Zygomatic Arch Imaging Techniques
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Questions and Answers

What is the proper positioning of the head for a Tangential Projection of the nasal bones?

  • Fully extended with MSP parallel to the film (correct)
  • Supine with MSP perpendicular to the film
  • Seated with neck hyperextended
  • Prone with chin elevated

    • Which angle is recommended for the chin positioning in the Law Method (PA oblique axial projection)?

  • 45° lateral
  • 15° caudad
  • 10° inferior
  • 25-30° cephalad (correct)

    • Which structure is primarily demonstrated in the Waters Method (Parieto-Acanthial Projection)?

  • Maxillary sinus of the side up (correct)
  • Zygomatic bone of the side down
  • Mandibular symphysis
  • Frontal bone structures

    • In the Caldwell Method (PA axial projection), what angle should the forehead and nose be positioned relative to the image receptor?

    <p>15° caudad</p> Signup and view all the answers

    What is the contraindication for a Tangential Projection for nasal bones?

    <p>Children with short nasal bones</p> Signup and view all the answers

    What is the primary orientation of the MSP in a lateral projection for facial bones?

    <p>Parallel to the IR</p> Signup and view all the answers

    In the PA axial projection, what is the required angle of the central ray?

    <p>30° caudad</p> Signup and view all the answers

    Which method is considered the best projection for visualizing facial bones?

    <p>Modified Waters Method</p> Signup and view all the answers

    Which projection involves the chin resting on the image receptor with the MSP perpendicular to the film?

    <p>Waters Method</p> Signup and view all the answers

    In a Modified Waters Method, at what angle should the OML be positioned in relation to the IR?

    <p>55°</p> Signup and view all the answers

    What is the key imaging feature to assess in a lateral projection of facial bones?

    <p>Mandibular rami superimposition</p> Signup and view all the answers

    What is the effect of the 30° caudad angle in the PA axial projection?

    <p>It centers the petrous portions below the orbits.</p> Signup and view all the answers

    In the Reverse Waters Method, what should be adjusted for trauma patients?

    <p>The angle of the central ray</p> Signup and view all the answers

    What is the appropriate neck position for a Tangential Projection concerning flat cheekbones?

    <p>Neck hyperextended</p> Signup and view all the answers

    In the PA Axial Projection of the mandibular symphysis, where should the patient's chin be positioned?

    <p>Chin pushed forward</p> Signup and view all the answers

    What is a key recommendation from the Zanelli Method for imaging the TMJ?

    <p>Increase contrast</p> Signup and view all the answers

    What is the angling method for the cephalad position in a PA Axial Projection of the mandibular body?

    <p>30°</p> Signup and view all the answers

    During the Submentovertical (SMV) Projection, what should be parallel to the image receptor (IR)?

    <p>IOML</p> Signup and view all the answers

    What is the proper positioning of the patient's head for the Modified Towne Method during the AP axial projection?

    <p>OML perpendicular to the IR</p> Signup and view all the answers

    What technique is employed in Panoramic Tomography?

    <p>Rotational tomography</p> Signup and view all the answers

    What is the primary purpose of the Modified Law Method in TMJ imaging?

    <p>To show open or closed mouth positions of TMJ</p> Signup and view all the answers

    What is the degree of cephalad angling recommended for the Inferosuperior Transfacial Position?

    <p>30°</p> Signup and view all the answers

    In the Tangential Projection, how is the top of the head positioned?

    <p>Tilted 15° away from the examined side</p> Signup and view all the answers

    What is the main anatomical area of focus in the PA Axial Projection technique for the mandible?

    <p>Mandibular symphysis</p> Signup and view all the answers

    Which method requires the zygomatic arch to be skimmed during projection?

    <p>May Method</p> Signup and view all the answers

    What is the optimal method for imaging the zygomatic arches when they are symmetric?

    <p>Schuller Method</p> Signup and view all the answers

    In the Modified Towne Method for TMJ imaging, where is the angle directed?

    <p>At the glabella</p> Signup and view all the answers

    What structures are primarily demonstrated in the Caldwell Method (PA axial Projection)?

    <p>All of the above</p> Signup and view all the answers

    In the Law Method (PA oblique axial Projection), which aspect is aimed to be visualized?

    <p>Floor and posterior wall of maxillary sinus</p> Signup and view all the answers

    What positioning is required for the Tangential Projection of the nasal bones?

    <p>Seated upright with the vertex of the head in contact with the IR</p> Signup and view all the answers

    Which angle is the central ray directed for the Waters Method (Parieto-Acanthial Projection)?

    <p>37° caudad</p> Signup and view all the answers

    What are the contraindications for performing a Tangential Projection?

    <p>Children or adults with short nasal bones</p> Signup and view all the answers

    Which projection uses a 30° caudad central ray angle to center on the orbits?

    <p>PA Axial Projection</p> Signup and view all the answers

    What orientation is the OML positioned at during the Modified Waters Method?

    <p>55° to the IR</p> Signup and view all the answers

    Which feature is best demonstrated in a lateral projection of facial bones?

    <p>Depressed fracture of frontal sinus</p> Signup and view all the answers

    In the Reverse Waters Method, what is the positioning of the MML?

    <p>Parallel to the IR</p> Signup and view all the answers

    During the Modified Waters Method, what is the required distance from the nose to the grid?

    <p>1.5 cm</p> Signup and view all the answers

    What is the primary purpose of the Parietoacanthial Projection, Modified Waters Method?

    <p>To displace the petrous ridge for improved visualization</p> Signup and view all the answers

    What structure should be centered in the PA Axial Projection when the patient's forehead and nose are in contact with the IR?

    <p>Center of the orbits</p> Signup and view all the answers

    In the Lateral Projection for facial bones, which structure must be aligned parallel to the IR?

    <p>IOMI</p> Signup and view all the answers

    What positioning is required for the Modified Titterington Method?

    <p>Prone with nose and chin on the image receptor</p> Signup and view all the answers

    What is the angulation of the central ray for the Modified Towne Method?

    <p>35° to 42° caudad</p> Signup and view all the answers

    What is the purpose of the Tangential Projection in patients with depressed fractures?

    <p>To demonstrate the zygomatic arch free from superimposition</p> Signup and view all the answers

    For which projection is the neck extended and IOML parallel to the image receptor?

    <p>May Method</p> Signup and view all the answers

    What is the correct angulation for the PA Axial Projection of the mandible?

    <p>20° to 25° cephalad</p> Signup and view all the answers

    What is the point of entry for the Schuller Method in TMJ imaging?

    <p>1/2 inch anterior and 2 inches superior to upside EAM</p> Signup and view all the answers

    In the PA Axial Projection (occlusal film) for the mandibular symphysis, what angle is required?

    <p>40° to 45° posteriorly</p> Signup and view all the answers

    Which method best demonstrates the condyloid processes of the mandible?

    <p>Towne Method</p> Signup and view all the answers

    What positioning is advised for the Submentovertical (SMV) Projection?

    <p>Supine with the IOML parallel to the IR</p> Signup and view all the answers

    What is required in the Modified Law Method for imaging TMJs?

    <p>The patient's head needs to be positioned in true lateral</p> Signup and view all the answers

    Which projection provides a limited view of the TMJ with both open and closed mouth images?

    <p>Modified Law Method</p> Signup and view all the answers

    In which projection technique is the patient required to hyperextend their neck?

    <p>Tangential Projection</p> Signup and view all the answers

    What is the angle required for Imaging the mandibular body in PA Axial Projection?

    <p>30° cephalad</p> Signup and view all the answers

    Which method is designed specifically to produce panoramic images of the mandible?

    <p>Panoramic Tomography</p> Signup and view all the answers

    What is the primary purpose of the Waters Method (Parieto-Acanthial Projection)?

    <p>To identify the displacement of the bony nasal septum</p> Signup and view all the answers

    Which structure is primarily demonstrated in the Law Method (PA oblique axial Projection)?

    <p>Posterior wall of the maxillary sinus</p> Signup and view all the answers

    What angle should the OML be positioned in relation to the IR for the Caldwell Method (PA axial Projection)?

    <p>15°</p> Signup and view all the answers

    What is the positioning of the patient for the Submentovertical Projection (SMV)?

    <p>Sitting straight with the neck hyperextended</p> Signup and view all the answers

    Which contraindications are noted for the Tangential Projection of the nasal bones?

    <p>Children or adults with short nasal bones</p> Signup and view all the answers

    In the PA Axial Projection, what structure is primarily centered?

    <p>Orbits</p> Signup and view all the answers

    What is the angle at which the OML should be positioned in the Modified Waters Method?

    <p>37°</p> Signup and view all the answers

    Which projection is considered the best for visualizing facial bones?

    <p>Waters Method</p> Signup and view all the answers

    In the Lateral Projection of the facial bones, which structures must be superimposed?

    <p>Orbital roofs and mandibular rami</p> Signup and view all the answers

    What adjustment should be made for trauma patients during the Reverse Waters Method?

    <p>Adjust the central ray position</p> Signup and view all the answers

    What is the primary benefit of performing a Modified Waters Method?

    <p>Visualizing the petrous ridge below orbital shadows</p> Signup and view all the answers

    During the Modified Waters Method, what is the angle of the CR?

    <p>35° cephalad</p> Signup and view all the answers

    Which projection involves the chin resting on the image receptor with the MSP perpendicular?

    <p>Waters Method</p> Signup and view all the answers

    What is the recommended angulation for the central ray in the PA Axial Projection of the mandibular body?

    <p>30° cephalad</p> Signup and view all the answers

    Which projection requires the patient's neck to be hyperextended and IOML parallel to the image receptor?

    <p>Tangential Projection</p> Signup and view all the answers

    In which position should the patient be when performing the Modified Towne Method?

    <p>Supine</p> Signup and view all the answers

    What is the correct positioning of the MSP for the PA Projection of the mandibular rami?

    <p>MSP perpendicular to the IR</p> Signup and view all the answers

    Which angle should the central ray be directed in the Modified Titterington Method for optimal imaging?

    <p>23° to 38°</p> Signup and view all the answers

    In the Submentovertical Projection (SMV), what positioning is required for the neck?

    <p>Neck fully extended</p> Signup and view all the answers

    Which projection is best suited for demonstrating fractures and dislocation of the TMJ?

    <p>Panoramic Tomography</p> Signup and view all the answers

    For the Mandibular Symphysis PA Axial Projection, where should the central ray be directed?

    <p>At the acanthion</p> Signup and view all the answers

    In the Modified Law Method, what is the recommended angle for the central ray?

    <p>15° caudad</p> Signup and view all the answers

    What angle is required for the central ray in the Modified Towne Method for TMJ imaging?

    <p>35° to 42° caudad</p> Signup and view all the answers

    Which structure is displayed through the Schuller Method (Axiolateral Projection)?

    <p>Condyloid processes</p> Signup and view all the answers

    What is the positioning of the patient during the May Method for imaging zygomatic arches?

    <p>Prone with chin on IR</p> Signup and view all the answers

    What is the intended view in the Tangential Projection for patients with depressed fractures?

    <p>Zygomatic arch free from superimposition</p> Signup and view all the answers

    What does the term 'verticosubmental projection' primarily refer to in imaging techniques?

    <p>Patient supine</p> Signup and view all the answers

    Which method ensures visualization of bilateral symmetric zygomatic arches free of superimposition?

    <p>Schuller Method</p> Signup and view all the answers

    In the Law Method (PA oblique axial projection), which anatomical structures are primarily visualized?

    <p>Maxillae and anterior nasal septum</p> Signup and view all the answers

    What is the required angulation for the central ray in the Caldwell Method (PA axial projection)?

    <p>15° caudad</p> Signup and view all the answers

    During the Waters Method (Parieto-Acanthial Projection), what angle should the OML be positioned in relation to the image receptor?

    <p>37°</p> Signup and view all the answers

    Which projection would be most beneficial for assessing lateral displacement of nasal bone fragments?

    <p>Tangential Projection</p> Signup and view all the answers

    What is the primary purpose of the Submentovertical Projection (SMV) in zygomatic arches imaging?

    <p>To display the zygomatic arch's full profile</p> Signup and view all the answers

    What positioning is required for the chin in the Modified Waters Method?

    <p>Chin on IR</p> Signup and view all the answers

    Which projection is described by a 30° caudad angle directed to the center of the orbits?

    <p>PA Axial Projection</p> Signup and view all the answers

    What is a key imaging feature observed in the Lateral Projection of facial bones?

    <p>Depressed fracture of frontal sinus</p> Signup and view all the answers

    In the Reverse Waters Method, which aspect must be adjusted for trauma patients?

    <p>CR angle</p> Signup and view all the answers

    What angle should the OML be positioned at during the Modified Waters Method?

    <p>55° to IR</p> Signup and view all the answers

    Which projection is primarily used for visualizing the petrous ridges below the orbital shadows?

    <p>Modified Waters Method</p> Signup and view all the answers

    Which positioning detail is specific to the PA Axial Projection?

    <p>Forehead and nose grounded on IR</p> Signup and view all the answers

    What structure is best demonstrated using the Waters Method?

    <p>Maxillary sinuses</p> Signup and view all the answers

    What angle is used for the vertex in the Modified Titterington Method to visualize zygomatic arches?

    <p>23-38°</p> Signup and view all the answers

    In the Modified Towne Method, what is the required angle of the central ray relative to the OML?

    <p>35° to 42° caudad</p> Signup and view all the answers

    What positioning is crucial in a Tangential Projection for patients with depressed fractures?

    <p>Neck hyperextended</p> Signup and view all the answers

    What essential anatomy is highlighted in the PA Axial Projection for the mandibular body?

    <p>Mandibular symphysis</p> Signup and view all the answers

    Which method employs the technique of skimming the zygomatic arch?

    <p>Tangential Projection</p> Signup and view all the answers

    In the Axiolateral Oblique Projection, what is the necessary rotation of the head toward the image receptor for visualizing the body?

    <p>30°</p> Signup and view all the answers

    What positioning is advised for the Submentovertical Projection (SMV)?

    <p>Supine with neck fully extended</p> Signup and view all the answers

    Which projection is primarily concerned with the temporomandibular joint (TMJ)?

    <p>Modified Law Method</p> Signup and view all the answers

    What is the angulation of the central ray for the Inferosuperior Transfacial Position?

    <p>30° cephalad</p> Signup and view all the answers

    During the Modified Towne Method for imaging the TMJ, where is the central ray directed?

    <p>3 inches above the nasion</p> Signup and view all the answers

    For the PA Axial Projection of the mandibular symphysis, what angulation is typically employed?

    <p>40° to 45° posteriorly</p> Signup and view all the answers

    What is a key feature demonstrated in the Tangential Projection for patients with flat cheekbones?

    <p>Zygomatic arch free of superimposition</p> Signup and view all the answers

    What specific structure does the Schuller Method aim to visualize in the Axiolateral Projection?

    <p>Mandibular fossa</p> Signup and view all the answers

    In the PA Projection for the mandibular body, where should the central ray be directed?

    <p>At the acanthion</p> Signup and view all the answers

    What is the correct angulation of the central ray in the Caldwell Method (PA axial Projection)?

    <p>15° caudad</p> Signup and view all the answers

    Which position is used for the Law Method (PA oblique axial Projection)?

    <p>Semiprone</p> Signup and view all the answers

    What anatomical structures are primarily demonstrated in the Tangential Projection for nasal bones?

    <p>Medial or lateral displacement of fragments</p> Signup and view all the answers

    In the Waters Method (Parieto-Acanthial Projection), what is the required angulation of the MML relative to the IR?

    <p>37°</p> Signup and view all the answers

    During the Submentovertical (SMV) Projection, what position should the neck be in?

    <p>Hyperextended</p> Signup and view all the answers

    What is the primary position of the chin for the Modified Waters Method?

    <p>Chin on IR</p> Signup and view all the answers

    In the PA Axial Projection, where should the central ray be directed?

    <p>Below the inferior margin of the orbits</p> Signup and view all the answers

    Which projection is described as the best method for demonstrating facial bones?

    <p>Waters Method</p> Signup and view all the answers

    What is the recommended angle for the OML in the Modified Waters Method?

    <p>55° to IR</p> Signup and view all the answers

    Which positioning technique should be applied when imaging a trauma patient in the Reverse Waters Method?

    <p>Adjust the central ray instead of the part</p> Signup and view all the answers

    What is the probable position of the petrous ridge in the Modified Waters Method?

    <p>Below the inferior border of orbits</p> Signup and view all the answers

    Which projection is specifically designed to visualize the zygomatic arches without distortion?

    <p>Modified Towne Method</p> Signup and view all the answers

    During the Parietoacanthial Projection, Modified Waters Method, what angle should be used for MML to IR?

    <p>37°</p> Signup and view all the answers

    What is the required angle for the central ray in the Modified Towne Method for the condyloid processes of the mandible?

    <p>30° to 42° caudad</p> Signup and view all the answers

    In the PA Axial Projection for the mandibular symphysis, where is the central ray directed?

    <p>At the acanthion</p> Signup and view all the answers

    During the Axiolateral Oblique Projection, which direction should the patient's head be rotated to visualize the mandibular body?

    <p>30° toward the IR</p> Signup and view all the answers

    What is the recommended central ray angle for the Tangential Projection of the zygomatic arch?

    <p>15° toward the side examined</p> Signup and view all the answers

    In the Schuller Method for TMJ imaging, what is the required angle of the central ray?

    <p>20° to 25° caudad</p> Signup and view all the answers

    What positioning is required for demonstrating the condyle and neck in the modified Law Method?

    <p>MSP at 15° to the IR</p> Signup and view all the answers

    For the Verticosubmental Projection, where should the vertex be placed in relation to the image receptor?

    <p>In contact with the IR</p> Signup and view all the answers

    What is the positioning of the IOML relative to the IR in the Submentovertical Projection?

    <p>Parallel to the IR</p> Signup and view all the answers

    In the Modified Titterington Method, where should the central ray be directed?

    <p>Midway between zygomatic arches</p> Signup and view all the answers

    What is the appropriate inclination of the central ray in the PA axial projection for the mandibular body?

    <p>30° caudad</p> Signup and view all the answers

    What additional method is recommended for improving contrast in TMJ imaging?

    <p>Utilizing an air-filled mouth</p> Signup and view all the answers

    When positioning the patient for the May Method, how should the neck be set?

    <p>Neck hyperextended</p> Signup and view all the answers

    In the Axiolateral Oblique Projection, what adjustment is made for muscular or hypersthenic patients?

    <p>MSP tilted an additional 15°</p> Signup and view all the answers

    What is the proper angulation of the central ray in the Caldwell Method?

    <p>15° caudad</p> Signup and view all the answers

    In the Law Method (PA oblique axial projection), which area is primarily visualized?

    <p>External orbital wall</p> Signup and view all the answers

    During the Waters Method (Parieto-Acanthial Projection), what is the recommended positioning of the MML?

    <p>IIR</p> Signup and view all the answers

    What is a contraindication for performing a Tangential Projection of the nasal bones?

    <p>Patients with short nasal bones</p> Signup and view all the answers

    In the Submentovertical (SMV) Projection, how should the neck be positioned?

