Cone Beam CT of the Head and Neck

Cone Beam CT of the Head and Neck
Chung How Kau • Kenneth Abramovitch
Sherif Galal Kamel • Marko Bozic
Cone Beam CT
of the Head and Neck
An Anatomical Atlas
Professor Chung How Kau
University of Alabama
Birmingham School of Dentistry
Department of Orthodontics
7th Avenue South 1919
35294 Birmingham Alabama
Room 305, USA
ckau@uab.edu
Dr. Kenneth Abramovitch
University of Texas
Health Science Center
Department of Diagnostic Sciences
Section for Oral Radiology
MD Anderson Blvd. 6516
77030 Houston Texas, USA
Kenneth.Abramovitch@uth.tmc.edu
Dr. Sherif Galal Kamel
University Hospital of Coventry
and Warwickshire
Clifford Bridge Road
CV2 2DX Coventry
Medical Residence Room 1-9A
UK
dr.sherif83@gmail.com
Dr. Marko Bozic
University Medical Center
Dept. of Maxillofacial and Oral
Surgery
Zaloska 2
1525 Ljubljana
Slovenia
marko.bozzich@gmail.com
ISBN: 978-3-642-12703-8 e-ISBN: 978-3-642-12704-5
DOI: 10.1007/978-3-642-12704-5
Springer Heidelberg Dordrecht London New York
Library of Congress Control Number: 2010932935
© Springer-Verlag Berlin Heidelberg 2011
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v
Preface
This book is dedicated to the memory of the three anonymous individuals
whose cadaver prosections are the subject matter of this atlas. We are deeply
respectful of and indebted to these anonymous individuals. They unknowingly have made a donation to science that will benefit students and clinicians in the imaging sciences. The handling of the cadaver donations that
are displayed in this clinical atlas was managed with respect and driven by
our scientific yearn for discovery; the discovery to benefit the current and
next generation of clinicians and researchers. These donations will enrich
the basic foundational knowledge base of human anatomy as depicted in
cone beam CT imaging. The current effort made it possible to correlate the
CBCT images with the actual physical image. This is a foundational knowledge base from which to build and make new discoveries. Future generations can then build on this foundational knowledge base to identify bone
density states, tissue function profiles (atrophy, hypertrophy, etc) disease
states (neoplasia, metaplasia, etc.). We trust that the boundaries have few
limits.
These anonymous individuals did not know what value or impact their
donation to science has made. But as shepherds, we have guided their donation to generate a high yield for the benefit of future scientific endeavors in
the imaging sciences.
We have done all in our power to preserve, protect, and maintain the dignity of these individuals. We did not know them in life but studied them in
vi Preface
death. Whether they have been rich or poor, introverted or extraverted, domineering or submissive, powerful or shy, we honored their remains and dignified their gift.
To the three of you, our deepest thanks.
Chung H. Kau
Kenneth Abramovitch
Marco Bozic
Sherif K. Gala
vii
The following people have been involved in the project without which this
atlas would never have been completed:
1. Professor Mark Wong
2. Dr. Fen Pan
3. Dr. Hasmat Popat
4. Miss Jennifer Nguyen
5. Mr. Kurt E Clark
6. Dr. Nada Souccar
Acknowledgments

ix
Introduction………………………………………………………………………. 1
Conventional Computed Tomography ………………………………. 2
CBCT …………………………………………………………………………… 3
CBCT Data………………………………………………………………… 4
CBCT Acquisition Systems …………………………………………….. 5
Uses of CBCT Technology………………………………………………. 6
Diagnosis…………………………………………………………………… 6
Clinical Applications of the CBCT ……………………………….. 7
Late Evaluation with CBCT…………………………………………. 7
The Purpose of the Clinical Atlas……………………………………… 8
References…………………………………………………………………….. 8
Axial …………………………………………………………………………………. 11
Coronal……………………………………………………………………………… 31
Sagittal ……………………………………………………………………………… 47
Contents
Introduction
C.H. Kau et al., Cone Beam CT of the Head and Neck,
DOI: 10.1007/978-3-642-12704-5_1, © Springer-Verlag Berlin Heidelberg 2011
2 Introduction
This pocket clinical atlas was produced to help dental and medical
colleagues understand and correlate structures of the head and neck
with cone beam computerized tomography (CBCT) imaging
technology.
