Full Mouth X-Rays

Sometimes the correct thing is to put a rectangular film into a round mouth, but not always. While intraoral imaging does an excellent job for some applications, it is only part of the picture. There are many regions of the patient's anatomy that can not be imaged with an intraoral radiograph. That is why we make the Orthopantomograph.The following is a strategy for identifying the anatomic strictures visualized on a panoramic radiograph.
  • Coronoid process of the mandible. Begin at the right coronoid process. Examine for coronoid hyperplasia. Tip of coronoid should not be more than 1cm above superior border of zygomatic arch.
  • Sigmoid notch. Do not mistake a rarefied medial sigmoid depression for pathosis.
  • Mandibular condyle. Evaluate for erosions, remodeling, eburnation, subchondral cysts, osteophyte formation which may signal arthritis.Less commonly, erosions may be caused by neoplastic disease.
  • Subcondylar (condylar neck) region. Evaluate.
  • Ramus of the mandible. Evaluate.
  • Angle of the mandible. Evaluate.
  • Inferior border of the mandible. Evaluate #4 - 7 for cortical integrity. Rule out fractures. Repeat steps 1 - 6 on the patient's left side.
  • Lingula. Evaluating the precise location in any individual patient assists in determination of where to give inferior alveolar nerve block.
  • Inferior alveolar neurovascular bundle (mandibular canal). Follow from lingula to mental foramen. In some patients the anterior extension which exits out the lingual foramen will be visible. Evaluate relationship of impacted teeth to the canal. Evaluate general bone quality and check for focal osseous defects.
  • Mastoid process. Evaluate structures on the left side of the maxilla first.
  • External auditory meatus. Evaluate.12 Glenoid fossa (temporal component of the TMJ). Check for erosions, sclerosis, and other signs of arthritis.
  • Glenoid fossa (temporal component of the TMJ). Check for erosions, sclerosis, and other signs of arthritis.
  • Articular eminence. Look for zygomatic air cell defect (ZACD).
  • Zygomatic arch. Do not mistake a wide zygomatico-temporal suture for a fracture. May also contain ZACD in the posterior half of the arch.
  • Pterygoid plates. Evaluate.
  • Pterygomaxillary fissure. Check for cortical integrity to rule out neoplasia.
  • Orbit. Evaluate.
  • Inferior orbital rim. Check for cortical integrity to rule out fracture.
  • Infraorbital canal. The infra-orbital foramen should not be viewed if the patient was properly positioned.
  • Nasal septum. Evaluate for septal deviation or perforation. Evaluate the nasal fossa for polyps.
  • Inferior turbinate/soft tissue concha covering. Evaluate.
  • Medial wall of the maxillary sinus. Evaluate.
  • Inferior border of the maxillary sinus. Evaluate.
  • Posterolateral wall of the maxillary sinus. Evaluate the integrity of the sinus walls to rule out developmental, inflammatory, traumatic or neoplastic processes. Examine the content of the sinus for the degree of pneumatization. Check for antral pseudocysts, chronic mucosal hypertrophy, polyposis, mucocele or neoplasia.
  • Malar process. Repeat 10 - 25 on the right side of the patient.
  • Hyoid bone. Evaluate.
  • Cervical vertebrae 1 - 4. Observe for osteophyte formation, loose bodies or other evidence of osteoarthrosis. Remember the circular radiolucency in C2 is the transverse foramen.
  • Epiglottis. Evaluate.
  • Soft tissues of the neck. Evaluate for a wide range of soft tissue calcifications.
  • Auricle (earlobe). Evaluate.
  • Styloid process. If elongated/ calcified stylo-hyoid ligament, rule out Eagle's syndrome.
  • Oropharyngeal airspace. Evaluate.
  • Nasal air. Evaluate.
  • Bone of the maxilla. Evaluate.
  • Evaluate dentition and prescribe further radiographic surveys as required.
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