Cone-beam computed tomography evaluation of the pterygomaxillary fissure and pterygopalatine fossa using 3D rendering programs

  • Murat Icen
  • Kaan OrhanEmail author
Anatomic Variations



The aim of this study was to investigate the detailed anatomy of the pterygomaxillary fissure (PMF) and pterygopalatine fossa (PPF) and variations therein using three-dimensional (3D) cone-beam computed tomography (CBCT) software.


This study was based on a retrospective evaluation of CBCT scans. A total of 825 CBCT images of patients (448 females, 377 males) who met the inclusion criteria were analyzed. PMF shapes were classified, and morphometric measurements (PMF area and PPF volume) were performed according to age, right/left side, and gender using 3D rendering programs. Maxillary and sphenoid sinus pathologies were also classified to reveal possible correlations between morphometric measurements. Analysis of variance was used for comparisons. Multiple comparisons were assessed using the Bonferroni test. Pearson’s test was used to assess correlations between parameters. A p value < 0.05 was considered to indicate statistical significance.


Six types of PMF shapes were defined. There were no significant differences in types according to gender, age or sinus pathology. Males had a significantly larger PMF area than females (p < 0.001). Left/right comparison of the PMF area revealed that the mean PMF coronal, axial, and sagittal area dimensions were significantly higher on the right side in all patients. Our results also indicated that the PMF area and PPF volume increased significantly after 40 years of age.


Various PMF shapes were defined and classified. PMF and PPF dimensions increased with age. Knowledge of these anatomical variations will allow surgeons to avoid damage to the neurovascular structures passing through the area.


Pterygomaxillary fissure Pterygopalatine fossa Morphometry Anatomy Cone-beam computed tomography 


Author contributions

KO and MI: project development, data collection, and manuscript writing. MI: data collection and manuscript editing. MI and KO: data analysis.


There was no funding in this study.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Oral and Maxillofacial Radiology, Faculty of DentistryZonguldak Bülent Ecevit UniversityZonguldakTurkey
  2. 2.Department of Dentomaxillofacial Radiology, Faculty of DentistryAnkara UniversityBesevlerTurkey
  3. 3.OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of MedicineUniversity of Leuven and Oral and Maxillofacial Surgery, University Hospitals LeuvenLeuvenBelgium

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