Normal Intraoral X-ray Appearance PDF

Normal X-ray appearance of intraoral film 1. Teeth and periodontal tissues: Teeth are composed of four types of tissues: calcified hard tissue enamel, dentin, cementum and soft tissue pulp 2 、 Periodontal tissue: periodontal membrane, alveolar bone, gingiva (1) enamel: the most calci...

Normal X-ray appearance of intraoral film 1. Teeth and periodontal tissues: Teeth are composed of four types of tissues: calcified hard tissue enamel, dentin, cementum and soft tissue pulp 2 、 Periodontal tissue: periodontal membrane, alveolar bone, gingiva (1) enamel: the most calcified and hard tissue in the body, the highest image density on the X- ray film, the occlusal surface of the posterior teeth, the thickest incisional edge of the anterior teeth, and the cap like coating on the dentin surface of the crown (2) dentin: it forms the main body of the tooth around the pulp, the shape is consistent with the tooth shape, the mineral content in the dentin is less than the enamel, and the X- ray image density is slightly lower than the enamel (3) cementum: it is a very thin layer of tissue covered on the surface of the root, and because the mineral content is not much different from the dentin, the image displayed on the X-ray film is not easy to distinguish from the dentin (4) pulp cavity: the pulp chamber of crown and root canal. The X-ray film shows the image of low density. The boundary between pulp chamber and root canal of single canal tooth is unclear. The X-ray film shows the image of low needle density. The mandibular molars usually have one pulp chamber and two root canals, and the pulp cavity is a low density image like "H". Maxillary molars: the pulp cavity is mostly round or oval, because of the influence of the projection angle. In young people, the pulp cavity is large, the root has not been formed, and the apical hole is in the shape of a trumpet. Teeth of the elderly: the secondary dentin increases, the medullary cavity becomes narrower and narrower, and the medullary cavity is small and thin. alveolar bone: the part of the upper and lower jaws surrounding the root of the tooth, also known as the alveolar process or alveolar ridge 1) alveolar fossa: a depression containing the root of a tooth. 2) free tip of alveolar process: the earliest manifestation of the disease is here. 3) alveolar space: The density of alveolar bone is lower than that of teeth. The bone density of the upper alveolar bone is thin, there are many cancellous bone and many trabeculae. At the intersection, there is a dot image with high density. The trabecular structure of the upper alveolar bone was granular. The bone density of the lower alveolar bone is thick, the bone is less spongy and the number of trabeculae is less The trabeculae of interdental bone are mostly arranged in horizontal direction, while the apical part is sometimes arranged radially. The trabecular structure of alveolar bone was reticular under X-ray. The thickness of trabecula is related to the function of teeth. In the functional group, the trabeculae were thick and numerous. (6) bone plate(the inherent alveolar bone),:the inner wall of the alveolar fossa, around the root of the tooth. On the X-ray film, the continuous high- density linear image surrounding the root of the tooth. Significance: early manifestations of some diseases: early periodontal disease, occlusal trauma, orthodontics. characteristic manifestations of lesions, (7) periodontal ligament: 0.15-0.38mm. On the X-ray film, there are continuous low-density linear images surrounding the root of the tooth, with uniform width. The continuity and uniform width of periodontal ligament and bone plate are of great significance in the diagnosis of dental diseases.  