Mandible, TMJ
Radiographs & Diagrams
2009

Mandible
PA

 PA Axial
 Axiolateral Oblique
 Towne Method (AP Axial)
 Modified Waters
 SMV
 Panorex

TMJ
Towne Method

 Schuller
 Law
 Panorex

PA Mandible
Rest pt’s forehead & nose

against bucky
Tuck in chin to bring OML

& MSP perp to IR
40” SID

CR perp to IR to exit @

junction of lips
Collimate to area of

mandible
Shows mandibular rami &

lateral portion of body
Rami s/b symmetrical

Mentum superimposed on

C-spine

Lateral Facial Bones
Coronoid process
a.
Mandibular fossa
b.
Neck of condyloid
c.
process
Mandibular notch
d.
Gonion
e.

Axiolateral Oblique- Mentum 45°
Place pt in a true lateral w/

SOI against IR
Mouth closed, neck extended

To visualize mentum, oblique

head 45° towards IR
Angle CR 25° cephalic to exit

area of interest
CR will skim under the closest

side of mandible to project
the opposite side (area of
interest) free of
superimposition

Axiolateral Oblique – Body
30°
Start from true lateral

Oblique head 30°

towards IR
25° CR angle

CR will exit body on

opposite side of
mandible
Collimate to mandible

on all sides

Axiolateral Oblique- General
Survey 10° - 15°
Oblique head 10°-

15° towards IR
 CR angled 25°
cephalad
 Area of interest
should be
demonstrated
w/minimal
superimposition &
foreshortening

Axiolateral Oblique- Labeling
Alveolar process
1.
2. Gonion
3. Ramus
4. Condyloid
process

Panorex (Eagle’s Syndrome)
Note extra styloid

processes lateral to
gonions

Law - TMJ
Head in true lateral

IPL perp & MSP parallel to IR

IOML perp to front edge of IR

SOI against IR

Rotate head 15° towards IR

Angle CR 15° caudad

Enters 1 ½ “ ↑ to upside EAM

Exits downside TMJ

SHOWS: TMJ Closed IR

Closed mouth: Condyle in TM

fossa
Open mouth: Condyle @

anterior margin of TM fossa

Panorex
Pt is seated w/IOML

parallel to floor & MSP
perp to IR
Teeth on bite piece,

chin in bite block
Fixed CR & SID

Shows: Flat image of

entire mandible; teeth,
TMJ’s, body, rami,
angles, symphysis,
condyles & coronoid
processes

Schuller - TMJ
Pt’s head in true lateral

(body obliqued as needed
for comfort)
IPL perp to IR, MSP

parallel
Angle CR 25°-30° caudad

Center ½ in anterior & 2 in

superior to upside EAM
Center IR to projected TMJ

Collimate on all sides to

aprox 4 in square
Closed mouth & open

mouth
Shows TMJ closest to IR


Law Method- TMJ
SOI closest to IR

Head lateral body obliqued as

necessary for comfort
IPL perp to IR to avoid tilt

From lateral, rotate face 15°

towards IR
Angle CR 15° caudad

centered to 1 ½ in ↑ to
upside EAM
Center IR to projected CR

Collimate on all sides to aprox

4 in square
Shows TMJ closest to IR


Law vs Schuller’s-how do you
tell?
Look for the hook

 Condyloid process
appears as a hook
on Law Method
radiographs.
 Appears to hook
around towards the
mouth

PA Mandible (Bad)
Taken on phantom

(no C-spine)
 OML is not
perpendicular

Law - TMJ
Law- look for the hook

Condyle appears to

hook towards the face
This one could use

more collimation

Modified Townes (Mandible)
OML & MSP perp to IR

CR angle 35°-40° caudad

Enter glabella (to pass

through EAM’s & B/T
gonions @ MSP)
Shows: condyloid

processes, TMJ fossae,
Mandibular rami free from
superimposition

SMV- Mandible
• IOML parallel to IR
CR enters ½ way B/T

gonions or 1 ½-2 in ↓
to mandibular symphysis
Shows mandible,

coronoid & condyloid
processes
Mandibular condyles

anterior to petrosae
Mandibular symphysis

superimposed on frontal
bone

Modified Townes (Mandible)
Note necklace in

anatomy

Panorex – Open/Closed

Townes - TMJ
OML & MSP perp to IR

CR angle 35° caudad to

pass 1” anterior to TMJ
level
(Angle 42° caudad if IOML

perp)
*Additional 5 ° may show

TM fossae & joint best
Shows: Condyloid process

& TMJ fossae (do 1 closed
& 1 open view)

Review- Skull Landmarks
Mentum
1.
Acanthion
2.
Nasion
3.
Glabella
4.
Vertex
5.
Head
6.
Outer canthus
7.
Inion
8.
Tragus
9.
mandible
10.

Review- Positioning Lines
EAM
1.
GML
2.
OML
3.
IOML
4.
AML
5.
MML
6.
8°
a.
7°
b.
10°
c.
20°
d.

Nasal bone
1.
Frontal process of maxilla
2.
Lacrimal bone
3.
Superior nasal conchae
4.
Inferior nasal conchae
5.
Vomer
6.
Alveolar process
7.
Mandible
8.
Maxilla
9.
Zygomatic process of
10.
maxilla
Zygoma
11.
Perpendicular plate of
12.
ethmoid

13. Temporal bone
14. Frontal portion of
maxilla
15. sphenoid
16. Parietal bone
17. Frontal bone

Skull- Lateral View
Vertex
1.
Inion
2.
Temporal bone
3.
Mastoid process
4.
Squamous portion of
5.
temporal bone
5a. Styloid process of temporal
bone
Mandible
6.
Maxilla
7.
Zygomatic arch
8.
Anterior nasal spine
9.

Lateral Skull (Contd.)
10. Sphenoid bone
11. Lacrimal bone
12. Nasal bone
13. Zygoma
14. Sphenoid
15. Frontal bone
16. Coronal suture
17. Squamosal
suture
18. Lambdoidal
suture

Maxillae & Palatine Bones
Palatine Process
A.
of Maxilla
B. Palatine Bones
C. Pterygoid process
of Sphenoid

Sinuses- Anterior View
Frontal Sinuses
1.
2. Ethmoid &
sphenoid Sinuses
3. Maxillary Sinuses

Sinuses – Lateral View
Frontal Sinuses
1.
2. Ethmoid Sinuses
3. Sphenoid Sinuses
4. Maxillary Sinuses

Mandible – Lateral View
Coronoid Process
A.
Manbidular Notch
B.
Neck of condyloid
C.
process
Head of condyloid
D.
process
Condyloid process
E.
Ramus
F.
Gonion
G.
Body
H.
Mentum
I.
Alveolar Process
J.