CBCT study on the positional relationship between marginal points of pterygomaxillary junction and anterior nasal spine.

Abstract

This study aimed to locate the inferior end (Pti) and the superior end (Pts) of pterygomaxillary junction (PMJ) relative to anterior nasal spine (ANS) so as to provide references for pterygomaxillary separation. The study was based on CBCT images of 109 Chinese patients. We projected Pti and Pts to the frontal plane and measured the distance as well as the positional relationship between the projection points and ANS via three-dimensional reconstruction image. On average, the ANS was 5.18mm above the Pti and the horizontal distance between the Pti and ANS was 21.86mm. The horizontal and vertical distances between Pts and ANS was 20.41mm and 10.91mm, respectively. The vertical height of PMJ was 16.09mm. Scatter plots diagrammatic centered on ANS showed that 73% (160/218) Pti and 64% (140/218) Pts appeared in a 45° fan shape ranged from 20 to 25mm radius in bilateral inferior and superior quadrant, respectively. There was no significant difference in the distance between both sides (P > 0.05). During the pterygomaxillary disjunction, it exists a risk of injuring neurovascular bundle of the pterygopalatine fossa 16.09mm above the lowest border of the pterygomaxillary junction. The region within a 45° fan shape ranged in 20-25mm radius in inferior quadrant centered on ANS might be suitable for the osteotome position. The positional relationship especially between the ANS and Pti found in this study provides a reference for surgeons during pterygomaxillary disjunction.