anatomie panoramica

8/13/2019 anatomie panoramica

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The following slides identify the anatomicalstructures found on Panoramic Radiographs.

Panoramic Anatomy

In navigating through the slides, you should clickon the left mouse button when you see themouse holding an x-ray tubehead or you are

done reading a slide. Hitting Enter or PageDown will also work. To go back to the previousslide, hit backspace or page up.


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Types of Panoramic Images

Single Real Image

Double Real Image

Ghost Image


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Single Real Image

Only 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.


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Double Real Image

Two images of a single object are seen on thefilm. Double real images are produced bystructures located in the midline . The x-ray

beam 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 bone

and the cervical spine .


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Ghost Image

Ghost 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)


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46

45 47 45

Air Spaces


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Panoramic Anatomy Key1. maxillary sinus2. pterygomaxillary fissure3. pterygoid plates4. hamulus5. zygomatic arch6. articular eminence7. zygomaticotemporal suture8. zygomatic process9. external auditory meatus

10. mastoid process

11. middle cranial fossa12. lateral border of the orbit13. infraorbital ridge14. infraorbital foramen15. infraorbital canal16. nasal fossa

17. nasal septum18. anterior nasal spine19. inferior concha20. incisive foramen21. hard palate22. maxillary tuberosity23. condyle24. coronoid process

25. sigmoid notch26. medial sigmoid depression27. styloid process28. cervical vertebrae29. external oblique ridge30. mandibular canal31. mandibular foramen32. lingula33. mental foramen34. submandibular gland fossa

35. internal oblique ridge36. mental fossa37. mental ridges38. genial tubercles39. hyoid bone40. tongue

41. soft palate42. uvula43. posterior pharyngeal wall44. ear lobe45. glossopharyngeal air space46. nasopharyngeal air space

47. palatoglossal air space


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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.


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28

14

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1322

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255

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9 12

14

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19

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1115

116

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30

44

3223

2

3126

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34

24

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1115

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30

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32 23

31

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36


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4121

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2146

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1

43

47

46

45

R L


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21

Red arrows point to ghost image of hard palate

23

39

R L


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320

R L

How old is this patient?a. 6-9 yearsb. 10-12 yearsc. 13-15 years

b. 10-12 years old


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28

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43

20

2R L


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2

31

transverse foramen

atlas

R L


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34

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47 19

R L

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).


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15

178 1

32

N

N = soft tissue of nose

R L

What head positioning error is seen on this film?

The head is tipped down too much, resulting in shortenedmandibular incisors and a V-shaped mandible.


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40

27

36

E

LN

LN = calcified lymph nodeE = epiglottis

R L


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What positioning error is seen on this film?The patients head is turned to the side. Note the width of theramus on each side (The red arrows are the same length).Which direction was the patients head turned (left or right)?

The head was turned to the left, bringing that side closer tothe film and decreasing the width of the ramus on that side.The green arrow points to the biteblock, centered on thecontact between the right central and lateral incisors.

?

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2

18

8

45

R L

? Identifies calcification, possibly in carotid or in lymph node


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33

8

746

47

E

E = epiglottis

R L


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21

2932

11

34

The black dots result from static electricity, caused byremoving the film too quickly from the cassette or from thebox of film (creates friction, which results in a staticdischarge).

R L

What causes the black dots identifed by the red arrow?What positioning error is seen on this film?

The chin is tipped up too much, giving a more squared offappearance to the mandible, creating a reverse smile andcausing the hard palate to be superimposed on the rootsof the maxillary teeth.


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30

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27

1

16

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20

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10

G

G = ghost of right mandible

R L


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14

27nose

24

47

39

The lead apron was placed too high on the back of the

patients neck.

R L

What caused the white (radiopaque) area indicated bythe red arrow?


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23

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12air cell

Air cell in zygomatic arch.

R L


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30

R L


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ghost of mandible

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45

10

6

5R L


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23 9

30

Note the relatively inferior location of the mandibular canal (30),providing plenty of room for the implant.

R L

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Pattern on right side of film (patients left) caused byexcessive oil on patients hair.