Normal anatomical structure  Maxillary Incisor 上颌切牙 a b a = nasal septum （鼻中隔） c b = inferior concha （下鼻甲） c = nasal fossa （鼻前庭） d d = anterior nasal spine （前鼻棘） e e = incisive foramen （切牙孔） f = median palatal suture （腭中缝） g = soft tissue of nose （鼻部的软组织） f g  facial view palatal view c f b a e d a = nasal septum （鼻中隔） e = incisive foramen （切牙孔） b = inferior concha （下鼻甲） f = median palatal c = nasal fossa （鼻前庭） suture （腭中缝） d = anterior nasal spine （前鼻棘） Nasal cavity and Nasal septum The nasal cavity is located at the top of the root tip of the upper incisor, which shows a symmetrical semicircular image with low density, and is separated by a high density bone septum, which is the nasal septum; it needs to be differentiated from the cyst. facial view Nasal septum （鼻中隔）  facial view a a Inferior concha facial view Inferior concha （下鼻甲）  facial view Nasal fossa facial view Nasal fossa （鼻前庭）  facial view Anterior nasal spine （前鼻棘）  Incisive foramen Between or slightly above the two upper central incisors, the images are mostly oval with low density. The image of incisor hole can be overlapped at the tip of the middle incisor, which is easily mistaken as periapical lesion. It can be distinguished by the integrity of periodontal ligament and bone plate. palatal view Incisive foramen （切牙孔） Median palatal suture It is located between the roots of the two upper central incisors, from the top of the alveolar process, showing a linear image of low density; on both sides of the image of low linear density are the dense bone layers of the palatal process of the two upper jaws. In childhood, because the jaw is not fully developed, the image of median palatal suture is wide, and from the top of alveolar ridge to nasal septum  palatal view Median palatal suture （腭中缝） Soft tissue of the nose （鼻部的软组织）  a a b b d e Red arrow points to periapical Red arrows = lip line （唇线） lesion （根尖损害）  d f g Red arrow = mesiodens Blue arrow = chronic periapical (supernumerary tooth) （额外牙 periodontitis. （根尖周炎） ） Superior foramina （孔） of the nasopalatine canals ( 鼻腭管 red arrows). These foramina lie in the floor of the nasal fossa （鼻前庭 ）. The nasopalatine canals ( 鼻腭管） travel downward to join in the incisive foramen( 切牙孔）. The red arrows point to the soft tissue of the nose. The green arrows identify the lip line. Maxillary Cuspid 上颌尖牙 a b a = floor of nasal fossa （鼻前庭底部） c b = maxillary sinus （上颌窦） c = lateral fossa （外侧的窝） d = nose （鼻） d  facial view a a c c b b a = floor of nasal fossa （鼻前庭底部） b = maxillary sinus （上颌窦） c = lateral fossa （外侧的窝或侧窝） (a & b form inverted Y)  facial view Floor of nasal fossa （鼻前庭底部） (red arrows)and anterior border( 前边 )of maxillary sinus (blue arrows), forming the inverted( 倒） (upside down) Y. Y  facial view Lateral fossa( 侧窝）. The radiolucency （射线投射性） results from a depression （窝） above and posterior to the lateral incisor （侧切牙）. To help rule out （排除 ) pathology （病变） , look for an intact lamina dura （ 硬骨板 ） surrounding the adjacent teeth.  Soft tissue of the nose Red arrows point to nasolabial fold （鼻 唇沟）. Also note the inverted Y. The maxillary sinus The white arrows indicate the floor of surrounds the root of the the nasal fossa （鼻前庭底部）. The maxillary sinus (red arrows) has canine, which may be pneumatized （含有气腔 )between the misinterpreted as 2nd premolar and first molar pathology. The red arrow identifies the lateral fossa （侧窝）. The pink arrow points to hcronic periapical periodontitis( abscess, granuloma , etc.). Maxillary Premolar 上颌前磨牙 a b c a = malar process （颧突） b = sinus septum （上颌窦间隔） c = sinus recess ( 上颌窦隐窝） d = maxillary sinus （上颌窦） d  facial view b b d a c a c d a = malar process （颧突） b = sinus recess( 上颌窦隐窝） c = sinus septum （上颌窦间隔） d = maxillary sinus （上颌窦）  facial view malar process （颧突） zygomatic bone ( 颧骨） Malar (zygomatic) process. U or j-shaped radiopacity, often superimposed over the roots of the molars, especially when using the bisecting-angle technique. The red arrows define the lower border of the zygomatic bone.  facial view Sinus septum （上颌窦间隔） Sinus septum （上颌窦间隔） is composed of folds of cortical bone （皮质骨） that arise from the floor and walls of the maxillary sinus, extending several millimeters into the sinus. In rare cases, the septum completely divides the sinus into separate compartments.  