OMD 351

Presentation Topic

Normal anatomic
landmarks of Panoramic
radiograph
 Normal anatomic landmarks
I-Important hard tissue shadows include:
Lateral pterygoid plate-11
Teeth-1
Hamulus-12
Mandible-2
Mastoid process-13
Maxilla-3
Maxillary tuberosity-14
Hard palate-4
Condyle-15
Zygomatic arches-5
Coronoid process-16
Styloid process-6
Internal & external oblique -17
Hyoid bone-7
ridge
Nasal septum and conchae-8
Orbital rim-9
Base of skull-10
Air in nasal fossa-1
Nasal septum-2
Lateral wall of-3
nasal fossa
Infraorbital-4
rim
Border of-5
infraorbital
canal
Pterygomaxillary fissure-6
Pterygoid spine of-7
sphenoid
Zygomtic arch-8
Mandibularcanal-12
Posterior wall of maxillary-9 Anterior nasal spine-13
sinus
Posterior wall of zygomatic process-110 Inferior border of-14
mandible
Ear lobe-11
Hyoid bone-15
Tip of nose-1
Hard palate-2
Orbit-3
Hard palate-4
Floor of maxillary sinus-5
Soft palate-6
Air between soft palate-7
&dorsum of tongue
Dorsum of tongue-8
Shadow of cervical spine-11
Shadow of opposite-9 Submandibular gland fossa-12
mandible
Mental foramen-10 Articular tubercle-13
 Inferior concha-1
Medial wall of-2
maxillary sinus
Posterior wall of-3
zygomatic process
Posterior wall of-4
maxillary sinus
Zygomatic arch-5
Hard palate-6
Floor of maxillary sinus-7
Dorsum of tongue-8 Soft palate-11
Inferior border of-9 Dorsum of tongue-12
pterygoid plates Calcified stylohyoid ligament-13
Ear lobe-14
Posterior wall of-10 Inferior border of opposite-15
nasopharynx mandible
Body of hyoid bone
Lateral pterygoid plate
Hamulus process
External autidory meatus
Maxillary tuberosity
Condylar head & neck
Coronoid
process
Sigmoid notch

Medial sigmoid
depression
Cervical vertebrae
Inferior border of
mandible
Mental foramen
Submandibular
fossa
Zygomatic process of temporal-1
bone (white arrows)
Glenoid fossa-2
Articular eminence-3
Zygomatico-temporal suture-4
(black arrows)
Zygoma-5
Zygoma
Articular
eminence

Glenoid
fossa
Nasal fossa
 Nasal
turbinates
Hard palate

Torus palatinus
 II-Important soft tissue shadows include

Ear lobes-1
Nasal cartilage-2
Soft palate-3
Dorsum of tongue-4
Lips and cheeks -5
Nasolabial fold-6
A dental panoramic tomograph showing the main real soft
tissue and air shadows drawn in on
one side of the radiograph, NC — nasal cartilages, EL — ear
lobe, SP — soft palate, DT — dorsum of tongue,
. Or — oropharnyx, NF — naso-labial fold, M — mouth
Ear lobe
Tongue

Soft
palate
Lip line
 Panoramic Air Spaces

 Nasopharyngeal Air Space

 Palatoglossal Air Space

Glossopharyngeal Air Space

46 hard palate soft palate

47
tongue
45

46 21 41

47
40
45
 46

47

45

Air spaces
1 = nasopharyngeal
2 = palatoglossal
3 = glossopharyngeal
 46

47

45

Air spaces
 Single Real Image

Only one image results from

a given anatomical structure.
Most images seen on a
panoramic film are of this
type.
Double Real Image
Two images of a single
object which is located in
the midline. Structures that
produce these double real
images include the hard &
soft palate, hyoid bone and
cervical spine.
 Ghost Image

Usually caused by
external objects such
as earrings but may be
produced by dense
anatomical structures
such as the mandible
GHOST IMAGE

Opaque shadow of an object

(jewelry, anatomy) located on
the opposite side of the
patient
Ghost Image:
 Opposite side
 Same shape
 Larger
 Projected higher on film
 Less distinct
 11
16
12
2
5 15 13 17
10
6 7 9
8
14
19
1
24
23 21
18
3
4
32
25
20
26 22

27 31
29

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37
39
35
30 28
38 36 34
 47
40
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46

42

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

26 8 32 23
16 1 31
3
20 4
34 44

30
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11 2
15
24

26 8 32 23
16 1 31
20 3

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21 41
42

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 Identify the anatomical
structures on the following
.slides
 Slide #
C
1
E

D G
F
B

Answers on next slide

 Slide #
C
1
E

D G
F
B

A = cervical vertebra; B = external oblique ridge; C = zygomatic

process; D = floor of maxillary sinus; E = zygomaticotemporal suture; F
= lingula; G = mandibular foramen
 Slide #
B
2
K
D

J
E I

A H

C G

Answers on next slide

 Slide #
B
2
K
D

J
E I

A H

C G

A = ear; B = external auditory meatus; C = submandibular

fossa; D = nasal septum; E = hard palate; F = mental
foramen; G = hyoid bone; H = mandibular canal; I =
pterygoid plates; J = articular eminence; K =
pterygomaxillary fissure
 Slide #
3 C
B

Answers on next slide

 Slide #
3 C
B

;A = palatoglossal air space; B = middle cranial fossa

C = lateral border of orbit; D = condyle; E = mental fossa
 Hard Tissue Inf. Orbital canal and foramen
Ant. wall of Maxillary sinus Articular eminence
Hard palate Ptregomaxillary Fissure Ext.
Floor of Maxillary sinus Auditory
Nasal fossa Inf. orbital rim
meatus
Panoramic Innominate line
(Infra temporal surface of
Zyg. bone
Man. fossa
Mandibular
condyle
Lat.
ptreg.
plate
Zygomatic
Zyg. bone
process
of Coronoid
Maxilla process

