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Panoramic Anatomy

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Welcome. In navigating through the slides, you
should click on the left mouse button when (1), you
see the mouse holding an x-ray tubehead (see
below), (2) you are directed to “click” for the next
action and (3) you are done reading a slide. Hitting
“Enter” or “Page Down” will also work. To go back
to the previous slide, hit “backspace” or “page up”.
If you right click anywhere on the screen and select
“Full Screen” the slides will be easier to view.
Click for next slide
Panoramic Anatomy
The following is a PowerPoint presentation. If you
right click on the screen and select “Full Screen”,
the images should fill the entire screen. If you
want to print slides 7, 8 and 9, you must rightclick, select “End Show” and then right click
again on slide you want to print and select
“Print”.
Types of Panoramic Images
Single Real Image
Double Real Image
Ghost Image
Single Real Image
Only one image results from a given anatomical
structure. The structure is located between the
rotation center and the film and the x-ray beam
only passes through the structure one time.
Most images seen on a panoramic film are of
this type.
Double Real Image
Two images of a single object are seen on the
film. Double real images are produced by
structures located in the midline. The x-ray
beam passes through these objects twice as
the tubehead rotates around the patient.
Structures that result in double real images
are the hard and soft palates, the hyoid bone
and the cervical spine.
Ghost Image
Ghost images are formed by dense objects
located between the tubehead and the rotation
center. These ghost images usually result from
external objects such as earrings, but they may be
produced by dense anatomical structures such as
the mandible. (For more information, see selfstudy module “Panoramic Technique”).
ghost image of earring
(between lines)
The following slides show anatomical
structures seen on panoramic films. The
accompanying keys identify the
structures by number. See what other
structures you can identify that are not
labeled. At the end of this presentation
there are 11 pre-test slides.
9
12
7
19
5
25
17
14
13
6
22
18
39
28
33
9
19
12
5
17
14
7
13
6
25
18
22
39
28
33
11
2
15
24
26
32
8
16
1
31
3
20
23
4
34
44
30
36
11
38
2
15
24
26
32
8
16
20
1
3
23
31
44
34
30
36
38
46
21
42
41
47
40
45
43
46
21
41
42
47
40
43
45
R
11
7
1
46
41
47
43
36
38
45
L
16
R
23
L
17
2
8
6
21
18
19
39
Red arrows point to ghost image of hard palate
R
11
9
3
20
How old is this patient?
a.
6-9 years
b. 10-12 years
c. 13-15 years
b. 10-12 years old
L
R
L
17
44
2
20
28
43
R
L
2
atlas
31
transverse foramen
R
L
15
46
47
19
6
27
34
What head positioning error is seen on this film?
The anterior teeth are positioned in front of the notch in the
bitestick, resulting in the widening of the anterior teeth (the
maxillary central incisors are as wide as the molars).
R
L
17
8
15
1
32
N
N = soft tissue of nose
What head positioning error is seen on this film?
The head is tipped down too much, resulting in shortened
mandibular incisors and a V-shaped mandible.
R
L
40
27
E
LN
36
LN = calcified lymph node
E = epiglottis
R
L
2
8
40
18
45
?
? Identifies calcification, possibly in carotid or in lymph node
What positioning error is seen on this film?
The
head was
turned
to thetoleft,
that
side
closer
to
The
patient’s
head
is turned
thebringing
side. Note
the
width
of the
the film
the arrows
width ofare
thethe
ramus
that side.
ramus
on and
eachdecreasing
side (The red
sameon
length).
The green
arrow
points
to the biteblock,
centered
onright)?
the
Which
direction
was
the patient’s
head turned
(left or
contact between the right central and lateral incisors.
R
L
8
7
46
47
33
E
E = epiglottis
R
L
11
21
3
29
32
34
What causes the black dots identifed by the red arrow?
Theblack
chin is
tipped
upfrom
too much,
giving a more
squared
The
dots
result
static electricity,
caused
by off
What
positioning
error is
seen
ona
this
film?
appearance
to
thetoo
mandible,
creating
reverse
smile
removing
the
film
quickly
from
the
cassette
or
fromand
the
causing
the
hard palate
to be
superimposed
the roots
box
of film
(creates
friction,
which
results in aon
static
of the maxillary teeth.
discharge).
R
L
16
10
9
20
3
42
27
30
1
44
G
36
G = ghost of right mandible
L
R
24
14
27
47
nose
39
What caused the white (radiopaque) area indicated by
the red arrow?
The lead apron was placed too high on the back of the
patient’s neck.
R
L
12
air cell
9
23
7
26
Air cell in zygomatic arch.
