-based semi-automated segmentation, and to assess the influence of sex and age on PPF morphometry in a Romanian cohort. Methods: This single-center, retrospective pilot cone-beam computed tomography (CBCT) study analyzed 50 patients (28 males and 22 females; age range 16-80 years). Semi-automated segmentation was performed using ITK-SNAP software, and linear measurements were obtained from multiplanar reconstructions. Results: Males exhibited significantly larger mean PPF volumes than females (right: 868.96 vs. 759.86 mm³, p = 0.018; left: 836.71 vs. 703.00 mm³, p = 0.003). Significant age-related differences were observed, with younger patients (≤40 years) showing greater volumes (right: 907.06 mm³; left: 845.90 mm³) than older patients (>40 years: right: 691.80 mm³; left: 675.45 mm³; p < 0.0001 and p = 0.0003, respectively). Similar trends were observed for linear dimensions: mean height and width were consistently greater in males, and height was greater in the ≤40 age group. Left-side width did not differ significantly across age groups. No clinically relevant bilateral asymmetry was identified. Intra- and inter-observer reliability were excellent across all parameters (ICC > 0.90). Conclusions: These findings provide preliminary morphometric reference data on the PPF with potential implications for preoperative planning in maxillofacial surgery, endoscopic approaches, and regional anesthesia, pending prospective clinical validation.