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 вЂњclickвЂќ for the next action and (3) you are done reading a slide. Hitting вЂњEnterвЂќ or вЂњPage DownвЂќ will also work. To go back to the previous slide, hit вЂњbackspaceвЂќ or вЂњpage upвЂќ. If you right click anywhere on the screen and select вЂњFull ScreenвЂќ 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 вЂњFull ScreenвЂќ, the images should fill the entire screen. If you want to print slides 7, 8 and 9, you must rightclick, select вЂњEnd ShowвЂќ and then right click again on slide you want to print and select вЂњPrintвЂќ. 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 вЂњPanoramic TechniqueвЂќ). 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 patientвЂ™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 patientвЂ™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 patientвЂ™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 (patientвЂ™s left) caused by excessive oil on patientвЂ™s hair. L R L 7 28 28 red arrow identifies fracture R L 27 44 34 Green arrow identifies вЂњpseudo-fractureвЂќ 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 patientвЂ™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 patientвЂ™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 (#вЂ™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 EagleвЂ™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.