X-RAY POSITIONING OF THE MANDIBLE (2020 UPDATED)
Summary
TLDRThis educational video script focuses on radiographic positioning of the mandible, emphasizing the challenges due to its superimposed and curved structure. It details various projections, particularly the PA mandible, to visualize fractures clearly without superimposition. The script also discusses alternative views like the OPG, lateral mandible, and axiolateral projections for specific cases, highlighting the importance of proper patient positioning and equipment use for accurate diagnostic imaging.
Takeaways
- π¦· The video discusses the radiographic positioning of the mandible, emphasizing the challenges due to its superimposition by other structures and curved shape.
- π¨ββοΈ It is recommended to watch this after understanding the cranial vault, facial bones, and sinuses from previous videos.
- π A PDF presentation is available for further study on pathologies like fractures that can occur in the facial bones and mandible.
- π The PA (Posteroanterior) mandible projection is the most frequently used technique to visualize fractures without superimposition.
- π¬ The PA mandible projection requires specific positioning with the orbitometal line and interpupillary line horizontal, and no tube angulation.
- π The positioning for the PA mandible projection aims to elongate the mandible to make fractures more visible and assess displacement.
- π The OPG (Orthopantomogram) is a valuable projection for the mandible but requires specialized equipment not available in all centers.
- ποΈ The Lateral mandible projection is less common due to the difficulty in interpreting superimposed mandibular sides but is useful in certain cases.
- 𦴠Axiolateral projections are used to examine specific areas like the temporomandibular joints (TMJs) when an OPG is not available.
- π€ΉββοΈ Positioning for axiolateral projections requires precise angles and patient positioning to isolate and visualize the area of interest.
- π The Orthopantomogram works by exposing a small area of the image receptor at a time while rotating around the patient to flatten the curved mandible structure.
Q & A
What is the main challenge in performing radiography on the mandible?
-The main challenge in performing radiography on the mandible is that it is a curved structure and is superimposed by many other structures, making it difficult to see fractures without any superimposition.
Why is the PA mandible projection frequently utilized in radiographic projections of the mandible?
-The PA mandible projection is frequently utilized because its purpose is to elongate the mandible maximally, allowing for the clear visualization of fractures without superimposition, especially those with lateral displacement.
What is the recommended technique for the PA mandible projection according to the video?
-The recommended technique for the PA mandible projection involves having the orbitometal line and interpupillary line horizontal, with no tube angulation, and centering in the midsagittal plane at the level of the mid-mandibular angles.
What is the purpose of the lateral mandible projection?
-The purpose of the lateral mandible projection is to provide a view of the mandible in a true lateral position, which can be useful when there is a query of a mandibular fracture, despite the superimposition of the two mandibular sides.
How should the patient's head be positioned for a lateral mandible projection?
-For a lateral mandible projection, the patient's head should be in a true lateral position with the interpupillary line horizontal, and the central ray should pass through the mid-mandible.
What is an Orthopantomogram (OPG) and how is it beneficial for mandible radiography?
-An Orthopantomogram (OPG) is a specialized projection that exposes a small area of the image receptor at a time while rotating around the patient, resulting in a flat representation of the curved mandible structure. It is beneficial as it shows the entirety of the mandible in one structure, which is useful for identifying fractures or other pathologies.
What are some common issues with OPG positioning and how can they be avoided?
-Common issues with OPG positioning include improper alignment of the bite plane, patient movement, and interference from broad shoulders. These can be avoided by ensuring the patient's bite plane is in a slight smile position, instructing the patient to stay still, and adjusting the patient's position to prevent shoulder interference.
Why is it important to remove metallic foreign bodies before performing an OPG?
-It is important to remove metallic foreign bodies before performing an OPG to prevent artifacts on the image, which can obscure the view of the mandible and other facial structures.
What is the purpose of the axial lateral projection for the temporomandibular joints (TMJs)?
-The purpose of the axial lateral projection for the TMJs is to project the target TMJ above the rest of the bones of the base of the skull, allowing for a clear view of the joint, which is particularly useful when querying a disruption to the TMJs.
How can the axial lateral mandible projection help in identifying fractures of the mandibular ramus or angle?
-The axial lateral mandible projection helps in identifying fractures of the mandibular ramus or angle by separating the mandibular angles and rami, allowing for a clearer view of the target area, which can be particularly useful when an OPG is not available or suitable.