    <p>Hyperextended</p> Signup and view all the answers

    What is the appropriate positioning of the petrous ridge in the Modified Waters Method?

    <p>Within the maxillary sinus</p> Signup and view all the answers

    Which projection is best suited for visualizing a depressed fracture of the frontal sinus?

    <p>Lateral Projection of facial bones</p> Signup and view all the answers

    In the PA Axial Projection, where should the central ray be directed?

    <p>Centered at the orbits</p> Signup and view all the answers

    What is the main purpose of the Reverse Waters Method?

    <p>To demonstrate the relationship of superior facial bones</p> Signup and view all the answers

    Which angle is required for the OML in the Modified Waters Method?

    <p>37°</p> Signup and view all the answers

    For the Lateral Projection of facial bones, what is the orientation of the IOMI relative to the IR?

    <p>Parallel</p> Signup and view all the answers

    What positioning should be adopted for the chin in the reverse Waters method?

    <p>Chin up with MML parallel to IR</p> Signup and view all the answers

    In the PA Axial Projection, how should the forehead and nose be positioned?

    <p>Resting on the IR</p> Signup and view all the answers

    What is the primary focus of the Modified Towne Method for TMJ imaging?

    <p>Condyloid processes of the mandible</p> Signup and view all the answers

    What is the angle at which the central ray is directed in the PA Axial Projection for the mandibular symphysis?

    <p>40° to 45° posteriorly</p> Signup and view all the answers

    In the Tangential Projection for flat cheek bones, what should the top of the head be tilted away from?

    <p>The side being examined</p> Signup and view all the answers

    Which of the following projections allows for assessment of fractures and dislocation of the mandible?

    <p>Panoramic Tomography</p> Signup and view all the answers

    Which method requires the patient's neck to be hyperextended?

    <p>May Method</p> Signup and view all the answers

    What structure should be visualized in the Lateral Projection to assess the TMJ?

    <p>Uppermost TMJ</p> Signup and view all the answers

    During the Modified Law Method, to what angle should the head be rotated to visualize the symphysis?

    <p>30° toward the IR</p> Signup and view all the answers

    What is the angle of cephalad direction required for the Axiolateral Oblique Projection of the body and ramus of the mandible?

    <p>25° cephalad</p> Signup and view all the answers

    In the Submentovertical (SMV) Projection, which anatomical landmark should be aligned with the film?

    <p>Vertex</p> Signup and view all the answers

    What is the central ray angle in degrees required for the PA Axial Projection of the mandibular rami?

    <p>20°-25° cephalad</p> Signup and view all the answers

    What positioning should the neck be in for the Inferosuperior Transfacial Position?

    <p>Neck extended</p> Signup and view all the answers

    What minimum distance should the zygomatic arch be from the outer canthus in the May Method?

    <p>1 1/2 inches</p> Signup and view all the answers

    What is the key indication for utilizing the Schuller Method in TMJ imaging?

    <p>To locate the condyle in the mandibular fossa</p> Signup and view all the answers

    What should be positioned parallel to the IR during the Submentovertical Projection?

    <p>IOML</p> Signup and view all the answers

    What is the positioning of the patient's chin in the Modified Titterington Method?

    <p>Chin on IR</p> Signup and view all the answers

    Which structure is NOT demonstrated by the Law Method (PA oblique axial projection)?

    <p>Petrous ridge</p> Signup and view all the answers

    In the Caldwell Method, what is the correct angulation of the central ray?

    <p>15° caudad</p> Signup and view all the answers

    What is the appropriate positioning of the patient's head during the Waters Method (Parieto-Acanthial Projection)?

    <p>OML perpendicular to IR</p> Signup and view all the answers

    Which projection involves positioning the patient's neck hyperextended?

    <p>Submentovertical Projection (SMV)</p> Signup and view all the answers

    What should the chin position be for the Law Method (PA oblique axial projection)?

    <p>Chin resting on the IR</p> Signup and view all the answers

    What is the required orientation of the MSP in the Lateral Projection for facial bones?

    <p>Parallel to the IR</p> Signup and view all the answers

    What projection is best for visualizing a depressed fracture of the frontal sinus?

    <p>Lateral Projection</p> Signup and view all the answers

    In the Modified Waters Method, what is the angle between the OML and the IR?

    <p>37 degrees</p> Signup and view all the answers

    What is the angle of the central ray in the PA Axial Projection?

    <p>30 degrees caudad</p> Signup and view all the answers

    During the Reverse Waters Method, how is the chin positioned?

    <p>Chin up</p> Signup and view all the answers

    What anatomical structure is visualized in the Waters Method below the maxillary sinuses?

    <p>Petrous ridge</p> Signup and view all the answers

    In the Modified Waters Method, which structure should the central ray exit?

    <p>Acanthion</p> Signup and view all the answers

    What effect does setting the OML at 55 degrees in the Modified Waters Method have?

    <p>Brings the petrous ridge within the maxillary sinus</p> Signup and view all the answers

    What is the positioning requirement for the neck in the Tangential Projection?

    <p>Neck hyperextended</p> Signup and view all the answers

    In the Modified Towne Method, where is the central ray angled towards?

    <p>35° to 42° caudad directed to the glabella</p> Signup and view all the answers

    What is the recommended positioning of the IOML in the Submentovertical (SMV) Projection?

    <p>Parallel to the IR</p> Signup and view all the answers

    Which projection is specifically indicated for patients with depressed fractures or flat cheekbones?

    <p>Tangential Projection</p> Signup and view all the answers

    What angle should the MSP be positioned at during the Modified Law Method?

    <p>15° towards the IR</p> Signup and view all the answers

    For the PA Axial Projection of the mandibular symphysis, where is the central ray directed?

    <p>At the acanthion</p> Signup and view all the answers

    What is the required angle for the cephalad direction in the PA Axial Projection of the mandible?

    <p>20° to 25°</p> Signup and view all the answers

    What positioning technique is utilized for the Modified Titterington Method?

    <p>Prone with chin on the IR</p> Signup and view all the answers

    Which of the following structures is best demonstrated using the Zanelli Method?

    <p>TMJ</p> Signup and view all the answers

    In the Schuller Method for TMJ imaging, what is the angling requirement?

    <p>25°-30° caudad</p> Signup and view all the answers

    What central ray angle is recommended for the Modified Towne Method for TMJ imaging?

    <p>35° caudad</p> Signup and view all the answers

    Which anatomy is critical to visualize in the PA Axial Projection of the mandibular body?

    <p>Mandibular corpus</p> Signup and view all the answers

    During the Verticosubmental Projection, what should be the positioning of the chin?

    <p>Resting on the IR</p> Signup and view all the answers

    What is the positioning of the patient for the Law Method (PA oblique axial projection)?

    <p>Semiprone with zygoma and nose angled cephalad</p> Signup and view all the answers

    In the Tangential Projection, what is the recommended orientation of the GAL (Glabella-Auricular Line)?

    <p>Parallel to the image receptor</p> Signup and view all the answers

    What critical angle is maintained for the Caldwell Method (PA axial projection)?

    <p>15° caudad</p> Signup and view all the answers

    What anatomical structures are demonstrated in the Waters Method (Parieto-Acanthial Projection)?

    <p>Zygomatic bone and inferior orbital margins</p> Signup and view all the answers

    What is a contraindication for performing a Tangential Projection regarding facial structure considerations?

    <p>Children or adults with short nasal bones</p> Signup and view all the answers

    What is the correct positioning of the patient's chin during the Modified Waters Method?

    <p>Chin positioned 1.9 cm from the grid</p> Signup and view all the answers

    In the PA axial projection, where should the central ray be directed?

    <p>At the center of the orbits</p> Signup and view all the answers

    During a lateral projection for facial bones, which structure should be aligned parallel to the image receptor?

    <p>Mid-sagittal plane (MSP)</p> Signup and view all the answers

    Which projection is recommended for imaging a blow-out fracture of the orbit?

    <p>Modified Waters Method</p> Signup and view all the answers

    What is the angle of the central ray in the Modified Waters Method?

    <p>37° cephalad</p> Signup and view all the answers

    What is the purpose of positioning the OML at a 55° angle in the Modified Waters Method?

    <p>To optimize visualization of the petrous ridge</p> Signup and view all the answers

    In a lateral projection, which of the following structures should not be superimposed?

    <p>Temporal bone</p> Signup and view all the answers

    Which projection requires the patient to be semiprone with the outer canthus positioned at the image receptor?

    <p>Lateral Projection</p> Signup and view all the answers

    What is the correct positioning of the patient's neck for a Tangential Projection aimed at the zygomatic arch?

    <p>Neck hyperextended with vertex on the IR</p> Signup and view all the answers

    Which angle is required for the central ray in the Modified Towne Method for TMJ imaging?

    <p>35° caudad</p> Signup and view all the answers

    For the May Method of zygomatic arch imaging, how is the patient's chin positioned?

    <p>Chin on the image receptor</p> Signup and view all the answers

    What is the correct angulation for the central ray in the PA axial projection of the mandibular body?

    <p>30° caudad</p> Signup and view all the answers

    What is the appropriate positioning of the patient's jaw for the Schuller Method in TMJ imaging?

    <p>Open mouth and closed mouth for both exposures</p> Signup and view all the answers

    In a Submentovertical (SMV) projection, which anatomical landmark is aligned at the center of the image receptor?

    <p>Gonion</p> Signup and view all the answers

    What is a key feature of the Verticosubmental Projection?

    <p>Demonstrates the condyle and neck</p> Signup and view all the answers

    Which method positions the patient with the neck fully extended and requires the IOML to be parallel to the image receptor?

    <p>Submentovertical Projection</p> Signup and view all the answers

    What is the purpose of using the Modified Titterington Method?

    <p>To demonstrate the zygomatic arches</p> Signup and view all the answers

    In the Panoramic Tomography technique, which of the following is primarily assessed?

    <p>Complete dental arch panorama</p> Signup and view all the answers

    How far above the nasion is the central ray pointed in the Modified Towne Method for TMJ imaging?

    <p>3 inches</p> Signup and view all the answers

    What positioning is necessary for patients with suspected fractures or dislocations when using Panoramic Tomography?

    <p>Seated upright with head straight</p> Signup and view all the answers

    Which projection requires tilting the top of the head 15° away from the side of examination?

    <p>Tangential Projection</p> Signup and view all the answers

    What structures are demonstrated in the Caldwell Method (PA axial Projection)?

    <p>Anatomical details of the orbital rims and petrous ridges</p> Signup and view all the answers

    Which angle is utilized for the chin in the Law Method (PA oblique axial Projection)?

    <p>25-30° cephalad</p> Signup and view all the answers

    Which projection performs a superior-inferior view for nasal bone assessment?

    <p>Tangential Projection</p> Signup and view all the answers

    In the Waters Method (Parieto-Acanthial Projection), what is the positioning of the facial structures relative to the IR?

    <p>OML is perpendicular</p> Signup and view all the answers

    What specific anatomy is targeted in the Submentovertical Projection (SMV) of the zygomatic arches?

    <p>Zygomatic arches and maxillary sinus</p> Signup and view all the answers

    What is the positioning of the outer canthus in the lateral projection?

    <p>It should be aligned with the affected side on the image receptor.</p> Signup and view all the answers

    In the PA axial projection, what anatomical structures are centered?

    <p>Petrous portions</p> Signup and view all the answers

    What angle should the OML be positioned at during the Waters method (Parieto-Acanthial Projection)?

    <p>37°</p> Signup and view all the answers

    Which projection is best for visualizing a blowout fracture of the orbital floor?

    <p>Modified Waters Method</p> Signup and view all the answers

    What is the required positioning of the MML in the Modified Waters Method?

    <p>Parallel to the image receptor</p> Signup and view all the answers

    What structure lies below the orbital shadows in the Modified Waters Method?

    <p>Petrous ridge</p> Signup and view all the answers

    In a lateral projection of facial bones, which structures should be superimposed?

    <p>Mandibular rami</p> Signup and view all the answers

    What specific adjustment should be made for trauma patients in the Reverse Waters Method?

    <p>Adjust the CR instead of the part.</p> Signup and view all the answers

    What is the primary purpose of the Modified Towne Method in imaging?

    <p>Demonstrating the condyloid processes of mandible</p> Signup and view all the answers

    Which projection requires the patient to hyperextend their neck?

    <p>Tangential Projection</p> Signup and view all the answers

    In the PA Axial Projection of the mandibular symphysis, how should the chin be positioned?

    <p>Chin protruded forward</p> Signup and view all the answers

    For the Schuller Method of TMJ imaging, what is the recommended angle of the central ray?

    <p>25-30° caudad</p> Signup and view all the answers

    What is the positioning of the neck during the Submentovertical Projection?

    <p>Neck fully extended</p> Signup and view all the answers

    Which projection is specifically indicated for patients with depressed fractures or flat cheekbones?

    <p>Tangential Projection</p> Signup and view all the answers

    What is emphasized in the imagery of the Mandibular Body in the PA Axial Projection?

    <p>Mandibular body</p> Signup and view all the answers

    During the Modified Law Method for TMJ imaging, what angle should the central ray be directed?

    <p>15° caudad</p> Signup and view all the answers

    What anatomical feature is primarily demonstrated by the Schuller Method?

    <p>Temporomandibular joints</p> Signup and view all the answers

    Which modification in the imaging technique involves placing the IOML parallel to the IR?

    <p>Submentovertical Projection</p> Signup and view all the answers

    In the Tangential Projection, how far behind the outer canthus should the central ray be aimed?

    <p>1 inch</p> Signup and view all the answers

    What type of projection is the Modified Titterington Method classified as?

    <p>PA Projection</p> Signup and view all the answers

    Which technique is primarily used for producing panoramic images of the mandible?

    <p>Panoramic Tomography</p> Signup and view all the answers

    Which structures are demonstrated in the Caldwell Method (PA axial projection)?

    <p>Maxillae and zygomatic bone</p> Signup and view all the answers

    What is the angulation of the central ray in the Law Method (PA oblique axial projection)?

    <p>25-30° cephalad</p> Signup and view all the answers

    Which positioning is indicated for the Waters Method (Parieto-Acanthial Projection)?

    <p>Head in a fully extended position with MML perpendicular to the IR</p> Signup and view all the answers

    Which projection can be contraindicated for patients with short nasal bones?

    <p>Tangential Projection</p> Signup and view all the answers

    In the Submentovertical Projection (SMV), which part of the head must be hyperextended?

    <p>Vertex</p> Signup and view all the answers

    What is the recommended angle for the OML in the Modified Waters Method?

    <p>55°</p> Signup and view all the answers

    In the Lateral Projection for facial bones, which structure is best visualized?

    <p>Zygomatic bones</p> Signup and view all the answers

    What is the required position of the chin in the Reverse Waters Method?

    <p>Extended upwards</p> Signup and view all the answers

    Which projection centers on the orbits and requires a 30° caudad angle?

    <p>PA Axial Projection</p> Signup and view all the answers

    In the Parietoacanthial Projection, what anatomical area should the petrous pyramids be positioned relative to?

    <p>Below the inferior border of the orbits</p> Signup and view all the answers

    What is the primary focus of the Modified Waters Method?

    <p>Maxillary sinuses</p> Signup and view all the answers

    Which projection involves the chin on the image receptor and the MSP perpendicular to the film?

    <p>Waters Method</p> Signup and view all the answers

    What is the position of the MSP in the Lateral Projection for facial bones?

    <p>Parallel to the IR</p> Signup and view all the answers

    What is the recommended angle for the vertex in the Modified Titterington Method?

    <p>23°-38°</p> Signup and view all the answers

    In the Tangential Projection, how should the neck be positioned?

    <p>Hyperextend</p> Signup and view all the answers

    Which projection is recommended for imaging the zygomatic arches critically, especially when a fracture is suspected?

    <p>Tangential Projection</p> Signup and view all the answers

    What positioning is indicated for the Modified Law Method of imaging the TMJ?

    <p>Semiprone with head in true lateral position</p> Signup and view all the answers

    When executing the PA Axial Projection for the mandibular body, what is the appropriate cephalad angle?

    <p>30°</p> Signup and view all the answers

    What is the best positioning of the chin during the Submentovertical Projection?

    <p>On the IR</p> Signup and view all the answers

    Which method requires the IOML to be parallel to the image receptor during the projection?

    <p>Verticosubmental Projection</p> Signup and view all the answers

    What is the specific entry point for the Schuller Method during TMJ imaging?

    <p>2 inches superior to the upside EAM</p> Signup and view all the answers

    In the Axiolateral Oblique Projection, what is the angle for the central ray when focusing on the body?

    <p>25° cephalad</p> Signup and view all the answers

    For the Modified Towne Method in TMJ imaging, where should the central ray be directed?

    <p>3 inches above nasion</p> Signup and view all the answers

    What positioning is required for obtaining a panoramic image of the mandible and TMJ in panoramic tomography?

    <p>Upright with neck extended and centered</p> Signup and view all the answers

    In the May Method (Tangential Projection), which angle should the chin be moved relative to the inner canthus?

    <p>1 1/2 inches posterior</p> Signup and view all the answers

    For the Inferosuperior Transfacial Position, which part of the patient's head is elevated?

    <p>Occipital region</p> Signup and view all the answers

    Which projection best demonstrates the coronoid processes of the mandible?