Methods used for radiographic evaluation and diagnosis have undergone enormous changes in the last 20 years. New technologies are
being developed and are becoming readily available to the medical and
dental field. The advancements in hardware and software have allowed
the development of innovative methods for facial diagnosis, treatment
planning, and clinical application.
CBCT was developed in the 1990s as an advancement in technology resulting from the demand for three-dimensional (3D) information
obtained by conventional computed tomography (CT) scans. The
development of CBCT technology reduces exposure by using lower
radiation dose, compared with conventional CT [1–3]. As the demand
for the technology increases, so has the market for custom built craniomaxillofacial CBCT devices. The rates of increase for CBCTs have
been increasing in number on the market over the last decade and a
variety of applications to the facial and dental environments have been
established [2].
Conventional Computed Tomography
CT technology was developed by Sir Godfrey Hounsfield in 1967 and
there has been a gradual evolution to five generations of the system.
First generation scanners consisted of a single radiation source and a
single detector and information was obtained slice by slice. The second generation was introduced as an improvement and multiple
detectors were incorporated within the plane of the scan. The third
generation was made possible by the advancement in detector and
data acquisition technology. These large detectors reduced the need
for the beam to translate around the object to be measured and were
often known as the “fan-beam” CTs. Ring artifacts were often seen on
CBCT 3
the images captured distorting the 3D image and obscuring certain
anatomical landmarks. The fourth generation was developed to counter this problem. A moving radiation source and a fixed detector ring
were introduced. This meant that modifications to the angle of the
radiation source had to be taken into account and more scattered radiation was seen. Finally the fifth (sometimes known as the sixth) generation scanners were the introduction to reduced “motion” or
“scatter” artifacts. As with the previous two generations, the detector
is stationary and the electron beam is electronically swept along a
semicircular tungsten strip anode. Projections of the X-rays are so
rapid that even the heart beat may be captured. This has led some
clinicians to hail it as a 4D motion capture device [2, 4]. In 2007, the
Toshiba “dynamic volume” scanner based on 320 slices is showing
the potential to significantly reduce radiation exposure by eliminating
the requirement for a helical examination in both cardiac CT angiography and whole brain perfusion studies for the evaluation of stroke
[online reference, 1].
There are, however, limitations to these CT systems. They are
expensive and require a lot of space. The 3D reconstruction is time
consuming and so less cost efficient. Furthermore the radiation exposure to the patient has limited their usage to complex craniofacial problems and for specialized diagnostic information only.
CBCT
CBCTs for dental, oral, and maxillofacial surgery and orthodontic
indications were designed to counter some of the limitations of the
conventional CT scanning devices. The radiation source consists of a
conventional low-radiation X-ray tube and the resultant beam is projected onto a flat panel detector (FPD) or a charge-coupled device
(CCD) with an image intensifier. The FPD was shown to have a high
spatial resolution [5]. The cone beam produces a more focused beam
and much less radiation scatter compared with the conventional fan-
4 Introduction
shaped CT devices [6]. This significantly increases the X-ray utilization and reduces the X-ray tube capacity required for volumetric
scanning [7]. It has been reported that the total radiation is approximately 20% of conventional CTs and equivalent to a full mouth periapical radiographic exposure [8]. CBCT can therefore be recommended
as a dose-sparing technique compared with alternative standard medical CT scans for common oral and maxillofacial radiographic imaging
tasks [9]. The images are comparable to the conventional CTs and may
be displayed as a full head view, as a skull view, or as localized regional
views.
CBCT Data
The tube and the detector perform one rotation (180 or 360°) around
the selected region. The resulting primary data are converted into slice
data. The reconstructed slice data can be viewed in user-defined planes.
The CT volume consists of a 3D array of image elements, called voxels.