facial view sinus recess( 上颌窦隐窝 ） Sinus recess. Increased area of radiolucency caused by outpocketing 外包缝合法 (localized expansion 局限扩大 ) of sinus wall. If superimposed over roots, may mimic ( 酷 似） pathology.  facial view maxillary sinus （上颌窦） Maxillary Sinus. An air-filled cavity lined with mucous membrane （粘膜）. Communicates with nasal cavity through 3-6 mm opening below middle concha. Red arrows point to neurovascular （神经血管的） canal containing superior alveolar （牙槽的） vessels and nerves. Blue arrows identify The red arrows point to radiopacity which is a the nasolabial fold （鼻唇 mucous retention cyst. 沟）. The thicker cheek （粘膜潴留囊肿） Note tissue makes the area relatively recent premolar more radiopaque extraction sites. Green posterior to the line. arrow points to neurovascular canal. Pneumatization. （气腔形成） Expansion of sinus wall into surrounding bone, usually in areas where teeth have been lost prematurely （早 期）. Increases with age.  Maxillary Molar 上颌磨牙 a = maxillary tuberosity （上颌结节） e f b = coronoid process （喙突） c = hamular process （翼钩） d d = pterygoid plates （翼板） c e = zygoma （颧骨） f = maxillary sinus b （上颌窦） a  facial view e e g g d d c f c a f a b b a = maxillary tuberosity* e = zygoma (dotted lines) （上颌结节 ) （颧骨 ） b = coronoid process f = maxillary sinus （喙突） （上颌窦） c = hamular process （翼钩） g = sinus recess ( 上颌窦隐窝） d = pterygoid plates （翼板） image of impacted third molar superimposed 叠加 Maxillary Tuberosity In the distal region of the last molar, the number of bone trabeculae in this region is less. The X-ray film often shows a sparse reticular structure, which is a normal osteoporotic area and should not be mistaken for osteopathy.  facial view Maxillary Tuberosity （上颌结节） Maxillary Tuberosity. The rounded elevation located at the posterior aspect of both sides of the maxilla. Aids in the retention of dentures （假 牙）.  facial view Coronoid process （喙突 ） Coronoid process （喙突）. A mandibular structure sometimes seen on the maxillary molar periapical film when using the bisecting angle technique with finger retention (The mouth is opened wide, moving the coronoid down and forward). Note the supernumerary （额外） molar. Coronoid process There is a triangle image extending from the back to the front in the area of 7 and 8 crowns. Because of the influence of projection technology, the image can overlap with the crown of the second and third molars or be under or behind them. Hamular process If the development of Hamular process is large, the image with long strip edge, about 0.2cm wide, 1cm long straight or slightly backward curved lower end, and slightly higher density, is behind the maxillary nodule 。  facial view Hamular process （翼钩 ） Hamular process （翼钩） (white arrows) and pterygoid plates （翼板） (purple arrows). The hamular process is an extension of the medial pterygoid plate of the sphenoid bone （蝶骨） , positioned just posterior to the maxillary tuberosity （上颌结节）. zygoma If the zygoma is large or the vertical angle of projection is large, it can be located above the tip of the first and second molars or overlapped on the root. It is an image with high density similar to triangle or semicircle, and it should be distinguished from the embedded teeth 。 