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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 24 19 21 18 4 41 22 40 26 20 29 31 32 1 3 42 15 13 16 12 17 10 7 9 2

27

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

12

19

14 25 18

17

13 6 22 39

28

33

11 15 24 26 8 16 20 34 36

32 1 4

23 31

44 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 45

43

R
7 1

11

46

41

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 27 19 6

34

What head positioning error is seen on this film? The anterior teeth are positioned in front of the notch in the bitestick, 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, side. Note the width of the The patients head is turned to thebringing that side closer to the film each side (The the width are the same length). ramus on and decreasing red arrowsof the ramus on that side. The direction was the to the biteblock, centered on the Whichgreen arrow pointspatients head turned (left or right)? contact between the right central and lateral incisors.

R
8 46 47 7

33

E = epiglottis

11

21

29 32 34

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

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air cell

12 9 23 7 26

Air cell in zygomatic arch.

24 26 7

22 27 30 38

5 10

6 47

45 ghost of mandible

R
9 7

15 23 5

21

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 C D E H I

A F

J K

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 H I A G J

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 E

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.