What supplementary projection is recommended to complement the OPG for a more comprehensive radiographic examination of the mandible?
-A supplementary projection such as the PA mandible is recommended to complement the OPG. This allows for the visualization of any displacement of fragments, which may not be clearly seen in the OPG due to superimposition in the midline over the cervical spine.
Outlines
π¦· Mandible Radiography Techniques and Considerations
This paragraph discusses the complexities of mandible radiography due to its superimposed and curved structure. It emphasizes the importance of the PA mandible projection for identifying fractures without superimposition. The speaker advocates for a specific technique to maximize mandible elongation, including positioning the orbitometal line and interpupillary line horizontally without tube angulation. The focus is on the PA mandible projection's ability to reveal fractures, especially those with lateral displacement, and the importance of knowing surface anatomy for accurate collimation and radiography settings.
π Lateral Mandibular and Axiolateral Projections for Fracture Assessment
The second paragraph delves into less common lateral mandibular projections and their challenges in clarifying fractures. It describes the positioning for a lateral mandibular projection, requiring a true lateral head position and specific image receptor dimensions. The paragraph also introduces the concept of axial lateral projections, particularly for examining the temporomandibular joints (TMJs), and explains the positioning and angulation required to isolate the TMJ over the parietal bone on the non-affected side. The discussion includes the use of open and closed mouth positions to assess TMJ functionality.
π Axiolateral Mandible Projection for Ramus and Angle Fractures
This section focuses on the axiolateral mandible projection, a technique used to examine potential fractures in the mandibular ramus or angle. The speaker clarifies the objective of this projection, which is to separate the mandibular angles and rami for clearer visualization. The positioning involves a combination of head rotation, head tilt, and tube angulation to achieve a 30-degree cephalad angle. The goal is to have the mandible parallel and close to the image receptor, which may require adjustments such as a small sponge under the patient's neck for comfort and artifact prevention.
π οΈ Orthopantomogram (OPG) Technique and Positioning
The fourth paragraph outlines the principles and positioning for an orthopantomogram (OPG), a specialized radiographic technique for the mandible. It highlights the importance of patient communication, removal of metallic objects, and the use of a bite piece for proper alignment. The speaker advises on patient positioning to ensure the head is still and the shoulders are relaxed to prevent movement during the OPG's rotational exposure. The paragraph also addresses common positioning errors and their impact on image quality, emphasizing the need for a horizontal orbitometer line and a vertical head position.
π Optimal Bite Plane Alignment in OPG for Mandible Imaging
The focus of this paragraph is on achieving the correct bite plane alignment during an OPG to ensure a sharp and clear image of the mandibular structures. It discusses the ideal curvature of the bite plane, which should resemble a slight smile, and how deviations from this can result in an 'angry mouth' appearance or an exaggerated smile, indicating the chin is too far forward or back, respectively. The speaker provides guidance on adjusting the patient's head position to correct these issues and achieve optimal image quality for dental and mandibular assessment.
β Final Thoughts on Mandible Radiography and Supplementary Projections
In the concluding paragraph, the speaker wraps up the discussion on mandible radiography, emphasizing that while the OPG is a valuable tool for visualizing the entire mandible, it should not replace supplementary projections like the PA mandible for assessing fragment displacement. The speaker acknowledges the midline superimposition over the cervical spine in OPG images and invites questions on cranial vault positioning while encouraging further study of the provided PDF file detailing common pathologies of the cranial vault and facial bones.
Mindmap
Keywords
π‘Mandible
π‘Radiography
π‘PA Mandible Projection
π‘Orbitometal Line
π‘Interpupillary Line
π‘Fracture
π‘Orthopantomogram (OPG)
π‘Axiolateral Projection
π‘Temporomandibular Joints (TMJs)
π‘Lateral Mandible Projection
π‘Superimposition
Highlights
The video discusses the radiographic positioning of the mandible, a complex area due to its superimposition by other structures and curved shape.
After the video, a PDF presentation on facial bone and mandible pathologies, especially fractures, is recommended for further study.
The PA mandible projection is the most frequently used technique to visualize fractures without superimposition.
Proper positioning for the PA mandible projection includes a horizontal orbitometal line and interpupillary line, with no tube angulation.
The PA mandible projection aims to elongate the mandible to make fractures and displacements more visible.
The OPG (Orthopantomogram) is a valuable projection for the mandible but requires specialized equipment.
Lateral mandible projections are less common due to the difficulty in clarifying fractures with overlapping images.