When the maxillary sinus is displayed, the image can overlap with the image of the maxillary sinus, and should not be mistaken for a dentigerous cyst. The zygoma is connected with the zygomatic process of the maxilla. If the maxillary sinus develops greatly and the zygomatic process of the maxilla is filled with gas, it can be shown as "V" shape dense line shadow.  facial view malar （颧骨 ) Zygomatic (malar) bone/process/arch. The zygomatic bone (white/black arrows) starts in the anterior aspect with the zygomatic process (blue arrow), which has a U-shape. The zygomatic bone extends posteriorly into the zygomatic arch 颧弓 (green arrow).  There is a low density image above the root when the cusps of the maxillary molars in the maxillary sinus. The large maxillary sinus extends backward to the maxillary nodule and forward to the canine area. In patients with long-term edentulous jaws or missing molars, the height of alveolar process is reduced due to absorption, and the sinus bottom can be slightly higher than alveolar process (the bite force can limit the growth of maxillary sinus) Shape: sometimes, the maxillary sinus floor can protrude into the alveolar space between the roots and surround several roots, making the sinus floor wavy. Sometimes, there are one or two dense linear images from the bottom of the sinus upward, making the sinus floor show "W" shape, which is the separation of the maxillary sinus. According to the continuous periodontal membrane and bone plate, the palatal root of molar is not located in maxillary sinus.  facial view Maxillary sinus( 上颌窦） Maxillary sinus. As seen in the above film, the floor of the maxillary sinus flows around the roots of the maxillary molars and premolars. The walls of the sinus may become very thin. As a result, sinusitis may put pressure on the superior alveolar nerves resulting in apparent tooth pain, even though the tooth is perfectly healthy. Note coronoid process (green arrow), zygomatic bone (blue arrow), sinus septum (yellow arrow) and neurovascular canal (orange arrows). The maxillary sinus is evident This film shows the coronoid anterior to the second molar process (green arrow) and a (black arrows) but it distomolar (blue arrow) that disappears posteriorly due to has erupted ahead of the the superimposition of the third molar (red arrow). A zygomatic bone. The orange distomolar is a arrows identify a mucous supernumerary tooth that retention cyst (retention erupts distal (posterior) to pseudocyst) within the sinus. the other molars. The zygomatic process (green arrows) is a prominent U- shaped radiopacity. Normally the zygomatic bone posterior to this is very dense and radiopaque. In this patient, however, the maxillary sinus has expanded into the zygomatic bone and makes the area more radiolucent (red arrows). The coronoid process (orange arrow), the pterygoid plates (blue arrows) and the maxillary tuberosity (pink arrows) are also identified. This film shows the expansion of the borders of the maxillary sinus through pneumatization (red arrows). This expansion increases with age and it may be accelerated as a result of chronic sinus infections. It is most commonly seen when the first molar is extracted prematurely, as in the film at right (the second and third molars have migrated anteriorly to close the space). The coronoid process is seen in the lower left-hand corner of each film. The green arrow identifies a sinus recess. Note the two distomolars in film at right (blue arrows). Mandibular Incisor 下颌切牙 a. lingual foramen( 舌孔） b. genial tubercles （颏棘） c. mental ridge （颏嵴） d. mental fossa （颏窝 ） d a b c genial tubercles It is located under the apex of the two lower incisors and the median joint of the mandible, showing a small round high- density image. In the center, there is a spot-shaped area of decreased density, with few bone trabeculae around it, which is a normal osteoporotic area.  lingual view facial view d c a b a = lingual foramen ( 舌孔） c = mental ridge （颏嵴） b = genial tubercles （颏棘） d = mental fossa （颏窝 ）  lingual view Lingual foramen ( 舌孔） Lingual foramen ( 舌孔）. Radiolucent “hole” in center of genial tubercles （颏棘）. Lingual nutrient vessels pass through this foramen.  