Panoramic films (OPTs/DPTs/OPGs) are a form of extra-oral radiograph that we take in dentistry. They provide an overview of the patient’s dentition as well as surrounding anatomy. You can see more about why we do panoramic films here.

Interpreting OPTs can be quite difficult if you’ve not seen many before and the aim of this post is to make you familiar with some of the key anatomical landmarks on this radiograph.

Anatomy of the Mandible

The mandibular condyle (brown highlight) will be seen as a rounded, radiopaque area located within the glenoid fossa towards the lateral aspects of the panoramic film.

The coronoid process (yellow highlight) is found medial to the condyle as a radiopaque, triangular area. It may superimpose over the maxillary tuberosity and the maxillary sinus.

Anatomy of Panoramic Films - Condyle and Coronoid Process
Condyle (brown) and coronoid process (yellow) of the mandible

The glenoid fossa (red line) is the concave area in the zygomatic process of the temporal bone – it is a key component of the temporomandibular joint (TMJ). Medial to the glenoid fossa, we can see the articular eminence (purple highlight).

Anatomy of Panoramic Films - Glenoid Fossa
Glenoid fossa (red line)
Anatomy of Panoramic Films - Articular Eminence
Articular Eminence (purple)

If we then follow on down from the condyle and coronoid processes, we reach the ramus of the mandible (blue highlight). This then leads on to the body of the mandible (green highlight). The location these join at is the angle of the mandible (purple line).

Anatomy of Panoramic Films - Mandible
The ramus of the mandible (blue) followed by the body of the mandible (green). Where these meet is the angle of the mandible (purple line)

Within the ramus of the mandible and going through the body of the mandible, you will notice a radiolucent band which is surrounded by two radiopaque bands – this is the inferior alveolar nerve canal (red lines) where the inferior alveolar nerve travels through. This will then travel to a radiolucent round/ovoid area around the apices of the lower first and second premolars – this is the mental foramen (blue highlight). The mental nerve exists from here.

Anatomy of Panoramic Films - Inferior Alveolar Nerve Canal + Mental Foramen
Inferior Alveolar Nerve Canal (red lines) and the mental foramen (blue)

The lower border of the mandible (orange highlight) is seen as a thick, radiopaque band.

Lower border of the mandible
Lower border of the mandible (orange)

Anatomy of the Maxilla

The maxillary sinuses (blue highlight) are seen as large, radiolucent areas above the maxillary dentition.

Maxillary Sinuses
Maxillary Sinuses (blue)

We can also identify the walls of the maxillary sinus. Panoramic films are carried out by rotation of the machine around the patient’s head – as a result, we should think of the image as the patient’s face flattened out. Therefore, on an OPT, we can see the posterior walls of the sinus (pink line) and the floor of the sinus (green line). These are seen as thin, radiopaque lines surrounding the maxillary sinus radiolucency. These lines are often close to the roots of the maxillary teeth.

Maxillary sinus walls
The posterior wall of the sinus (pink) and the sinus floor (green)

The zygomatic process of the maxilla (red line) can also be seen as a radiopaque U/J/V-shaped line around the upper first/second molar teeth.

Zygomatic Process
Zygomatic Process (red line)

Anatomy of the Nose

We can see the borders of the nasal cavity medial to the walls of the maxillary sinus. The nasal cavity itself is highlighted blue.

Nasal Cavity
Nasal Cavity (blue)

The nasal septum (blue highlight) is seen as a radiopacity at the centre of the nasal cavity. Inferior nasal turbinates (pink highlight) are usually visible as round

Soft tissue of the nose
The nasal septum (blue) and the inferior nasal turbinate (pink)

The floor of the nasal cavity/hard palate (green highlight) is seen as a thin, radiopaque line. This may be superimposed over the maxillary sinus or maxillary teeth.

Hard palate
Hard palate (green)

Anatomy of the Midface

The orbital rim (red line) can often be seen as a thick, semi-circular, radiopaque line superior to the maxillary sinuses.

Orbital Rim
Orbital Rim (red line)

Lateral to the maxillary sinuses, we can see the pterygomaxillary fissure (green highlight). This is an inverse teardrop radiolucency, surrounding by a thin radiopaque line.

Pterygomaxillary Fissure
Pterygomaxillary Fissure (green)

The zygomatic bone (purple highlight) can also be identified as a radiopacity if we follow laterally from from the zygomatic process of maxillary bone. It will usually be superimposed over the maxillary tuberosity and pterygomaxillary fissure.

Zygoma
Zygoma (purple)

Other anatomy

The external auditory meatus (red highlight) is seen as a round/ovoid radiolucent area lateral to the mandibular condyle and glenoid fossa.

External auditory meatus
External auditory meatus (red)

The soft tissue of the earlobe (blue line) can also be seen as a radiopaque area roughly around the ramus of the mandible.

Earlobe
Earlobe (blue line)

The cervical spine (purple highlight) is typically superimposed over the centre of the OPT – this often makes interpretation of anterior anatomy difficult. Depending on patient positioning, the cervical spine may also be present laterally on the film.

Cervical spine
Cervical spine (purple)

Adjacent to the cervical spine, if it is present laterally, you can see radiopaque pointed structures which are the styloid processes (yellow highlight).

Styloid process
Styloid process (yellow)

Inferior to, or along, the lower border of the mandible, we would see the hyoid bone (green highlight) as a radiopaque structure either side.

Hyoid bone
Hyoid bone (green)

The soft palate (red highlight) is a radiopaque mass seen next to the hard palate but with lower density due to the lack of bone.

Soft palate
Soft palate (red)

There are also several other airspaces that can be identified on panoramic films. The nasopharynx (red highlight) is a radiolucent area coming from the nasal cavity. Below this, we have the oropharynx (purple highlight) which is a radiolucent area jointed to the oral cavity. Finally, below this, we have the hypopharynx (pink highlight).

Panoramic films - Nasopharynx
Nasopharynx (red)
Panoramic films - Oropharynx
Oropharynx (purple)
Panoramic films - Hypopharynx
Hypopharynx (pink)

Useful Links & Recommended Reading

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BDS (Hons.) MFDS RCPS (Glasg.) Cert Med Ed FHEA - Currently working as a Speciality Doctor in OMFS and as an Associate Dentist

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