Article
We came across this case which demonstrates the importance of correct patient positioning within the focal trough in dental panoramic radiography to visualize the anterior mandible adequately.
The patient presented for a surgical assessment of an impacted upper right canine. A panoramic radiograph was taken (Figure 1). Incidentally, the anterior mandible, apical to the lower anterior teeth, demonstrated what appeared to be a well-defined, large unilocular radiolucency, with partial cortication at its superior aspect. The lower border of the mandible was intact.
The presence of an odontogenic cyst or tumour could not be ruled out therefore, to characterize this area further, a lower 45° occlusal radiograph was acquired (Figure 2). This demonstrated normal trabecular pattern of the mandible with normal length and morphology of the anterior incisor roots.
This case highlights the importance of understanding the diagnostic limitations of tomography and, in particular, the role of the focal trough in relation to a change in the patient's position. In this case, the slight chin down position has resulted in the anterior mandible being outside of the focal trough and therefore blurred out.
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