appearance of anatomic structures on panoramic image

7/27/2019 Appearance of Anatomic Structures on Panoramic Image

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ARTICULAR TUBERCLE OF THE TEMPORALBONE

ZYGOMA

ZYGMOID PROCESS OF MAXILLA PTERIGOMAXILLARY FISSURE ORBITAL RIM HARD PALATE

INFERIOR NASAL SPINE NASAL SEPTUM ANTERIOR NASAL SPINE

MAXILLARY LANDMARKS


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FLOOR OF THE MAXILLARY SINUS

EAR LOBE CERVICAL VERTEBRAL BODY STYLOID PROCESS


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MANDIBULAR CONDYLE NECK OF MANDIBULAR CONDYLE CORONOID PROCESS OF MANDIBLE

INFERIOR ALVEOLAR CANAL INFERIOR BORDER OF MANDIBLE MENTAL FORAMEN SUBMANDIBULAR FOSSA

MANDIBULAR ANGLE SIGMOID NOTCH EXTERNAL OBLIQUE RIDGE

MANDIBULAR LANDMARKS


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NASOPHARYNX OROPHARYNX SOFT PALATE AND UVULA

POSTERIOR SURFACE IF THE TONGUE POSTERIOR PHARYNGEAL WALL HARD PALATE HYOID BONE

NECK,SPINAL AND SOFT TISSUE


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The clinician should be able to able to follow acortical border around the entire bone, with theexception of the dental areas.

This border should be smooth, without

interruptions & should have symmetricalthicknesses in comparable anatomic areas.

The trabeculation of the mandible tends to bemore plentiful in the anterior regions, whereas

the marrow comparment increases toward theangle and into the ramus

However theses trabecular patternsanddensities should be relatively symmetric.

THE MANDIBLE


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The mandibular condyle is generally slightlyanteroinferior to its normal closed positionedbecause the patient has to slightly open &

protrude the mandible to engage thepositioning of the device in most panoramicmachines.

The TMJ can be assessed for gross anatomic

changes of the condylar head & the glenoidfossa.

The soft tissue articular disc & posteriorligamentous attachment cannot be assessed.

More definitive assessment of TMJ can bedone by CBCT,MRI,CT.


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Pharyngeal airway shadow Posterior wall of the nasopharynx Cervical vertebrae

Ear lobe & ear decorations Nasal cartilage and nasal decorations Soft palate and uvula Dorsum of the tongue and tongue

decorations Ghost shadows of the opposite side of the

mandible and metallic decorations

Shadows of other structures superimposed onthe mandible ramal area.


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From the angle of the mandible,viewing shouldbe continued anteriorly toward the symphysealregion

The fracture often manifests as a discontinuityas the in the inferior border;a sharp change inthe level of the occlusal plane indicates thatthe fracture passes through the tooth-bearingarea, whereas a cant in the entire occlusaltable without a step disformity in the occlusalplane indicates that the fracture is posterior tothe tooth-bearing area.

The width of the cortical bone at the inferiorborder of the mandible should be at least 3mmin adults and of uniform density


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Asymmetry of size may result from improperpatient positioning or conditions such ashemifacial hyperplasia or hypoplasia.

The hyoid bone may be projected below oronto the inferior border of the mandible.

Trabeculation is most evident within thealveolar process.

The mandibular canals and mental foraminaare usually clearly visualized in yhe ramusand body of the mandible.

When only one border of the canal is seen,it

is typically the inferior border.The canals usually rise to meet the mental


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foramina, often looping several millimeters anterior ofthe mental foramina; this is termed the anterior loopof the mandibular canal, and its position and extent

are considerations when planning dental implants inthe mandibular canine regions.The mandible should be examined for radiolucencies

or opacities.The midline is more opaque because of the mantal

protuberance, increased trabecular numbers, andattenuation of the beam as it passes through thecervical spine

Depressions on the lingual surfaces of the

mandible ,which are occupied by submandibular andsublingual glands appear more radiolucent.


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The midface is a complex mixture of bones,air cavities & soft tissues, all of whichappear on the panoramic images.

Bones appearing on panoramic images are temporal, zygoma, mandible, frontal,maxilla, sphenoid, ethamoid, vomer, nasal,turbinate and palate.

The maxilla can be compartmentalized intomajor sites of examination:

MIDFACIAL REGEION


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a. Cortical boundary of maxilla.

b. Pterygomaxillary fissure

c. Maxillary sinus

d. Zygomatic complex

e. Nasal cavity and conchae

f. TMJ

g. Maxillary dentition and supporting alveolus.

.The posterior border of the pterygomaxillary fissureis the pterygoid spine of the sphenoid bone.

. Pterygomaxillary fissure has an inverted teardrop

appearance; it is inportant because


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It is inportant because maxillary sinusmucoceles and carcinomas will destroy theposterior maxillary border , which is then

menifested as loss of the anterior border ofpterygomaxillary fissure. Lefort fractures of the maxilla by defination

involve the pterygoid plates, and this will

often inittially diagnosed by disturbances ofintegrity of the pterygomaxillary fissure onthe panoramic image.

Maxillary sinuses are usually well visualized

on panoramic image.The mesial border of the maxillary sinus is

not demonstrated on the panoramic image.


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The superior border of the maxillary sinus isdemonstrated on the panoramic image.

The posterior aspect of the sinus is more opaquebecause of superimposition of zygoma.

Zygomatic complex or butteress is a verycomplex anatomic area with contributions fromzygomatic, frontal, maxillary bones.

maxillary sinus can pneumatize the zygomatic

processs of maxilla upto zygomaticomaxillarysuture.

This can result in appearance of the elliptical,corticated radiolucency in maxillary sinus, possibly

superimposed over the roots of the molar tooth, ona panoramic image.


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The Zygomaticotemporal suture lies in themiddle of the zygomatic arch and maystimulate a fracture if visualized on image.

The mastoid cells will pneumatize thetemporal bone all the way tozygomaticotemporal suture , giving theglenoid fossa of the TMJ multilocular

appearance or soap-bubbly radiolucency.


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A number of opaque soft tissue structures may beidentified on panoramic radiographs, including thetongue arching across the film under the hardpalate,lip markings,the soft palate extending

posteriorly from the hard palate over each ramus,nose, ear lobes.

Nasal fossa, nasopharynx, oral cavity andoropharynx superimpose radiolucent shadows.

The epiglottis and thyroid cartilage are often seenin panoramic images.

THE SOFT TISSUE


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Panoramic image is a demonstration of thecomplete dentition.

It is particularly important to closelyexamine the impacted third molar,thererelationship to critical anatomic structures mandibular canal, floor and posterior wall ofmaxillary sinus, the maxillary

tuberosity,pericoronal and periradicularbone.

DENTITION

appearance of anatomic structures on panoramic image

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