Axiolateral projections can be useful for examining the temporomandibular joints (TMJs) when OPG is not available.
Axiolateral TMJ projections involve a 25-degree angulation to project the TMJ above the base of the skull.
Axiolateral mandible projections are challenging and aim to separate the mandibular angles and rami for clearer fracture visualization.
OPG positioning requires careful patient communication and removal of metallic objects to prevent image artifacts.
The correct bite device is crucial for OPG to ensure the teeth are in the same plane for a sharper image.
Proper patient positioning in OPG is key to capturing the entire mandible in focus, including maintaining a horizontal orbitometer line.
The bite plane in an OPG should resemble a slight smile, indicating correct patient positioning.
Supplementary projections like the PA mandible are necessary alongside OPG to show fragment displacements.
The midline of the OPG is often superimposed over the cervical spine, which can compromise image quality in that area.
Transcripts
this video covers the positioning of the
mandible
it should be watched after having first
viewed the
three preceding videos which looked at
the cranial vault
the facial bones and the sinuses
after this video there is a pdf
presentation which describes
some of the pathologies particularly
fractures
which can readily occur within the
facial bones and mandible and i
encourage you to have a look at that
non-narrated presentation
the mandible is a potentially
challenging area
to perform radiography on
because it's superimposed by many other
structures
and it's a curved structure it can be
very challenging to
to see fractures of this region
as such there are some projections which
can be utilized on the mandible
but probably the only one which is
utilized very frequently
is the pa mandible amongst the plane
radiographic projections
the pa mandible projection can be
undertaken a number of different ways
essentially the purpose of this
projection is to be able to
elongate the mandible maximally
so that any fractures can be seen
without any superimposition
and any fractures which have a
displacement media laterally can be seen
readily as such while there are a number
of different ways to
perform this projection the technique
which i advocate for you
here should have the best chance of
being able to show any fractures
for the pa mandible projection the
common information is that the
orbitometal line
should be horizontal that is that the
uh forehead is tucked in so the
patient's nose and forehead is against
the
image receptor and the interpupillary
line should be horizontal
when we undertake those two things you
can see that the primary beam should be
able to elongate that mandibular
structure
i do not advocate a tube angulation for
mandibular projections
now the intention of this projection is
to have the divergent ray
cutting through the mandibular angle and
elongating the entirety of the mandible
that is the
intention here
so a pa mandible projection requires for
the orbitometer line to be horizontal
and the interpupillary line to be
horizontal
there should be no tube angulation and
the centering point should be
in the midsagittal plane at the level of
the mid
mandibular angles the head is positioned
such that the patient's nose and
forehead is against the image
you should collimate superiorly to
include the entirety of the external
order trimiatus which is the patient's
earhole level and all the way down to
the patient's mental synthesis and both
of those
surface anatomy structures should be
well known to you
when you perform this projection which
is on a 24 by 30 portrait with about 75
kbp
you should end up with a projection
which looks like this
now as you can see if the mandible has
been elongated
and if there is a fracture hopefully
there won't be any superimposition of
the proximal and distal fragment
sections
over each other so you should be able to
see that fracture
we should be able to see almost all of
the mandible certainly the superior most
parts of the temporomandibular joints
are going to be superimposed by the
lower part of the facial bones and the
the temporal constructs
and certainly the medial aspect that is
the midline
mental symphysis aspect is going to be
superimposed over the cervical spine
however we should be able to see the
entire mandible
even with some superimposition
assuming that the mandible is a
symmetrical structure and it can be
displaced somewhat by fracture
we should be able to see that mandible
as a fairly symmetrical structure
so we've performed our pa mandible
the next views that you do really depend
upon the facilities available to your
particular
imaging center the opg
or orthopantomogram is a very good
projection for the mandible but it
requires specialized equipment and not
all centers have access to it
as such it's important to be able to
describe some of the other
projections as well
the lateral mandible tends to be
undertaken
reasonably infrequently when a patient
has
got a queried mandibular fracture
superimposing
the two mandibular sides over each other
doesn't really clarify the situation if
anything it probably makes it a little
bit more challenging
however to perform a lateral mandible
projection
requires for the head to be in a true
lateral position and as i've discussed
in previous videos
having the patient positioned in
approximately a 45 degree
rotation of their thorax such that then
their head is turned in a true lateral
position
is the best way to position these the
interpupillary
line should be a horizontal structure
