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Similarly, bone loss is not uniform, with the greatest resorption occurring in the ascending process of the maxilla. Pessa measured the length of the perpendicular line from the nasion to the pyriform on standardized lateral views of three-dimensional CT images and observed that the distance increases significantly with aging, indicating preferential bone loss in the lower part of the pyriform aperture (Fig.
This manifests clinically as posterior displacement of the alar base (relative to the fixed position of the medial canthus) (Fig. In youth, the piriform (P) lies anterior to the anterior lacrimal crest (A). Deepening of the maxilla results in posterior positioning of the nasolabial crease and adjacent upper lip.