This study investigates craniofacial asymmetry and its correlation with the piriform aperture in macerated human skulls. Asymmetry, defined as deviation from bilateral symmetry in facial structures, is multifactorial in origin. Influences may be genetic, epigenetic and environmental. A total of 100 skulls from the Osteological Collection of the Faculty of Medicine in Sarajevo were examined in a prospective, randomized, quantitative-qualitative design. The most common piriform aperture shapes were consistent across sexes. Male skulls exhibited greater height of the piriform aperture (3.5 ± 0.3 cm) than female skulls (3.2 ± 0.3 cm), while width was similar. Strong correlations (p < 0.01) were found between piriform aperture height and surface area and between aperture width and surface area. Skull dimensions showed that male skulls were generally longer, while female skulls had a higher cephalic index. Male skulls showed a predominance of dolichocephalic and mesocephalic types in contrast to female skulls which were mostly brachycephalic and mesocephalic. Significant asymmetry patterns were observed. Male skulls with right-sided and female skulls with left-sided asymmetry were present. Correlations between piriform aperture dimensions and overall facial measurements were statistically significant. A high incidence of petalias (asymmetrical protrusions) was found, especially when it comes to parietopetalias (98%). The study concludes that asymmetry in skulls is common and statistically significant. Multidimensional approach using different anthropometric points is more effective when it comes to the assessment of craniofacial asymmetry than relying solely on basic facial measurements.