Dental panoramic radiography

Question 1

Error: Patient not positioned upright (neck sticking out)

Answer 1

Zone 3 mandibular body: Ghost c-spine extends downward beyond mandibular teeth to obscure midportion of mandible

Question 2

Error: Patient too far FORWARD (not biting in groove)

Answer 2

Zone 1 dentition: Ant. teeth (especially lowers) are narrowed
Zone 5 ramus-spine: C-spine superimposed on ramus and condyles symmetrically on both sides

Question 3

Error: Patient is positioned too far BACK

Answer 3

Zone 1 dentition: Ant. teeth (especially lowers) are widened.

Zone 2 nose-sinus: Lower turbinate and meati are spread out across maxillary sinus bilaterally

Zone 4 condyles: condyles appear close to/off lateral edges of film

Zone 5 ramus-spine: Ghost images of rami are seen superimposing post. molars and rami symmetrically

Question 4

Errror: Patients chin is tipped too LOW

Answer 4

Zone 1 dentition: “smile” is exaggerated, apices of mandibular ant. teeth are cropped

Zone 3 mandibular body: Mandible widened vertically in the ant. region. Traversed by elongated double image and/or ghost of hyoid bone

Zone 4 TMJ: condyles approach upper film edge and can be cropped

Question 5

Error: Patients chin is tipped too HIGH

Answer 5

Zone 1 dentition: “smile” line is lost. Apices of maxillary teeth are cropped

Zone 2 nose-sinus: Real, double and ghost of palate form widened radiopaque line that superimposes apices of maxillary teeth

Zone 4 TMJ: condyles approach lateral edges of film/”cut-off” symmetrically bilaterally

Question 6

Error: patients chin is not on the chin rest

Answer 6

Zone’s 2 & 4 nose-sinus & TMJ: Cropped by upper edge of film

Zones 3 & 6 mandible body and hyoid: These zones contain only soft tissue shadows rather than bony anatomy

Question 7

Error: Lips open/tongue is not on palate

Answer 7

Zone 1: crowns of upper and lower teeth ant. obscured by air, apical region of maxillary teeth obscured by dark air space

Zone 2: palatoglossal air space obscures maxillary apical alveolar bone

Question 8

Error: Patients head is rotated

Answer 8

Zone 1: Post teeth on one side are widened and overlapped interproximally. On the other side, post teeth are narrowed

Zone 2: Inf turbinate and meati spread across maxiallary sinus on the side with the widened rami

zone 5: ramus is widened on the side with widened post teeth. Ramus is narrowed on other side

–> Narrow ramus indicated rotation in that direction

Question 9

Error: patients head is tilted

Answer 9

Zone 3: Lower edge of mandible almost horizontal on one side

Zone 4: On the side where interocclusial gap is widened, condyles are enlarged

Question 10

Bone cysts

Answer 10

Dark cyst on xray

Question 11

Submandibular calcification

Answer 11

Calcification over submandibular gland (near hyoid bone)

Question 12

Cancer of mandible

Answer 12

Reduced density/hole in mandible