Extraoral Radiography

Professor Nancy Rivaldo Monroe Community College


Define extraoral Indications for use of extraoral Define cassette What is an intensifying screen? Advantage and disadvantage of intensifying screens What is screen film? How is speed/intensification determined?


What is a grid? What are the 7 common extraoral exposures? What is a cephalometric radiograph? What are two extraoral exposures commonly used in cephalometrics? What is the best extraoral exposure for maxillary sinus?


What is sialography? What techniques are used to examine the TMJ?


Film packet or cassette placed outside oral cavity Advantages --usually easier than intraoral --minimal equipment needed Indications for use --patient has limited opening --area to be viewed is larger then can be seen on intraoral radiograph



Light-tight container in which film placed Rigid or flexible Flat or curved Varying sizes Should have ³L´ or ³R´ identification for orientation of images in relation to patient


Tubeside of cassette placed toward head Radiation enters film from opposite side 

Intensifying Screens 

Intensify or increase radiation Decrease exposure time Coated with a fluorescence substance Material responsible for fluorescence called phosphors Phosphors emit light when irradiated


Type of phosphor plays role in speed or intensification Calcium tungstate produces blue light Rare earth elements sensitive to light in green portion of light spectrum Rare earth elements more efficient in converting x-ray energy into light

Screen Composition 



Structural component upon which other screen elements are applied Made of polyester Provides rigidity to the screen  


Coating of white titanium dioxide Reflects stray light back to x-ray film Increases efficiency and sensitivity Contributes to dose reduction   


Contains phosphor materials that fluoresce Emit visible light when irradiated 

Screen Film    

Used with intensifying screen (film placed between two intensifying screens in cassette holder) Cassette irradiated, screens convert x-ray energy into light, which in turn exposes screen film This additional mean of exposing film = intensifying =decrease radiation to patient Indirect imaging


Used to prevent scattered radiation from reaching film Series of narrow lead strips separated by spaces of low-density material Act as cleaning device to improve image contrast  

Lateral Oblique (Lateral Jaw)    

Film positioned lateral to jaw on side of patient¶s face to be examined Used with children and patients with limited jaw opening Examines posterior region of mandible View fractures, impactions, salivary stones in floor of mouth

Lateral Skull 

Lateral view of entire skull Primary use = cephalometrics: --assess patient profile --assist in predicting jaw growth pattern --used for measuring arch size changes Can also view fractures and pathologic conditions

Lateral Sinus 

Modification of lateral skull Used to examine growths, infections or foreign bodies in maxillary sinus 

Posteroanterior of Skull   

Shows entire skull in posterioranterior plane Primary use = cephalometrics --measure skull growth --observe growth abnormalities Used to view fractures and pathologic conditions of skull in frontal plane

Posteroanterior of Mandible 

Shows entire mandible in frontal plane Used to localize impactions, fractures and pathologic conditions 

Posteroanterior of Sinus 

Referred to as Waters View Best projection for maxillary sinus Used to view fractures of maxilla, malar bone and zygomatic arch  

Submental Vertex 

See structures as if viewer looking upward from under patient¶s chin Can view condylar heads, base of skull and sphenoid sinus Used to view fractures and displacements of zygomatic arch  


Extraoral radiographs of head used for making skull measurements Purpose is to correlate skeletal growth with tooth development and position Lateral skull and posteroanterior projection of skull most commonly used in ortho surveys  

Hand-Wrist Films
Used to correlate chronologic age with: --skeletal age and development --dental aged and development  Based on principle that these bones are good indications of skeletal maturation due to the many centers of ossification in this area 

TMJ Survey 

TMJ tomography = radiographic technique to examine joint Other radiographs (pan) will show the bone and relationship of joint components only (erosions, bony deposits) 


Used for imaging soft tissue components of TMJ Radiopaque die injected into joint space View condyle, glenoid fossa and joint space  

Transcranial TMJ 

Radiograph taken through or across the skull or cranium Lindblom technique most common Shows glenoid fossa and relationship to condyle  


Examination of salivary gland Uses radiopaque dye injected into ducts Initial radiograph taken followed by successive radiographs to visualize draining of gland  

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