R L


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red arrow identifies fracture

28

28

7

R L


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Green arrow identifies pseudo -fracture caused bypalatoglossal air space.Red arrows point to odontogenic keratocyst.

34

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R L


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Ghost images of earrings

R L


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Ghost images of earrings

15 2R L


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Hearing aid (red arrow) with ghost (green arrow).

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28

28

R L


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Ghost image of metal used to restore left angle of mandible

R L


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Ghost images of mandibles(dotted line outlines ghost of left ramus-angle overright side of mandible)

R L


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Identify the anatomical structureson the following slides.

Slide # 1


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Slide # 1

A

B

C

D

E

FG

R L

ABCD

EFG

Cervical vertebraExternal oblique ridgeZygomatic processMaxillary sinus

Mandibular foramenLingulaZygomaticotemporal suture

Slid # 2


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A

D

E

F

G

H

I

J

K

Slide # 2

C

R B L

ABCDEF

GHI

JK

Ear lobeExternal auditory meatusSubmandibular gland fossaNasal septumHard palateMental foramen

Hyoid boneMandibular canalPterygoid platesArticular eminencePterygomaxillary fissure

Slid # 3


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Slide # 3

A

E

D

BCR L

ABCDE

Palatoglossal air spaceMiddle cranial fossaLateral border of the orbitCondyleMental fossa


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Slide # 5


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Slide # 5

A

I

H

G

F

E

D

C

B

J

R L

ABCDE

FGHI

J

Glossopharyngeal air spaceStyloid processNasopharyngeal air spacePterygoid platesCondyle

Infraorbital canalInfraorbital foramenSoft palateMandibular canal

Lingula

Slide # 6


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Slide # 6

A

BCD

E

FG

Mental foramen

Incisive foramenSoft tissue of noseAnterior nasal spine

Pterygoid plates

Ear lobeHyoid bone

G

F

E

A

E

DC

B

R L

The radiolucency (red arrows) seen in the ramus and thirdmolar area on the patients right side is an ameloblastoma.(Differential includes dentigerous cyst, radicular cyst, OKC).

Slide # 7


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Slide # 7

D

C

BAR L

A

BCD

Posterior border of maxillary sinus

Inferior border of orbitInferior conchaInferior border of maxillary sinus

The radiolucency (red arrows) seen in the ramus on the

patients left side is a squamous cell carcinoma.

Slide # 8


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Slide # 8

E

DC

B

A

R L

ABC

DE

Maxillary tuberosityHard palateCoronoid process

Floor of middle cranial fossaPosterior pharyngeal wall

This child has a condition known as cherubism. The mandibular lesionsinvolve both rami, extending into the coronoid process (the condyle israrely involved). The maxillary lesions are located in the tuberosityregions, causing anterior displacement of 2nd and 3rd molars.

Slide # 9


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Slide # 9

F

E

DC

B

A

R L

ABC

DEF

Zygomatic archExternal oblique ridgePalatoglossal air space

Soft palatePterygomaxillary fissureStyloid process

This patient has multiple supernumerary premolars in the

mandible (#s 21, 28 and 29 were extracted).

Slide # 10


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Slide # 10

F

EDB

A

CR L

ABC

DEF

Mandibular canalSoft tissue of noseNasal fossa

Hard palateMandibular foramenStyloid process

This patient has impacted mandibular third molars that havemigrated up into the coronoid processes. Note also the long,

thin condylar necks and small condyles.

Slide # 11


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Slide # 11

D

CB

E

A

R L

A

BC

DE

Sigmoid notch

Nasal septumCoronoid process

Articular eminence

Mental foramen(on crest of ridge)The green arrows identify a calcified stylohyoid ligament. If there isassociated neck pain, the condition is known as Eagles Syndrome(recent history of neck trauma or surgery) or Stylohyoid Syndrome (no

history of trauma/surgery). The red box outlines several radiopacitieswhich represent tonsillar calcifications.


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This concludes the section on PanoramicAnatomy.

Additional self-study modules are availableat: http://dent.osu.edu/radiology/resources.htm

If you have any questions, you may e-mailme at: [email protected]

Robert M. Jaynes, DDS, MSDirector, Radiology GroupCollege of DentistryOhio State University

anatomie panoramica

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