Dual attachment of the buccinator muscle at the pterygoid hamulus: implications for pterygoid implant surgery

Purpose Pterygoid implants are a viable alternative to sinus-lifting procedures; however, their placement may risk damaging adjacent soft tissues. This study aimed to clarify the morphology of the buccinator muscle (Bu), particularly its attachment to the pterygoid hamulus, and to assess the risk of injury during implant surgery. Methods Cadaveric dissection, histological analysis, and micro-computed tomography were performed. Bone morphometry was used to evaluate the maxillary tuberosity. Histological sections were analyzed to measure the distance between the Bu and the maxillary tuberosity, as well as to examine its attachment to the pterygoid hamulus. Results Substantial individual variation was observed in the shape and bone density of the maxillary tuberosity, with some specimens exhibiting low bone volume fraction (BV/TV). The Bu was located immediately posterior to the tuberosity at the root of the pterygoid hamulus (mean: 0.61 mm), but more distant at the tip (mean: 2.37 mm). The muscle exhibited a dual mode of attachment: tendinous at the root and periosteal at the tip. Implant perforation near the root may therefore pose a higher risk of muscle injury. Conclusions This study revealed a dual attachment of the buccinator muscle to the pterygoid hamulus and emphasized its close proximity to the maxillary tuberosity. Additionally, low BV/TV values in some specimens highlight the anatomical variability of this region. Understanding individual differences in bone structure and the precise location of soft tissue attachments is essential for safer and more predictable pterygoid implant placement.