Assessment of zygomatico-maxillary suture fusion across skeletal maturation stages from preadolescence to young adulthood

Abstract

Objective: To characterize the zygomatico-maxillary suture fusion (ZMSF) from preadolescence to young adulthood. Methods: A total of 573 subjects (283 males, 290 females; age, 6–18 years) were divided into 26 groups based on sex and age. Three-dimensional computed tomography images were reconstructed and oriented using ON3D software. The cervical vertebrae maturation index (CVMI) and ZMSF stages were identified using 6-stage and 5-stage scoring systems, respectively. The distributions of CVMI stage and ZMSF stage in each group were statistically analyzed. Results: Females exhibited earlier appearance and a narrower range of onset (CVMI stage-2, ZMSF stage-2), middle (CVMI stage-4, ZMSF stage-3), and completion (CVMI stage-6, ZMSF stage-5), indicating faster skeletal maturation compared to males. Both males and females showed strong positive correlations between age and CVMI stage, between age and ZMSF stage, and between CVMI stage and ZMSF stage (all P < 0.001). The mean ages at ZMSF stage-3 and stage-4 (11.9–14.7 years for males, 9.7–12.6 years for females) may indicate the peak of pubertal growth. Regression equations for ZMSF stage (y), age (a), and CVMI stage (b) were y = –0.508 + (0.169 × a) + (0.509 × b) + (–0.006 × ab) for males and y = –1.227 + (0.285 × a) + (0.804 × b) + (–0.034 × ab) for females. Multivariable ordinal logistic regression analyses indicated that increases in age and progress in CVMI stage were associated with more advanced ZMSF stage, suggesting that ZMSF follows the general skeletal maturation curve. Conclusions: The ZMSF stages showed strong correlations with age and progression of the CVMI stage.