Each voxel is characterized with a height, width, and depth. Since the
voxel sizes are known from the acquisition, correct measurements can
be performed on the images. The spatial resolution in a CT image
depends on a number of factors during acquisition (e.g., focal spot, size
detector element…) and reconstruction (reconstruction kernel, interpolation process, voxel size). Image noise depends on the total exposure
and the reconstruction noise. Increasing the current in the X-ray tube
increases the signal-to-noise ratio, and thus reduces the quantum noise
of the statistical nature of X-rays, at the expense of patient dose. The
artifacts of CT imaging are the consequence of beam hardening, photon scattering, nonlinear partial volume effect, motion, stair step artifact, and others.
Most machines support the digital imaging and communications in
medicine (DICOM) format export. The images can therefore be used
for most if not all the (software) applications utilized by conventional CT [10].
CBCT Acquisition Systems 5
The following is a summary of the additions and modifications of
CBCT as compared with conventional CT, which make CBCT a more
appealing alternative:
• Radiation dose is lower. This is mainly because of the lower effective tube current used for the CBCT: while the voltage of the source
is approximately the same (90–120 kV), the current is roughly
between 1 and 8 mA for the CBCT while e.g., for the multislice CT
the current is around 80 mA but can also be as high as 200 mA.
• Detection systems are different (FPD or CCD with image intensifier.
• The resolution is higher; this is mainly due to lesser isotropic voxel
size [11].
• There is less artifacts caused by metallic structures but because of
lower dose there is more noise and detailed information about soft
tissues is lost [10].
• CBCT is less expensive and smaller.
CBCT Acquisition Systems
In 2005, four main CBCT devices were reported in the literature and it
was expected that many companies were to enter the market [2]. In
July 2008, there were 16 manufacturers of CBCT devices producing
23 different models. There are various classifications of devices but
CBCT devices may be divided to fit into four subcategories based on
the need of the clinician: and one field of view of the scan (FOV)
• Dentoalveolar (FOV less than 8 cm)
• Maxillo-mandibular (FOV between 8 and 15 cm)
• Skeletal (FOV between 15 and 21 cm)
• Head and neck (FOV above 21 cm)
The important differences besides the clinical classification are the
radiation dose, size and weight, time needed for the reconstruction,
voxel size, scanning time etc. Furthermore the differences in prices,
software, and warranty are important considerations.
6 Introduction
Uses of CBCT Technology
Radiographic evaluation and diagnosis have undergone enormous
changes in the last 20 years. The important differences between the
devices are their FOV, the irradiation dose, size and weight, time
needed for the reconstruction, voxel size, scanning time, price, software and warranty. The use of CBCT has many applications. The indications for the CBCT imaging has not been clearly established yet.
However, CBCT imaging may be used for the following reasons:
1. Diagnosis
2. Clinical application
3. Clinical evaluation of treatment outcomes
Diagnosis
Common uses of CBCT technology in the head and neck is for impacted
teeth evaluation [13], implant treatment planning [14], evaluations of
the temporomandibular joint (TMJ) [15], simulations for orthodontic
and surgical planning, diagnosis of dento-alveolar pathology, evaluation of the nasal/paranasal sinuses, and pharyngeal airways [16].
Furthermore, craniofacial anomalies, for example cleft patients and
those undergoing combined orthodontic and maxillofacial therapy,
benefit greatly from CBCT imaging as the technology provides more
information than conventional images [17]. There has been a debate on
the routine use of technology in orthodontics and further studies are
needed [18]. It has also been proven that CBCT is accurate to identify
apical periodontitis [19]. A recently suggested CBCT-aided method for
determination of root curvature radius allows a more reliable and predictable endodontic planning, which reflects directly on a more efficacious preparation of curved root canals [20]. CBCT provides better
diagnostic and quantitative information on periodontal bone levels in
three dimensions than conventional radiography [21]. CBCT can also
Uses of CBCT Technology 7
be used for maxillofacial growth and development assessment and
dental age estimation [22].
Clinical Applications of the CBCT
CBCT provides information for 3D models made by rapid prototyping.
