Lecture 4

Extraoral Radiographic Examination
All views made of orofacial region with films

positioned extraorally
Extraoral Radiography
Used for Panoramic,

Lateral Jaw,
Cephalometric, Skull
and TMJ views
Indications
To examine areas not fully covered by
intraoral films
To visualize the skull and facial structures
To evaluate skeletal growth in orthodontics
All projections can be made with

conventional dental x-ray machines, or
larger x-ray units designed specifically for
extraoral radiography
Means of fixing the tube head in a
standardized position
A cephalostat must be available for
reproducible positioning of the patient
Intraoral
Pan/Ceph
Specialty Extraoral
Head Positioner/Film Holder
head positioner
cassette
holder
A combination of film and intensifying

screens is needed for all extraoral
radiographic projections
Use of grids to decrease fog from scattered
radiation and increasing contrast
Cassette/Film
Grid
primary x-rays grid film

scatter radiation
Frankfort plane is a classic reference line

The canthomeatal line is more easily
visualized and so more preferred
Posteroanterior Projection (PA)

Beam passed in a posterior-to-anterior
direction through the skull
Used to examine skull for

• Disease,
• Trauma,
• or developmental abnormalities
• Changes in the mediolateral dimensions of the
skull
• Good visualization of facial structures, including
the frontal and ethmoid sinuses, nasal fossae
• Cassette is positioned vertically in front of

patient’s head in a holding device
• Canthomeatal line is parallel to the floor
• Petrous ridge should lie in the lower third of
the orbit
• Central ray is directed perpendicular to the

film from a source 36-40 inches away
• The source should be coincident with the
midsagittal plane of the head at the level of
the bridge of the nose
• Exposure parameters vary depending on the

type of x-ray machine, distance from source
to patient, and screen film combination
• Speed class 250: kVp 70, mAs about 30-50
Taken with intraoral x-
ray machine. (Note round
collimation). Not
recommended, but
possible.
Lateral Skull Projection

Used to survey skull and facial bones for
• Trauma
• Disease
• Developmental abnormalities
• Revealing nasopharyngeal soft tissues
• Paranasal sinuses and hard palate
• Assessment of facial growth
• Pretreatment and posttreatment records
• Facial soft tissue profile
• Film is placed vertically near the left side of

the face with midsagittal plane parallel to
the film
• Wedge filter is placed over the anterior of
the beam at the tube head
• For cephalometric projection the distance is
60 inches from source to midsagittal plane
• Speed class 250: kVp 70, mAs about 15-25

Waters’ Projection
Used to
• Evaluate maxillary sinuses, frontal and
ethmoid sinuses
• The orbit, the zygomaticofrontal suture and
the nasal cavity
• It demonstrates the position of the coronoid
process
• Film is placed vertically with sagittal plane of

patient perpendicular to it
• The canthomeatal line 37 degrees above
horizontal
• If mouth is open, the image of the sphenoid
sinus will project onto the palate
• Central ray at the level of the maxillary sinus
through midsagittal plane
• Speed class 250: kVp 70, mAs 100

Reverse-Town’s Projection
Used to
Examine suspected condylar fracture of the
neck
Medially displaced condyle
Posterolateral wall of maxillary sinus
• Film is placed vertically in front of the

patient’s head with canthomeatal line
downward 25 to 30 degrees
• Opening wide reveals the condyles better
• Central ray through the occibital bone
• Beam is collimated to reduce exposure

Submentovertex Projection
Demonstrates the
• Base of the skull
• Position and orientation of the condyles
• Sphenoid sinus
• Curvature of the mandible
• Lateral wall of maxillary sinuses
• Fractures zygomatic arch
• Film is placed vertically behind patients head

• Neck is extended backwards with vertex of the
skull on the center of the cassette
• Midsagittal plane perpendicular to the floor
• Canthomeatal like 10 degrees past vertical past
vertical, Frankfort plane is vertical
• Central ray directed below the mandible upward
and toward the vertex of the skull

Lecture 4

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Extraoral Radiographic Examination

Extraoral Radiographic Examination

All views made of orofacial region with films

Used for Panoramic,

All projections can be made with

A combination of film and intensifying

primary x-rays grid film

Frankfort plane is a classic reference line

Posteroanterior Projection (PA)

Used to examine skull for

• Cassette is positioned vertically in front of

• Central ray is directed perpendicular to the

• Exposure parameters vary depending on the

Lateral Skull Projection

• Film is placed vertically near the left side of

• Speed class 250: kVp 70, mAs about 15-25

• Film is placed vertically with sagittal plane of

• Speed class 250: kVp 70, mAs 100

• Film is placed vertically in front of the

• Speed class 250: kVp 70, mAs 100

• Film is placed vertically behind patients head

• Speed class 250: kVp 70, mAs 100

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