lingual view genial tubercles （颏 棘） Genial tubercles. Radiopaque area in the midline, midway between the inferior border of the mandible and the apices of the incisors. Serve as attachments for the genioglossus （颏舌肌 ） and geniohyoid （颏舌骨肌 ） muscles. May have radiolucent hole in center (lingual foramen), but not on this film. Note double rooted canine （尖牙） (red arrows).  facial view Mental ridge （颏嵴） Mental ridge （颏嵴）. These represent the raised portions of the mental protuberance （颏隆凸） on either side of the midline. More commonly seen when using the bisecting angle technique, when the x-ray beam is directed at an upward angle through the ridges.  facial view Mental fossa （颏窝 ） Mental fossa （颏窝 ）. This represents a depression on the labial aspect of the mandible overlying the roots of the incisors. The resulting radiolucency may be mistaken for pathology.  Nutrient canals The low density strip image, which is usually located in the anterior teeth area of the mandible and parallel to the long axis of the teeth, has different number, length and thickness, which is the image of small blood vessels entering the alveolar process. Patients with a history of trauma should pay attention to the difference between them and alveolar fracture line. The image of nutrient tube is soft, not as rigid as fracture line, and the image density is slightly higher than fracture line. The radiolucent area above The orange arrows above corresponds to the location identify nutrient canals. of the mental fossa （颏窝 ）. They are most often seen in However, this slide older persons with thin represents chronic periapical bone, and in those with high periodontitis; these teeth are blood pressure or advanced non-vital, due to trauma. periodontitis.  Mandibular Canine 下颌尖牙 a = mental ridge （颏嵴 ) c b = genial tubercles( 颏棘 ） / lingual foramen （舌孔） c = mental foramen （颏孔） b a  facial view lingual view b db22 d a d c b d1 a = mental ridge （颏嵴 ) b1 = genial tubercles ( 颏棘 ） c = mental foramen （颏孔） b2 = lingual foramen （舌孔）  facial view mental ridge （颏嵴 ) Mental ridge （颏嵴 ) 。 The raised portions of the mental protuberance （颏隆凸）， sloping （倾斜的 ） downward and backward from the midline.  lingual view genial tubercles ( 颏棘 ） Lingual foramen/genial tubercles. (See description under mandibular incisor above).  facial view The red arrows identify the mandibular canal （下颌管 ） and the blue arrow points to the mental foramen （颏孔）. Mandibular Premolar 下颌前磨牙 c a = mylohyoid ridge （颌舌骨嵴 ） b = mandibular canal （下颌管） c = submandibular gland fossa （下颌下腺窝） d = mental foramen （颏孔）  facial view lingual view b a d c b = mandibular a = mylohyoid ridge （颌舌骨嵴 ） canal （下颌管） (internal oblique 内斜线 ) d = mental foramen c = submandibular gland （颏孔） fossa （下颌下腺窝）  lingual view mylohyoid ridge （颌舌骨嵴 ） Mylohyoid (internal oblique) ridge. This radiopaque ridge is the attachment for the mylohyoid （下颌舌骨的 ） muscle. The ridge runs downward and forward from the third molar region to the area of the premolars.  facial view mandibular canal （下颌管） Mandibular canal （下颌管）. (Inferior alveolar canal). Runs downward from the mandibular foramen to the mental foramen, passing close to the roots of the molars. More easily seen in the molar periapical.  