    <p>Verticosubmental Projection</p> Signup and view all the answers

    Study Notes

    Posterior to Outer Canthi

    • Best demonstrated using a bilateral symmetric zygomatic arch projection
    • Uses the Schuller/Pfeiffer method
    • Verticosub mento (VSM) projection can also be used to visualize the zygomatic arch

    Modified Titterington Method

    • Prone position
    • Nose and chin on the image receptor (IR)
    • MSP perpendicular to the IR
    • Vertex angle is 23-38° midway between the zygomatic arches
    • Well-demonstrated zygomatic arches

    Modified Towne Method

    • Supine position
    • MSP perpendicular to the IR
    • DML perpendicular to the IR
    • TOML perpendicular to the IR
    • CR directed 6/labella, 1 inch above nasion
    • 30° caudad angle for the Jug Handle view
    • 37° caudad angle for bilateral symmetric zygomatic arches free of superimposition
    • Unilateral zygomatic arch projections can also be performed

    Tangential Projection

    • Upright position
    • Neck hyperextended
    • Vertex on the IR
    • IOML parallel to to the IR
    • MSP angled 15° toward the side being examined
    • Head tilted 15° away from the side being examined
    • CR centered 1 inch posterior to the outer canthus
    • Zygomatic arch free from superimposition

    May Method

    • Prone position
    • Neck extended
    • Chin on the IR
    • 10MI parallel to the IR
    • MSP angled 15° away from the side examined
    • Top of head tiled 15° away
    • CR centered 1.5 inches posterior to the outer canthus
    • Zygomatic arch free from superimposition
    • Used for patients with depressed fractures or flat cheekbones

    Mandibular Symphysis

    • Seated, upright position
    • MSP perpendicular to the film
    • Chin extended forward
    • CR angled 40-45° posteriorly
    • Visualizes the mandibular symphysis, mental foramina, and roots of the lower teeth

    Mandibular Rami

    • Prone or seated position
    • Forehead and nose on the IR
    • OML perpendicular to the IR
    • MSP perpendicular to the IR
    • CR centered on the acanthion
    • Visualizes the mandibular body and rami
    • Useful for detecting medial or lateral displacement of fragments in fractures of the rami

    Mandibular Body

    • Prone position
    • Nose and chin on the IR
    • Mandibular symphysis parallel to the IR
    • AML perpendicular to the IR
    • MSP perpendicular to the IR
    • CR centered on the ul of the lips
    • Visualizes the mandibular body

    PA Axial Projection

    • Prone position
    • Forehead and nose on the IR
    • OML perpendicular to the IR
    • MSP perpendicular to the IR
    • CR angled 20-25° cephalad
    • CR centered on the acanthion
    • Visualizes the mandibular body, rami, and condylar processes
    • Used for medial or lateral displacement of fragments in fractures of the rami
    • Increased contrast
    • TMJ visualization
    • Filling the mouth with air

    Towne Method

    • Supine position
    • Chin tucked
    • OML perpendicular to the IR
    • TOML perpendicular to the IR
    • MSP perpendicular to the IR
    • CR angled 35-42° caudad
    • CR centered on the glabella
    • Visualizes: condyloid processes of the mandible, TM fossae
    • 40° angle visualizes the TM fossae and mastoid portion
    • Contraindications: not for trauma patients, mouth open and mandible protruded

    Axiolateral Oblique Projection

    • Seated, semiprone, or semisupine position
    • Head lateral
    • IPL perpendicular to the IR for the ramus
    • Head rotated 30° toward the IR for the body
    • Head rotated 45° toward the IR for the symphysis
    • CR angled 25° cephalad
    • Visualizes the desired portion of the mandible
    • Reduce the possibility of projecting the shoulder over the mandible

    Submentovertical Projection (SMV)

    • Upright or supine position
    • MSP perpendicular to the IR
    • Neck fully extended
    • Vertex on the IR
    • IOML parallel to the IR
    • CR centered midway between the gonion and 10ML
    • Visualizes the mandibular body, coronoid, and condylar processes of the rami

    Verticosubmental Projection

    • Prone position
    • MSP perpendicular to the IR
    • Chin on IR
    • IOML parallel to the IR
    • CR centered 10ML and posterior to the outer canthi
    • Visualizes: coronoid process, condyle and neck of the condylar processes

    Panoramic Tomography (Orthopantomography)

    • Rotational tomography technique employed to produce images of curved surfaces
    • Visualizes the entire mandible, TMJ, and dental arches
    • Useful for general survey studies of dental abnormalities
    • Adjuvant for pre-bone marrow transplant

    Temporomandibular Articulations

    • Supine position
    • MSP perpendicular to the IR
    • OML perpendicular to the IR
    • Closed mouth: posterior teeth in contact, not incisors
    • Open mouth: open as wide as possible, condyles carried out of mandibular fossa, petrosa on the condyle
    • CR angled 35° caudad
    • Centered 3 inches (7.6 cm) above nasion for the best TM fossae visualization
    • 5° angle visualizes the TMJ
    • Visualizes: condyles of mandible, mandibular fossae (temporal)
    • Contraindications: not for trauma patients, mouth open and mandible protruded

    Schuller Method

    • Semiprone position
    • Head lateral
    • Affected side on the IR
    • MSP parallel to the IR
    • IPL perpendicular to the IR
    • CR angled 25-30° caudad
    • CR centered 1/2 inch anterior and 2 inches superior to the upside EAM
    • Visualizes: TMJ, open mouth, closed mouth, condyle in mandibular fossa, condyle inferior to the articular tubercle

    Modified Law Method

    • Semiprone position
    • TMJ closed mouth
    • Open mouth
    • Use IR-changing tunnel or Bucky tray
    • Bilateral
    • MSP angled 15° towards the IR
    • IPL perpendicular to the IR
    • AML parallel to the IR
    • Cheek on the IR (1/2 inch anterior)
    • CR angled 15°, 1.5 inches caudad
    • Visualizes: condyles and neck (mandible), relationship between the superior mandibular fossa and the condyle, open and closed mouth

    Inferosuperior Transfacial Position

    • Semiprone position
    • True lateral
    • IPL angled 10-15° towards the IR
    • MSP angled 15° towards the IR
    • CR angled 30° cephalad
    • Visualizes: uppermost TMJ and gonion

    Albers-Schonberg Method

    • Semiprone position
    • True lateral
    • IPL perpendicular to the IR
    • MSP parallel to the IR
    • 10ML parallel to the IR
    • CR angled 20° cephalad
    • Visualizes: lower TMJ, lateral, in open and closed mouth positions

    Zanelli Method

    • Lateral recumbent position
    • Head in true lateral
    • Parietal region on the IR
    • MSP angled 30° towards the IR
    • CR centered on the uppermost gonion
    • Visualizes: TMJ

    Lateral Projection for Eye Localize Foreign Bodies

    • Semiprone position
    • Outer canthus of the affected side on the IR
    • MSP parallel to the IR
    • IPL perpendicular to the IR
    • CR centered on the outer canthus
    • R or L position
    • Non-grid, increased resolution, magnification

    PA Axial Projection for Eye Localize Foreign Bodies

    • MSP perpendicular to the IR
    • OML perpendicular to the IR
    • Forehead and nose resting on the IR
    • CR angled 30° caudad
    • Centered on the center of the orbits
    • Visualizes: petrous portions (temporal) below the inferior margin of the orbits

    Parietoacanthial Projection, Modified Waters Method

    • Chin on the IR
    • MSP perpendicular to the IR
    • DML angled 50° towards the IR
    • CR centered on the mid orbits
    • Visualizes: petrous pyramid below orbital shadows

    Facial Bones

    • Semiprone position
    • MSP parallel to the IR
    • IOML parallel to the IR
    • IPL perpendicular to the IR
    • R or L position
    • Centered on the zygoma/malar (between the outer canthus)
    • Visualizes: depressed fracture of the frontal sinus

    Facial Profile: Relationship Bony & Soft Tissue

    • Uses two films: one with intensifying screen (bone positive), one non-screen film (soft tissue negative)

    Waters Method

    • Prone position
    • MSP perpendicular to the IR
    • MML perpendicular to the IR
    • OML angled 37° towards the IR
    • Nose (3/4 inch) away from the grid
    • CRS MML parallel to the exit acanthion
    • Visualizes: orbits, maxillae, zygomatic arches, petrous ridge below maxillary sinuses

    Modified Waters Method

    • Prone position
    • MSP perpendicular to the IR
    • MML perpendicular to the IR
    • OML angled 55° towards the IR
    • CR centered on the acanthion
    • Visualizes: Petrous ridge below the inferior border of the orbits, petrous ridge within the maxillary sinus, orbital floor
    • Useful for diagnosing a blowout fracture

    Reverse Waters Method

    • Supine position
    • MSP perpendicular to the IR
    • MML perpendicular to the IR
    • Chin up
    • DML angled 37° towards the IR
    • CR centered on the acanthion
    • Visualizes: superior facial bones (magnified waters method)
    • For trauma patients, adjust the CR instead of the part. CR parallel to the MML.

    Caldwell Method

    • Prone position
    • Forehead and nose on the IR
    • MSP perpendicular to the IR
    • OML perpendicular to the IR
    • CR angled 15° towards the acanthion
    • Visualizes: orbital rims, maxillae, nasal septum, zygomatic bone, anterior nasal septum, petrous ridge, orbital floors

    Law Method

    • Semiprone position
    • Zygoma and nose on the IR
    • Chin on the IR (posterior gonion)
    • Unaffected side on the IR
    • OML perpendicular to the IR
    • CR angled 25-30° towards the lower antrum
    • Obsolete method
    • Visualizes: floor and posterior wall of the maxillary sinus on the down side, external orbital wall, zygomatic bone, anterior wall of the maxillary sinus on the upside

    Nasal Bones (STL Nose)

    • Semiprone position
    • MSP parallel to the IR
    • 10MI perpendicular the IR
    • IPL perpendicular to the IR
    • CR centered 1/2 inch above nasion
    • R or L position
    • Visualizes: nasal bones, soft tissue structures

    Tangential Projection (Superior-Inferior Projection)

    • Extraoral:
      • Prone position
      • Fully extended chin
      • MSP perpendicular to the IR
      • GAL perpendicular to the IR
    • Intraoral:
      • Supine position
      • Head elevated
      • MSP perpendicular to the film
      • CAL perpendicular to the film
    • CR parallel to GAL and nasal bone portion that extends beyond CAL
    • For demonstration: medial or lateral displacement of fragments in fractures
    • Contraindications: children or adults with short nasal bones, concave face, protruding upper teeth

    Waters Method (Parietoacanthial Projection)

    • Prone position
    • MSP perpendicular to the IR
    • MML perpendicular to the IR
    • DML angled 37°towards the IR
    • Nose 1.9 cm away from the IR
    • CR centered on the acanthion
    • Visualizes: displacement of bony nasal septum and depressed fractures of nasal wings

    Zygomatic Arches

    • Seated (upright) position
    • MSP perpendicular to the IR
    • 10MI parallel to the IR
    • Vertex of head on the IR
    • Neck hyperextended CR centered 1 inch above the inferior border of the zygomatic arches.
    • Visualizes: the zygomatic arches

    Lateral Projection (Eye)

    • semiprone position
    • outer canthus aligned with IR
    • affected side on IR
    • MSP parallel to IR
    • IPL perpendicular to IR
    • Superimposed orbital roofs
      • outer canthus aligns with R or L position
      • non-grid technique for higher resolution
      • magnified image

    PA Axial Projection (Eye)

    • MSP perpendicular to IR
    • OML perpendicular to IR
    • Forehead and nose resting on IR
    • 30° caudad angulation
    • Center of orbits aligned with CR
    • Petrous portions (temporal) below inferior margin of the orbits

    Parietoacanthial Projection (Modified Waters), (Eye)

    • Chin on IR
    • MSP perpendicular to IR
    • DML at 50° to IR
    • Midorbits clearly visualized
    • Petrous pyramid below orbital shadows

    Lateral Projection (Facial Bones)

    • semiprone position
    • MSP // IR
    • IOMI // IR
    • IPL perpendicular to IR
    • Best for visualizing depressed fractures of the frontal sinus
    • R or L position used
    • Zygoma/malar aligned with outer canthus
    • EAM used as landmark
    • Superimposed facial bones:
      • superimposed mandibular rami
      • orbital roofs
      • zygomatic bone
      • Centered, avoiding rotation
      • Sella turcica visible

    Facial Profile (Facial Bones)

    • Two films used for visualization:
      • Film with intensifying screen - bone positive
      • Non-screen film - soft tissue negative

    Waters Method (Parieto-Acanthial Projection)

    • Prone position
    • MSP perpendicular to IR
    • MML perpendicular to IR
    • OML at 37° to IR
    • Nose 1.9cm away from grid
    • CRS MML exiting through acanthion
    • Best projection for visualizing facial bones:
      • orbits
      • maxillae
      • zygomatic arches
      • Petrous ridge below maxillary sinuses

    Modified Waters Method (Modified Parietoacanthial Projection)

    • Prone position
    • MSP perpendicular to IR
    • MML perpendicular to IR
    • OML at 55° to IR
    • CR directed at Acanthion
    • 35° CR
    • Petrous ridge below inferior border of orbits
    • Petrous ridge within maxillary sinus
    • Orbital floor perpendicular to CR
    • Inferior displacement of orbital floor and opacified maxillary sinus
    • Ideal for visualizing blow-out fx

    Reverse Waters Method (Acanthial-Parietal Projection)

    • Supine position
    • MSP parallel to IR
    • MML perpendicular to IR
    • Chin elevated
    • DML at 37° to IR
    • CR directed at Acanthion
    • Superior facial bones magnified
    • In a trauma patient adjust the CR instead of the part, aligning CR with MML

    Caldwell Method (PA Axial Projection)

    • Prone position
    • Forehead and nose on IR caudad
    • MSP perpendicular to IR
    • OML perpendicular to IR
    • 15° CR directed at acanthion
    • Visualizes:
      • Orbital rims
      • Maxillae
      • Nasal septum
      • Zygomatic bones
      • Anterior nasal septum
      • Petrous ridge - lower third of orbits
      • Petrous ridge - below inferior orbital margins
      • Orbital floors
    • Radiolucent forehead with 30° caudad angulation (Exaggerated Caldwell)

    Law Method (PA Oblique Axial Projection)

    • Semiprone position
    • Zygoma and nose cephalad
    • Chin on IR at posterior gonion
    • Unaffected side on IR
    • OML perpendicular to IR
    • 25° - 30° CR directed towards lower antrum
    • Obsolete technique
    • Visualizes:
      • Floor and posterior wall of maxillary sinus on the side down
      • External orbital wall
      • Zygomatic bone
      • Anterior wall of maxillary sinus on the side up

    Nasal Bones (STL Nose)

    • Semiprone position
    • MSP parallel to IR
    • 10MI perpendicular to IR
    • IPL perpendicular to IR
    • CR directed 1/2 inch towards nasion
    • Visualizes:
      • Nasal bones
      • Soft tissue structures near the IR
    • R or L positioning
    • Use occlusal film

    Tangential Projection (Superior-Inferior Projection)

    • Extraoral IR:
      • Prone position
      • Fully extended chin
      • MSP perpendicular to IR
      • GAL perpendicular to IR
    • Intraoral film: Insert occlusal film 1 inch in the mouth
      • Supine position
      • Head elevated
      • MSP perpendicular to film
      • CAL perpendicular to film
    • CR parallel to GAL, aligning with the portion of the nasal bones that extend beyond the CAL
    • Demonstrates:
      • Medial or lateral displacement of fragments in fractures
    • Contraindications:
      • Children or adults with short nasal bones
      • Concave face
      • Protruding upper teeth

    Waters Method (Parieto-Acanthial Projection)

    • Prone position
    • MSP perpendicular to IR
    • MML perpendicular to IR
    • DML at 37° to IR
    • Nose 1.9 cm away from IR
    • CR directed at Acanthion
    • Demonstrates:
      • Displacement of the bony nasal septum
      • Depressed fractures of nasal wings

    Submentovertical Projection (SMV) (Zygomatic Arches)

    • Seated or upright position
    • MSP perpendicular to IR
    • 10MI parallel to IR
    • Vertex of head on IR
    • Neck hyperextended
    • CR directed 1 inch posterior to the outer canthi
    • Best demonstration of bilateral symmetric zygomatic arches
    • Schuller/Pfeiffer method
    • Reduced exposure factor
    • Verticosubmento (VSM) method

    Modified Titterington Method (PA Axial Superoinferior Projection)

    • Prone position
    • Nose and chin on IR
    • MSP perpendicular to IR
    • 23° - 38° CR angulated, vertex midway between zygomatic arches
    • Well visualized zygomatic arches

    Modified Towne Method (AP Axial Projection)

    • Supine position
    • MSP perpendicular to IR
    • DML perpendicular to IR
    • TOML perpendicular to IR
    • CR directed at glabella, 1 inch above nasion
    • 30° caudad angulation
    • 37° caudad angulation
    • Jug Handle view
    • Bilateral symmetric zygomatic arches without superimposition
    • Unilateral zygomatic arch, one side only

    Tangential Projection

    • Upright position
    • Neck hyperextended
    • Vertex on IR
    • IOML parallel to IR
    • MSP at 15° towards the side examined
    • Top of head tilted at 15° away from the side examied
    • CR directed at 10ML
    • Skims at zygomatic arch
    • CR directed 1 inch posterior to outer canthus
    • Zygomatic arch free from superimposition
    • Used for patients with depressed fractures or flat cheekbones

    May Method (Tangential Projection)

    • Prone position
    • Neck extended
    • Chin on IR
    • 10MI parallel to IR
    • MSP at 15° away from the side examined
    • Top of head tilted at 15° away from the side examined
    • CR directed 1 1/2 inch posterior to the outer canthus
    • Zygomatic arch free from superimposition
    • Used for patients with depressed fractures or flat cheekbones

    PA Axial Projection (occlusal film) (Mandibular Symphysis)

    • Seated or upright position
    • MSP perpendicular to film
    • Chin forward
    • 40°-45° posterior angulation
    • Between the lips and tip of the chin
    • Visualizes:
      • Mandibular symphysis
      • Mental foramina
      • Roots of lower teeth

    PA Projection (Mandibular Rami)

    • Prone or seated position
    • Forehead and nose on IR
    • OML perpendicular to IR
    • MSP perpendicular to IR
    • CR directed at acanthion
    • Visualizes: - Mandibular body - Rami
    • Used to identify medial or lateral displacement of fragments in fractures of the rami

    PA Axial Projection (Mandibular Rami)

    • Prone position
    • Forehead and nose on IR
    • OML perpendicular to IR
    • MSP perpendicular to IR
    • 20° - 25° cephalad angulation
    • CR directed at acanthion
    • Visualizes:
      • Mandibular body and rami
      • Condylar processes
    • Used to identify medial or lateral displacement of fragments in fractures of the rami

    PA Projection (Mandibular Body)

    • Prone position
    • Nose and chin on IR
    • Mandibular symphysis parallel to IR
    • AML perpendicular to IR
    • MSP perpendicular to IR
    • CR directed at the upper lip
    • Visualizes:
      • Mandibular body

    PA Axial Projection (Mandibular Body)

    • Prone position
    • Nose and chin on IR
    • Mandibular symphysis parallel to IR
    • AML perpendicular to IR
    • MSP perpendicular to IR
    • 30° cephalad angulation
    • CR directed midway between the TMJs
    • Visualizes:
      • Mandibular body
      • TMJs - inferior to mastoid process
    • Zanelli's recommendation for increased contrast:
      • TMJ
      • Fill the mouth with air

    Towne Method (AP Axial Projection) (Mandible)

    • Supine position
    • Chin tucked
    • OML perpendicular to IR
    • TOML perpendicular to IR
    • MSP perpendicular to IR
    • 35° to 42° caudad angulation
    • CR directed at glabella
    • Visualizes:
      • Condyloid processes of the mandible
      • TM fossae
    • 40° angulation:
      • TM fossae and mastoid portion
    • Jug Handle View
    • Bilateral symmetric zygomatic arches free of superimposition

    Axiolateral Oblique Projection (Mandible)

    • Seated, semiprone, semisuine position
    • Head in lateral position
    • IPL perpendicular to IR for the ramus
    • Rotate head 30° towards IR for the body
    • Rotate head 45° towards IR for the symphysis
    • Place desired portion of mandible parallel to IR
    • 25° cephalad angulation
    • Visualizes:
      • Mandibular region of interest
      • Mandibular body and rami
      • One half of the mandible perpendicular to the IR
    • Semisupine position: Use a wedge sponge
    • Muscular/hypersthenic patient: MSP at 15° - 10° cephalad to IR
    • Reduces possibility of projecting shoulder over mandible

    Submentovertical Projection (SMV) (Mandible)

    • Upright or supine position
    • MSP perpendicular to IR
    • Neck fully extended
    • Vertex on IR
    • IOML parallel to IR
    • CR directed at 10ML between gonions
    • Midway between the gonions
    • Visualizes:
      • Mandibular body
      • Coronoid
      • Condyloid processes of rami
    • Schuller/Pfeiffer method

