Radiology Lecture 06 - Panoramic Landmarks

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1.

2.

3.

1. Condyle
2. Neck of mandible
3. Coronoid process
of mandible
4. Ghost image of
body of mandible
5. Mandibular
(Inferior alveolar)
canal
6. Mandible (inferior
border)
7. Shadow of
vertebrae
8. Mental foramen
9. Mandibular fossa
10. Angle of mandible
11. External oblique
ridge
12. Sigmoid
(Mandibular) notch
1. Images not as
sharp as
bitewings/periapicals
2. Geometric
distortion
3. Shadows and
"ghost" images
4. Can be overused,
leading to excessive
exposure

4.

Identify landmarks

5.

List four weaknesses of panoramic

radiographs.

1. Inferior border
of maxillary
sinus
2. Maxillary
sinus
3. Zygomatic
process of
maxilla
4. Septum of
maxillary sinus
5. Zygoma
(Zygomatic bone)
6. Inferior border
of zygomatic arch

Identify landmarks

1. Lip line
2. Mental ridge
3. Genial tubercle
4. Lingual
foramen
5. Inferior border
of mandible

Identify landmarks
6.

1. Incisive foramen
2. Tip of nose
3. Lateral fossa
4. Nasal fossa
5. Nasal septum
6. Border of nasal
fossa
7. Nasal spine
8. Median palatine
suture

Identify landmarks

1. Maxilla has
fine, uniform
trabeculae while
the mandible has
coarse,
randomlyoriented
trabeculae
2. The medullary
spaces are small
while the
mandibular
spaces are large
(when compared
on the same
person)

Explain the difference in bone structure

between the maxilla and mandible
concerning:
1. Appearance of trabeculae
2. Appearance of medullary spaces

7.

1. Nasal fossa
2. Border of
nasal fossa and
maxillary sinus
(Inverted "Y")
3. Maxillary
sinus

11.

2. Nutrient canal
3. Nutrient
foramen

Identify landmarks (except for #4)

8.

1. Oblique ride
2. Mylohyoid
ridge
3. Mandibular
canal
4.
Submandibular
fossa

Identify #2 & #3
12.

Identify A & B
13.

Identify landmarks
9.

14.

1. Real images
2. Ghost images
only
3. Real and ghost
images
4. Double real
and ghost
images

What types of images may be produced

from the:
1. Vertical line area
2. Horizontal line area
3. Combined line area
4. Center area
10.

1. Reduced
patient exposure
when trying to
view entire oral
region
2. Good overall
"screening"
technique
3. Time saving
tool

A: Hard Palate
B: Hyoid Bone

Ala-tragus line

When taking a pan, this anatomical

landmark must be parallel with the floor.

Because it is
being moved by
orthodontia
(brackets and
wires seen along
crowns).

Why is the PDL so wide?

15.

Because the
tooth was just
recently
extracted.

List two benefits of panoramic

radiographs.

Why is the lamina dura still visible here?

16.

Cancellous;
trabeculae,
bone; medullary
spaces, bone
marrow

21.

The alveolar bone shown can also be

called __________ bone. The
radioopaque segments are termed
_________ and contain __________,
while the radiolucent spaces in-between
are termed _________ and contain
_________.

Identify
22.

23.
17.

Genial tubercle

External oblique
ridge
24.

Ghost images

These are produced when an object is

located between X-ray source & center of
rotation.

In the posterior
mandible

Where in the mouth are the medullary

spaces the largest?

Inferior border
of maxillary
sinus

Identify
18.

19.

20.

False. Ghost
images, while
larger and more
blurry, are not
mirror images.
They are
oriented the
same way as
their real
counterparts.

T/F: A ghost image is a larger, more

blurry, mirror image of the real object.

Fixed or 3-point
rotation;
continuously
moving center of
rotation

Older machines used a __________

center of rotation while the new machines
use a __________ center of rotation.

Focal trough or
Image layer

It is important to keep your object within

the __________ so that anatomical
areas of interest are shown with the
greatest sharpness.

Identify line
25.

Mandibular
(lingual) tori

Identify radioopacity
26.

27.

Mandibular 2nd
Premolar

The mental foramen is typically next to

this tooth.

Maxillary sinus

Identify blue arrow

28.

29.

Oblique;
mylohyoid

The external oblique ridge is also called

the __________ ridge while the internal
oblique ridge is also called the
__________ ridge.

36.

Patient moved
during
exposure.

What error occurred?

30.

35.

37.

Patient's head
was tilted down.
38.

What error occurred?

31.

Patient's head
was tilted up.

39.

What error occurred?

32.

33.

34.

Patient's tongue
was not kept
against the roof
of the mouth. An
air space
created the
radiolucent
band.
Real or Double
images

What error occurred?

40.

These are produced when an object is

located between center of rotation &
detector.

Stepladder

The horizontal arrangement of trabeculae

indicated is sometimes referred to as a
__________ pattern.

Superior

From the sagittal view, external oblique

ridges are superior/inferior to internal
oblique ridges.

The anterior
teeth appear
blurred and
widened.
Increased
ghosting of the
mandible
occurs.

What would happen if the patient's head

was too far back?

The football
player - thick
trabeculae with
small medullary
spaces.

Who would have denser alveolar bone: a

6'5", 260lb professional football player or
a petite, adult woman?

The mandibular
incisors are out
of focus. The
hyoid bone is
superimposed
over the
mandible. The
premolars are
overlapped.
"Smiley"
appearance is
enhanced.

How do you know the patient's chin was

too low?

The maxillary
incisors are out
of focus and the
hard palate
appears along
the apices of the
maxillary teeth.
"Smiley"
appearance is
flattened out.

How do you know the patient's chin was

too high?

The maxillary
sinus has
dropped into the
space previously
occupied by a
tooth (now
extracted);
Pneumatization
of the maxillary
sinus

What happened here? This is known as

__________.

41.

The patient on
the right is older
because the PDL
is thinner.

49.

Which of these patients is older? Why?

Hint: It doesn't have to do with the # of
teeth.
42.

43.

The patient
slouched. The
radio opaque
triangular
region is due to
superimposition
of the spine on
the image.

What error occurred?

The patient was

too far back.

What error occurred?

44.

The patient was

too far forward.

What error occurred?

45.

The patient's
head was
turned.

What error occurred?

46.

47.

48.

The patients
head was placed
too far forward
during the x-ray.

If the anterior teeth are out of focus and

narrow, the spine overlaps the ramus and
the premolars are overlapped, what might
have happened?

The radiolucent
area is due to the
mental foramen,
not an abscess.

T/F: This abscess will not harm the tooth

because it is not touching it.

True

T/F: The vertical component of a ghost

image is more blurred than its horizontal
component.

True

T/F: Alveolar bone crests are somewhat pointed

between anterior teeth and more rounded or flat between
posterior teeth.