Dr. Özkan ADIGÜZEL

1. Panoramic Anatomy
The following slides identify the anatomical
structures found on Panoramic Radiographs.
In navigating through the slides, you should click
on the left mouse button when you see the
mouse holding an x-ray tubehead or 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”.

2. Types of Panoramic Images
Single Real Image
Double Real Image
Ghost Image

3. 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.

4. 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.

5. 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 self-
study module “Panoramic Technique”).
ghost image of earring
(between lines)

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
3
44 4
25 42
41 32
20
22
27
40 26 31
29
33
37
39
35
30 28
43 38 36 34

7. Air Spaces
46
45 47 45

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 foramen
10. mastoid process 34. submandibular gland fossa
11. middle cranial fossa 35. internal oblique ridge
12. lateral border of the orbit 36. mental fossa
13. infraorbital ridge 37. mental ridges
14. infraorbital foramen 38. genial tubercles
15. infraorbital canal 39. hyoid bone
16. nasal fossa 40. tongue
17. nasal septum 41. soft palate
18. anterior nasal spine 42. uvula
19. inferior concha 43. posterior pharyngeal wall
20. incisive foramen 44. ear lobe
21. hard palate 45. glossopharyngeal air space
22. maxillary tuberosity 46. nasopharyngeal air space
23. condyle 47. palatoglossal air space
24. coronoid process

9. The following slides show anatomical
structures seen on panoramic films. See
what other structures you can identify
that are not labeled. At the end of this
presentation there are 11 test slides.

10. 9 12
7
19
5 17 13
25 14 6
22
18
39
28
33
9 12 19 7
17 13
14
5 25 6
22
18
39
28 33

11. 11 2
15
24
26 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. 46
21 41
42
47
40 45
43
46 21 41
42
47
40
45
43

13. R 11
L
7
1
46 41
47
43
36 45
38

14. 16
R 23 17 L
2 8
6
21
18 19
39
Red arrows point to ghost image of hard palate

15. 11
R 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. R 17 L
2
44 20
28
43

17. R 2
L
atlas
31
transverse foramen

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. 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. R L
40
27
E
LN
36
LN = calcified lymph node
E = epiglottis

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 the
ramus 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. R L
8
46 7
47
33
E
E = epiglottis

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. R 16 L
10 9
20
3
42 27
30
1
44
G
36
G = ghost of right mandible

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. R 12 L
air cell 9
23
7
26
Air cell in zygomatic arch.

27. R L
24
26 7
22
27
30
38

28. R 5
L
10
6
47
45
ghost of mandible

29. R 15
L
9 23
7 5
21
44
39
30
Note the relatively inferior location of the mandibular canal (30),
providing plenty of room for the implant.

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. R L
7
28
28
red arrow identifies fracture

32. R L
27
44
34
Green arrow identifies “pseudo-fracture” caused by
palatoglossal air space.
Red arrows point to odontogenic keratocyst.

33. Ghost images of earrings
R L

34. Ghost images of earrings
R L
15 2

35. R L
27
28
28
Hearing aid (red arrow) with ghost (green arrow).

36. Ghost image of metal used to restore left angle of mandible
R L

37. R L
Ghost images of mandibles
(dotted line outlines ghost of left ramus-angle over
right side of mandible)

38. Identify the anatomical structures
on the following slides.

39. Slide # 1
R C
L
E
D G
F
B
A
A Cervical vertebra E Zygomaticotemporal suture
B External oblique ridge F Lingula
C Zygomatic process G Mandibular foramen
D Maxillary sinus

40. Slide # 2
R B K
L
D
J
E I
A H
F
C G
A Ear lobe G Hyoid bone
B External auditory meatus H Mandibular canal
C Submandibular gland fossa I Pterygoid plates
D Nasal septum J Articular eminence
E Hard palate K Pterygomaxillary fissure
F Mental foramen

41. Slide # 3
R 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. Slide # 4
R D I L
E H
B C
A G
F
J
K
L
A Cervical vertebra G Hard palate
B Zygomaticotemporal suture H Post. wall of maxillary sinus
C Zygomatic process I External auditory meatus
D Nasal septum J Posterior pharyngeal wall
E Inferior concha K Mental foramen
F Soft tissue of nose L Mental fossa

43. This concludes the section on Panoramic
Anatomy.
Additional self-study modules are available
at: http://dent.osu.edu/radiology/resources.htm
If you have any questions, you may e-mail
me at: jaynes.1@osu.edu
Robert M. Jaynes, DDS, MS
Director, Radiology Group
College of Dentistry
Ohio State University