and the central ray passes through the
mid
mandible and by mid mandible what i mean
is essentially a point halfway between
the
mental symphysis and the external
auditory meatus
that lateral mandibular projection
should have
a 24 by 30 landscape or
portrait image receptor it doesn't
really matter too much but i tend to go
with landscape
and it really does require for the
patient to really have that sort of once
again that shoulder and neck and close
to the image receptor
when performed well it should look
something like this and you can see that
there is almost complete superimposition
of structures such as the mandibular
angle and
mandibular rami the mandibular condyles
and the petrous temporal bones
aren't perfectly superimposed because
they are a more peripheral structure
on this image lateral mandible
and or lateral facial bones can be
undertaken with a special
form of lateral imaging of the facial
bones called lateral cephalometry
which basically uh puts the patient's
head
into a clamp-like device
which means that the patient will be in
a true lateral position
but it can be performed quite readily
just with standard radiographic
positioning
so we should have superimposition of
bilateral structures we should see the
entirety of the mandible and it should
be very close to a true lateral
projection
if you do not have access to an opg
but there is a query or suspicion
of a fracture around the mandibular
ramus
and angle then the axiolatural
projections can be useful
the first axiolateral projection i'd
like to talk about is for the
tmjs
and an axio lateral projection is
essentially
one which introduces an angle to a
patient
in approximately a lateral position
if you wanted to have a look at the
patient's temporomandibular joints an
opg or lateral cephalometry is the ideal
projection
however without having access to those
if you wanted to see whether or not the
patient had a disruption
to their temporomandibular joints or
tmj's
then the axiolateral projection is what
you do
starting off with the patient in a true
lateral position
what you're going to do is instead of
having the central rod be a horizontal
structure
you are going to introduce an angulation
such that the central ray passes through
the tmj
closest to the image receptor now often
what this means
is first of all having a practice run
sitting
or standing the patient against the
erect bucky and then assessing
the level of their temporomandibular
joints their ear hole
level so that you can ensure that your
image receptor is at the correct level
then
introducing about a 25 degree coordinate
angulation
such that it strikes the image receptor
at that height
then bring the patient back in and
position them in a true lateral position
and you should end up with the
superimposition of the target
temporomandibular joint over the
parietal bone
on the non-affected side
so hopefully that smooth plate like bone
of
for example in this image the patient's
left parietal bone will be superimposed
over the tmj and you should see that
target tmj
quite well so
the axial electrical tmj projection is a
true lateral
with the affected side touching the
image receptor but a 25 degree cord out
angulation
hitting that target tmj passing through
the parietal bone on the other side
depending upon the queried pathology
it might be performed with the patient's
mouth open or closed
or still or an open
and closed series if you were querying
something such as
a temporomandibular joint dislocation or
subluxation
this patient is having a
axiolateral tmj projection with an open
mouth this photograph shows a tube
angulation of 30 degrees i don't think
30 degrees is necessary 20 to 25
should be all you require because all
you're really trying to do
is to project that temporary
temporomandibular joint above the rest
of the bones of the base of the skull so
30 degrees is a bit too much there
and we should end up with something like
this hopefully you can see the
socket there of the temporomandibular
fossa and hopefully you can see the
mandibular condyle
now in this projection these two
projections we have both
a closed and an open projection when the
patient's mouth is
open or when your mouth is open your
mandible moves
inferiorly and anteriorly such that that
condyle will then move against that
process just anterior to the
temporomandibular fossa
an axiolateral tmj projection is
commonly very commonly performed
bilaterally and so you may end up doing
open and closed left open and closed
right to be able to show that tmj
functionality
the axiolateral mandible is probably one
of the most difficult projections to
describe
rather than go straight into the
positioning of this projection
i'd instead like to tell you the
objective and that will hopefully
clarify
why we are doing this projection and how
we do it
the image in front of you shows a young
lady who is
having some x-rays done of her mandible
perhaps she's not a suitable candidate
for an opg or perhaps we don't have
access to an opg machine
but we have a query of a possible
fracture of the
mandibular ramus or angle
for that reason axiolateral mandible
projections can be performed
now these can be performed with the
patient supine as was the way this
photograph was originally taken
or erect and that's the way that i've
actually just rotated this
photograph
now in this photograph
we have the patient's right side being
closest to the image receptor
and we are imaging the right hand side
the purpose of this projection this
photograph in front of you
is to try to get the majority
of the right side of the patient's
mandible