    Verticosubmental Projection

    • Prone position
    • MSP perpendicular to IR
    • Chin on IR
    • IOML parallel to IR
    • CR directed at 10ML, posterior to outer canthi
    • Visualizes:
      • Coronoid processes
    • Schuller method
    • Aligned with occlusal plane
    • Better visualization of condyle and neck of the condylar processes

    Panoramic Tomography (Orthopantomography) - Rotational Tomography

    • Technique employed to produce tomograms of curved surfaces
    • Useful in suspected fractures and dislocations
    • Provides panoramic image of the entire mandible, TMJ, and dental arches
    • Distortion-free lateral image of the entire mandible
    • For patients with severe mandibular or TMJ trauma
    • Useful for survey studies of dental abnormalities
    • Adjuvant for pre-bone marrow transplant

    Modified Towne Method (AP Axial Projection) (Temporomandibular Articulations)

    • Supine position
    • MSP perpendicular to IR
    • OML perpendicular to IR
    • Closed-mouth - Posterior teeth in contact (not incisors)
    • Open-mouth:
      • Open as wide as possible
      • Condyles carried out of the mandibular fossa
      • Petrosa on condyle
    • 35° caudad angulation
    • CR directed 3 inches above nasion
    • Best demonstration of the TM fossae
    • CR angulation at 5° to 20°
    • Visualizes:
      • TMJ
      • Condyles of the mandible
      • Mandibular fossae (temporal)
        • Closed-mouth
        • Open-mouth
      • Condyle and temporomandibular articulation below pars petros
    • Contraindications:
      • Not for trauma patients
      • Mouth open and mandible protruded (jutted forward)

    Schuller Method (Axiolateral Projection)

    • Semiprone position
    • Head in lateral position
    • Affected side on IR
    • MSP parallel to IR
    • IPL perpendicular to IR
    • 25° - 30° caudad angulation
    • CR directed half an inch anterior and 2 inches superior to the upside EAM
    • TMJ - open mouth
    • TMJ - closed mouth - anterior to EAM
    • Visualizes: - Closed mouth - condyle in mandibular fossa - Open mouth - Condyle inferior to articular tubercle
    • R or L position
    • To localize TMJ: - Half an inch anterior to EAM - 1 inch inferior to EAM
    • 2 exposures: - Closed mouth - Open mouth (unless contraindicated)

    Modified Law Method (Axiolateral Oblique/Lateral/Transcranial/Axial Projection)

    • Semiprone position
    • TMJ - closed mouth
    • TMJ - open mouth
    • Use IR-changing tunnel or Bucky tray
    • Bilateral
    • MSP at 15° to IR
    • IPL perpendicular to IR
    • AML parallel to IR
    • Cheek on IR (1/2 inch anterior)
    • 15° caudad angulation 1 1/2 inches (3.8 cm)
    • Visualizes:
      • Condyles and neck of the mandible
      • Relation between superior mandibular fossa and condyle
      • To EAM:
        • Open mouth - mandibular fossa visualized
        • Open mouth - Inferior and anterior excursion of the condyle visualized
        • Closed mouth - Fractures of the neck and condyle of the ramus

    Inferosuperior Transfacial Position

    • Semiprone position
    • True lateral position
    • IPL at 10° - 15° to IR
    • MSP at 15° to IR
    • 30° cephalad angulation
    • Visualizes:
      • Uppermost TMJ
      • Gonion

    Albers-Schonberg Method (Lateral Transfacial Position)

    • Semiprone position
    • Head in true lateral position
    • IPL perpendicular to IR
    • MSP parallel to IR
    • 10ML parallel to IR
    • 20° cephalad angulation
    • Visualizes:
      • Lower TMJ
      • Lateral view in open and closed mouth positions

    Zanelli Method (Lateral Transfacial Position)

    • Lateral recumbent position
    • Head in true lateral position
    • Parietal region on IR
    • MSP at 30° to IR
    • CR directed at the uppermost gonion
    • Visualizes:
      • TMJ

    EYE Localize Foreign Bodies

    • Lateral Projection: Semiprone position with the affected side on the image receptor (IR). The outer canthus is aligned with the IR, the median sagittal plane (MSP) is parallel to the IR, and the infraorbital plane (IPL) is perpendicular to the IR. This projection offers superimposed orbital roofs and increased resolution. The position can be R or L. Magnification is used.
    • PA Axial Projection: MSP is perpendicular to the IR, the orbitomeatal line (OML) is perpendicular to the IR, the forehead and nose are resting on the IR. The central ray is angled 30° caudad and directed toward the center of the orbits. The petrous portions of the temporal bones are positioned below the inferior margin of the orbits. 
    • Parietoacanthial Projection, Modified Waters Method: This is a PA Projection used for partially displacing the petrous ridge. The chin is placed on the IR, the MSP is perpendicular to the IR, and the dorsomeatal line (DML) is angled 50° to the IR. The mid-orbits are targeted, with the petrous pyramids positioned below the orbital shadows. 

    Facial Bones

    • Lateral Projection: Semiprone position with the MSP parallel to the IR, infraorbitomeatal line (IOML) parallel to the IR, and the IPL perpendicular to the IR. This projection is ideal for demonstrating depressed fractures of the frontal sinus and offers detailed visualization of various facial bones. The position can be R or L.
    • Facial Profile: Two films are used – bone positive with intensifying screen and soft tissue negative with non-screen film, highlighting bone and soft tissue contrast.

    Waters Method (Parieto Acanthial Projection)

    • Prone position with the MSP perpendicular to the IR, MML perpendicular to the IR, OML angled 37° to the IR, and the nose (3/4) in (1.9cm) away from the grid. The CR exits the acanthion. This method is the best projection for demonstrating the orbits, maxillae, zygomatic arches, and petrous ridge below maxillary sinuses.  

    Modified Waters Method (Modified Parietoacanthial Projection)

    • Prone position with the MSP perpendicular to the IR, MML perpendicular to the IR, OML angled 55° to the IR. The CR is angled 35° caudad towards the acanthion. The petrous ridge is positioned below the inferior border of the orbits, often within the maxillary sinuses. The orbital floor is parallel to the CR. This method is useful for demonstrating blow-out fractures and inferior displacements of the orbital floor and opacified maxillary sinus. 

    Reverse Waters Method (Acanthial Parietal Projection)

    • Supine position with MSP parallel to the IR, MML perpendicular to the IR, the chin lifted upwards, and the DML angled 37° to the IR. The central ray is angled towards the acanthion. This method is designed to magnify the superior facial bones. When applied to trauma patients, the CR is adjusted instead of the patient's position, keeping the CR parallel to the MML.

    Caldwell Method (PA axial Projection)

    • Prone position with the forehead and nose against the IR, MSP perpendicular to the IR, and OML perpendicular to the IR. The central ray is angled 15° towards the acanthion. This method is best for demonstrating orbital rims, maxillae, nasal septum, zygomatic bone, and anterior nasal septum. The petrous ridge is positioned below the inferior margins of the orbits or in the lower third of the orbits. 

    Law Method (PA oblique Axial Projection)

    • Semiprone position with the zygoma and nose pointing cephalad, chin positioned on the IR at the posterior gonion, the unaffected side against the IR, and the OML perpendicular to the IR. The central ray is angled 25° to 30° for the lower antrum. This method, though obsolete, is helpful for demonstrating the floor and posterior wall of the maxillary sinus on the lower side, as well as the external orbital wall, zygomatic bone, and the anterior wall of the maxillary sinus on the upper side.

    Nasal Bones (STL nose)

    • Semiprone position with MSP parallel to the IR, 10MI perpendicular to the IR, and IPL perpendicular to the IR. The central ray is directed 1/2 inch more towards the nasion. This projection focuses on demonstrating the nasal bones and soft tissue structures. The position can be R or L. The occlusal film is used.

    Tangential Projection (Superior-Inferior Projection)

    • Extraoral IR: Prone position with the chin fully extended, MSP perpendicular to the IR, and GAL perpendicular to the IR.
    • Intraoral film: Supine position with the head elevated, MSP perpendicular to the film, and CAL perpendicular to the film. 

    Waters Method (Parieto-Acanthial Projection)

    • Prone position with the MSP perpendicular to the IR, MML perpendicular to the IR, DML angled 37° to the IR, and nose 1.9 cm away from the IR. The central ray is directed towards the acanthion. This method is useful for demonstrating displacements of the bony nasal septum or depressed fractures of the nasal wings.

    Zygomatic Arches

    • Submentovertical Projection (SMV): Seated or upright, MSP perpendicular to the IR, 10MI parallel to the IR, vertex against the IR, and the neck hyperextended. The central ray is directed 1 inch posterior to the outer canthi. This projection offers the best demonstration of symmetric zygomatic arches. 
    • Modified Titterington Method (PA axial Superoinferior Projection): Prone position with nose and chin resting on the IR, and MSP perpendicular to the IR. The central ray is angled 23° to 38° towards the vertex, midway between the zygomatic arches. Provides a clear view of the zygomatic arches.  

    Modified Towne Method (AP Axial Projection)

    • Supine position with MSP perpendicular to the IR, DML perpendicular to the IR, TOML perpendicular to the IR, and the central ray angled 30° to 37° caudad towards the glabella (6/labella, 1 inch above nasion). This method, also known as the Jug Handle view, offers a clear demonstration of bilateral symmetric zygomatic arches, free of superimposition. An alternate approach focuses on a single side, targeting the unilateral zygomatic arch. 

    Tangential Projection (For PT w/ depressed fx or flat cheek bones: ) 

    • Upright position with neck hyperextended, vertex resting on the IR, IOML parallel to the IR, and MSP angled 15° towards the examined side (top of head tilted 15° away). The central ray is angled towards the 10ML. This method is used when the patient has a depressed fracture or flattened cheekbones, allowing for the zygomatic arch to be shown free of superimposition.. 

    May Method (Tangential Projection)

    • Prone position with neck extended, chin on the IR, 10MI parallel to the IR, MSP angled 15° away from the examined side, and the top of the head tilted 15° away. The central ray is directed 1 1/2 inches posterior to the outer canthus. This method is useful for demonstrating the zygomatic arch free of superimposition.

    Mandibular Symphysis

    • PA Axial Projection: Seated or upright, MSP perpendicular to the film, the chin jutted forward. The central ray is angled 40° to 45° posteriorly. This method is used for visualizing the mandibular symphysis, mental foramina, and lower teeth roots.
    • PA Axial Projection (occlusal film): Seated or upright, MSP perpendicular to the film, with the chin extended forward. The central ray is angled 40° to 45° posteriorly. This method demonstrates the mandibular symphysis, mental foramina, and the root of the lower teeth.

    Mandibular Rami

    • PA Projection: Seated or prone with forehead and nose resting on the IR, OML perpendicular to the IR, and MSP perpendicular to the IR. The central ray is directed towards the acanthion. This projection is useful for demonstrating the mandibular body and rami. 
    • PA Axial Projection: Prone position with forehead and nose resting on the IR, OML perpendicular to the IR, and MSP perpendicular to the IR. The central ray is angled 20°-25° cephalad towards the acanthion. This projection is useful for demonstrating the mandibular body, rami, and condylar processes.

    Mandibular Body

    • PA Projection: Prone position with nose and chin resting on the IR, mandibular symphysis parallel to the IR, AML perpendicular to the IR, and MSP perpendicular to the IR. The central ray is directed towards the upper lip. This projection is used for visualizing the mandibular body.
    • PA Axial Projection: Prone position with nose and chin resting on the IR, mandibular symphysis parallel to the IR, AML perpendicular to the IR, and MSP perpendicular to the IR. The central ray is angled 30° cephalad towards the midpoint between the TMJs.
    • Increase contrast.
    • Fill the mouth with air.

    Towne Method (AP Axial Projectim)

    • Supine position with the chin tucked in, OML perpendicular to the IR, TOML perpendicular to the IR, and MSP perpendicular to the IR. The central ray is angled 35° to 42° caudad towards the glabella. This method, designed for visualizing the condyloid process of the mandible and the TM fossae, is more effective with a 40° angle, which offers a clear view of the TM fossae and mastoid portions. 

    Mandible

    • Axiolateral Oblique Projection: Seated, semiprone, or semisupine positions with the head in a lateral position. The IPL is perpendicular to the IR for the ramus, with the head rotated 30° for the body and 45° for the symphysis, ensuring the desired portion of the mandible is parallel to the IR. The central ray is angled 25° cephalad. This projection demonstrates the mandibular region of interest, body and rami.
    • Submentovertical Projection (SMV): Seated/upright or supine position, MSP perpendicular to the IR, neck fully extended, vertex resting on the IR with the IOML parallel to the IR. The central ray is angled towards the 10ML and the midpoint between the gonion. This projection offeres visualization of the mandibular body, coronoid, and condyloid processes of the rami. 
    • Verticosubmental Projection: Prone position, MSP perpendicular to the IR, chin resting on the IR, and the IOML parallel to the IR. The central ray is angled towards the 10ML, posterior to the outer canthi. This projection is useful for visualizing the coronoid processes and offers better demonstration of the condyle and neck of the condylar processes.

    Panoramic Tomography (Orthopantomography)

    Rotational Tomography

    • This technique is used to create images of curved surfaces.

    Temporomandibular Articulations

    • Modified Towne Method (AP axial Projection): Supine position, MSP perpendicular to the IR, OML perpendicular to the IR, jaw closed with posterior teeth in contact or open as wide as possible, with the condyles carried out of the mandibular fossa. The central ray is angled 35° caudad towards a point 3 inches above the nasion. This method provides an optimal view of the TM fossae. Variations in the angle (5°) can be used to focus on other aspects of the TMJ, allowing visualization of the condyles of the mandible, mandibular fossae, etc.  
    • Schuller Method (Axiolateral Projection): Semiprone position with the head in a lateral position, affected side facing the IR, MSP parallel to the IR, and IPL perpendicular to the IR. The central ray is angled 25° to 30° caudad, directed 1/2 inch anterior and 2 inches superior to the upside EAM. This method is commonly used to demonstrate both closed-mouth and open-mouth positions of the TMJ. 
    • Modified Law Method (Axiolateral Oblique/Lateral/Transcranial/ Axial Projection): Semiprone position with the TMJ in either closed or open mouth position, using an IR-changing tunnel or Bucky tray. The MSP is angled 15° to the IR. The central ray is angled 15° caudad, directed 1 1/2 inches towards the EAM. This projection offers visualization of the condyles and neck of the mandible as well as the relationship between superior mandibular fossa and the condyle.
    • Inferosuperior Transfacial Position: Semiprone position with the head in a true lateral position, IPL angled 10° to 15° to the IR, and MSP angled 15° to the IR. The central ray is angled 30° cephalad. This position is used for visualizing the uppermost TMJ and gonion.  
    • Albers-Schonberg Method (Lateral Transfacial Position): Semiprone position, true lateral view of the head, IPL perpendicular to the IR, MSP parallel to the IR, and 10ML parallel to the IR. The central ray is angled 20° cephalad. This projection offers visualization of the lower TMJ in both open and closed mouth positions.
    • 2anelli Method (Lateral Transfacial Position): Lateral recumbent position, head in true lateral view, parietal region against the IR, MSP angled 30° to the IR. The central ray is directed towards the uppermost gonion. This projection is useful for demonstrating the TMJ.  

    Lateral Projection

    • Semiprone position with outer canthus of the eye aligned with the IR
    • Affected side is placed on the cassette
    • MSP is parallel to the IR
    • IPL is perpendicular to the IR
    • Superimposed orbital roofs can be visualized on the image, with the outer canthus indicating the R or L position
    • Non-grid images are used for increased resolution and magnification

    PA Axial Projection

    • MSP is perpendicular to the IR
    • OML is perpendicular to the IR
    • Patient rests forehead and nose on the cassette
    • CR angled 30° caudad and centered on the orbits
    • Petrous portions of the temporal bone are projected below the inferior margin of the orbits

    Parietoacanthial Projection, Modified Waters Method

    • Chin is placed on the cassette
    • MSP is perpendicular to the IR
    • DML is angled 50° to the IR
    • Mid-orbits and the petrous pyramid are visualized below the orbital shadows

    Lateral Projection

    • Semiprone position with MSP parallel to the IR
    • IOMI and IPL are perpendicular to the IR
    • This projection provides the best visualization of depressed fractures of the frontal sinus
    • The zygoma and malar are visualized between the outer canthus and EAM
    • Superimposed facial bones include the mandibular rami, orbital roofs, and zygomatic bone
    • No rotation is required, and the sella turcica should be centered

    Facial Profile

    • Two films are used to visualize bony and soft tissue structures
    • An intensifying screen is used for bone positive images
    • A non-screen film is used for soft tissue negative images

    Waters Method (Parieto Acanthial Projection)

    • Prone position with MSP perpendicular to the IR
    • MML is perpendicular to the IR
    • OML is angled 37° to the IR
    • Nose is placed 1.9cm away from the cassette
    • CRS and MML are parallel to the exit point of the acanthion
    • This projection is considered the best for visualizing facial bones, including orbits, maxillae, zygomatic arches, and the petrous ridge below the maxillary sinuses

    Modified Waters Method (Modified Parietoacanthial Projection)

    • Prone position with MSP perpendicular to the IR
    • MML is perpendicular to the IR
    • OML is angled 55° to the IR
    • CR is angled 35° and directed to the acanthion
    • The petrous ridge is visualized below the inferior border of the orbits and within the maxillary sinus
    • The orbital floor is parallel to the CR
    • This projection is used to visualize inferior displacement of the orbital floor and opacified maxillary sinus, commonly seen in blowout fractures

    Reverse Waters Method (Acanthial Parietal Projection)

    • Supine position with MSP perpendicular to the IR
    • MML is perpendicular to the IR
    • Chin is elevated
    • DML is angled 37° to the IR
    • CR is directed to the acanthion
    • This projection provides a magnified view of the superior facial bones
    • For trauma patients, adjustments to the CR are made rather than the position of the part
    • CR is aligned parallel to the MML

    Caldwell Method (PA Axial Projection)

    • Prone position with forehead and nose resting on the cassette
    • MSP is perpendicular to the IR
    • OML is perpendicular to the IR
    • CR is angled 15° to the acanthion
    • This projection provides visualization of the orbital rims, maxillae, nasal septum, zygomatic bone, anterior nasal septum, and the petrous ridge
    • Petrous ridge is visualized in the lower third of the orbits and below the inferior orbital margins
    • The orbital floors are visualized

    Law Method (PA Oblique Axial Projection)

    • Semiprone position with the zygoma and nose positioned cephalad
    • Chin is placed on the cassette, aligned with the posterior gonion
    • Unaffected side is placed on the cassette
    • OML is perpendicular to the IR
    • CR is angled 25-30° to the lower antrum

    Nasal Bones (STL Nose)

    • Semiprone position with MSP parallel to the IR
    • 10MI is perpendicular to the IR
    • IPL is perpendicular to the IR
    • CR is directed 1/2 inch more superiorly from the nasion
    • This projection visualizes the nasal bones and soft tissue structures
    • R or L position is used
    • Occlusal film can be used