lingual view submandibular gland fossa （下颌下腺 窝） Submandibular gland fossa （下颌下腺窝）. The depression below the mylohyoid ridge （颌舌骨嵴 ） where the submandibular gland is located. More obvious in the molar periapical film.  facial view mental foramen （颏孔） Mental foramen （颏孔）. Usually located midway between the upper and lower borders of the body of the mandible, in the area of the premolars. May mimic pathology if superimposed （重叠） over the apex （根尖） of one of the premolars.  The green arrow points to the The mental foramen （颏孔） mental foramen. The yellow arrow (blue arrow) is adjacent to a identifies a periapical lesion on # periapical lesion associated 30. Note the overextension （伸展过 with tooth # 21 (red arrow). 度 ） of the silver point in the distal There is slight external root, the perforation of the mesial resorption on # 21. root and the amalgam （汞合金） protruding （伸出的 ） through the perforation from the pulp chamber （髓室）. Mandibular Molar a = external oblique ridge( 外斜线） b = mylohyoid ridge （颌舌骨嵴） c = mandibular canal （下颌管） d = submandibular gland fossa （下颌下腺窝）  facial view lingual view a b c d a = external oblique ridge b = mylohyoid ridge ( 外斜线） （颌舌骨嵴） c = mandibular canal d = submandibular gland （下颌管） fossa （下颌下腺窝）  b a d c a = external oblique ridge ( 外斜线） b = mylohyoid ridge （颌舌骨嵴） c = mandibular canal （下颌管） d = submandibular gland fossa （下颌下腺窝）  facial view external oblique ridge ( 外斜 线） External oblique ridge( 外斜线） A continuation of the anterior border of the ramus （分支）， passing downward and forward on the buccal side of the mandible. It appears as a distinct radiopaque line which usually ends anteriorly in the area of the first molar. Serves as an attachment of the buccinator （颊肌） muscle. (The red arrows point to the mylohyoid ridge （颌舌骨嵴） ).  lingual view mylohyoid ridge （颌舌骨嵴 ） Mylohyoid ridge （颌舌骨嵴） (internal oblique). Located on the lingual surface of the mandible, extending from the third molar area to the premolar region. Serves as the attachment of the mylohyoid muscle （下颌舌骨肌）.  facial view mandibular canal （下颌管） Mandibular (inferior alveolar 下齿槽 ) canal （下颌管）. Arises at the mandibular foramen （下颌孔） on the lingual side of the ramus and passes downward and forward, moving from the lingual side of the mandible in the third molar region to the buccal side of the mandible in the premolar region. Contains the inferior alveolar nerve and vessels.  lingual view submandibular gland fossa （下颌下腺窝 ） Submandibular gland fossa （下颌下腺窝）. A depression ( 凹陷 ) on the lingual side of the mandible below the mylohyoid ridge （颌舌骨嵴）. The submandibular gland （ 颌下腺） is located in this region. Due to the thinness of bone, the trabecular （有小梁的） pattern of the bone is very sparse （稀少） and results in the area being very radiolucent. The fact that it occurs bilaterally( 两侧 地 )helps to differentiate it from pathology. The external oblique ridge ( 外斜线） (red arrows) and the mylohyoid ridge （颌舌骨嵴） (blue arrows) usually run parallel with each other, with the external oblique ridge ( 外斜线） always being higher on the film. The mandibular canal (red arrows identify inferior border of canal) usually runs very close to the roots of the molars, especially the third molar. This can be a problem when extracting these teeth. Note the extreme dilaceration (curving) of the roots of the third molar (green arrow) in the film at left. The film at right shows “kissing” impactions located at the superior border of the canal. Identify the anatomical structures on the following eight slides. The answers are on the last slide.  Slide # 1 A. The red arrows identify the ?  Slide # 2 A. The red arrow points to the ? B. The white arrows identify the ? C. The blue arrow points to the ? D. The yellow arrow identifies the ?  Slide # 3 A. The small radioluceny identified by the green arrow is the ?  Slide # 4 A. The radiopacity identified by the blue arrows is the ? B. The orange arrow identifies the ?  Slide # 5 A. The yellow arrows point to the ? B. The red arrows identify the ?  