in contact with the image receptor and
parallel with the image receptor
it's not a true lateral projection you
can see that we have got a
cephalad angulation the purpose of that
cephalad angulation
is to project the patient's left
mandibular ramus and angle superiorly
and out of the way
the right side is the area of interest
on this
projection now you'll notice that i have
not
stated a particular tube angulation at
this point
the purpose of this projection is to
separate the mandibular
angles and rami to achieve that
we have an approximately 30 degree
cephalad angulation
that 30 degree cephalad angulation
can be achieved by a 30 degree
tube angulation a 30 degree
tilting of the head to the side
or any combination of those two angles
to create the sum of 30 degrees
so i will be describing this as though
the patient's head is tilted
15 degrees on this side and with a 15
degree tube angulation
but the important message is this tube
angulation
plus head tilt equals 30 degrees
there is an additional positioning
rotation to the scribe as well
but if you are mindful of the fact that
this mandible
the right hand side of this patient's
mandible needs to be parallel to
and closely as close as possible to in
contact with the image receptor
will be able to understand this
projection
we start off with the patient in
approximately a lateral position
we then have the patient
turn their head
toward the image receptor
so the patient if you were to have a
look at the patient's eyes they are not
looking
straight ahead but rather their head has
been turned
15 degrees toward that image receptor
if you were to feel your own mandible
now you could obviously feel that it
starts out as a broad structure near
your ears
and tapers into the midline by turning
the head towards one side
we bring the majority of that mandibular
structure
parallel with the long axis or parallel
with a plane of the film
after we have rotated the head we also
then
tilt the head such that
it plus the tube angulation
equals 30 degrees so i've mentioned 15
degrees there
however it is part of your total
angulation
often having a small sponge underneath
the patient's
neck and mandible may assist so long as
it's not going to cause an artefact
so the head is turned into the image
receptor
and the mandible is slightly away
from the image receptor but the forehead
is tilted
closer in that will separate
the left and right mandibular rami
so 15 degree head
rotation 15 degree head
tilt 15 degree tube angulation
but functionally the head tilt and
angulation
equals 30 degrees
now if you're able to achieve that this
is what you should end up with
a position where the patient is off
lateral that is that their head is not
in a true lateral position it's 15
degrees turned into the erect bucky or
table bucky
and it is also angulated such that the
top of the head is closer in towards the
film the forehead is closer
so the interpupillary line will be on a
15 degree angle is another way of
considering it
the tube angulation plus that head tilt
equals 30 degrees the centering point is
going to be
in the target mandibular body so the
central ray is going to pass
essentially just anterior to the
mandibular angle
and at the midpoint between those two
mandibular
angles
it can be done erect or supine and you
can see that this is one way of
performing the projection it does
distort the image a little touch so i
would prefer to have the image receptor
be flat
but it's not a bad way of positioning it
this is what you should end up with it's
actually a very very pretty
projection once it's performed well you
can see on this particular projection
that the entirety of the patient's
mandibular condyle
angle ramus and body almost all the way
up to the mental symphysis can be
projected
clear of any of the rest of the skull
and the rest
of the mandible the the target side is
showing well but the non-target side's
projected way off the top of the image
you will get some superimposition over
hyoid bones and things like that that's
very very normal
and so in terms of the criteria we
should show the mandibular condyles off
the cervical spine so we can see that
condyle
and that that target region the affected
side of body
ramus mandible can be seen maximally
once we get into the curvature of the
patient's mental synthesis we
will the anatomy will be distorted of
course
we'll perform this projection
bilaterally to show
both sides because we are going to be
very likely to have multiple fractures
over the mandible
and now the orthopedimogram
the principle of an orthopantomogram
is to only expose a small
area of the image receptor at one
particular time
and that over that exposure and as we
expose segment by segment of the image
receptor
the entirety of the x-ray tube and image
receptor
rotate around the patient subsequently
we should end up with a curved structure
of the mandible
being shown as a flat structure across
the plane of the image receptor
opg positioning is something which is
frequently done quite
poorly there are a number of things that
i'd like you to be aware of
first of all communicate with your
patient try to get all metallic foreign
bodies out of the way
earrings nose piercings other facial
piercings false teeth things like that
should be
taken out of the possibility of causing
an artifact on the image in front of you
there you can see
in that photograph that the model is
biting onto a small piece of plastic
that is essentially between her teeth
this is the most correct byte device to
use
if you have been on placement and have
seen an opg you may have seen some which
