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Panoramic Anatomy
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Ghost Image
Ghost images are formed by dense objectslocated between the tubehead and the rotation
center. These ghost images usually result from
external objects such as earrings, but they may be
produced by dense anatomical structures such as
the mandible. (For more information, see self-study module Panoramic Technique).
ghost image of earring
(between lines)
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9
525
28
14
33
12
18
17
19
1322
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
3223
2
3126
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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40
43
43
42
42
4121
40
21
46
46
41
45
45
47
47
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36
41
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
E
LN
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
45
R L
? Identifies calcification, possibly in carotid or in lymph node
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33
8
746
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
27
nose
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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7
27
26
24
22
38
30
R L
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ghost of mandible
47
45
10
6
5R L
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7
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
44
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1
29
31
2426
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
28
7
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 2R L
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Hearing aid (red arrow) with ghost (green arrow).
27
28
28
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.
Slide # 1
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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 Cervical vertebra
Lingula
Zygomaticotemporal suture
Slid # 2
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A
D
E
F
G
H
I
J
K
Slide # 2
C
R B L
AB
C
D
E
F
GH
I
J
K
Ear lobeExternal auditory meatus
Submandibular gland fossa
Nasal septum
Hard palate
Mental foramen
Hyoid boneMandibular canal
Pterygoid plates
Articular eminence
Pterygomaxillary fissure
Slid # 3
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Slide # 3
A
E
D
BCR L
A
B
C
D
E
Palatoglossal air space
Middle cranial fossa
Lateral border of the orbit
Condyle
Mental fossa
Slid # 4
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Slide # 4
K
J
I
H
G
F
E
D
CB
A
L
R L
AB
C
D
E
F
GH
I
J
K
L
Cervical vertebraZygomaticotemporal 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
Slide # 5
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Slide # 5
A
I
H
G
F
E
D
C
B
J
R L
A
B
C
D
E
F
G
H
I
J
Glossopharyngeal air space
Styloid process
Nasopharyngeal air space
Pterygoid plates
Condyle
Infraorbital canal
Infraorbital foramen
Soft palate
Mandibular canal
Lingula
Slide # 6
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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).
Slide # 7
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Slide # 7
D
C
B
ARL
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.
Slide # 8
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Slide # 8
E
DC
B
A
R L
A
BC
D
E
Maxillary tuberosity
Hard palateCoronoid 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.
Slide # 9
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Slide # 9
F
E
D
C
B
A
R L
A
BC
D
EF
Zygomatic arch
External oblique ridgePalatoglossal air space
Soft palate
Pterygomaxillary fissureStyloid process
This patient has multiple supernumerary premolars in the
mandible (#s 21, 28 and 29 were extracted).
Slide # 10
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Slide # 10
F
ED
B
A
CR L
A
B
C
D
EF
Mandibular canal
Soft tissue of nose
Nasal fossa
Hard palate
Mandibular foramenStyloid 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
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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