Morphometric Analysis of Lateral Nasal Wall and Pterygomaxillary Junction in Class II and III Skeletal Malocclusions: Implications for Orthognathic Surgical Strategy

BACKGROUND: In Le Fort I osteotomy, precise anatomic knowledge is essential to minimize intraoperative bleeding, particularly during lateral nasal wall osteotomy (LNO) and pterygomaxillary junction (PMJ) separation. This study aimed to evaluate the morphometric characteristics of the lateral nasal wall and PMJ in patients with different skeletal deformities. MATERIALS AND METHODS: Measurements were performed on axial CT sections obtained 4 mm superior to the piriform aperture. Lateral nasal wall length (mm) and angle (degrees), as well as PMJ width, length, and angle, were measured bilaterally in patients with class II and class III deformities. Statistical significance was set at P<0.05. RESULTS: A total of 87 patients were included. PMJ width was significantly greater in class II patients compared with class III (P<0.001), whereas PMJ length was significantly greater in class III patients (P=0.022) and in females compared with males (P=0.031). PMJ angle was significantly narrower in class II patients (P=0.014). No significant difference was observed in LNW angle between skeletal classes (P=0.656). CONCLUSIONS: Morphometric variations of the lateral nasal wall and pterygomaxillary junction differ according to skeletal pattern and sex and may influence surgical technique during Le Fort I osteotomy. Preoperative evaluation of patient-specific anatomy is essential to improve surgical safety and predictability.