Slide # 6 A. The red arrow points to the ? B. The orange arrow points to the ? C. The blue arrows point to the radiolucent line known as the ?  Slide # 7 A. The red arrows point to the ?  Slide # 8 A. The red arrows identify the ? B. What is the name of the radiolucent area surrounding the canal?  KEY Slide # 1: A. Floor of the nasal fossa Slide # 2: A. Coronoid process B. Maxillary sinus (pneumatized into maxillary tuberosity) C. Sinus septum D. Zygomatic process Slide # 3: A. Lingual foramen Slide # 4: A. Mylohyoid ridge B. Submandibular gland fossa Slide # 5: A. Zygomatic process B. Maxillary sinus Slide # 6: A. Inferior concha B. Nasal septum C. Median palatal suture Slide # 7: A. Mental ridge Slide # 8: A. Mandibular canal B. Submandibular gland fossa  11 16 12 2 5 15 13 17 10 6 7 9 8 14 19 1 24 23 21 18 3 4 32 25 20 26 22 27 31 29 33 37 39 35 30 28 38 36 34  47 40 41 46 42 44 45 43  Panoramic Anatomy Key 1. maxillary sinus 25. sigmoid notch 2. pterygomaxillary fissure 26. medial sigmoid depression 3. pterygoid plates 27. styloid process 4. hamulus 28. cervical vertebrae 5. zygomatic arch 29. external oblique ridge 6. articular eminence 30. mandibular canal 7. zygomaticotemporal suture 31. mandibular foramen 8. zygomatic process 32. lingula 9. external auditory meatus 33. mental foramen 10. mastoid process 34. submandibular gland fossa 11. middle cranial fossa 35. internal oblique ridge 12. lateral border of the orbit 36. mental fossa 13. infraorbital ridge 37. mental ridges 14. infraorbital foramen 38. genial tubercles 15. infraorbital canal 39. hyoid bone 16. nasal fossa 40. tongue 17. nasal septum 41. soft palate 18. anterior nasal spine 42. uvula 19. inferior concha 43. posterior pharyngeal wall 20. incisive foramen 44. ear lobe 21. hard palate 45. glossopharyngeal air space 22. maxillary tuberosity 46. nasopharyngeal air space 23. condyle 47. palatoglossal air space 24. coronoid process You may print this page by right-clicking and selecting “Print” 9 12 7 19 5 17 13 25 14 6 22 18 39 28 33 9 12 19 7 17 13 14 5 25 6 22 18 39 28 33  11 2 15 24 26 8 32 23 16 1 31 3 20 4 34 44 30 38 11 2 15 24 26 8 32 23 16 1 31 20 3 44 34 30 38  46 21 41 42 47 40 45 43 46 21 41 42 47 40 45 43  11 7 1 46 41 47 43 36 45 38  16 23 17 2 8 6 21 18 19 39 Red arrows point to ghost （重影） image of hard palate  11 9 3 20  17 2 44 20 28 43  2 atlas 31 transverse foramen  15 46 47 19 6 27 34  17 8 1 15 32 N  40 27 E LN 36  2 8 40 18 45 ? ? Identifies calcification, possibly in carotid or in lymph node  8 46 7 47 33 epiglottis  11 21 3 29 32 34 Red arrow identifies static electricity, caused by removing the film too quickly from the cassette or from the box of film (creates friction, which results in a static discharge).  16 10 9 20 3 42 27 30 1 44 ghost of mandible 36  24 14 27 47 nose 39 Lead apron located too high on back of patient’s neck.  12 air cell 9 23 7 26 Air cell in zygomatic arch.  24 26 7 22 27 30 38  5 10 6 47 45 ghost of mandible  15 23 7 9 21 39 30 Note the relatively inferior location of the mandibular canal (30), providing plenty of room for the implant.  24 26 31 1 29 Pattern on right side of film (patient’s left) caused by excessive oil on patient’s hair.  7 28 28 red arrow identifies fracture 27 44 34 Green arrow identifies “pseudo-fracture” caused by palatoglossal air space. Red arrows point to odontogenic keratocyst. Ghost images of earrings Ghost images of earrings 15 2  27 28 28 Hearing aid (red arrow) with ghost (green arrow). Ghost image of metal used to restore left angle of mandible  Ghost images of mandibles (dotted line outlines ghost of left ramus-angle over right side of mandible) Identify the anatomical structures on the following slides.  