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Practical Panoramic Imaging

Course Number: 589

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Anatomical Structures

Anatomically representative. A panoramic image should be a good representation of the maxillofacial structures that it depicts. This means that there is adequate coverage of the osseous structures and that they are represented with an acceptable degree of accuracy. To determine correct anatomic representation, a visual assessment of the panoramic radiographic image should be performed for accuracy of both anatomic structures and the dentition.

  • Anatomic assessment. Several features can be used to determine anatomic accuracy including:

    • The condyles are on image, usually in the upper outer sextant and at same level.

    • Palate and ghost images of palate should be above the apices of the maxillary teeth, running through the lower portion of the maxillary sinus.

    • Ramus width should be similar on both left and right sides.

ce589 - Content - Features of an Ideal Panoramic Radiograph - Figure 9

Figure 32. Anatomic Assessment Features. Compare specific structures to assess panoramic anatomic accuracy.

Panoramic anatomy. A reference guide for anatomic structures commonly observed on a panoramic image appears below. Many of these structures are mentioned in the prior text and in the subsequent discussion of common errors.

ce589 - Content - Features of an Ideal Panoramic Radiograph - Figure 10

Figure 33. Anatomic Structures Present on a Panoramic Image

1. Mandibular Condyle12. Cervical Vertebra23. Genial Tubercles
2. Coronoid Process13. Zygomatic Process24. Nasal Concha
3. Nasopharyngeal Airspace14. Incisive Foramen25. External Oblique Ridge
4. Oropharyngeal Airspace15. Mandibular Foramen26. Angle of the Mandible
5. Styloid Process16. Mandibular Canal Space27. Zygomatic Bone
6. Lateral Pterygoid Plate17. Soft Palate28. Glenoid Fossa
7. Zygomatic Arch18. Hyoid Bone29. Inferior Border of the Mandible
8. Articular Eminence19. Hard Palate30. Palatoglossal Airspace
9. Anterior Nasal Spine20. Nasal Septum31. Pterygomaxillary Fissure
10. Mental Foramen21. Maxillary Sinus Floor32. Maxillary Tuberosity
11. Infraorbital Canal22. Nasal Fossa33. Zygomaticotemporal Suture

Features of the Dentition. Several visual features of the dentition can be used to assess whether the teeth, particularly the anterior teeth, are positioned correctly within the focal trough:

  • No or slight upward curve of teeth in the arch

  • No tooth size discrepancy on left or right side

  • Anterior teeth in focus (see pulp canal clearly)

  • Anterior teeth shape is “normal”

  • Not too narrow or too wide

  • Premolars will always overlap due to inherent x-ray beam projection to the arch of the teeth in this region.

ce589 - Content - Features of an Ideal Panoramic Radiograph - Figure 11

Figure 34. Points of Comparison. Examine and compare these features of the dentition to assess panoramic anatomic accuracy.

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