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.

Types of Panoramic Images

Single Real Image

Double Real Image Ghost Image

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.

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.

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 selfstudy 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 5 6 8 14 23 44 25 19 21 18 4 41 22 20 29 31 32 1 3 42 15 13

16
12 17 10 7 9 2

24

27

40

26

33 39 43 30 38 36

37 35 34 28

Air Spaces
46

45

47

45

Panoramic Anatomy Key

1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. maxillary sinus pterygomaxillary fissure pterygoid plates hamulus zygomatic arch articular eminence zygomaticotemporal suture zygomatic process external auditory meatus mastoid process middle cranial fossa lateral border of the orbit infraorbital ridge infraorbital foramen infraorbital canal nasal fossa nasal septum anterior nasal spine inferior concha incisive foramen hard palate maxillary tuberosity condyle coronoid process 25. sigmoid notch 26. medial sigmoid depression 27. styloid process 28. cervical vertebrae 29. external oblique ridge 30. mandibular canal 31. mandibular foramen 32. lingula 33. mental foramen 34. submandibular gland fossa 35. internal oblique ridge 36. mental fossa 37. mental ridges 38. genial tubercles 39. hyoid bone 40. tongue 41. soft palate 42. uvula 43. posterior pharyngeal wall 44. ear lobe 45. glossopharyngeal air space 46. nasopharyngeal air space 47. palatoglossal air space

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.

12

19

25

14 18

17

13 22

39 28 33 9 19 7

12

14 25 18

17

13 6

22
39

28

33

11

15
24 26 8 16

32 1 3

23 31 44

20
34 36

4
30

38

11 24 26 8

2 15 32 16 20 1 3

23

31
44

34 36 38

30

46 42 21 41

47 40 45

43

46 42

21

41

47 40 43 45

R
7 1 46 41

11

47

43 36 38 45

16

23

17

L
8 6

21

18

19

39

Red arrows point to ghost image of hard palate

R
9

11

20

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

b. 10-12 years old

17

L
2

44

20 28 43

R
atlas

31

transverse foramen

R
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
17 15 8 1

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
40 27

E LN

36

LN = calcified lymph node E = epiglottis

R
2

40 18

45
?

? Identifies calcification, possibly in carotid or in lymph node

What positioning error is seen on this film? The head was turned to the left, that side closer to The patients head is turned to thebringing side. Note the width of the the film decreasing the arrows width of the ramus on that side. ramus on and each side (The red are the same length). The green arrow points to the biteblock, centered on the Which direction was the patients head turned (left or right)? contact between the right central and lateral incisors.

R
8 46 47 7

33

E = epiglottis

11

21 3 29 32 34

What causes the black dots identifed by the red arrow? The chin is tipped up too much, giving a more squared The black dots result from static electricity, caused by off What positioning error is seen on this film? appearance to the mandible, creating a reverse smile and removing the film too quickly from the cassette or from the causing the hard palate to be superimposed the roots box of film (creates friction, which results in aon static of the maxillary teeth. discharge).

R
10

16 9

20 42 1 44 G 36 30

3 27

G = ghost of right mandible

R
24 14 27 nose 47

39

What caused the white (radiopaque) area indicated by the red arrow? The lead apron was placed too high on the back of the patients neck.

R
air cell

12 9 23 7 26

Air cell in zygomatic arch.

24

26

22 27 30 38

5 10

6 47

45 ghost of mandible

R
9 7

15
23 21 5

44

39 30

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

R
26

24

31 29

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

R
7 28 28

red arrow identifies fracture

27 44

34

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

Ghost images of earrings

R L

Ghost images of earrings

R
15 2

27 28

28

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

Ghost image of metal used to restore left angle of mandible

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

Identify the anatomical structures on the following slides.

Slide # 1
R
C E

D F B

A B C D

Cervical vertebra External oblique ridge Zygomatic process Maxillary sinus

E F G

Zygomaticotemporal suture Lingula Mandibular foramen

Slide # 2
R
B D K

J E I

A F C G

A B C D E F

Ear lobe External auditory meatus Submandibular gland fossa Nasal septum Hard palate Mental foramen

G H I J K

Hyoid bone Mandibular canal Pterygoid plates Articular eminence Pterygomaxillary fissure

Slide # 3
R
B C

L
D

A B C D E

Palatoglossal air space Middle cranial fossa Lateral border of the orbit Condyle Mental fossa

Slide # 4
R
B A F C D E H I

J K L

A B C D E F

G Hard palate Cervical vertebra Zygomaticotemporal suture H Post. wall of maxillary sinus I External auditory meatus Zygomatic process J Posterior pharyngeal wall Nasal septum K Mental foramen Inferior concha L Mental fossa Soft tissue of nose

Slide # 5
R
E F

C D
B

J H
I

A B C D E

Glossopharyngeal air space Styloid process Nasopharyngeal air space Pterygoid plates Condyle

F G H I J

Infraorbital canal Infraorbital foramen Soft palate Mandibular canal Lingula

Slide # 6
R
C
D E E

A B C D

Mental foramen Incisive foramen Soft tissue of nose Anterior nasal spine

E Pterygoid plates F Ear lobe G Hyoid bone

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

Slide # 7
R
A B C

A B C D

Posterior border of maxillary sinus Inferior border of orbit Inferior concha Inferior border of maxillary sinus

The radiolucency (red arrows) seen in the ramus on the patients left side is a squamous cell carcinoma.

Slide # 8
R
A C D

A Maxillary tuberosity B Hard palate C Coronoid process

D Floor of middle cranial fossa E Posterior pharyngeal wall

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

Slide # 9
R
D A C F

A Zygomatic arch B External oblique ridge C Palatoglossal air space

D Soft palate E Pterygomaxillary fissure F Styloid process

This patient has multiple supernumerary premolars in the mandible (#s 21, 28 and 29 were extracted).

Slide # 10
R
C

D B A

A Mandibular canal B Soft tissue of nose C Nasal fossa

D Hard palate E Mandibular foramen F Styloid process

This patient has impacted mandibular third molars that have migrated up into the coronoid processes. Note also the long, thin condylar necks and small condyles.

Slide # 11
R
B A C

A Sigmoid notch B Nasal septum C Coronoid process

D Articular eminence E Mental foramen (on crest of ridge)

The green arrows identify a calcified stylohyoid ligament. If there is associated 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 radiopacities which represent tonsillar calcifications.

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