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”.
Types of Panoramic Images Single Real Image Double Real Image Ghost Image
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.
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.
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)
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
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).
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.
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 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.
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).
R 16 L 10 9 20 3 42 27 30 1 44 G 36 G = ghost of right mandible
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.
R 12 L air cell 9 23 7 26 Air cell in zygomatic arch.
R L 27 2828 Hearing aid (red arrow) with ghost (green arrow).
Ghost image of metal used to restore left angle of mandibleR L
R L Ghost images of mandibles (dotted line outlines ghost of left ramus-angle over right side of mandible)
Identify the anatomical structureson the following slides.
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
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
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
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
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: email@example.comRobert M. Jaynes, DDS, MSDirector, Radiology GroupCollege of DentistryOhio State University