Radiology Lecture 06 - Panoramic Landmarks

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1.

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 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

4.

Identify landmarks

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

Identify landmarks

5.

2.

List four weaknesses of panoramic radiographs.

Identify landmarks
6.

3.

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.

Identify #2 & #3
12.

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

A: Hard Palate B: Hyoid Bone

Identify A & B
13.

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

Identify landmarks
9.

When taking a pan, this anatomical landmark must be parallel with the floor.

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

14.

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.

Why is the PDL so wide?

15.

Because the tooth was just recently extracted.

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

List two benefits of panoramic radiographs.

Why is the lamina dura still visible here?

16.

Cancellous; trabeculae, bone; medullary spaces, bone marrow

21.

Genial tubercle

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 _________.
17.

Identify
22.

Ghost images

These are produced when an object is located between X-ray source & center of rotation. Where in the mouth are the medullary spaces the largest?

23.

External oblique ridge

24.

In the posterior mandible Inferior border of maxillary sinus

Identify
18.

False. Ghost images, while larger and more blurry, are not mirror images. They are oriented the same way as their real counterparts. Fixed or 3-point rotation; continuously moving center of rotation Focal trough or Image layer

T/F: A ghost image is a larger, more blurry, mirror image of the real object.

Identify line
25.

Mandibular (lingual) tori

19.

Older machines used a __________ center of rotation while the new machines use a __________ center of rotation. Identify radioopacity It is important to keep your object within the __________ so that anatomical areas of interest are shown with the greatest sharpness.
26.

20.

Mandibular 2nd Premolar Maxillary sinus

The mental foramen is typically next to this tooth.

27.

Identify blue arrow

28.

Oblique; mylohyoid

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

35.

Superior

From the sagittal view, external oblique ridges are superior/inferior to internal oblique ridges. What would happen if the patient's head was too far back?

36.

29.

Patient moved during exposure.

The anterior teeth appear blurred and widened. Increased ghosting of the mandible occurs. The football player - thick trabeculae with small medullary spaces. The mandibular incisors are out of focus. The hyoid bone is superimposed over the mandible. The premolars are overlapped. "Smiley" appearance is enhanced. The maxillary incisors are out of focus and the hard palate appears along the apices of the maxillary teeth. "Smiley" appearance is flattened out. The maxillary sinus has dropped into the space previously occupied by a tooth (now extracted); Pneumatization of the maxillary sinus

What error occurred?

30.

37.

Patient's head was tilted down.

38.

Who would have denser alveolar bone: a 6'5", 260lb professional football player or a petite, adult woman?

How do you know the patient's chin was too low?

What error occurred?

31.

Patient's head was tilted up.

39.

What error occurred?

32.

How do you know the patient's chin was too high?

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

What error occurred?

40.

33.

These are produced when an object is located between center of rotation & detector.

34.

What happened here? This is known as __________.

The horizontal arrangement of trabeculae indicated is sometimes referred to as a __________ pattern.

41.

The patient on the right is older because the PDL is thinner. Which of these patients is older? Why? Hint: It doesn't have to do with the # of teeth.

49.

True

T/F: Alveolar bone crests are somewhat pointed between anterior teeth and more rounded or flat between posterior teeth.

42.

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

What error occurred?

43.

What error occurred?

44.

The patient was too far forward.

What error occurred?

45.

The patient's head was turned.

What error occurred?

46.

The patients head was placed too far forward during the x-ray. The radiolucent area is due to the mental foramen, not an abscess. True

If the anterior teeth are out of focus and narrow, the spine overlaps the ramus and the premolars are overlapped, what might have happened? T/F: This abscess will not harm the tooth because it is not touching it.

47.

48.

T/F: The vertical component of a ghost image is more blurred than its horizontal component.