The obtained 3D models can serve as a matrix that enables precise
planning of operations such as for mini-implant positions in anatomically complex sites [23]. A recent study that included phantoms
and human cadavers showed that intraoperative CBCT quantifiably
improved surgical performance in all excision tasks and significantly
increased surgical confidence. Such intraoperative imaging in combination with real-time tracking and navigation should be of great benefit
in delicate procedures in which excision must be executed in close
proximity to critical structures [24]. Another study included 179 patients
undergoing facial surgery and intraoperative CBCT was used. The
acquisition of the data sets was uncomplicated, and image quality was
sufficient to assess the postoperative result in all cases [25].
Late Evaluation with CBCT
CBCT is also a tool for the evaluation of surgical and orthodontic treatment. There have not been a lot of papers published but they are
increasing in their number as the CBCT is becoming more readily
available. CBCT was successfully used to compare the anteroposterior
positions of the cleft-side piriform margin and alar base with those of
the noncleft side in 52 postoperative unilateral cleft lip patients with no
alveolar bone graft [26]. CBCT can be used in combination with 3D
soft tissue data obtained with stereo photogrammetry, structured light
systems and laser acquisition systems for diagnostic, treatment planning and posttreatment evaluation purposes [27]. Evaluation of the
nasal and paranasal sinuses and of the pharyngeal airway is also becoming more relevant.
8 Introduction
The Purpose of the Clinical Atlas
The purpose of this clinical atlas is to provide every dental or medical
colleague with the platform to observe and understand images from the
Cone Beam Technology. Great care has been put into the dissection of
the cadavers and the reproductions of the slice sections both on the
human specimens and the CBCT image.
It is hoped that this will serve as a reference for all who are working
in the area of CBCT imaging of the head and neck.
References
1. Tam, K.C., S. Samarasekera, and F. Sauer, Exact cone beam CT with a spiral
scan. Phys Med Biol, 1998. 43(4): p. 1015-24.
2. Kau, C.H., et al., Three-dimensional cone beam computerized tomography in
orthodontics. J Orthod, 2005. 32(4): p. 282-93.
3. Tsiklakis, K., et al., Dose reduction in maxillofacial imaging using low dose
Cone Beam CT. Eur J Radiol, 2005. 56(3): p. 413-7.
4. Robb, R.A., X-ray computed tomography: an engineering synthesis of multiscientific principles. Crit Rev Biomed Eng, 1982. 7(4): p. 265-333.
5. Baba, R., et al., Comparison of flat-panel detector and image-intensifier detector for cone-beam CT. Comput Med Imaging Graph, 2002. 26(3): p. 153-8.
6. Mah, J. and D. Hatcher, Current status and future needs in craniofacial imaging.
Orthod Craniofac Res, 2003. 6(Suppl 1): p. 10-6; discussion 179-82.
7. Sukovic, P., Cone beam computed tomography in craniofacial imaging. Orthod
Craniofac Res, 2003. 6 Suppl 1: p. 31-6; discussion 179-82.
8. Mah, J.K., et al., Radiation absorbed in maxillofacial imaging with a new dental
computed tomography device. Oral Surg Oral Med Oral Pathol Oral Radiol
Endod, 2003. 96(4): p. 508-13.
9. Ludlow, J.B. and M. Ivanovic, Comparative dosimetry of dental CBCT devices
and 64-slice CT for oral and maxillofacial radiology. Oral Surg Oral Med Oral
Pathol Oral Radiol Endod, 2008. 106(1): p. 930-8.
10. Swennen, G.R.J., F. Schutyser, and J.-E. Hausamen, Three-dimensional cephalometry: a color atlas and manual. 1st. ed. 2006, Berlin: Springer. xxi, 365 p.
11. Hashimoto, K., et al., A comparison of a new limited cone beam computed
tomography machine for dental use with a multidetector row helical CT machine.
Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 2003. 95(3): p. 371-7.
12. The 2007 Recommendations of the International Commission on Radiological
Protection. ICRP publication 103. Ann ICRP, 2007. 37(2-4): p. 1-332.
Uses of CBCT Technology 9
13. Nakajima, A., et al., Two- and three-dimensional orthodontic imaging using
limited cone beam-computed tomography. Angle Orthod, 2005. 75(6): p.
895-903.
14. Madrigal, C., et al., Study of available bone for interforaminal implant treatment using cone-beam computed tomography. Med Oral Patol Oral Cir Bucal,
2008. 13(5): p. E307-12.
