OPT Self Study

8/6/2019 OPT Self Study

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Welcome. In navigating through the slides, you

should click on the left mouse button when (1),

you see the mouse holding an x-ray tubehead(see below), (2) you are directed to click for

the next action and (3) you are done reading a

slide. Hitting Enter or Page Down will also

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Click for next slide


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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).


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46

45 47 45

Air Spaces


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Panoramic Anatomy Key1. maxillary sinus

2. pterygomaxillary fissure

3. pterygoid plates

4. hamulus5. zygomatic arch

6. articular eminence

7. zygomaticotemporal suture

8. zygomatic process

9. external auditory meatus

10. mastoid process

11. middle cranial fossa

12. lateral border of the orbit

13. infraorbital ridge

14. infraorbital foramen

15. infraorbital canal

16. nasal fossa

17. nasal septum18. anterior nasal spine

19. inferior concha

20. incisive foramen

21. hard palate

22. maxillary tuberosity

23. condyle

24. coronoid process

25. sigmoid notch

26. medial sigmoid depression

27. styloid process

28. cervical vertebrae29. 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 palate42. uvula

43. posterior pharyngeal wall

44. ear lobe

45. glossopharyngeal air space

46. nasopharyngeal air space

47. palatoglossal air space


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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.


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9

525

28

14

33

12

18

17

19

13

22

7

39

6

33

255

28

9 12

14

18

17

19

22

13

7

6

39


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8

20

1115

116

3

30

44

32 23

2

31

26

38

34

24

8

20

11

15

1

2

3

30

44

32 23

31

38

34

16

24

26

4

36

36


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43

43

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42

4121

40

21

46

46

41

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47

47


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36

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38

7

11

1

43

47

46

45

R L


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2 8

19

17

18

6

16

21

Red arrows point to ghost image of hard palate

23

39

R L


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9

11

320

R L

How old is this patient?

a. 6-9 years

b. 10-12 years

c. 13-15 years

b. 10-12 years old


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28

17

44

43

20

2

R L


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2

31

transverse foramen

atlas

R L


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15

34

27

6

46

47 19

R L

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).


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15

17

8 1

32

N

N = soft tissue of nose

R L

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.


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40

27

36

ELN

LN = calcified lymph node

E = epiglottis

R L


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What positioning error is seen on this film?

The patients head is turned to the side. Note the width of the

ramus on each side (The red arrows are the same length).

Which direction was the patients head turned (left or right)?

The head was turned to the left, bringing that side closer to

the film and decreasing the width of the ramus on that side.

The green arrow points to the biteblock, centered on the

contact between the right central and lateral incisors.

?

40

2

18

8

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R L

? Identifies calcification, possibly in carotid or in lymph node


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33

8746

47

E

E = epiglottis

R L


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3

21

29

32

11

34

The black dots result from static electricity, caused by

removing the film too quickly from the cassette or from the

box of film (creates friction, which results in a static

discharge).

R L

What causes the black dots identifed by the red arrow?

What positioning error is seen on this film?The chin is tipped up too much, giving a more squared off

appearance to the mandible, creating a reverse smile and

causing the hard palate to be superimposed on the roots

of the maxillary teeth.


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3

30

9

27

1

16

44

20

36

42

10

G

G = ghost of right mandible

R L


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14

27nose

24

47

39

The lead apron was placed too high on the back of the

patients neck.

R L

What caused the white (radiopaque) area indicated by

the red arrow?


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9

23

26

7

12

air cell

Air cell in zygomatic arch.

R L


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27

26

24

22

38

30

R L


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39

15

21

239

30

Note the relatively inferior location of the mandibular canal (30),

providing plenty of room for the implant.

R L

5

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1

29

31

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Pattern on right side of film (patients left) caused by

excessive oil on patients hair.

R L


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red arrow identifies fracture

28

287

R L


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Green arrow identifies pseudo-fracture caused by

palatoglossal air space.

Red arrows point to odontogenic keratocyst.

34

44

27

R L


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Ghost images of earrings

R

L


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Ghost images of earrings

15 2

R L


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Ghost image of metal used to restore left angle of mandible

R L


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Ghost images of mandibles

(dotted line outlines ghost of left ramus-angle over

right side of mandible)

R L


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Identify the anatomical structures

on the following slides.


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Slide # 1

A

B

C

D

E

F

G

R L

A

B

C

D

E

F

G

Cervical vertebra

External oblique ridge

Zygomatic process

Maxillary sinus

Mandibular foramen

Lingula

Zygomaticotemporal suture


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A

D

E

F

G

H

I

J

K

Slide # 2

C

R B L

A

B

C

D

E

F

GH

I

J

K

Ear lobe

External auditory meatus

Submandibular gland fossa

Nasal septum

Hard palate

Mental foramen

Hyoid boneMandibular canal

Pterygoid plates

Articular eminence

Pterygomaxillary fissure


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Slide # 4

K

J

I

H

G

F

E

D

CB

A

L

R L

A

B

C

D

E

F

GH

I

J

K

L

Cervical vertebra

Zygomaticotemporal suture

Zygomatic process

Nasal septum

Inferior concha

Soft tissue of nose

Hard palatePost. wall of maxillary sinus

External auditory meatus

Posterior pharyngeal wall

Mental foramen

Mental fossa


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Slide # 6

A

BC

D

E

FG

Mental foramen

Incisive foramenSoft tissue of nose

Anterior nasal spine

Pterygoid plates

Ear lobeHyoid bone

G

F

E

A

E

D

C

B

R L

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).


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Slide # 7

D

C

B

AR L

A

BC

D

Posterior border of maxillary sinus

Inferior border of orbitInferior concha

Inferior border of maxillary sinus

The radiolucency (red arrows) seen in the ramus on the

patients left side is a squamous cell carcinoma.


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Slide # 8

E

DC

B

A

R L

A

B

C

D

EMaxillary tuberosity

Hard palate

Coronoid process

Floor of middle cranial fossa

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.


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Slide # 9

F

E

D

C

B

A

R L

A

B

C

D

EF

Zygomatic arch

External oblique ridge

Palatoglossal air space

Soft palate

Pterygomaxillary fissureStyloid process

This patient has multiple supernumerary premolars in the

mandible (#s 21, 28 and 29 were extracted).


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Slide # 10

F

ED

B

A

CR L

A

B

C

D

E

F

Mandibular canal

Soft tissue of nose

Nasal fossa

Hard palate

Mandibular foramen

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.


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Slide # 11

D

CB

E

A

R L

A

BC

D

E

Sigmoid notch

Nasal septumCoronoid process

Articular eminence

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

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