{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T21:14:32Z","timestamp":1789679672644,"version":"4.0.1"},"reference-count":30,"publisher":"MDPI AG","issue":"18","license":[{"start":{"date-parts":[[2025,9,15]],"date-time":"2025-09-15T00:00:00Z","timestamp":1757894400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background\/Objectives: Bilateral symmetry of craniofacial structures is a fundamental principle in clinical application, particularly in procedures involving unilateral trauma or skeletal loss. The zygomaticomaxillary suture (ZMS), located at the articulation between the zygomatic bone and maxilla, is considered a potentially stable midfacial landmark owing to its distinct anatomical position and relevance in surgical planning. This study aimed to evaluate the bilateral symmetry of the ZMS and its surrounding anatomical structures in healthy adults using three-dimensional CT reconstructions and to develop predictive models for contralateral estimation. Methods: Craniofacial CT scans of 200 adult individuals (101 females and 99 males, aged \u226518 years) were retrospectively analyzed. Fourteen morphometric parameters related to the ZMS and adjacent craniofacial structures were measured bilaterally on 3D reconstructions generated from CT data. Statistical analyses included tests for normality, sex and side comparisons, correlation analysis, and linear regression to develop side-predictive formulas. Results: No statistically significant differences were found between the right and left sides for any parameter, confirming a high degree of bilateral symmetry. However, significant sex-based differences were observed in two parameters: the lateral extension of the ZMS (p = 0.024 right; p = 0.046 left) and piriform aperture width (p = 0.017). Regression models developed for each sex provided reliable estimates of contralateral morphometric values based on single-sided measurements. Conclusions: The results confirm high bilateral symmetry of the ZMS and adjacent midfacial structures, supporting its reliability as a reference point in surgical planning and facial reconstruction. Regression models enhance the accuracy of mirror-based approaches in unilateral midfacial defects.<\/jats:p>","DOI":"10.3390\/diagnostics15182330","type":"journal-article","created":{"date-parts":[[2025,9,15]],"date-time":"2025-09-15T09:43:41Z","timestamp":1757929421000},"page":"2330","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["CT-Based Morphometric Analysis of Zygomaticomaxillary Suture Symmetry: Implications for Diagnostic Imaging"],"prefix":"10.3390","volume":"15","author":[{"given":"Atakan","family":"K\u0131rteke","sequence":"first","affiliation":[{"name":"Department of Radiology, Nev Hospital, Sanl\u0131urfa 63300, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hilal","family":"G\u00f6ren","sequence":"additional","affiliation":[{"name":"Department of Anatomy, Faculty of Medicine, Bilecik \u015eeyh Edebali University, Bilecik 11230, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1412-2634","authenticated-orcid":false,"given":"Nilg\u00fcn","family":"Tuncel \u00c7ini","sequence":"additional","affiliation":[{"name":"Department of Anatomy, Faculty of Medicine, Bilecik \u015eeyh Edebali University, Bilecik 11230, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,9,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Babacan, S., and Deniz, M. (2025). The harmony and balance of the facial organs for a natural face beauty: A novel perspective for cosmetic\/aesthetic interventions. Medicina, 61.","DOI":"10.3390\/medicina61060958"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"5637","DOI":"10.1007\/s00784-023-05185-x","article-title":"Probing real-world Central European population midfacial skeleton symmetry for maxillofacial surgery","volume":"27","author":"Franke","year":"2023","journal-title":"Clin. Oral Investig."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"234.e1","DOI":"10.1016\/j.forsciint.2011.11.016","article-title":"Zygomaticomaxillary suture shape analyzed with digital morphometrics: Reassessing patterns of variation in American Indian and European populations","volume":"217","author":"Sholts","year":"2012","journal-title":"Forensic Sci. Int."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1007\/s00784-011-0512-4","article-title":"A three-dimensional comparison of a morphometric and conventional cephalometric midsagittal planes for craniofacial asymmetry","volume":"16","author":"Damstra","year":"2012","journal-title":"Clin. Oral Investig."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"379","DOI":"10.1007\/s00276-006-0104-1","article-title":"Neural symmetry and functional asymmetry of the mandible","volume":"28","author":"Captier","year":"2006","journal-title":"Surg. Radiol. Anat."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"101857","DOI":"10.1016\/j.jormas.2024.101857","article-title":"Symmetry recovery in zygomaticomaxillary complex fractures compared to normal unfractured population: A new reliable 3D evaluation","volume":"125","author":"Dubron","year":"2024","journal-title":"J. Stomatol. Oral Maxillofac. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Franke, A., Matschke, J.B., Bu\u010dkova, M., Rahrisch, L., Lauer, G., and Leonhardt, H. (2025). Symmetry-based analysis after surgical treatment of zygomaticomaxillary complex fractures using intraoperative cone-beam computed tomography: A retrospective case-control study. Sci. Rep., 15.","DOI":"10.1038\/s41598-025-90481-7"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"311","DOI":"10.1016\/j.jcms.2018.12.003","article-title":"Quantitative assessment of symmetry recovery in navigation-assisted surgical reduction of zygomaticomaxillary complex fractures","volume":"47","author":"Bao","year":"2019","journal-title":"J. Craniomaxillofac. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"468","DOI":"10.3889\/oamjms.2016.067","article-title":"Midfacial reconstruction\u2014A systematic review","volume":"4","author":"Emara","year":"2016","journal-title":"Open Access Maced. J. Med. Sci."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Wilkat, M., K\u00fcbler, N., and Rana, M. (2021). Advances in the resection and reconstruction of midfacial tumors through computer assisted surgery. Front. Oncol., 11.","DOI":"10.3389\/fonc.2021.719528"},{"key":"ref_11","first-page":"397","article-title":"Symmetry of the face: Review of a complex matter","volume":"37","author":"Kessler","year":"2025","journal-title":"J. Oral. Maxillofac. Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"348","DOI":"10.1055\/s-0043-1770765","article-title":"Facial anthropometric measurements and principles\u2014Overview and implications for aesthetic treatments","volume":"40","author":"Armengou","year":"2024","journal-title":"Facial Plast. Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1275","DOI":"10.1097\/PRS.0000000000010164","article-title":"Facial and cranial symmetry after one-piece fronto-orbital advancement with distraction for isolated unilateral coronal synostosis","volume":"151","author":"Park","year":"2023","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"340","DOI":"10.1016\/j.ajodo.2023.01.015","article-title":"The association between dental and facial symmetry in adolescents","volume":"164","author":"Silinevica","year":"2023","journal-title":"Am. J. Orthod. Dentofac. Orthop."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1026","DOI":"10.1097\/SCS.0000000000004627","article-title":"Integrating a profile of frontal face with its mirror image for facial reconstruction","volume":"29","author":"Kaur","year":"2018","journal-title":"J. Craniofac. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1474","DOI":"10.1097\/SCS.0000000000008382","article-title":"A novel method for quantitative three-dimensional analysis of zygomatico-maxillary complex symmetry","volume":"33","author":"Rosenberg","year":"2022","journal-title":"J. Craniofac. Surg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"600","DOI":"10.1016\/j.jcms.2018.02.012","article-title":"Assessing symmetry of zygomatic bone through three-dimensional segmentation on computed tomography scan and \u201cmirroring\u201d procedure: A contribution for reconstructive maxillofacial surgery","volume":"46","author":"Gibelli","year":"2018","journal-title":"J. Craniomaxillofac. Surg."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Benedetti, S., Frosolini, A., Cascino, F., Pignataro, L.V., Franz, L., Marioni, G., Gabriele, G., and Gennaro, P. (2025). Computer-assisted evaluation of zygomatic fracture outcomes: Case series and proposal of a reproducible workflow. Tomography, 11.","DOI":"10.3390\/tomography11020019"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"611","DOI":"10.1007\/s11548-022-02775-0","article-title":"Three-dimensional quantification of skeletal midfacial complex symmetry","volume":"18","author":"Morgan","year":"2023","journal-title":"Int. J. Comput. Assist. Radiol. Surg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"917","DOI":"10.1007\/s00276-013-1116-2","article-title":"Morphometric measurements and sexual dimorphism of the piriform aperture in adults","volume":"35","author":"Moreddu","year":"2013","journal-title":"Surg. Radiol. Anat."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"707","DOI":"10.5603\/FM.a2021.0080","article-title":"Analysis of gender differences on pyriform aperture of human skulls using geometric morphometric method","volume":"81","author":"Prazina","year":"2022","journal-title":"Folia Morphol."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Toneva, D., Nikolova, S., Tasheva-Terzieva, E., Zlatareva, D., and Lazarov, N. (2022). A geometric morphometric study on sexual dimorphism in viscerocranium. Biology, 11.","DOI":"10.3390\/biology11091333"},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Wu, Z., Gao, X., Long, H., and Lai, W. (2022). Quantitative analysis of facial symmetry by using three-dimensional technology. BMC Oral Health, 22.","DOI":"10.1186\/s12903-022-02315-x"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1186\/s40902-020-00260-9","article-title":"Quantification of three-dimensional facial asymmetry for diagnosis and postoperative evaluation of orthognathic surgery","volume":"42","author":"Cao","year":"2020","journal-title":"Maxillofac. Plast. Reconstr. Surg."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1093\/ejo\/cjr091","article-title":"Three-dimensional quantification of facial symmetry in adolescents using laser surface scanning","volume":"36","author":"Djordjevic","year":"2014","journal-title":"Eur. J. Orthod."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1016\/j.ajodo.2019.12.014","article-title":"Three-dimensional assessment of facial asymmetry using dense correspondence, symmetry, and midline analysis","volume":"158","author":"Lum","year":"2020","journal-title":"Am. J. Orthod. Dentofac. Orthop."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"315.e1","DOI":"10.1016\/j.joms.2014.09.022","article-title":"How accurate is the treatment of midfacial fractures by a specific navigation system integrating \u201cmirroring\u201d computational planning? Beyond mere average difference analysis","volume":"73","author":"Pierrefeu","year":"2015","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1697","DOI":"10.1016\/j.joms.2010.07.049","article-title":"\u201cMirroring\u201d computational planning, navigation guidance system, and intraoperative mobile C-arm cone-beam computed tomography with flat-panel detector: A new rationale in primary and secondary treatment of midfacial fractures?","volume":"69","author":"Scolozzi","year":"2011","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"170","DOI":"10.3109\/10929088.2011.581901","article-title":"Image guided surgical navigation integrating \u201cmirroring\u201d computational planning based on intra-operative cone-beam CT imaging: A promising new approach for management of primary bilateral midfacial fractures","volume":"16","author":"Terzic","year":"2011","journal-title":"Comput. Aided Surg."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"White, H.E., Goswami, A., and Tucker, A.S. (2021). The intertwined evolution and development of sutures and cranial morphology. Front. Cell Dev. Biol., 9.","DOI":"10.3389\/fcell.2021.653579"}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/15\/18\/2330\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:45:33Z","timestamp":1760035533000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/15\/18\/2330"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,15]]},"references-count":30,"journal-issue":{"issue":"18","published-online":{"date-parts":[[2025,9]]}},"alternative-id":["diagnostics15182330"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics15182330","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,15]]}}}