have got this byte device
some which use like a tray that the
mandible slides into or probably both
and for most machines it's an
interchangeable thing
ideally you should wherever possible
utilize the bite
piece it will have a groove in the top
and bottom to allow for the top and
bottom teeth to be in the
same plane and so you're going to end up
with a sharper image of the teeth
in addition while it is less fun to bite
on something to just rest your chin
in a slot it will have a
better image quality and it does mean
that the patient's less likely to
turn their head which is the case when
you use the tray
the patient is placed in the opg machine
after you've removed all of the
foreign bodies and things like that
communicate well with your patient and
let them know that the machine is going
to take
10 seconds it's going to make noise and
most particularly
and this is very very important for
broader shoulder patients
let them know that if the machine
brushes up against their shoulders that
they are to try to stay as still as they
can and to let it move around
them
the patient will bite onto the bite
piece or as necessary slide their
chin into that mandibular tray and a
rest is going to be placed against the
forehead
and possibly some clamps against the
side of the head as you can see in this
photograph
with the intent of keeping the head
absolutely still
the orbitometer line should be
horizontal
and so this photograph the chin has
tilted up a little bit too far i would
have liked to have seen
the chin down a little touch more
the patient's shoulders should be
relaxed now
in this particular photograph this model
is is a slim
shouldered lady however one of the
things that you can do
is to wrap your arms underneath
that bar that you can see in front of
the patient
and so the left hand holds on to the
right
bar and vice versa that will then bring
the shoulders
anteriorly and medially and that should
allow
for the tube to move around the patient
with a little bit more comfort and less
safety issues the head should be
vertical the vertical line should be
running straight down their face
and these opgs can be performed in a
with a patient in a chair and that's
fine particularly if you've had a
patient who's had an assault or
something like that
and you want to make sure that they're
not a fainting risk but really you
should be assessing your patient for
their
ability to comply if you use a chair
do not use a rotating chair because if
the tube hits the patient's shoulders
that rotating chair is just going to
rotate the patient around as well
okay so use a chair with fixed legs
tell that patient to stay nice and still
not to turn their head
and what you should end up with is a
nice
gentle opg
now when performed well the the standard
positioning doesn't really apply for the
opg because
you can't change the angle it's an image
receptor specialized for the purpose or
indeed a dr
opg machine and the central ray of
course well it's going to go all the way
around that patient so it's going to be
at approximately the level of the
the mid mandible you should have that
interpupillary line horizontal though
the mirror in front of the patient
should have
lines etched into it to enable you to
know if the patient's in a true
interpupillary line being horizontal
position
when the projection has been performed
and the
orbit hermeator line is horizontal you
should end up with the image that you
can see in the middle of the screen
there
if the patient's chin is too far forward
or the head has been tilted too far back
you're going to end up with a much more
easily performed opg because the head's
up nice and high
but it's not going to get the majority
of those facial bones
structures those mandibular structures
in the same plane so it's going to be
out of focus
similarly if you have got the chin too
far back the forehead too far
forward you're once again going to
project
structures outside of that plane of
focus
and so once again you're not going to be
able to see good detail of all of the
teeth and mandibular structures
so when an opg has been performed
well the patients bite plane
that is the alignment of their upper and
lower teeth
should be in a slight smile and the
image in front of you
in the middle of screen represents the
ideal curvature of the bite plane
if you've got a flat bite plane like the
image on the top of the screen
that looks like they've got an angry
mouth you've got the chin too far
forward you need to bring the forehead
more forward
and conversely if you've got that very
very exaggerated huge
smile that you can see down the bottom
the chin is too far back you really need
to bring that
chin forehead chin forward and forehead
back
the opg is one which really does require
a fair amount of compliance but it is a
very very good projection for being able
to show the entirety of the mandible as
one structure
it is not the be all and end-all of
radiography the mandible you still do
need a supplementary projection
such as the pa mandible a complementary
projection i should say
so as to be able to show any
displacement of fragments
the opg always suffers from the fact
that in the midline it's going to be
superimposed over the c-spine so you may
have some compromised image quality
there
if you have any questions about any of
the positioning of the cranial vault
please do jump onto discussion board
otherwise i encourage you to have a look
at the final pdf file which outlines
the common pathologies of the cranial
vault
and facial bones and good luck with your
studies
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