Slide # 1 C E D G F B A Answers on next slide  Slide # 1 C E D G F B A A = cervical vertebra; B = external oblique ridge; C = zygomatic process; D = floor of maxillary sinus; E = zygomaticotemporal suture; F = lingula; G = mandibular foramen  Slide # 2 B K D J E I A H F C G Answers on next slide  Slide # 2 B K D J E I A H F C G A = ear; B = external auditory meatus; C = submandibular fossa; D = nasal septum; E = hard palate; F = mental foramen; G = hyoid bone; H = mandibular canal; I = pterygoid plates; J = articular eminence; K = pterygomaxillary fissure  Slide # 3 C B D A E Answers on next slide  Slide # 3 C B D A E A = palatoglossal air space; B = middle cranial fossa; C = lateral border of orbit; D = condyle; E = mental fossa  Slide # 4 D I E H B C A G F J K L Answers on next slide  Slide # 4 D I E H B C A G F J K L A = cervical vertebra; B = zygomaticotemporal suture; C = zygomatic process; D = nasal septum; E = inferior concha; F = soft tissue of nose; G = hard palate; H = posterior border of maxillary sinus; I = external auditory meatus; J = posterior pharyngeal wall; K = mental foramen; L = mental fossa  Slide # 5 E F G C D J B H I A Answers on next slide  Slide # 5 E F G C D J B H I A A = glossopharyngeal air space; B = styloid process; C = nasopharyngeal air space; D = pterygoid plates; E = condyle; F = infraorbital canal; G = infraorbital foramen; H = soft palate; I = mandibular canal; J = lingula  Slide # 6 E C D E B F G A Answers on next slide  Slide # 6 E C D E B F G A A = mental foramen; B = incisive foramen; C = soft tissue of nose; D = anterior nasal spine; E = pterygoid plates; F = ear; G = hyoid bone The radiolucency (red arrows) seen in the ramus and third molar area on the patient’s right side is an ameloblastoma. (Differential includes dentigerous cyst, radicular cyst, OKC).  Slide # 7 A B C D Answers on next slide  Slide # 7 A B C D A = posterior border of maxillary sinus; B = infraorbital ridge; C = inferior concha; D = inferior border of maxillary sinus (pneumatized to crest of bone) The radiolucency (red arrows) seen in the ramus on the patient’s left side is a squamous （鳞状） cell carcinoma.  Slide # 8 D A C B E Answers on next slide  Slide # 8 D A C B E A = maxillary tuberosity; B = hard palate; C = coronoid process; D = floor of middle cranial fossa; E = posterior pharyngeal （咽的） wall This child has a condition known as cherubism （巨颌症）. The mandibular lesions involve both rami, extending into the coronoid process (the condyle is rarely involved). The maxillary lesions are located in the tuberosity regions, causing anterior displacement of 2 nd and 3rd molars.  Slide # 9 E D A C F B Answers on next slide  Slide # 9 E D A C F B A = zygomatic arch; B = external oblique ridge; C = palatoglossal air space; D = soft palate; E = pterygomaxillary fissure; F = styloid process This patient has multiple supernumerary premolars in the mandible (#’s 21, 28 and 29 were extracted).  Slide # 10 C D E B A F Answers on next slide  Slide # 10 C D E B A F A = mandibular canal; B = soft tissue of nose; C = nasal fossa; D = hard palate; E = mandibular foramen; F = styloid process This patient has impacted mandibular third molars that have migrated up into the coronoid processes. Note also the long, thin condylar necks and small condyles.  Slide # 11 B C A D E Answers on next slide  Slide # 11 B C A D E A = sigmoid notch; B = nasal septum; C = coronoid process; D = articular eminence; E = mental foramen (on crest of ridge). The green arrows identify a calcified stylohyoid ligament. If there is associated neck pain, the condition is known as Eagle’s syndrome (recent history of neck trauma or surgery) or stylohyoid syndrome (no history of trauma/surgery). The red box outlines several radiopacities which represent tonsillar calcifications.