Principle of panoramic image formation Patient positioning and head alignment Interpreting the Panoramic Image Its difficult

because: The complex anatomy of the midface The superimposition of various anatomic structures The changing projection orientation Potential artifacts associated with machine and patient movement Patient positioning and patient anatomy

Appearances of important Anatomic Structures on the Panoramic Image The mandible Condylar process and temporomandibular joint Coronoid process Ramus Body and Angel Anterior Sextant Teeth and Supporting structures

Shadows of others structures can be superimposed over the mandibular ramal area Pharygeal airway shadow especially when the patient was unable to expel the air and place the tongue in the palate during exposure Posterior wall of nasopharynx Cervical vertebrae-especially in patient with pronounced anterior lordosis, typically seen in severely osteoporotic individuals Ear lobe and ear decoration Soft palate and uvula Dorson of the tongue Ghost shadow of the opposite site of mandible The midface region

Cortical boundary of the maxilla, including posterior border and the alveolar ridge Pterygomaxillary fissure Maxillary sinuses Zygomatic complex, including inferior and lateral orbital rims, zygomatic process of maxilla and anterior portion of zygomatic arch Nasal cavity and conchae Temporomandibular joint Maxillary dentition and supporting alveolus

Soft tissue Opaque soft tissue Tongue Lip markings Soft palate Posterior wall of the oral and nasal pharynx Nasal septum Ear lobes Nose Nasolabial folds

Radiolucent Airway shadows Nasal fossa Nasal pharynx Oral cavity Oral harynx Epiglottis Thyroid cartilages

Superimpose and Ghost Image

Superimpose on the image of normal anatomic structures xrays beam project projects through a dense object (earring, spinal column, mandibular ramus, or hard palate These contralateral images are term ghost images and they may obscure normal anatomy or be mistaken for pathology Dentition If the anterior teeth are excessively wide or narrow, this suggest malposition of the patient If the teeth are wider on the one side than the other, this suggests the patients sagittal palne was rotated The teeth should be examine for gross abnormalities of number, position and anatomy