    Tangential Projection (Superior-Inferior Projection)

    • Extraoral IR: prone position with fully extended chin, MSP perpendicular to the IR, and GAL perpendicular to the IR
    • Intraoral film: supine position with head elevated, MSP perpendicular to the film, and CAL perpendicular to the film
    • The CR aligns with the GAL and the nasal bone portion that extends beyond the CAL
    • Used to visualize medial or lateral displacement of fragments in nasal bone fractures

    Waters Method (Parieto-Acanthial Projection)

    • Prone position with MSP perpendicular to the IR
    • MML is perpendicular to the IR
    • DML is angled 37° to the IR
    • Nose is placed 1.9cm away from the cassette
    • CR is directed to the acanthion
    • This projection is used to evaluate the displacement of the bony nasal septum and depressed fractures of the nasal wings

    Submentovertical Projection (SMV)

    • Seated upright position with MSP perpendicular to the IR
    • 10MI is parallel to the IR
    • Vertex of the head is placed on the cassette
    • Neck hyperextended
    • CR is directed 1 inch posterior to the outer canthi
    • Provides bilateral symmetrical visualization of the zygomatic arches

    Modified Titterington Method (PA Axial Superoinferior Projection)

    • Prone position with the nose and chin resting on the cassette
    • MSP is perpendicular to the IR
    • CR is angled 23-38° to the vertex, midway between the zygomatic arches
    • This projection provides clear visualization of the zygomatic arches

    Modified Towne Method (AP Axial Projection)

    • Supine position with MSP perpendicular to the IR
    • DML and TOML are perpendicular to the IR
    • CR is directed 1 inch above the nasion, 6/labella
    • CR angled 30° caudad or 37° caudad
    • This projection provides a visualization of the bilateral symmetrical zygomatic arches, free of superimposition
    • It is also referred to as the "Jug Handle View"
    • For unilateral zygomatic arch projections, only one side is visualized

    Tangential Projection

    • Upright position with neck hyperextended
    • Vertex is placed on the cassette
    • IOML is parallel to the IR
    • MSP is angled 15° toward the side being examined
    • Top of the head is tilted 15° away from the side being examined
    • CR is directed to the 10ML
    • This is used to visualize the zygomatic arch free of superimposition, especially for patients with depressed fractures or flat cheekbones

    May Method (Tangential Projection)

    • Prone position with neck extended
    • Chin is placed on the cassette
    • 10MI is parallel to the IR
    • MSP is angled 15° away from the side being examined
    • Top of the head is tilted 15° away from the side being examined
    • CR is directed 1 1/2 inches posterior to the outer canthus
    • This is used to visualize the zygomatic arch free of superimposition, especially for patients with depressed fractures or flat cheekbones

    PA Axial Projection (Occlusal Film)

    • Seated upright position with MSP perpendicular to the film
    • Chin forward
    • CR angled 40-45° posteriorly
    • This projection is used to visualize the mandibular symphysis, mental foramina, and roots of the lower teeth

    PA Projection

    • Prone or seated position with the forehead and nose resting on the cassette
    • OML is perpendicular to the IR
    • MSP is perpendicular to the IR
    • CR is directed to the acanthion
    • This projection shows the mandibular body and rami
    • Used to visualize medial or lateral displacement of fragments in fractures of the rami

    PA Axial Projection

    • Prone position with forehead and nose resting on the cassette
    • OML and MSP are both perpendicular to the IR
    • CR is angled 20-25° cephalad and directed to the acanthion
    • This projection shows the mandibular body, rami, and condylar processes
    • Used to visualize medial or lateral displacement of fragments in fractures of the rami

    PA Projection

    • Prone position with nose and chin resting on the cassette
    • Mandibular symphysis is parallel to the IR
    • AML is perpendicular to the IR
    • MSP is perpendicular to the IR
    • CR is directed to the ul of the lips
    • This projection is used to visualize the mandibular body

    PA Axial Projection

    • Prone position with nose and chin resting on the cassette
    • Mandibular symphysis is parallel to the IR
    • AML is perpendicular to the IR
    • MSP is perpendicular to the IR
    • CR is angled 30° cephalad and directed midway between the TMJ
    • This projection is used to visualize the mandibular body and TMJ
    • TMJs are visualized inferior to the mastoid process

    Towne Method (AP Axial Projection)

    • Supine position with chin tucked
    • OML and TOML are perpendicular to the IR
    • MSP is perpendicular to the IR
    • CR is angled 35-42° caudad and directed to the glabella
    • This projection is used to visualize the condyloid processes of the mandible and TM fossae
    • Angling the CR to 40° provides visualization of the TM fossae and mastoid portion
    • The projection is not suitable for trauma patients
    • Patients should avoid opening their mouths or protruding their mandibles

    Axiolateral Oblique Projection

    • Seated, semiprone, or semisupine position with the head in lateral position
    • IPL is perpendicular to the IR
    • Head is rotated 30° toward the IR for the body, and 45° for the symphysis
    • CR angled 25° cephalad
    • This projection is used to visualize the region of interest in the mandible
    • A wedge sponge may be used for semisupine positioning
    • MSP should be angled 15° to 10° cephalad to the IR for muscular or hypersthenic patients

    Submentovertical Projection (SMV)

    • Upright or supine position with MSP perpendicular to the IR
    • Neck is fully extended
    • Vertex is placed on the cassette
    • IOML is parallel to the IR
    • CR is directed to the 10ML, 6/n gonion, and midway between
    • This projection is used to visualize the mandibular body, coronoid, and condyloid processes of the rami

    Verticosubmental Projection

    • Prone position with MSP perpendicular to the IR
    • Chin placed on the cassette
    • IOML is parallel to the IR
    • CR is directed to the 10ML, posterior outer canthi
    • This projection is used to visualize the coronoid processes, condyle, and neck of the condylar processes

    Panoramic Tomography (Orthopantomography)

    • Rotational tomography used to produce mograms of curved surfaces
    • Valuable for patients suspected of fractures and dislocations
    • Provides a panoramic image of the entire mandible, TMJ, and dental arches
    • Provides a distortion-free lateral image of the entire mandible
    • Useful for general survey studies of dental abnormalities
    • Used as an adjuvant for pre-bone marrow transplant patients

    Modified Towne Method (AP Axial Projection)

    • Supine position with MSP perpendicular to the IR
    • OML is perpendicular to the IR
    • Closed-mouth: posterior teeth in contact
    • Open-mouth: mouth is opened as wide as possible, condyles are carried out of the mandibular fossa, and petrosa is on the condyle
    • CR is angled 35° caudad and directed 3 inches (7.6cm) above the nasion
    • This projection is best for visualizing the TM fossae
    • Angling the CR at 5° shows the TMJ
    • The condyles of the mandible, the mandibular fossae (temporal), and the condyle and temporomandibular articulation below the pars petros are visualized

    Schuller Method (Axiolateral Projection)

    • Semiprone position with the head in lateral position
    • Affected side is placed on the cassette
    • MSP is parallel to the IR
    • IPL is perpendicular to the IR
    • CR is angled 25-30° caudad and directed 1/2 inch anterior and 2 inches superior to the upside EAM
    • This projection visualizes the TMJ in both open and closed mouth positions
    • In the closed-mouth position, the condyle is in the mandibular fossa
    • In the open-mouth position, the condyle is inferior to the articular tubercle

    Modified Law Method (Axiolateral Oblique/Lateral/Transcranial/ Axial Projection)

    • Semiprone position with the TMJ in closed or open mouth position
    • Bilateral projections are used
    • MSP is angled 15° to the IR
    • IPL is perpendicular to the IR
    • AML is parallel to the IR
    • Cheek is placed on the IR (1/2 inch anterior)
    • CR is angled 15° caudad and directed 1 1/2 inches (3.8cm) to the EAM
    • This projection is used to visualize the condyles and neck of the mandible, as well as the relationship between the superior mandibular fossa and condyle
    • In the open-mouth position, the mandibular fossa, inferior and anterior excursion of the condyle, and fractures of the neck and condyle of the ramus are visualized
    • In the closed-mouth position, fractures of the neck and condyle of the ramus are visualized

    Inferosuperior Transfacial Position

    • Semiprone position with head in true lateral position
    • IPL is angled 10-15° to the IR
    • MSP is angled 15° to the IR
    • CR is angled 30° cephalad
    • This projection is used to visualize the uppermost TMJ and gonion

    Albers-Schonberg Method (Lateral Transfacial Position)

    • Semiprone position with the head in true lateral
    • IPL is perpendicular to the IR
    • MSP is parallel to the IR
    • 10ML is parallel to the IR
    • CR is angled 20° cephalad
    • This projection is used to visualize the lower TMJ in both open and closed mouth positions

    2anelli Method (Lateral Transfacial Position )

    • Lateral recumbent position with the head in true lateral
    • Parietal region is placed on the cassette
    • MSP is angled 30° to the IR
    • CR is directed to the uppermost gonion
    • This projection is used to visualize the TMJ

    Eye Localize Foreign Bodies

    • Lateral Projection
      • Semiprone Position: Affected side on image receptor (IR).
      • Outer Canthus Alignment: Outer canthus aligned with IR.
      • Superimposed Orbital Roofs: Outer canthus determines right or left position, non-grid, increased resolution, magnification.
      • Image Receptor Alignment: MSP parallel to IR, IPL perpendicular to IR.
    • PA Axial Projection
      • Image Receptor Alignment: MSP perpendicular to IR, OML perpendicular to IR.
      • Patient Position: Rest forehead and nose on IR.
      • Central Ray Direction: 30° caudad angled towards center of orbits.
      • Petrous Portion Positioning: Petrous portions below inferior margin of orbits.
    • Parietoacanthial Projection: (Modified Waters Method)
      • Patient Position: Chin on IR, MSP perpendicular to IR, DML 50° to IR.
      • Purpose: Displaces petrous ridge partially.
      • Imaging Area: Midorbits.
      • Petrous Positioning: Petrous pyramids below orbital shadows.

    Facial Bones

    • Lateral Projection
      • Patient Position: Semiprone, MSP parallel to IR, IOMI parallel to IR, IPL perpendicular to IR.
      • Best Depiction: Depressed fracture of frontal sinus.
      • Superimposed Structures: Mandibular rami, orbital roofs, zygomatic bone.
      • Image Receptor Alignment: Centered on the side of interest, no rotation.
    • Facial Profile (Bony & Soft Tissue):
      • Technique: Two films used - one for bony structures (intensifying screen), one for soft tissue (non-screen).

    Waters Method

    • Patient Position: Prone, MSP perpendicular to IR, MML perpendicular to IR, OML 37° to IR, nose 1.9 cm away from IR.
      • Central Ray Angulation: Central ray (CRS) aligns to MML and exits at acanthion.
      • Best Projection for Facial Bones: Orbits, maxillae, zygomatic arches, petrous ridge.
      • Petrous Ridge Positioning: Petrous ridge below maxillary sinuses.

    Modified Waters Method

    • Patient Position: Prone, MSP perpendicular to IR, MML perpendicular to IR, OML 55° to IR.
      • Central Ray Direction: 35° angled towards acanthion.
      • Petrous Ridge Positioning: Petrous ridge below inferior border of orbits and within maxillary sinus.
      • Orbital Floor Alignment: Orbital floor parallel to central ray.
      • Best Depiction: Blowout fractures (inferior displacement of orbital floor and opacified maxillary sinus).

    Reverse Waters Method

    • Patient Position: Supine, MSP parallel to IR, MML perpendicular to IR, chin up, DML 37° to IR.
      • Central Ray Direction: Angled towards acanthion.
      • Best Depiction: Superior facial bones.
      • Trauma Adjustments: Adjust the central ray direction instead of the patient position.

    Caldwell Method

    • Patient Position: Prone, forehead & nose resting on IR, MSP perpendicular to IR, OML perpendicular to IR.
      • Central Ray Direction: 15° angled towards acanthion.
      • Best Depiction: Orbital rims, maxillae, nasal septum, zygomatic bone, anterior nasal septum, petrous ridge.
      • Petrous Ridge Positioning: Petrous ridge lower third of orbits and below inferior orbital margins.
      • Radiolucent Forehead: 30° caudad (exaggerated Caldwell).

    Law Method

    • Patient Position: Semiprone (affected side down), chin on IR (posterior gonion), zygoma and nose cephalad, unaffected side on IR, OML perpendicular to IR.
      • Central Ray Direction: 25-30° angled towards lower antrum.
      • Best Depiction: Floor and posterior wall of the maxillary sinus (affected side), external orbital wall, zygomatic bone.

    Nasal Bones

    • Patient Position: Semiprone, MSP parallel to IR, 10MI perpendicular to IR, IPL perpendicular to IR.
      • Central Ray Direction: Angled towards nasion (1/2 inch).
      • Best Depiction: Nasal bones and surrounding soft tissues.
      • Image Receptor Placement: Near the IR.
      • Alternative Media: Occlusal film may be used.

    Tangential Projection

    • Extraoral Technique: Prone, fully extended chin, MSP perpendicular to IR, GAL perpendicular to IR.
    • Intraoral Technique: Supine, head elevated, MSP perpendicular to film, CAL perpendicular to film.
      • Central Ray Direction: Aimed parallel to the GAL, specifically the portion of the nasal bone extending beyond the CAL.
      • Best Depiction: Medial or lateral displacement of fragments in fractures.
      • Contraindications: Children or adults with short nasal bones, concave face, protruding upper teeth.

    Waters Method for Nasal Bones

    • Patient Position: Prone, MSP perpendicular to IR, MML perpendicular to IR, DML 37° to IR, nose 1.9 cm away from IR.
      • Central Ray Direction: Angled towards acanthion.
      • Best Depiction: Displacement of the bony nasal septum and depressed fracture of the nasal wings.

    Zygomatic Arches

    • Submentovertical Projection: (SMV)
      • Patient Position: Seated upright, head hyperextended, vertex on IR, MSP perpendicular to IR, 10MI parallel to IR.
      • Central Ray Direction: Angled 1 inch posterior to outer canthi.
      • Best Depiction: Bilateral symmetric zygomatic arches.
      • Alternative Name: Schuller/Pfeiffer method, Verticosubmento (VSM).
    • Modified Titterington Method: (PA Axial Superoinferior Projection)
      • Patient Position: Prone, nose and chin on IR, MSP perpendicular to IR.
      • Central Ray Direction: 23-38° angled towards vertex, midway between zygomatic arches.
      • Best Depiction: Zygomatic arches.

    Modified Towne Method

    • Patient Position: Supine, MSP perpendicular to IR, DML perpendicular to IR, TOML perpendicular to IR.
      • Central Ray Direction: 30° caudad, 37° caudad angled towards glabella (1 inch above nasion).
      • Best Depiction: Bilateral symmetric zygomatic arches without superimposition (Jug Handle view).
      • Unilateral Application: Can be used for one zygomatic arch only.

    Tangential Projection

    • Patient Position: Upright, neck hyperextended, vertex on IR, IOML parallel to IR, MSP 15° towards the side of interest, top of head tilted 15° away from the side of interest.
      • Central Ray Direction: Angled towards 10ML, skimming the zygomatic arch.
      • Best Depiction: Zygomatic arch without superimposition.

    May Method

    • Patient Position: Prone, neck extended, chin on IR, 10MI parallel to IR, MSP 15° away from the side of interest, top of head tilted 15° away from the side of interest.
      • Central Ray Direction: Angled 1 1/2 inches posterior to the outer canthus.
      • Best Depiction: Zygomatic arch without superimposition.

    Mandibular Symphysis

    • PA Axial Projection: (Occlusal film)
      • Patient Position: Seated upright, MSP perpendicular to film, chin forward.
      • Central Ray Direction: 40-45° angled posteriorly.
      • Best Depiction: Mandibular symphysis, mental foramina, roots of lower teeth.

    Mandibular Rami

    • PA Projection
      • Patient Position: Prone or seated, forehead and nose on IR, OML perpendicular to IR, MSP perpendicular to IR.
      • Central Ray Direction: Angled towards acanthion.
      • Best Depiction: Mandibular body and rami, for medial or lateral displacement of fragments in fractures.
    • PA Axial Projection
      • Patient Position: Prone, forehead and nose on IR, OML perpendicular to IR, MSP perpendicular to IR.
      • Central Ray Direction: 20-25° cephalad angled towards acanthion.
      • Best Depiction: Mandibular body & rami, condylar processes, for medial or lateral displacement of fragments in fractures.

    Mandibular Body

    • PA Projection
      • Patient Position: Prone, nose and chin IR (mandibular symphysis parallel to IR), AML perpendicular to IR, MSP perpendicular to IR.
      • Central Ray Direction: Angled towards the ul of the lips.
      • Best Depiction: Mandibular body.
    • PA Axial Projection
      • Patient Position: Prone, nose & chin IR (mandibular symphysis parallel to IR), AML perpendicular to IR, MSP perpendicular to IR.
      • Central Ray Direction: 30° cephalad angled midway between the TMJs.
      • Best Depiction: Mandibular body, TMJs (inferior to the mastoid process).
      • Zanelli Technique (Recommended): Increase contrast, TMJ, fill the mouth with air.
    • Towne Method: (AP Axial Projection)
      • Patient Position: Supine, chin tucked, OML perpendicular to IR, TOML perpendicular to IR, MSP perpendicular to IR.
      • Central Ray Direction: 35-42° caudad angled towards glabella.
      • Best Depiction: Condyloid processes of the mandible, TM fossae.
      • 40° Angulation: TM fossae and mastoid portion.

    Mandible

    • Axiolateral Oblique Projection
      • Patient Position: Seated or semiprone or semisupine (head lateral), IPL perpendicular to IR (ramus), rotate head 30° towards IR (body), rotate head 45° towards IR (symphysis).
      • Central Ray Direction: 25° cephalad.
      • Best Depiction: Mandibular region of interest (body & rami).
      • Patient Considerations: Use wedge sponge for semisupine positioning.
      • Positioning Adjustments: MSP 15-10° cephalad to IR, for muscular or hypersthenic patients.
      • Benefits: Reduces the possibility of projecting the shoulder over the mandible.

    Submentovertical Projection (SMV)

    • Patient Position: Upright or supine, MSP perpendicular to IR, neck fully extended, vertex on IR, IOML parallel to IR.
      • Central Ray Direction: 10ML, 6/n gonion.
      • Best Depiction: Mandibular body, coronoid, condyloid processes of rami.
      • Alternative Name: Schuller/Pfeiffer method.

    Verticosubmental Projection

    • Patient Position: Prone, MSP perpendicular to IR, chin on IR, IOML parallel to IR.
      • Central Ray Direction: 10ML, posterior outer canthi.
      • Best Depiction: Coronoid processes, condyle, neck condylar processes.
      • Alternative Name: Schuller method.

    Panoramic Tomography

    • Technique: Rotational tomography (used to produce mograms of curved surfaces).
    • Best Depiction: Overall view of the mandible, TMJ, dental arches.
    • Benefits: Distortion-free lateral image of the entire mandible.
    • Applications: Severe mandibular or TMJ trauma, dental abnormalities, bone marrow transplant
      • Caution: Distortion: Distortion in the panoramic image, particularly noticeable in the anterior mandible and soft tissues.