C- Spine

Mental foramen
Ext. oblique ridge Hyoid bone
Inf. Alveolar canal
Inf. border of Mandible
Soft tissue (edentulous)
Middle meatus

Soft palate Inf. nasal meatus

Inf. nasal concha (turbinate)

Dorsal surface of the tongue
Post. Wall of the pharynx

Upper
lip Ghost image of opposite Man.
Lower lip
 Common errors
I-Patient preparation errors

Ghost image-1
Lead apron artifact-2
Ghost of opposite ramus
 Ghost images of mandibles
(dotted line outlines ghost of left ramus-angle over
right side of mandible)
Ghost image of metal used to restore left angle of mandible
 Lead Apron shadow

The lead apron should be placed low on the back of the patient’s
neck so that it does not block off the x-ray beam as the tubehead
passes behind the patient. (A thyroid collar is never used for
panoramic films). If the apron blocks the beam, a completely
radiopaque shadow is produced on the film overlying a portion of
the mandible; no evidence of teeth or bone is seen in this area.
White areas on film represent lead apron being placed
too high on back of neck.
White areas caused by placing lead apron too high
on back of neck. (Note row of stitching of material
on lead apron at left above).
II-Patient positioning errors

Positioning of lips and tongue-1

Positioning of the Frankfort plane upward-2

Positioning of the Frankfort plane downward-3

Positioning of teeth anterior to the focal trough-4

Positioning of teeth posterior to the focal trough -5

Positioning of the midsagital plane-6

Positioning of the spine-7

Positioning of lips
 Palatoglossal Air Space

Right before exposing the film, the patient is asked to

swallow (to feel the tongue elevate to contact the palate)
and to keep the tongue against the palate during the entire
exposure. This will help to eliminate the palatoglossal air
space (see red arrows above). If this radiolucent band
appears on the film, it may mask periapical radiolucencies
that might be present .
The palatoglossal air space (radiolucent
band above roots of maxillary teeth) results
from failure to place and maintain the
tongue against the palate during exposure.
Positioning of tongue
Positioning of the Frankfort plane upward
 HEAD TIPPED UP

Squared-off mandible, palate superimposed over maxillary teeth

Positioning of the Frankfort plane upward
 The hard palate and floor of the nasal cavity
appear superimposed over the roots of the
maxillary teeth.

 There is a loss of detail in the maxillary incisor

region.

 The maxillary incisors appear blurred and

magnified.

 A reverse smile line (curved downward) is

apparent on the radiograph.
Positioning of the Frankfort plane upward
)patient’s chin is tilted up(
Positioning of the Frankfort plane downward
 HEAD TIPPED DOWN

Mandibular incisors shortened, V-shaped mandible

Positioning of the Frankfort plane downward
 The mandibular incisors appear blurred.

 There is a loss of detail in the anterior

apical regions.

 The condyles may not be visible.

 An "exaggerated smile line" (curved

upward) is apparent on the radiograph.
Positioning of the Frankfort plane downward
)patient’s chin is tilted down(
 Teeth too anterior

If the incisors are positioned anterior to the notch in the

bitestick, they will end up closer to the film, which passes in
front of the patient. This results in a reduction in the width of
the images of the front teeth (less magnification) and, since
they are now slightly outside the focal trough, the images of the
teeth will be blurred.
Incisors positioned anterior to notch in bitestick.
Anterior teeth narrower.
Incisors positioned anterior to notch in bitestick.
Anterior teeth narrower and blurred.
 Teeth too posterior

If the incisors are positioned posterior to the notch in the

bitestick, they will end up farther from the film, which passes
in front of the patient. This results in an increase in the width
of the images of the front teeth (more magnification) and,
since they are now slightly outside the focal trough, the
images of the teeth will be blurred.
 Teeth too posterior

Anterior teeth wider and blurred

Incisors positioned posterior to notch in
bitestick. Incisors wider than normal.
Incisors positioned posterior to notch in
bitestick. Incisors wider than normal and
blurred.
Positioning of teeth posterior to the focal trough
 Head Turned

Turning the head moves the teeth closer to the film on one side
(b, above) and farther from the film on the other side (a, above).
This results in an enlargement of the images of the teeth and
ramus on one side and a reduction in the size of the images on
the other side.
Structures smaller on the side to which head is
turned; larger on opposite side.
Head turned to the right, moving the teeth closer to the
film on that side. The teeth on the left side, being farther
from the film, will be magnified more and appear larger.
Head turned to the left. The ramus is wider on the right
side.
Shadow of vertebral column, usually
from patient not standing straight
White area in the center of the film represents the shadow of
the vertebral column due to patient slouching. Although faint,
you will usually be able to see outlines of the teeth and bone in
the area.
Positioning of the spine
Miscellaneous Technique Errors

Static Electricity
Failure to remove dentures
Failure to remove glasses
Patient movement
Over-exposure or Under-exposure
Static electricity caused by friction when removing film from
box or cassette too rapidly.
Failure to remove complete upper denture before exposre.
This is usually not a problem since the denture acrylic is not
dense enough to block the image of the maxillary bone.
Leaving partial dentures in the mouth for a panoramic film
will usually obscure important diagnostic information as seen
in the above film. Note the hearing aid in the left ear (green
arrow) and its ghost image overlying the right orbit (red
arrows).
Failure to remove glasses. Also note squared-off mandible and
reverse “smile”, indicating chin tipped up too much.
Patient movement
Slight patient movement indicated by notching of mandible at
arrow.
Patient movement
Over-exposure

Under-exposure
 Faculty of
Dentistry