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Grand RoundsRobert P. Moskal BSc, DMDThe University of Illinois
at ChicagoNovember 16, 1998
Radiographic Projections
Posteroanterior view (PA):general skull exam for disease,
trauma, developmental abnormalities, assess mediolateral
dimensions of skull, and assymetriesSTRUCTURE: frontal &
ethmoid sinus, nasal fossae, orbits, frontal bones mandible
symphysis skull outline POSITION: -head centered and facing film-
canthomeatal line parallel to floor (nose and forehead usually
touching film)CENTRAL RAY: - XR beam parallel to canthomeatal line
aiming at max central incisorsNote: (AP View) - XR from anterior to
posterior
Lateral Skull (lateral cephalometric):general skull exam for
disease, trauma, developmental abnormalities, assess
facialproportions and assymetries,STRUCTURES: skull and soft tissue
assessment paranasal structures and paired structures overlapped
hard palatePOSITION: Left side of skull closest to film-
canthomeatal line parallel to floor (in LAT CEPHFrankfurt
Horizontal parallel to floor)CENTRAL RAY:- XR beam parallel to
canthomeatal line or FH at 60" ( Note: filter anterior to better
reveal soft tissue of face)
Occipitomental (37oWaters) View:variation of PA view
STRUCTURES: Maxillae, Orbits, Zygomatic archesMaxillary sinuses
(air-fluid levels?) frontal & ethmoid sinuses, nasal cavity,
zygomatico-frontal suture P
POSITION: - patient upright, prone- head centered & facing
film with chin touching film- canthomeatal line 37
oto film
CENTRAL RAY: beam perpendicular to film, exiting at subnasale
acanthion)
Modified Occipitomental View (55oWaters):modified "shallow"
Waters view
STRUCTURES: Maxillae, Orbits, Zygomatic arches- less axial
angulation, petrous ridges just below infraorbital rimsPOSITION -
patient upright, prone or supine- head centered & facing film
with chin touching film canthomeatal line 55
oto film
CENTRAL RAY: beam perpendicular to film, exiting at subnasale /
acanthion)
Reverse Occipitomental View ( Reverse-Waters):STRUCTURES: same
but increased magnification and is an AP viewPOSITION: head
centered and film behind headinfraorbitomeatal line perpendicular
to film (or canthomeatal lineperpendicular to film)CENTRAL RAY: 30
ocephalad to infraorbitomeatal line(37 degrees to canthomeatal
line)
Tangential Nasal:(Intraoral or Extraoral)STRUCTURES: Nasal bones
for medial or lateral displacement offragments in
fracturesPOSITION: - supine with occlusal xray in teeth
(Intraorally)- prone with chin extended and ray parallel to
glabelloalveolar line(ext)- head centeredCENTRAL RAY: beam
perpendicular to film & parallel to glabelloalveolar line
Lateral Nasal:STRUCTURES: Nasal bones, Rt and Lt.POSITION:
supine/upright- canthomeatal lines parallel to floor
- film on side of interest or bilaterallyCENTRAL RAY:
perpendicular to bridge of nose at 2cm distal to nasion- use close
collimation for detail
Submento-vertex (SMV or "Jug-handles"):Aka. Tangential Zygomatic
ArchSTRUCTURES: Zygomatic arches, base of skull, pterygoid
plates,sphenoid sinus curvature of mandiblePOSITION:-supine,
upright-extend neck with film behind head-Infraorbitomeatal line
nearly parallel to filmCENTRAL RAY:perpendicular to
infraorbitomeatal line and centered between
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zygomatic arches. It passes through coronal plane lying approx.
1" posterior toouter canthi. Decrease kVp to highlight thin,
unobstructed zygomatic arches.
Submental Vertex:tangential images of unilateral zygomatic
archesSTRUCTURES: Zygomatic arches (One isolated side)POSITION:
supine/upright- infraorbitomeatal lines parallel as possible to
film
- 15 degree top of head tilttoward examining sideCENTRAL RAY:
perpendicular to infraorbitomeatal line and centered to zygomatic
arch
Submental Vertex (Mays view):STRUCTURES: Zygomatic arches (One
isolated side)POSITION: - prone or facing film- 15 degree tilt top
of head away from examining sideCENTRAL RAY: perpendicular to
infraorbitomeatal line, directed through arch
Townes View (30o):
tangential images of unilateral zygomatic arches, AP
viewSTRUCTURES: Condyle, neck, ramusPOSITION: Upright or supine
with film behind headcanthomeatal (FH) line perpendicular to film
and parallel to floorCENTRAL RAY: from anterior, 30degrees coronal
to FH or canthomeatal plane and directed towards condyles.
Modified Townes View(35o):
STRUCTURES: samePOSITION: sameCENTRAL RAY: anteroposteriorly, 35
degrees coronal to canthomeatal planeReverse-Townes View
(PA):STRUCTURE: same as townesPOSITION: Prone or upright facing
filmCanthomeatal line perpendicular to filmopen mouth as wide as
possible, helps in visualization of TMJCENTRAL RAY:postero-anterior
direction30
ocaudad to canthomeatal line
Lateral Oblique View:STRUCTURES: Rt & Lt Mandibular body,
angle,ramus and condyleopposite condylar head and glenoid
fossaPOSITION: upright, supine, film on side being studied extend
neck so mandibular body is parallel to transverse axis of
filmrotate head so mandibular body is parallel to plane of
filmCENTRAL RAY: CR to enter slightly posterior to mandibular angle
on the side farthest from the film at an angle ofaproximately 25
degrees cephalad to body/angle/ramus region on film side.Note:If
appropriate density, can evaluate position of opposite TMJ in its
fossa. Can aim CR more anteriorly along body to
evaluateparasymphysis or posterosuperior at ramus
Intraoral Radiologic Projections
Maxillary Occlusal:STRUCTURES: Superoinferior projection of the
roof of the mouth palatine processes of maxillae horizontal plates
of palatinebone maxillary dental arch, anterior nosePOSITION: any
comfortable position film placed intraorally and secured with teeth
or fingerCENTRAL RAY: XR source from superior to inferior
Perpendicular to film, centered on medial saggital plane &
Coronal planepassing anterior to outer canthiMODIFICATIONS: central
ray 60
ocaudad, directed to distal lower 1/3 of nose
Mandibular Occlusal:STRUCTURES: mandibular dental arch, anterior
floor of the mouth symphysis and anterior mandibular body,
sublingual
gland submandibular glandsPOSITION: any comfortable position
with head extended film placed intraorally and secured with teeth
or fingerCENTRAL RAY: XR source from inferior to superior
Perpendicular to film, centered on medial saggital planeCoronal
plane passing through second molarsMODIFICATIONS: Direct CR 55
degrees cephalad to tip of chin
Ordering OptionsMandibular Series: Rt & Lt Lateral
ObliquesPA of mandible
Facial Series: PA headLateral Skull