    Temporomandibular Articulations

    • Modified Towne Method: (AP Axial Projection)
      • Patient Position: Supine, MSP perpendicular to IR, OML perpendicular to IR, closed mouth- teeth in contact, open mouth- as wide as possible.
      • Central Ray Direction: 35° caudad, 3 inches (7. 6 cm ) above nasion.
      • Best Depiction: TM fossae, TMJ (condyle of mandible, mandibular fossa).
      • 5° Variation: TMJ.
      • Petrous Positioning: Condyles and temporomandibular articulation below pars petros.
      • Contraindications: Not for trauma; not for open mouth with protruded mandible.
    • Schuller Method: (Axiolateral Projection)
      • Patient Position: Semiprone (head lateral), MSP parallel to IR, IPL perpendicular to IR, affected side on IR.
      • Central Ray Direction: 25-30° caudad, 1/2 inch anterior and 2 inches superior to upside EAM.
      • Best Depiction: TMJ (open-mouth, closed-mouth).
      • Closed-Mouth Positioning: Condyle in mandibular fossa.
      • Open-Mouth Positioning: Condyle inferior to articular tubercle.
      • Positioning Technique: 1/2 inch anterior to EAM, 1 inch inferior to EAM for localization.
      • Recommended Exposures: Two exposures (closed-mouth, open-mouth if not contraindicated).
    • Modified Law Method: (Axiolateral Oblique/Lateral/Transcranial/Axial Projection)
      • Patient Position: Semiprone, TMJ (closed and open mouth), use IR- changing tunnel or Bucky tray, bilateral, MSP 15° to IR, IPL perpendicular to IR, AML parallel to IR, cheek on IR (1/2 inch anterior)
      • Central Ray Direction: 15° caudad, 1 1/2 inches (3.8 cm).
      • Best Depiction: Condyles & neck (mandible), relationship between superior mandibular fossa & condyle.
      • Open Mouth Positioning: Mandibular fossa, inferior and anterior excursion of condyle.
      • Closed Mouth Positioning: Fractures of neck and condyle of ramus.
    • Inferosuperior Transfacial Position:
      • Patient Position: Semiprone, true lateral, IPL 10-15° to IR, MSP 15° to IR.
      • Central Ray Direction: 30° cephalad.
      • Best Depiction: Uppermost TMJ, gonion.
    • Albers-Schonberg Method: (Lateral Transfacial Position)
      • Patient Position: Semiprone, true lateral, IPL perpendicular to IR, MSP parallel to IR, 10ML parallel IR.
      • Central Ray Direction: 20° cephalad.
      • Best Depiction: Lower TMJ, lateral view in open and closed-mouth positions.
    • Zanelli Method: (Lateral Transfacial Position)
      • Patient Position: Lateral recumbent, head true lateral, parietal region on IR, MSP 30° to IR.
      • Central Ray Direction: Angled towards uppermost gonion.
      • Best Depiction: TMJ.

    Eye Localize Foreign Bodies

    • Lateral Projection: Patient is semiprone with the affected side facing the image receptor (IR). The outer canthus is aligned with the IR. The medial sagittal plane (MSP) is parallel to the IR. The infraorbital plane (IPL) is perpendicular to the IR. This projection helps visualize the orbital roofs.

    • PA Axial Projection: Patient's MSP is perpendicular to the IR. The orbitomeatal line (OML) is perpendicular to the IR. The patient's forehead and nose are resting on the IR. The central ray (CR) is angled 30° caudad. The centering point for the CR is the center of the orbits, ensuring that the petrous portions (of the temporal bone) are positioned below the inferior margin of the orbits.

    • Parietoacanthial Projection, Modified Waters Method: This projection is essentially a PA projection with the petrous ridge partially displaced. Placing the chin firmly on the IR, the MSP is lateral to the IR. The DML (Dentomeatal Line) is angled 50° to the IR with the mid-orbits as the centering point. The petrous pyramid is visualized below the orbital shadows.

    Facial Bones

    • Lateral Projection: A semiprone position is employed with the MSP parallel to the IR. The infraorbitomeatal line (IOML) is parallel to the IR. The IPL perpendicular to the IR. This projection is ideal for showcasing a depressed fracture of the frontal sinus, revealing the zygoma/malar region between the outer canthus, and the external auditory meatus (EAM). This projection is not without limitations, as it also reveals superimposition of facial bones including the mandibular rami, orbital roofs, and zygomatic bone.

    • Facial Profile: This technique utilizes two films with intensifying screens for bone visualization and a non-screen film for soft tissue imaging. This method offers both bone positive and soft tissue negative images to thoroughly assess the relationship between bony structures and soft tissue.

    Waters Method (Parieto Acanthial Projection)

    • Patient is prone with the MSP perpendicular to the IR, and the MML (mentomeatal line) is perpendicular to the IR. The OML is angled 37° to the IR. The nose is positioned 1.9 cm away from the grid. The CR is directed through the MML, exiting at the acanthion. This projection provides a clear view of the orbits, maxillae, zygomatic arches, and the positioning of the petrous ridge below the maxillary sinuses.

    Modified Waters Method (Modified Parietoacanthial Projection)

    • Patient is prone with the MSP and MML perpendicular to the IR, and the OML angled 55° to the IR. The CR is angled 35° and directed through the acanthion. This projection is essential for visualizing the petrous ridge below the inferior border of the orbits and within the maxillary sinus. It offers a precise view of the orbital floor in relation to the IR and the CR, crucial for identifying blow-out fractures.

    Reverse Waters Method (Acanthial Parietal Projection)

    • The patient is supine with the MSP parallel to the IR, and the MML lateral to the IR. The chin is lifted, and the DML is angled 37° to the IR. The CR is directed towards the acanthion. This projection offers a magnified view of the superior facial bones, often utilized in trauma cases when the CR needs adjustment instead of repositioning the patient.

    Caldwell Method (PA Axial Projection)

    • Patient is prone with the forehead and nose resting on the IR. The MSP is perpendicular to the IR, and the OML is also perpendicular to the IR. The CR is angled 15° toward the acanthion. This method is valuable for studying orbital rims, maxillae, nasal septum, zygomatic bone, anterior nasal septum, and positioning of the petrous ridge in relation to the orbits. A 30° caudad angle can be used to enhance visualization of the forehead, creating an "exaggerated Caldwell" projection.

    Law Method (PA Oblique Axial Projection)

    • Patient is semiprone with the zygoma and nose directed cephalad. The chin is positioned on the IR facing the posterior gonion, with the affected side towards the IR. The OML is perpendicular to the IR. The CR is angled 25-30° towards the lower antrum.
      This method (now obsolete) offered an understanding of the floor and posterior wall of the maxillary sinus on the side facing down, along with the external orbital wall, zygomatic bone, and anterior wall of the maxillary sinus on the side facing up.

    Nasal Bones (STL Nose)

    • Patient is semiprone with the MSP parallel to the IR. The 10MI (10-meter inclination) is perpendicular to the IR. The IPL is lateral to the IR. The CR is directed 1/2 inch above the nasion, ensuring a clear view of the nasal bones and soft tissues.

    Tangential Projection (Superior-Inferior Projection)

    • Extraoral: The patient is prone with the chin fully extended. The MSP is perpendicular to the IR, with the GAL (Gonion-Acanthion Line) perpendicular to the IR.
    • Intraoral: The patient is supine with the head elevated. The MSP is perpendicular to the film, and the CAL (Cranial-Acanthion Line) is perpendicular to the film. An occlusal film is placed in the mouth. This projection is beneficial for identifying medial or lateral displacement of fragments in nasal bone fractures, but it has contraindications for patients with short nasal bones, concave faces, or protruding upper teeth.

    Waters Method (Parieto-Acanthial Projection)

    • Patient is prone with the MSP perpendicular to the IR. The MML is perpendicular to the IR, and the DML is angled 37° to the IR. The nose is positioned 1.9 cm away from the IR. The CR is directed towards the acanthion. This projection is useful for identifying displacement of the bony nasal septum and depressed fractures of the nasal wings.

    Zygomatic Arches

    • Submentovertical Projection (SMV): Patient is seated upright with the MSP lateral to the IR. The 10MI is parallel to the IR, and the vertex of the head is placed on the IR. The neck is hyperextended. The CR is directed 1 inch posterior to the outer canthi. This projection provides a symmetrical view of the zygomatic arches.

    • Modified Titterington Method (PA Axial Superoinferior Projection): Patient is prone with the nose and chin resting on the IR. The MSP is lateral to the IR. The CR is angled 23-38° towards the vertex, centered midway between the zygomatic arches, providing distinct visualization of the zygomatic arches.

    • Modified Towne Method (AP Axial Projection): Patient is supine with the MSP perpendicular to the IR. The DML perpendicular to the IR, and the TOML (temporomandibular line) perpendicular to the IR. The CR is angled 30° caudad and directed towards the glabella (located 1 inch above the nasion). This projection provides a symmetrical view of the zygomatic arches while minimizing superimposition.

    • Tangential Projection: Patient is upright with the neck hyperextended. The vertex is placed on the IR. The IOML is parallel to the IR. The MSP is angled 15° towards the side being examined, and the top of the head is tilted 15° in the opposite direction. The CR is directed towards the 10ML. This projection is employed when there is a suspected depressed fracture or flattening of the cheekbones.

    • May Method (Tangential Projection): The patient is prone with the neck extended. The chin is placed on the IR, and the 10MI is parallel to the IR. The MSP is angled 15° away from the side being examined, and the top of the head is tilted 15° in the opposite direction. The CR is directed 1 1/2 inches posterior to the outer canthus. This projection is also used to visualize the zygomatic arch without superimposition.

    Mandibular Symphysis

    • PA Axial Projection: Patient is seated upright with the MSP perpendicular to the occlusal film. The chin is protruded forward. The CR is angled 40-45° posteriorly. This projection allows visualization of the mandibular symphysis, mental foramina, and roots of the lower teeth.

    Mandibular Rami

    • PA Projection: Patient is prone/seated with the forehead and nose resting on the IR. The OML is perpendicular to the IR, and the MSP is perpendicular to the IR. The CR is directed towards the acanthion. This projection provides a view of the mandibular body and rami, useful for identifying medial or lateral displacement of fragments in rami fractures.

    • PA Axial Projection: Patient is prone with the forehead and nose resting on the IR. The OML is perpendicular to the IR, and the MSP is perpendicular to the IR. The CR is angled 20-25° cephalad and directed towards the acanthion. This projection offers a view of the mandibular body, rami, and condylar processes, useful for assessing medial or lateral displacement of fragments in rami fractures.

    Mandibular Body

    • PA Projection: Patient is prone with the nose and chin on the IR. The mandibular symphysis is parallel to the IR. The AML (Anterior Mandibular Line) is perpendicular to the IR, and the MSP is lateral to the IR. The CR is directed towards the upper lip. This projection is used to visualize the mandibular body.

    • PA Axial Projection: Patient is prone with the nose and chin resting on the IR. The mandibular symphysis is parallel to the IR. The AML is perpendicular to the IR, and the MSP is lateral to the IR. The CR is angled 30° cephalad, directed towards the midpoint between the TMJ. This projection provides a view of the mandibular body and the TMJ's (positioned inferior to the mastoid process).

    Mandibular

    • Axiolateral Oblique Projection: Patient is seated/semiprone/semisupine with the head positioned laterally. The IPL is perpendicular to the IR for visualizing the ramus. The head is rotated 30° towards the IR for the body and 45° towards the IR visualizing the symphysis. The CR is angled 25° cephalad. This projection provides a clear view of the mandibular region of interest, including the body and rami.

    • Submentovertical Projection (SMV): The patient is upright/supine with the MSP perpendicular to the IR. The neck is fully extended, and the vertex is on the IR. The IOML is parallel to the IR. The CR targets the 10ML, located 6/n gonion, and midway between them. This projection is useful for visualizing the mandibular body, coronoid, and condyloid processes of the rami.

    • Verticosubmental Projection: Patient is prone with the MSP perpendicular to the IR. The chin is placed on the IR. The IOML is parallel to the IR. The CR is directed towards the 10ML, targeting the posterior outer canthi. This projection is superior for demonstrating the coronoid processes, condyle, and neck of the condylar processes.

    Panoramic Tomography (Orthopantomography)

    • Rotational Tomography: A technique employed for producing a 2D image of curved surfaces. Used for diagnosis of suspected mandibular fracture, dislocations, or dental abnormalities.

    Temporomandibular Articulations

    • Modified Towne Method (AP Axial Projection): Patient is supine with the MSP perpendicular to the IR. The OML is perpendicular to the IR. For a closed mouth view, the posterior teeth are in contact. For an open mouth view, the mouth is opened as wide as possible.

    • The CR is angled 35° caudad and directed towards a point 3 inches above the nasion. This projection provides a detailed view of the TM fossae.

    • Schuller Method (Axiolateral Projection): Patient is semiprone with the head positioned laterally. The affected side is facing the IR. The MSP is parallel to the IR, and the IPL is perpendicular to the IR. The CR is angled 25-30° caudad, directed 1/2 inch anterior and 2 inches superior to the upside EAM.

    • Modified Law Method (Axiolateral Oblique/Lateral/Transcranial/ Axial Projection): Patient is semiprone with the TMJ either closed or open, using an IR-changing tunnel or Bucky tray for bilateral imaging. The MSP angle is 15° towards the IR. The IPL is perpendicular to the IR, and the AML is parallel to the IR. The cheek is positioned on the IR, 1/2 inch anterior to the EAM. The CR is angled 15° and 1 1/2 inches caudad. This projection is important for showcasing the condyle, neck, and relationship between the superior mandibular fossa and the condyle with respect to the EAM.

    • Inferosuperior Transfacial Position: Patient is semiprone in a true lateral position with the IPL angled between 10-15° to the IR. The MSP is angled 15° towards the IR. The CR is angled 30° cephalad. This method is used to portray the uppermost TMJ and gonion.

    • Albers-Schonberg Method (Lateral Transfacial Position): Patient is semiprone in a true lateral position with the IPL perpendicular to the IR. The MSP is parallel to the IR. The 10ML is parallel to the IR. The CR is angled 20° cephalad. This method is used for the lateral view of the lower TMJ in both open and closed mouth positions.

    • 2anelli Method (Lateral Transfacial Position): Patient is in a lateral recumbent position with the head in a true lateral position. The parietal region is on the IR. The MSP is angled 30° towards the IR. The CR is directed towards the uppermost gonion. This method is used to visualize the TMJ.

    Eye Localize Foreign Bodies

    • Lateral Projection - semiprone position, affected side on IR, outer canthus & MSP parallel to IR, IPL perpendicular to IR
    • Superimposed orbital roofs - outer canthus, R or L position, non-grid, increased resolution, magnification
    • PA Axial Projection - MSP & OML perpendicular to IR, rest forehead & nose on IR
    • 30° Caudad - center of orbits, petrous portions below inferior margin of orbits
    • Parietoacanthial Projection, Modified Waters Method - (PA Projection) displaces the petrous ridge in part, chin on IR, MSP parallel to IR, DML 50° to IR
    • Midorbits - Petrous pyramid below orbital shadows

    Facial Bones

    • Lateral Projection - semiprone position, MSP & IOMI parallel to IR, IPL perpendicular to IR, best for depressed fracture of frontal sinus
    • Superimposed Facial Bone - superimposed mandibular rami, orbital roofs, zygomatic bone, center, no rotation, sella turcica
    • Facial Profile - 2 films used, w/ intensifying screen (bone positive), nonscreen film (soft tissue negative)

    Waters Method (Parieto Acanthial Projection)

    • prone, MSP perpendicular to IR, MML perpendicular to IR, OML 37° to IR, nose 1.9cm from grid
    • CRS MML // exit acanthion - best projection for facial bones, orbits, maxillae, zygomatic arches, petrous ridge below maxillary sinuses
    • Modified Waters Method - prone, MSP perpendicular to IR, MML perpendicular to IR, OML 55° to IR
    • I Acanthion - 35° CR, petrous ridge below orbital border, petrous ridge within maxillary sinus, orbital floor parallel to CR, inferior displacement of orbital floor & opacified maxillary sinus, blow out fracture
    • Reverse Waters Method - supine, MSP parallel to IR, MML perpendicular to IR, chin up, DML 37° to IR
    • I Acanthion - for superior facial bones (magnified waters method), for trauma adjust CR instead of the part
    • Caldwell Method - prone, forehead & nose on IR caudal, MSP & OML perpendicular to IR
    • 15° Acanthion - orbital rims, maxillae, nasal septum, zygomatic bone, anterior nasal septum, petrous ridge below inferior orbital margins
    • Radiolucent forehead 30° caudad (exaggerated Caldwell)
    • Law Method - semiprone, zygoma & nose cephalad, chin on IR, unaffected side on IR, OML perpendicular to IR
    • 25-30° Lower antrum (Obsolete) - floor & posterior wall of maxillary sinus of side down, external orbital wall, zygomatic bone, anterior wall of maxillary sinus of side up

    Nasal Bones (STL nose)

    • semiprone, MSP parallel to IR, 10MI perpendicular to IR, IPL perpendicular to IR
    • I (1/2 in) more nasion - nasal bones, soft tissue structures, R or L position, occlusal film
    • Tangential Projection (Superior-Inferior Projection) - Extraoral IR: prone, fully extended chin, MSP perpendicular to IR, GAL perpendicular to IR
    • Intraoral film - insert occlusal 1 in mouth, supine, head elevated, MSP perpendicular to film, CAL perpendicular to film
    • // GAL nasal bone portion that extend beyond the CAL - for demo: medial or lateral displacement of fragments in fractures
    • Contraindications - children or adults w/ short nasal bones, concave face, protruding upper teeth
    • Waters Method - prone, MSP perpendicular to IR, MML perpendicular to IR, DML 37° to IR, nose 1.9cm away from IR
    • I Acanthion - displacement of bony nasal septum & depressed fx of nasal wings

    Zygomatic Arches

    • Submentovertical Projection (SMV) - seated, upright, MSP parallel to IR, 10MI parallel to IR, vertex head on IR, neck hyperextended
    • I 1in.posterior to outer canthi - best demo: bilateral symmetric zygomatic arches
    • Modified Titterington Method (PA axial Superoinferior Projection) - prone, nose & chin on IR, MSP parallel to IR
    • 23-38° vertex midway b/n zygomatic arches - well shown zygomatic arches
    • Modified Towne Method (AP axial Projection) - supine, MSP perpendicular to IR, DML & TOML perpendicular to IR
    • 6/labella (1 in above nasion) - 30° caudad, 37° caudad
    • Jug Handle view - bilateral symmetric zygomatic arches free of superposition, unilateral zygomatic arch - one side only
    • Tangential Projection (For PT w/ depressed fx or flat cheek bones) - upright, neck hyperextended, Vextex on IR, IOML parallel to IR, MSP 15° toward side of examined, top of head tilt 15° away
    • I 10ML - skim at zygomatic arch, 1 in posterior to outer canthus, zygomatic arch free from superimposition
    • May Method - prone, neck extended, chin on IR, 10MI parallel to IR, MSP 15° away from side examined, top of head tilt 15° away
    • I 1 1/2 in posterior to outer canthus - zygomatic arch free of superimposition, for PT w/ depressed fx or flat cheekbones

