Self study-pan-anatomy

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Dr. Özkan ADIGÜZEL

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Self study-pan-anatomy

  1. 1. Panoramic AnatomyThe following slides identify the anatomicalstructures found on Panoramic Radiographs.In navigating through the slides, you should clickon the left mouse button when you see themouse holding an x-ray tubehead or you aredone reading a slide. Hitting “Enter” or “PageDown” will also work. To go back to the previousslide, hit “backspace” or “page up”.
  2. 2. Types of Panoramic Images Single Real Image Double Real Image Ghost Image
  3. 3. Single Real ImageOnly one image results from a given anatomicalstructure. The structure is located between therotation center and the film and the x-ray beamonly passes through the structure one time.Most images seen on a panoramic film are ofthis type.
  4. 4. Double Real ImageTwo images of a single object are seen on thefilm. Double real images are produced bystructures located in the midline. The x-raybeam passes through these objects twice asthe tubehead rotates around the patient.Structures that result in double real imagesare the hard and soft palates, the hyoid boneand the cervical spine.
  5. 5. Ghost ImageGhost images are formed by dense objectslocated between the tubehead and the rotationcenter. These ghost images usually result fromexternal objects such as earrings, but they may beproduced by dense anatomical structures such asthe mandible. (For more information, see self-study module “Panoramic Technique”). ghost image of earring (between lines)
  6. 6. Panoramic Anatomy The numbers on the diagram below and on the next slide (air spaces) correspond to the numbers on the key (slide 9). 11 16 12 2 5 15 13 17 10 6 7 9 8 14 19 1 24 23 21 18 344 4 25 42 41 32 20 22 27 40 26 31 29 33 37 39 35 30 28 43 38 36 34
  7. 7. Air Spaces 4645 47 45
  8. 8. Panoramic Anatomy Key 1. maxillary sinus 25. sigmoid notch 2. pterygomaxillary fissure 26. medial sigmoid depression 3. pterygoid plates 27. styloid process 4. hamulus 28. cervical vertebrae 5. zygomatic arch 29. external oblique ridge 6. articular eminence 30. mandibular canal 7. zygomaticotemporal suture 31. mandibular foramen 8. zygomatic process 32. lingula 9. external auditory meatus 33. mental foramen10. mastoid process 34. submandibular gland fossa11. middle cranial fossa 35. internal oblique ridge12. lateral border of the orbit 36. mental fossa13. infraorbital ridge 37. mental ridges14. infraorbital foramen 38. genial tubercles15. infraorbital canal 39. hyoid bone16. nasal fossa 40. tongue17. nasal septum 41. soft palate18. anterior nasal spine 42. uvula19. inferior concha 43. posterior pharyngeal wall20. incisive foramen 44. ear lobe21. hard palate 45. glossopharyngeal air space22. maxillary tuberosity 46. nasopharyngeal air space23. condyle 47. palatoglossal air space24. coronoid process
  9. 9. The following slides show anatomicalstructures seen on panoramic films. Seewhat other structures you can identifythat are not labeled. At the end of thispresentation there are 11 test slides.
  10. 10. 9 12 7 19 5 17 13 25 14 6 22 18 39 28 339 12 19 7 17 13 14 5 25 6 22 18 39 28 33
  11. 11. 11 2 15 2426 8 32 23 16 1 31 3 20 4 34 44 30 36 38 11 2 15 24 26 8 32 23 16 1 31 20 3 44 34 30 36 38
  12. 12. 46 21 41 42 47 40 4543 46 21 41 42 47 40 45 43
  13. 13. R 11 L 7 1 46 41 47 43 36 45 38
  14. 14. 16R 23 17 L 2 8 6 21 18 19 39 Red arrows point to ghost image of hard palate
  15. 15. 11R L 9 3 20 How old is this patient? a. 6-9 years b. 10-12 years b. 10-12 years old c. 13-15 years
  16. 16. R 17 L 2 44 20 28 43
  17. 17. R 2 L atlas 31 transverse foramen