R
L
24
7
26
22
27
30
38
R
L
5
10
6
47
45
ghost of mandible
R
L
15
23
9
7
21
5
44
39
30
Note the relatively inferior location of the mandibular canal (30),
providing plenty of room for the implant.
R
24
26
31
1
29
Pattern on right side of film (patient’s left) caused by
excessive oil on patient’s hair.
L
R
L
7
28
28
red arrow identifies fracture
R
L
27
44
34
Green arrow identifies “pseudo-fracture” caused by
palatoglossal air space.
Red arrows point to odontogenic keratocyst.
Ghost images of earrings
R
L
Ghost images of earrings
L
R
15
2
R
L
27
28
28
Hearing aid (red arrow) with ghost (green arrow).
Ghost image of metal used to restore left angle of mandible
R
L
R
L
Ghost images of mandibles
(dotted line outlines ghost of left ramus-angle over
right side of mandible)
Identify the anatomical structures
on the following slides.
Slide # 1
R
L
C
E
D
G
F
B
A
A
B
C
D
Cervical vertebra
External oblique ridge
Zygomatic process
Maxillary sinus
E
F
G
Zygomaticotemporal suture
Lingula
Cervical vertebra
Slide # 2
R
B
L
K
D
J
E
I
A
H
F
C
A
B
C
D
E
F
Ear lobe
External auditory meatus
Submandibular gland fossa
Nasal septum
Hard palate
Mental foramen
G
G
H
I
J
K
Hyoid bone
Mandibular canal
Pterygoid plates
Articular eminence
Pterygomaxillary fissure
Slide # 3
R
L
C
B
D
A
E
A
B
C
D
E
Palatoglossal air space
Middle cranial fossa
Lateral border of the orbit
Condyle
Mental fossa
Slide # 4
R
E
B
L
I
D
H
C
A
G
F
J
K
L
A
B
C
D
E
F
G Hard palate
Cervical vertebra
Zygomaticotemporal suture H Post. wall of maxillary sinus
I External auditory meatus
Zygomatic process
J Posterior pharyngeal wall
Nasal septum
K Mental foramen
Inferior concha
L Mental fossa
Soft tissue of nose
Slide # 5
R
L
E
F
G
C
D
J
H
B
I
A
A
B
C
D
E
Glossopharyngeal air space
Styloid process
Nasopharyngeal air space
Pterygoid plates
Condyle
F
G
H
I
J
Infraorbital canal
Infraorbital foramen
Soft palate
Mandibular canal
Lingula
Slide # 6
R
L
E
C
D
E
B
F
G
A
A
B
C
D
Mental foramen
Incisive foramen
Soft tissue of nose
Anterior nasal spine
E Pterygoid plates
F Ear lobe
G Hyoid bone
The radiolucency (red arrows) seen in the ramus and third
molar area on the patient’s right side is an ameloblastoma.
(Differential includes dentigerous cyst, radicular cyst, OKC).
Slide # 7
R
L
A
B
C
D
A
B
C
D
Posterior border of maxillary sinus
Inferior border of orbit
Inferior concha
Inferior border of maxillary sinus
The radiolucency (red arrows) seen in the ramus on the
patient’s left side is a squamous cell carcinoma.
Slide # 8
L
R
C
A
D
B
E
A Maxillary tuberosity
B Hard palate
C Coronoid process
D Floor of middle cranial fossa
E Posterior pharyngeal wall
This child has a condition known as cherubism. The mandibular lesions
involve both rami, extending into the coronoid process (the condyle is
rarely involved). The maxillary lesions are located in the tuberosity
regions, causing anterior displacement of 2nd and 3rd molars.
Slide # 9
R
L
E
D
A
C
F
B
A Zygomatic arch
B External oblique ridge
C Palatoglossal air space
D Soft palate
E Pterygomaxillary fissure
F Styloid process
This patient has multiple supernumerary premolars in the
mandible (#’s 21, 28 and 29 were extracted).
Slide # 10
R
L
C
D
E
B
A
A Mandibular canal
B Soft tissue of nose
C Nasal fossa
F
D Hard palate
E Mandibular foramen
F Styloid process
This patient has impacted mandibular third molars that have
migrated up into the coronoid processes. Note also the long,
thin condylar necks and small condyles.
Slide # 11
L
R
B
A
C
D
E
A Sigmoid notch
B Nasal septum
C Coronoid process
D Articular eminence
E Mental foramen
(on crest of ridge)
The green arrows identify a calcified stylohyoid ligament. If there is
associated neck pain, the condition is known as Eagle’s Syndrome
(recent history of neck trauma or surgery) or Stylohyoid Syndrome (no
history of trauma/surgery). The red box outlines several radiopacities
which represent tonsillar calcifications.
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