    Mandibular Symphysis

    • PA Axial Projection (occlusal film) - seated, upright, MSP perpendicular to film, chin forward
    • 40° to 45° posteriorly - mandibular symphysis, mental foramina, roots (lower lower)

    Mandibular Rami

    • PA Projection - prone or seated, forehead & nose on IR, OML & MSP perpendicular to IR
    • I Acanthion - mandibular body & rami, for medial or lateral displacement of fragments in fracture of rami
    • PA Axial Projection - prone, forehead & nose on IR, OML & MSP perpendicular to IR
    • 20°-25° cephalad - I Acanthion, mandibular body & rami, condylar processes, for medial or lateral displacement of fragments in fx of rami

    Mandibular Body

    • PA Projection - prone, nose & chin on IR, mandibular symphis parallel to IR, AML & MSP perpendicular to IR
    • I ul of lips - mandibular body
    • PA Axial Projection - prone, nose & chin on IR, mandibular symphysis parallel to IR, AML & MSP perpendicular to IR
    • 30° cephalad - midway b/n TMJ, mandibular body, TMJ's - inferior to mastoid process
    • Zanelli Recommended - ↑ contrast, TMJ, fill the mouth w/ air
    • Towne Method - supine, chin - tuck, OML, TOML, MSP perpendicular to IR
    • 35° to 42° caudad - Glabella, condyloid processes of mandible, tm fossae

    Mandible

    • Axiolateral Oblique Projection - seated, semiprone or semisupine, head lateral position, IPL perpendicular to IR, rotate head 30° toward IR for Body, rotate head 45° toward IR for Symphysis
    • 25° cephalad - mandibular region of interest, mandibular body & rami, 1/ to IR
    • Submentovertical Projection (SMV) - upright or supine, MSP perpendicular to IR, neck fully extended, vertex on IR, IOML parallel to IR
    • 10ML - 6/n gonion, midway b/n, mandibular body, coronoid, condyloid processes of rami
    • Verticosubmental Projection - prone, MSP perpendicular to IR, chin on IR, IOML parallel to IR
    • 10ML - posterior outer canthi, coronoid processes visible, schuller method, or occlusal plane, better demo: condyle & neck condylar processes

    Panoramic Tomography (Orthopantomography)

    • Rotational Tomography - technique employed to produced tomograms of curved surfaces
    • For fracture & dislocation suspected - panoramic image of the entire mandible, TMJ, dental arches, distortion-free lateral image of the entire mandible
    • Useful for general survey studies of dental abnormalities - adjuvant for pre-bone marrow transplant

    Temporomandibular Articulations

    • Modified Towne Method - supine, MSP perpendicular to IR, OML perpendicular to IR
    • 35° caudad - 3 in above nasion, best demo: tm fossae
    • 5° - tmJ, demo: condyles of mandible, mandibular fossae (temporal) - closed-mouth, open-mouth, condyle & temporomandibular articulation below pars petros
    • Contraindications - not for trauma pt, mouth open & mandible protruded
    • Schuller Method - Semiprone, head lateral, affected side on IR, MSP parallel to IR, IPL perpendicular to IR
    • 25-30° caudad - 1/2 in anterior, 2 in superior to upside EAM
    • To localize TMJ - 1/2 inch anterior EAM, 1 inch inferior EAM
    • 2 exposures - closed-mouth, open-mouth (unless contraindicated)
    • Modified Law Method - semiprone, TMJ closed or open mouth, bilateral, MSP 15° to IR, IPL perpendicular to IR, AML parallel to IR, cheek on IR (1/2 anterior)
    • 15° 1 1/2 in caudad* - condyles & neck (mandible), relation b/n superior mandibular fossa & condyle
    • Inferosuperior Transfacial Position - semiprone, true lateral, IPL 10 - 15° to IR, MSP 15° to IR
    • 30° cephalad - uppermost TMJ, gonion
    • Albers-Schonberg Method - semiprone, head in true lateral, IPL perpendicular to IR, MSP parallel to IR, 10ML parallel to IR
    • 20° cephalad - lower tmJ, lateral, in open & close mouth position
    • 2anelli Method - lateral recumbent, head in true lateral, parietal region on IR, MSP 30° to IR
    • I uppermost gonion - TMJ

    Eye Localize Foreign Bodies

    • Lateral Projection: Used for visualizing the orbital roof.
      • Patient is in semiprone position with the affected side facing the IR.
      • MSP is parallel to the IR, and IPL is perpendicular to the IR.
      • Superimposed orbital roofs, outer canthus, and non-grid image provide high resolution and magnification.
    • PA Axial Projection: Visualizes the orbits with 30° of caudad angulation.
      • MSP and OML perpendicular to the IR.
      • Patient rests forehead and nose on IR.
      • Petrous portions of the temporal bone are visualized below the inferior margin of the orbits.
    • Parietoacanthial Projection, Modified Waters Method: Provides a view of the midorbit, with the petrous pyramid positioned below the orbital shadow.
      • Patient's chin is on the IR with MSP perpendicular to the IR and DML angled at 50°.

    Facial Bones

    • Lateral Projection: Best for visualizing depressed fracture of the frontal sinus.
      • Patient is in semiprone position with MSP parallel and IOMI perpendicular to the IR.
      • Superimposed features include mandibular rami, orbital roofs, and zygomatic bone.
      • The projection maximizes visualization of the zygoma and malar area between the outer canthus.
    • Facial profile: Employing two films with intensifying screen (bone positive) and a nonscreen film (soft tissue negative) allows for comprehensive soft tissue and bony structure visualization.

    Waters Method (Parieto Acanthial Projection)

    • Often used for demonstrating facial bones, orbits, maxillae, and zygomatic arches.
      • Patient is prone with the MSP and MML perpendicular to the IR, and OML angled at 37°.
      • Nose is placed 1.9 cm away from the grid.
      • Petrous ridge is visualized below the maxillary sinuses.

    Modified Waters Method (Modified Parietoacanthial Projection)

    • Provides a view of the petrous ridge below the inferior border of the orbits.
      • Patient is prone with MSP and MML perpendicular to the IR, and OML angled at 55°.
      • CR is angled 35° and directed towards the acanthion.
      • Blowout fx is well demonstrated with the orbital floor parallel to the CR.

    Reverse Waters Method (Acanthial Parietal Projection)

    • Used to magnify the superior facial bones.
      • Patient is supine with MSP perpendicular and MML parallel to the IR.
      • Chin is raised, and DML is angled at 37° towards the acanthion.
      • CR should be parallel to the MML for trauma patients.

    Caldwell Method (PA axial Projection)

    • Demonstrates the orbital rims, maxillae, nasal septum, zygomatic bone, and anterior nasal septum.
      • Patient prone with forehead and nose on the IR, MSP and OML perpendicular to the IR.
      • CR is angled 15° towards the acanthion.
      • Petrous ridge is visualized below the inferior orbital margins.

    Law Method (PA oblique axial Projection)

    • Obsoleted method mainly used for demonstrating the floor and posterior wall of the maxillary sinus of the side facing down.
      • Patient is semiprone with zygoma and nose cephalad on the IR.
      • Chin is placed on the IR, and OML perpendicular to the IR.
      • CR is angled 25-30° towards the lower antrum.

    Nasal Bones (STL nose)

    • Provides a view of the nasal bones and surrounding soft tissue structures.
      • Patient is in semiprone position with MSP parallel to the IR, 10MI perpendicular to the IR, and IPL perpendicular to the IR.
      • The nasion is centered with the IR by placing the occlusal film 1/2 inch superior.

    Tangential Projection (Superior-Inferior Projection)

    • Used for demonstrating medial or lateral displacement of fragments in nasal bone fractures.
      • For extraoral IR, the patient is prone with the chin extended, MSP perpendicular and GAL perpendicular to the IR.
      • For intraoral film, the patient is supine with the head elevated, MSP perpendicular and CAL parallel to the film.

    Waters Method (Parieto-Acanthial Projection)

    • Shows displacement of bony nasal septum and depressed fx of nasal wings.
      • Patient is prone with MSP perpendicular, MML parallel to the IR, OML angled at 37°, nose 1.9 cm away from the IR.
      • CR angled towards the acanthion.

    Zygomatic Arches

    • Submentovertical Projection (SMV): Provides a view of the zygomatic arches, showing bilateral symmetry.
      • Patient is upright or seated with MSP perpendicular to the IR, 10MI parallel to the IR, vertex of head on IR, and neck hyperextended.
    • Modified Titterington Method (PA axial Superoinferior Projection): Visualizes the zygomatic arches with minimal superimposition.
      • Patient is prone with MSP perpendicular to the IR, and nose and chin on the IR.
      • CR is angled 23-38° towards the vertex, midway between the zygomatic arches.
    • Modified Towne Method (AP axial Projection): Provides a "jug handle" view of the zygomatic arches.
      • Patient is supine with MSP perpendicular to the IR, DML perpendicular to the IR, and TOML perpendicular to the IR.
      • CR is angled 30-37° towards the glabella.

    Tangential Projection (For PT w/ depressed fx or flat cheek bones)

    • Demonstrates the zygomatic arch without superimposition.
      • Patient is upright with neck hyperextended, vertex on the IR, IOML parallel to the IR,MSP angled 15° towards the examined side, and the top of the head tilted 15° away.

    May Method (Tangential Projection)

    • Similar to Tangential Projection, this method is also for patients with depressed fractures or flat cheekbones.
      • Patient is prone with neck extended, chin on IR, 10MI parallel to the IR, MSP angled 15° away from the examined side, and the top of the head tilted 15° away.
      • CR is angled 1 1/2 inches posterior to the outer canthus.

    Mandibular Symphysis

    • PA Axial Projection (occlusal film): Visualizes the mandibular symphysis and mental formanina.
      • Patient is seated with MSP perpendicular to the film.
      • Chin is protruded forward with CR angled 40-45° posteriorly.

    Mandibular Rami

    • PA Projection: Visualizes the mandibular body and rami, demonstrating medial or lateral displacement of fragments in ramus fractures.
      • Patient is prone/seated with forehead and nose on the IR, OML parallel to the IR, and MSP perpendicular to the IR.
      • CR is angled towards the acanthion.
    • PA Axial Projection: Similar to the PA projection, but with a 20-25° cephalad angulation for better visualization of the condylar processes.

    Mandibular Body

    • PA Projection: Demonstrates the mandibular body.
      • Patient is prone with nose and chin on the IR, mandibular symphysis parallel, AML perpendicular, MSP perpendicular to the IR.
      • CR is angled towards the ul of the lips.
    • PA Axial Projection: Similar to the PA projection, but with 30° cephalad angulation to visualize the TMJs.
      • CR is angled towards the midpoint between the TMJs.
    • Zanelli Recommended: This method improves contrast for TMJ visualization, achieved by filling the mouth with air.

    Towne Method (AP Axial Projectim)

    • Best for visualizing the condyloid processes of the mandible and TM fossae.
      • Patient is supine with chin tucked, OML perpendicular, TOML perpendicular, and MSP perpendicular to the IR.
      • CR is angled 35-42° caudad towards the glabella.

    Mandible

    • Axiolateral Oblique Projection: Provides a view of various sections of the mandible by rotating the head.
      • Patient is seated/semiprone/semisupine with head in a lateral position, IPL perpendicular to the IR.
      • CR is angled 25° cephalad and directed towards the desired portion of the mandible (body, ramus, or symphysis).
    • Submentovertical Projection (SMV): Visualizes the mandibular body, coronoid, and condyloid processes.
      • Patient is upright/supine with MSP perpendicular to the IR, neck fully extended, vertex on the IR, and IOML parallel to the IR.
    • Verticosubmental Projection: Demonstrates the coronoid processes, condyle, and neck of the condylar processes.
      • Patient is prone with MSP perpendicular to the IR, chin on the IR, and IOML parallel to the IR.

    Panoramic Tomography (Orthopantomography)

    • Rotational Tomography: This technique produces mograms of curved surfaces, useful for visualizing the entire mandible and TMJ.
      • Provides a distortion-free lateral image of the mandible.
      • Advised for patients with severe mandibular or TMJ trauma.

    Temporomandibular Articulations

    • Modified Towne Method (AP axial Projection): Shows the TM fossae, condyles of the mandible, and mandibular fossae (temporal).
      • Patient is supine with MSP perpendicular to the IR, OML perpendicular to the IR, and mouth either closed (posterior teeth in contact) or open (as wide as possible).
      • CR is angled 35° caudad towards a point 3 inches above the nasion.
    • Schuller Method (Axiolateral Projection): Provides a view of the TMJ in both open and closed mouth positions.
      • Patient is semiprone with head lateral, affected side facing the IR, MSP parallel, and IPL perpendicular to the IR.
      • CR is angled 25-30° caudad, 1/2 inch anterior, and 2 inches superior to the upside EAM.
    • Modified Law Method (Axiolateral Oblique/Lateral/Transcranial/ Axial Projection): Useful for evaluating condyles, neck of the mandible, relation between the superior mandibular fossa and condyle, and fractures of the neck or condyle of the ramus.
      • Patient is semiprone with TMJ closed or open mouth, MSP angled 15° towards the IR, IPL perpendicular to the IR, and AML parallel to the IR.
      • CR is angled 15° caudad towards the EAM.
    • Inferosuperior Transfacial Position: Visualizes the uppermost TMJ and gonion.
      • Patient is semiprone with true lateral position, IPL angled 10-15° towards the IR, and MSP angled 15° towards the IR.
      • CR is angled 30° cephalad.
    • Albers-Schonberg Method (Lateral Transfacial Position): Provides a lateral view of the lower TMJ in open and closed mouth positions.
      • Patient is semiprone with true lateral position, IPL perpendicular to the IR, MSP parallel to the IR, and 10ML parallel to the IR.
      • CR is angled 20° cephalad.
    • 2anelli Method (Lateral Transfacial Position ): Used for visualizing TMJ.
      • Patient is in lateral recumbent position with true lateral position, parietal region on IR, MSP angled 30° towards the IR.
      • CR is angled towards the uppermost gonion.

    Lateral Projection (EYE)

    • Semiprone position with the affected side on the image receptor (IR).
    • MSP (Midsagittal Plane) parallel to IR.
    • IPL (Inferior-Posterior Line) perpendicular to IR.
    • Superimposed orbital roofs can be visualized.

    PA Axial Projection (EYE)

    • MSP perpendicular to IR.
    • OML (Orbitomeatal Line) perpendicular to IR.
    • Forehead and nose are resting on the IR.
    • 30° caudad angle of the CR.
    • Center the CR on the orbits.
    • Petrous portions of the temporal bone are projected below the inferior margin of the orbits.

    Parietoacanthial Projection, Modified Waters Method (EYE)

    • Chin on IR.
    • MSP perpendicular to IR.
    • DML (Dentomeatal Line) at 50° to IR.
    • Petrous pyramid is projected below the orbital shadows.

    Lateral Projection (Facial Bones)

    • Semiprone position with MSP parallel to IR.
    • IOMI (Inferior-Outer Margin of Orbit) parallel to IR.
    • IPL perpendicular to IR.
    • Ideal for demonstrating depressed fracture of the frontal sinus.
    • Superimposed facial bones include mandibular rami, orbital roofs, zygomatic bone.

    Facial Profile Projection

    • Utilizes two films: one with intensifying screen for bone visualization, and one without screen for soft tissue visualization.

    Waters Method (Parieto Acanthial Projection)

    • Prone position with MSP perpendicular to IR.
    • MML (Mandibulomeatal Line) perpendicular to IR.
    • OML at 37° to IR.
    • Nose is positioned 1.9 cm away from the grid.
    • Demonstrates orbits, maxillae, zygomatic arches, petrous ridge.

    Modified Waters Method (Modified Parietoacanthial Projection)

    • Prone position with MSP perpendicular to IR.
    • MML perpendicular to IR.
    • OML at 55° to IR.
    • CR directed at Acanthion with a 35° angle.
    • Shows petrous ridge below the inferior border of orbits and within the maxillary sinus.
    • Ideal for visualizing blowout fractures.

    Reverse Waters Method (Acanthial Parietal Projection)

    • Supine position with MSP parallel to IR.
    • MML perpendicular to IR.
    • Chin lifted with DML at 37° to IR.
    • CR directed at Acanthion.
    • Magnifies superior facial bones.

    Caldwell Method (PA Axial Projection)

    • Prone position with forehead and nose on the IR.
    • MSP perpendicular to IR.
    • OML perpendicular to IR.
    • CR directed 15° cephalad to Acanthion.
    • Demonstrates orbital rims, maxillae, nasal septum, zygomatic bone, and petrous ridge.
    • 30° caudad angle of the CR exaggerated Caldwell view.

    Law Method (PA Oblique Axial Projection)

    • Semiprone position with zygoma and nose cephalad.
    • Chin on IR with the affected side on the IR.
    • OML perpendicular to IR.
    • CR angled 25-30° to the lower antrum.
    • Demonstrates the floor and posterior wall of the maxillary sinus.
    • No longer commonly used.

    Nasal Bones (STL Nose)

    • Semiprone position with MSP parallel to IR.
    • 10MI (10-inch Midline) perpendicular to IR.
    • IPL perpendicular to IR.
    • CR directed ½ inch superior to nasion.
    • Utilizes occlusal film.

    Tangential Projection (Superior-Inferior Projection)

    • Prone position with MSP perpendicular to IR and GAL (Glabello-Alveolar Line) perpendicular to IR.
    • May also be performed intraorally with occlusal film.
    • Demonstrates medial or lateral displacement of nasal bone fragments.
    • Not recommended for children or adults with short nasal bones.

    Waters Method (Parieto-Acanthial Projection)

    • Prone position with MSP perpendicular to IR.
    • MML perpendicular to IR.
    • DML at 37° to IR.
    • Nose 1.9 cm away from the IR.
    • CR directed at Acanthion.
    • Evaluates for displacement of bony nasal septum and depressed nasal wing fractures.

    Submentovertical Projection (SMV) (Zygomatic Arches)

    • Seated or upright position with MSP perpendicular to IR.
    • 10MI parallel to IR.
    • Vertex of head on IR.
    • Best demonstrates symmetrical zygomatic arches.

    Modified Titterington Method (PA Axial Superoinferior Projection)

    • Prone position with nose and chin on the IR.
    • MSP perpendicular to IR.
    • CR angled 23-38° to the vertex midway between the zygomatic arches.
    • Visualizes zygomatic arches.

    Modified Towne Method (AP Axial Projection)

    • Supine position with MSP perpendicular to IR.
    • DML perpendicular to IR.
    • TOML (temporomandibular line) perpendicular to IR.
    • CR angled 30° caudad towards glabella.
    • Demonstrates zygomatic arches, condyloid processes of mandible, and temporomandibular fossa.

    Tangential Projection (For Patients with Depressed Fractures)

    • Upright position with neck hyperextended.
    • Vertex of head on IR.
    • IOML parallel to IR.
    • MSP angled 15° toward the side of examination.
    • Head tilted 15° away from examined side.
    • CR directed along 10ML.
    • Visualizes zygomatic arch free of superimposition.