  18. 18. R L 15 46 47 19 6 27 34 What head positioning error is seen on this film? The anterior teeth are positioned behind the notch in the bitestick (farther from the film), resulting in the widening of the anterior teeth (the maxillary central incisors are as wide as the molars).
  19. 19. R L 17 8 1 15 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.
  20. 20. R L 40 27 E LN 36 LN = calcified lymph node E = epiglottis
  21. 21. 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 patient’s head is turned to thebringing that side closer to The head was turned to the left, side. Note the width of theramus on and decreasingred arrowsof the ramus on that side. the film each side (The the width are the same length).Whichgreen arrow pointspatient’s head turned (left or right)? The direction was the to the biteblock, centered on the contact between the right central and lateral incisors.
  22. 22. R L 8 46 7 47 33 E E = epiglottis
  23. 23. R 11 L 21 3 29 32 34 What causes the black dots identifed by the red arrow? The black is tipped up too much, electricity, caused by off The chin dots result from static giving a more squared removing the to the mandible,is seen on this film? from the What positioning error creating cassette smile and appearance film too quickly from the a reverseor box of film (creates friction, be superimposed on the roots causing the hard palate to which results in a static of the maxillary teeth. discharge).
  24. 24. R 16 L 10 9 20 3 42 27 30 1 44 G 36 G = ghost of right mandible
  25. 25. R L 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.
  26. 26. R 12 L air cell 9 23 7 26 Air cell in zygomatic arch.
  27. 27. R L 24 26 7 2227 30 38
  28. 28. R 5 L 10 6 47 45ghost of mandible
  29. 29. R 15 L 9 23 7 5 21 44 39 30Note the relatively inferior location of the mandibular canal (30),providing plenty of room for the implant.
  30. 30. R 24 L 26 31 1 29 Pattern on right side of film (patient’s left) caused by excessive oil on patient’s hair.
  31. 31. R L 7 2828 red arrow identifies fracture
  32. 32. R L27 44 34 Green arrow identifies “pseudo-fracture” caused by palatoglossal air space. Red arrows point to odontogenic keratocyst.
  33. 33. Ghost images of earringsR L
  34. 34. Ghost images of earringsR L 15 2
  35. 35. R L 27 2828 Hearing aid (red arrow) with ghost (green arrow).
  36. 36. Ghost image of metal used to restore left angle of mandibleR L
  37. 37. R L Ghost images of mandibles (dotted line outlines ghost of left ramus-angle over right side of mandible)
  38. 38. Identify the anatomical structureson the following slides.
  39. 39. Slide # 1R C L E D G F B AA Cervical vertebra E Zygomaticotemporal sutureB External oblique ridge F LingulaC Zygomatic process G Mandibular foramenD Maxillary sinus
  40. 40. Slide # 2R B K L D J E I A H F C GA Ear lobe G Hyoid boneB External auditory meatus H Mandibular canalC Submandibular gland fossa I Pterygoid platesD Nasal septum J Articular eminenceE Hard palate K Pterygomaxillary fissureF Mental foramen
  41. 41. Slide # 3R C L B D A E A Palatoglossal air space B Middle cranial fossa C Lateral border of the orbit D Condyle E Mental fossa
  42. 42. Slide # 4R D I L E H B C A G F J K LA Cervical vertebra G Hard palateB Zygomaticotemporal suture H Post. wall of maxillary sinusC Zygomatic process I External auditory meatusD Nasal septum J Posterior pharyngeal wallE Inferior concha K Mental foramenF Soft tissue of nose L Mental fossa
  43. 43. This concludes the section on PanoramicAnatomy.Additional self-study modules are availableat: http://dent.osu.edu/radiology/resources.htmIf you have any questions, you may e-mailme at: jaynes.1@osu.eduRobert M. Jaynes, DDS, MSDirector, Radiology GroupCollege of DentistryOhio State University

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