Background: Information on the onset and gender differences of midfacial skeletal changes, including the complete understanding of the theory behind the clockwise rotational theory, remains elusive.
Methods: One hundred fifty-seven Caucasian individuals (10 men and 10 women aged 20 to 29 years, 30 to 39 years, 40 to 49 years, 50 to 59 years, 60 to 69 years, 70 to 79 years, and 80 to 89 years, and eight men and nine women aged 90 to 98 years) were investigated. Multiplanar computed tomographic scans with standardized angle and distance measurements in all three anatomical axes and in alignment to the sella-nasion (horizontal) line were conducted.
Results: Both men and women displayed an increase in orbital floor angle (p < 0.001, maximum at 60 to 69 years), decrease in maxillary angle (p = 0.035, 40 to 49 years), increase in palate angle (p < 0.001, 50 to 59 years), increase in vomer angle (p = 0.022, 30 to 39 years), but a decrease in the pterygoid angle (p = 0.002, 80 to 89 years). Orbital width decreased (p < 0.001, 60 to 69 years), pyriform aperture width increased (p = 0.015, 60 to 69 years), and midfacial height decreased with aging (p < 0.001, 60 to 69 years).
Conclusions: Age-related changes of the midfacial skeleton occurred independently of gender, but at various time points in different locations. The observed changes seem to be driven by a bone resorption center located in the posterior maxilla, rather than by a rotational movement of the facial skeleton.