    May Method (Tangential Projection)

    • Prone position with neck extended.
    • Chin on IR.
    • 10MI parallel to IR.
    • MSP angled 15° away from the side of examination.
    • Head tilted 15° away from examined side.
    • CR directed 1.5 inches posterior to the outer canthus.
    • Shows zygomatic arch free of superimposition.

    PA Axial Projection (Occlusal Film) (Mandibular Symphysis)

    • Seated or upright position with MSP perpendicular to film.
    • Chin forward.
    • CR angled 40-45° posteriorly.
    • Demonstrates mandibular symphysis, mental foramina, and tooth roots.

    PA Projection (Mandibular Rami)

    • Prone or seated position with forehead and nose on the IR.
    • OML perpendicular to IR.
    • MSP perpendicular to IR.
    • CR directed at Acanthion.
    • Visualizes mandibular body and rami.

    PA Axial Projection (Mandibular Rami)

    • Prone position with forehead and nose on the IR.
    • OML perpendicular to IR.
    • MSP perpendicular to IR.
    • CR angled 20-25° cephalad to Acanthion.
    • Demonstrates mandibular body, rami, and condylar processes.

    PA Projection (Mandibular Body)

    • Prone position with nose and chin on IR.
    • Mandibular symphysis parallel to IR.
    • AML (Anterior Mandibular Line) perpendicular to IR.
    • MSP perpendicular to IR.
    • CR directed at the upper lip.
    • Shows mandibular body.

    PA Axial Projection (Mandibular Body)

    • Prone position with nose and chin on IR.
    • Mandibular symphysis parallel to IR.
    • AML perpendicular to IR.
    • MSP perpendicular to IR.
    • CR angled 30° cephalad to the midpoint between the TMJ's.
    • Demonstrates mandibular body and TMJ's.

    Towne Method (AP Axial Projection)

    • Supine position with chin tucked.
    • OML perpendicular to IR.
    • TOML perpendicular to IR.
    • MSP perpendicular to IR.
    • CR angled 35-42° caudad to Glabella.
    • Visualizes condyloid processes of mandible, TM fossae, and mastoid portion.

    Axiolateral Oblique Projection (Mandible)

    • Seated, semiprone, or semisupine position.
    • Head in lateral position with the desired portion of mandible parallel to IR.
    • CR angled 25° cephalad.
    • Body, symphysis, or ramus can be visualized depending on rotation of the head.

    Submentovertical Projection (SMV) (Mandible)

    • Upright or supine position with MSP perpendicular to IR.
    • Neck fully extended.
    • Vertex of head on IR.
    • IOML parallel to IR.
    • CR directed at the point 6/n the gonion (angle of mandible).

    Verticosubmental Projection

    • Prone position with MSP perpendicular to IR.
    • Chin on IR.
    • IOML parallel to IR.
    • CR directed at the point 6/n the posterior outer canthi or the occlusal plane.
    • Demonstrates coronoid and condylar processes.

    Panoramic Tomography (Orthopantomography)

    • Rotational tomography technique for curved surfaces.
    • Provides a comprehensive image of the mandible, TMJ, and dental arches.
    • Useful for trauma, dental abnormalities, and pre-bone marrow transplant studies.

    Modified Towne Method (AP Axial Projection) (Temporomandibular Articulations)

    • Supine position with MSP perpendicular to IR.
    • OML perpendicular to IR.
    • Mouth closed or open.
    • CR angled 35° caudad towards 3 inches above the nasion.
    • Demonstrates TM fossae, condyles, and articulation.
    • Contraindicated in trauma patients or those with a protruded mandible.

    Schuller Method (Axiolateral Projection)

    • Semiprone position with affected side on IR.
    • MSP parallel to IR.
    • IPL perpendicular to IR.
    • CR angled 25-30° caudad.
    • Visualizes TMJ in both open and closed mouth positions.
    • Requires two exposures - closed mouth and open mouth.

    Modified Law Method (Axiolateral Oblique/Lateral/Transcranial/ Axial Projection)

    • Semiprone position with TMJ either open or closed.
    • MSP angled 15° to IR.
    • IPL perpendicular to IR.
    • AML parallel to IR.
    • Cheek on IR (½ inch anterior).
    • CR angled 15° caudad.
    • Ideal for visualizing condyles, neck of mandible, and fracture of the neck and condyle of the ramus.

    Inferosuperior Transfacial Position

    • Semiprone position with IPL 10-15° to IR.
    • MSP angled 15° to IR.
    • CR angled 30° cephalad.
    • Demonstrates the uppermost TMJ and gonion.

    Albers-Schonberg Method (Lateral Transfacial Position)

    • Semiprone position with head in true lateral.
    • IPL perpendicular to IR.
    • MSP parallel to IR.
    • 10ML parallel to IR.
    • CR angled 20° cephalad.
    • Shows the lower TMJ in both open and closed mouth positions.

    2anelli Method (Lateral Transfacial Position)

    • Lateral recumbent position with head in true lateral.
    • Parietal region on IR.
    • MSP angled 30° to IR.
    • CR directed at the uppermost gonion.
    • Demonstrates TMJ.

    EYE Localize Foreign Bodies

    • Lateral Projection:

      • Position the patient semiprone with the affected side on the image receptor (IR).
      • Ensure the midsagittal plane (MSP) is parallel to the IR and the infraorbital-meatal line (IOML) is perpendicular to the IR.
      • This projection allows for the superposition of orbital roofs, which are better visualized in the outer canthus.
      • Non-grid technique enhances resolution and magnification.

    • PA Axial Projection:

      • Position the patient with the MSP perpendicular to the IR and OML parallel to the IR.
      • Ensure the forehead and nose rest comfortably onto the IR.
      • Use a 30° caudad angle, centering the central ray (CR) on the orbits.
      • This projection allows for the visualization of the petrous portions (temporal bones) below the inferior margin of the orbits.

    • Parietoacanthial Projection, Modified Waters Method:

      • Place the patient's chin on the IR with the MSP parallel to the IR.
      • Directs the CR at a 50° angle to the IR, targeting the mid-orbits.
      • This projection displaces the petrous ridge, showcasing the petrous pyramid below the orbital shadows.

    Facial Bones

    • Lateral Projection:

      • Position the patient semiprone with the MSP parallel to the IR, the infraorbital-meatal line (IOML) parallel to the IR, and the infraorbital-meatal line (IOML) perpendicular to the IR.
      • This projection is best for visualizing depressed fractures of the frontal sinus.
      • Key anatomical landmarks include the zygoma/malar region, the external auditory meatus (EAM), and the superimposed facial bones like the mandibular rami, orbital roofs, and zygomatic bones.

    • Facial Profile:

      • Use two films:
        • One film with an intensifying screen to enhance bone visibility.
        • A non-screen film to visualize soft tissue details.
        • This method allows for visual comparison of bony and soft tissue structures.

    Waters Method (Parieto Acanthial Projection)

    • Best projection for visualizing facial bones:

      • Superior orbits
      • Maxillae
      • Zygomatic arches
      • Petrous ridge below maxillary sinuses

    • Position the patient prone with the MSP perpendicular to the IR, MML parallel to the IR, and OML angled 37° to the IR.

    • Ensure the nose is 1.9 cm away from the grid.

    • The central ray (CR) is directed towards the acanthion, which is in line with the MML.

    Modified Waters Method (Modified Parietoacanthial Projection)

    • Position the patient prone with the MSP perpendicular to the IR, MML parallel to the IR, and OML angled 55° to the IR.
    • Center the CR on the acanthion, angling it at 35°.
    • This projection allows for visualization of:
      • Petrous ridge below the inferior border of the orbits
      • Petrous ridge within the maxillary sinus
      • Orbital floor parallel to the CR
      • Inferior displacement of the orbital floor
      • Opacified maxillary sinus (indicating a possible blow-out fracture)

    Reverse Waters Method (Acanthial Parietal Projection)

    • Position the patient supine with the MSP perpendicular to the IR, MML parallel to the IR, the chin lifted, and the DML directed 37° towards the IR.
    • Center the CR on the acanthion for a magnified view of the superior facial bones.
    • This projection is helpful for trauma patients, with adjustments made to the CR instead of the patient's position.

    Caldwell Method (PA axial Projection)

    • Position the patient prone with the MSP perpendicular to the IR, OML parallel to the IR, and the forehead and nose resting on the IR in a caudad orientation.

    • Center the CR 15° below the acanthion.

    • Allows for visualization of the:

      • Orbital rims
      • Maxillae
      • Nasal septum
      • Zygomatic bones
      • Anterior nasal septum
      • Petrous ridge in the lower third of the orbits
      • Petrous ridge below the inferior orbital margins
      • Orbital floors

    • A 30° caudad angle exaggerates the Caldwell method, displaying a radiolucent forehead.

    Law Method (PA oblique axial Projection)

    • Semiprone position with the zygoma and nose positioned cephalad.
    • Place the chin on the IR, aligning the posterior gonion with the IR.
    • Ensure the unaffected side is facing the IR, with the OML parallel to the IR.
    • Angle the CR 25-30 degrees for visualization of the:
      • Floor and posterior wall of the maxillary sinus on the dependent side
      • External orbital wall
      • Zygomatic bone
      • Anterior wall of the maxillary sinus on the non-dependent side

    Nasal Bones (STL Nose)

    • Position the patient semiprone with the MSP parallel to the IR, 10MI perpendicular to the IR, and IPL parallel to the IR.
    • Center the CR 1/2 inch superior to the nasion.
    • This projection provides a clear view of the nasal bones and surrounding soft tissues.
    • Allows for differentiation of right and left positions and can be performed with an occlusal film.

    Tangential Projection (Superior-Inferior Projection)

    • Extraoral:
      • Position the patient prone with their chin fully extended, MSP perpendicular to the IR, and GAL parallel to the IR.
    • Intraoral:
      • Place an occlusal film intraorally.
      • Position the patient supine with their head elevated, MSP perpendicular to the film, and CAL parallel to the film.
    • This projection can be performed with an extraoral or intraoral film.
    • Best for visualizing medial or lateral displacement of fragments in nasal bone fractures.
    • Cons:
      • Not suitable for children or adults with short nasal bones.
      • Can be problematic with a concave face or protruding upper teeth.

    Waters Method (Parieto-Acanthial Projection)

    • Position the patient prone with the MSP perpendicular to the IR, MML parallel to the IR, DML angled 37° to the IR, and the nose 1.9 cm away from the IR.
    • Center the CR on the acanthion.
    • Primarily for visualization of:
      • Displacement of the bony nasal septum
      • Depressed fractures in the nasal wings

    Zygomatic Arches

    • Submentovertical Projection (SMV):

      • Position the patient seated upright or supine with the MSP perpendicular to the IR, 10MI parallel to the IR, and vertex resting on the IR.
      • Extend the neck fully.
      • Center the CR 1 inch posterior to the outer canthi.
      • This projection provides optimal visualization of bilateral, symmetrical zygomatic arches.

    • Modified Titterington Method (PA axial Superoinferior Projection):

      • Position the patient prone with the nose and chin resting on the IR and the MSP perpendicular to the IR.
      • Angle the CR 23-38° towards the vertex, centering it midway between the zygomatic arches.
      • This projection effectively demonstrates the zygomatic arches.

    • Modified Towne Method (AP axial Projection):

      • Position the patient supine with the MSP perpendicular to the IR, DML parallel to the IR, and the TOML perpendicular to the IR.
      • Center the CR at a 6/laballa point (1 inch above the nasion).
      • Angle the CR 30-37° caudad.
      • This projection, also known as the "Jug Handle view," allows for visualization of symmetrical zygomatic arches without superimposition.
      • A unilateral view can be performed to showcase one zygomatic arch.

    • Tangential Projection (For PT w/ depressed fx or flat cheek bones):

      • Position the patient upright with their neck hyperextended and the vertex resting on the IR.
        • Ensure the IOML is parallel to the IR and rotate the MSP 15° towards the side being examined.
        • Tilt the top of the head 15° away from the side being examined.
      • Center the CR on the 10ML.
      • This projection allows for better visualization of the zygomatic arch without superimposition.

    • May Method (Tangential Projection):

      • Position the patient prone with their neck extended and chin resting on the IR.
      • Ensure the 10MI is parallel to the IR and rotate the MSP 15° away from the side being examined.
      • Tilt the top of the head 15° away from the side being examined.
      • Center the CR 1 1/2 inches posterior to the outer canthus.
      • This projection is specifically designed for individuals with depressed fractures or flat cheek bones.

    Mandibular Symphysis

    • PA Axial Projection (occlusal film):
      • Position the patient upright, centering the MSP perpendicular to the occlusal film.
      • Ensure the chin is positioned forward.
      • Angle the CR 40°-45° posteriorly.
      • This projection effectively displays the mandibular symphysis, mental foramina, and roots of the lower teeth.

    Mandibular Rami

    • PA Projection:

      • Position the patient prone, seated, or supine with the forehead and nose resting on the IR.
      • Ensure the OML is parallel to the IR, and the MSP is perpendicular to the IR.
      • Center the CR on the acanthion.
      • This projection captures the mandibular body and rami, best for visualizing medial or lateral displacement of fragments in rami fractures.

    • PA Axial Projection:

      • Position the patient prone with the forehead and nose resting on the IR.
      • Ensure the OML is parallel to the IR and the MSP is perpendicular to the IR.
      • Angle the CR 20-25° cephalad towards the acanthion.
      • This projection captures the mandibular body and rami, and the condylar processes, allowing for assessment of medial or lateral displacement of fragments in rami fractures.

    Mandibular Body

    • PA Projection:

      • Position the patient prone with the nose and chin resting on the IR.
      • Ensure the mandibular symphysis is parallel to the IR, AML is perpendicular to the IR, and the MSP is perpendicular to the IR.
      • Center the CR on the upper lip.
      • This projection allows for a clear view of the mandibular body.

    • PA Axial Projection:

      • Position the patient prone with the nose and chin resting on the IR.
      • Ensure the mandibular symphysis is parallel to the IR, AML is perpendicular to the IR, and the MSP is perpendicular to the IR.
      • Angle the CR 30° cephalad toward the midpoint between the TMJs.
      • This projection allows for visualization of the mandibular body and the TMJs inferior to the mastoid processes.

    • Zanelli Recommended Method:

      • This method utilizes a higher contrast setting to enhance visualization of the TMJ.
      • It involves filling the mouth with air to improve contrast.

    Towne Method (AP Axial Projection)

    • Supine position with the chin tucked, OML parallel to the IR, TOML perpendicular to the IR, and MSP perpendicular to the IR.
    • Angle the CR 35-42° caudad toward the glabella (point between the eyebrows).
    • This projection effectively displays the condyloid processes of the mandible and the TM fossae.
    • A 40° angle captures the TM fossae and the mastoid portion of the temporal bone.

    Mandible

    • Axiolateral Oblique Projection:
      • Position the patient either seated, semiprone, or semisupine.
      • Ensure the head is in a lateral position with the IPL parallel to the IR.
      • Rotate the patient's head 30° toward the IR for a view of the mandibular body, and 45° toward the IR for the symphysis.
      • Angle the CR 25° cephalad toward the target area of the mandible.
      • This projection allows for visualization of the mandibular body and rami.
        • The patient's MSP should be parallel to the IR.
        • Use a wedge sponge to support the patient in the semisupine position.
        • For muscular or hypersthenic patients, adjust the MSP 15°- 10° cephalad to the IR.

    Submentovertical Projection (SMV)

    • Position the patient either upright or supine with the MSP perpendicular to the IR, neck fully extended, vertex resting on the IR, and IOML parallel to the IR.
    • Center the CR on the 10ML, positioned 6/n the gonion, and midway between the gonion and the vertex.
    • This projection demonstrates the mandibular body, coronoid, and condyloid processes of the rami.

    Verticosubmental Projection

    • Position the patient prone with the MSP perpendicular to the IR, chin positioned on the IR, and the IOML parallel to the IR.
    • Center the CR on the 10ML, positioned posterior to the outer canthi.
    • This projection allows for visualization of the coronoid processes, condyle, and neck of the condylar processes.

    Panoramic Tomography (Orthopantomography)

    • Rotational tomography technique used to generate radiographic images of curved surfaces.

    • It provides a clear view of:

      • The entire mandible
      • TMJ's
      • Dental arches

    • It produces a distortion-free lateral image of the mandible which is helpful for:

      • Patients with severe mandibular or TMJ trauma.
      • General survey studies of dental abnormalities.
      • Pre-bone marrow transplant evaluations.

    Temporomandibular Articulations

    • Modified Towne Method (AP axial Projection):

      • Position the patient supine with the MSP perpendicular to the IR, OML parallel to the IR.
      • Close-mouth: Ensure posterior teeth are in contact (incisors are not).
      • Open-mouth: Maximize mouth opening, ensuring that the condyles are out of the mandibular fossae.
      • Angle the CR 35° caudad, 3 inches above the nasion.
      • This projection allows for optimal visualization of the TM fossae.
      • By angling the CR 5° caudad, it highlights the TMJ, condyles of the mandible, and mandibular fossae (temporal bone) for both the close-mouth and open-mouth views.

    • Contraindications:

      • Not suitable for trauma patients.
      • Patients with an open mouth and a protruded mandible.

    • Schuller Method (Axiolateral Projection):

      • Position the patient semiprone with the affected side facing the IR.
      • Ensure the MSP is parallel to the IR, IPL is perpendicular to the IR, and CR is angled 25-30° caudad.
      • Center the CR 1/2 inch anterior and 2 inches superior to the ipsilateral EAM.
      • Open-mouth: Condyles are visualized inferior to the articular tubercle.
      • Closed-mouth: Condyles are positioned within the mandibular fossa.

    • Modified Law Method (Axiolateral Oblique/Lateral/Transcranial/ Axial Projection):

      • Position the patient semiprone, ensuring the MSP is 15° from the IR and IPL is perpendicular to the IR.
      • Angle the CR 15° caudad, 1 1/2 inches (3.8 cm) anterior to the EAM.
      • This projection allows for the visualization of the condyles and neck (mandible).
      • Closed-mouth: The image showcases the relation between the superior mandibular fossa and condyle.
      • Open-mouth: The image captures the mandibular fossa, condyle excursion (inferior and anterior), and neck and condyle fractures.

    • Inferosuperior Transfacial Position:

      • Position the patient semiprone, with a true lateral view, IPL angled 10-15° from the IR, and MSP angled 15° from the IR.
      • Angle the CR 30° cephalad toward the uppermost TMJ and gonion.

    • Albers-Schonberg Method (Lateral Transfacial Position):

      • Position the patient semiprone with a true lateral view, centering the IPL perpendicular to the IR, MSP parallel to the IR, and 10ML // IR.
      • Angle the CR 20° cephalad, targeting the lower TMJ.
      • This projection offers a lateral view in both open and closed-mouth positions.

    • 2anelli Method (Lateral Transfacial Position):

      • Place the patient in a lateral recumbent position, ensuring a true lateral view.
      • Center the IR on the parietal region, with the MSP angled 30° from the IR.
      • Center the CR on the uppermost gonion.
      • This projection captures the TMJ.

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    Description

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