Cone-Beam Computed Tomography Morphometric Analysis of the Pterygopalatine Fossa and Greater Palatine Canal in a Saudi Cohort: A Retrospective Cross-Sectional CBCT Study

Background: Accurate knowledge of the pterygopalatine fossa (PPF) and the greater palatine canal/foramen (GPC/GPF) is clinically important for administering anesthesia through the canals and for planning surgical access to the posterior maxilla. Cone-beam computed tomography (CBCT) enables evaluation of anatomic structures of interest in individual patients when two-dimensional imaging methods are inadequate. Methods: This cross-sectional study retrospectively analyzed 150 CBCT datasets from residents of Abha city in the Asir region of Saudi Arabia who visited a dental hospital from November 2025 to February 2026; of these, 65 datasets were included. Bilateral measurements of the PPF-GPC complex and the anteroposterior (AP) position of the GPF were taken; subject-level means were used to avoid non-independence. Multivariate models adjusted for age and sex were fitted. Curvature was assessed using a cluster logistic model. Results: The mean length of the PPF-GPC complex was 33.12 ± 3.07 mm (P5-P95 interval, 28.91–39.50). After adjusting for age and sex, males had a longer pathway (+2.25 mm; 95% confidence interval [CI], 0.35–4.15; p = 0.020); pathway length decreased slightly with increasing age (−0.38 mm per decade; 95% CI, −0.73 to −0.03; p = 0.034). The mean distance from the ANS to the GPF was 47.28 ± 3.58 mm and increased with age by 0.67 mm per decade (95% CI, 0.23–1.11; p = 0.003). Curved canals accounted for 56.2% of the sides examined. No significant association was observed between sex and either curvature status or side. Conclusions: In this population, the length of the pathway from the palate to the PPF and the AP location of the GPF showed clinically relevant variations among individuals. Adjusted estimates indicated that sex and age can predictably influence the length of the pathway and the distance of the GPF from the ANS, supporting the use of patient-specific CBCT evaluations to identify landmarks for anesthesia through the canals or when planning posterior maxillary surgical procedures.