15. Honda, K., et al., Osseous abnormalities of the mandibular condyle: diagnostic
reliability of cone beam computed tomography compared with helical computed tomography based on an autopsy material. Dentomaxillofac Radiol,
2006. 35(3): p. 152-7.
16. Maki, K., et al., Computer-assisted simulations in orthodontic diagnosis and the
application of a new cone beam X-ray computed tomography. Orthod Craniofac
Res, 2003. 6(Suppl 1): p. 95-101; discussion 179-82.
17. Korbmacher, H., et al., Value of two cone-beam computed tomography systems
from an orthodontic point of view. J Orofac Orthop, 2007. 68(4): p. 278-89.
18. Silva, M.A., et al., Cone-beam computed tomography for routine orthodontic
treatment planning: a radiation dose evaluation. Am J Orthod Dentofacial
Orthop, 2008. 133(5): p. 640 e1-5.
19. Estrela, C., et al., Accuracy of cone beam computed tomography and panoramic
and periapical radiography for detection of apical periodontitis. J Endod, 2008.
34(3): p. 273-9.
20. Estrela, C., et al., Method for determination of root curvature radius using conebeam computed tomography images. Braz Dent J, 2008. 19(2): p. 114-8.
21. Mol, A. and A. Balasundaram, In vitro cone beam computed tomography imaging of periodontal bone. Dentomaxillofac Radiol, 2008. 37(6): p. 319-24.
22. Yang, F., R. Jacobs, and G. Willems, Dental age estimation through volume
matching of teeth imaged by cone-beam CT. Forensic Sci Int, 2006. 159(Suppl 1):
p. S78-83.
23. Kim, S.H., et al., Surgical positioning of orthodontic mini-implants with guides
fabricated on models replicated with cone-beam computed tomography. Am J
Orthod Dentofacial Orthop, 2007. 131(4 Suppl): p. S82-9.
24. Chan, Y., et al., Cone-beam computed tomography on a mobile C-arm: novel
intraoperative imaging technology for guidance of head and neck surgery.
J Otolaryngol Head Neck Surg, 2008. 37(1): p. 81-90.
25. Pohlenz, P., et al., Clinical indications and perspectives for intraoperative conebeam computed tomography in oral and maxillofacial surgery. Oral Surg Oral
Med Oral Pathol Oral Radiol Endod, 2007. 103(3): p. 412-7.
26. Miyamoto, J., et al., Evaluation of cleft lip bony depression of piriform margin
and nasal deformity with cone beam computed tomography: “retruded-like”
appearance and anteroposterior position of the alar base. Plast Reconstr Surg,
2007. 120(6): p. 1612-20.
27. Lane, C. and W. Harrell, Jr., Completing the 3-dimensional picture. Am J
Orthod Dentofacial Orthop, 2008. 133(4): p. 612-20.

Axial
C.H. Kau et al., Cone Beam CT of the Head and Neck,
DOI: 10.1007/978-3-642-12704-5_2, © Springer-Verlag Berlin Heidelberg 2011
12 Axial
9 – Mandible-body
33 – Temporal bone-styloid process
68 – C2 Axis-transverse process
70 – C2 Axis-body
71 – C2 Axis-spine
78 – Mandibular cuspid (Root)
80 – Mandibular first bi-cuspid (Root)
84 – Mandibular lateral incisor teeth (Root)
92 – Maxillary central incisor teeth (Root)
107 – Face
Axial 13
9 – Mandible-body
33 – Temporal bone-styloid process
68 – C2 Axis-transverse process
70 – C2 Axis-body
71 – C2 Axis-spine
78 – Mandibular cuspid (Root)
80 – Mandibular first bi-cuspid (Root)
84 – Mandibular lateral Incisor teeth (Root)
92 – Maxillary central incisor teeth (Root)
107 – Face
14 Axial
67 – C1 Atlas-posterior arch/ tubercle
70 – C2 Axis-body
82 – Mandibular first molar (Root)
85 – Mandibular second bi-cuspid (Crown)
87 – Mandibular second molar (Crown)
89 – Mandibular third molar (Crown)
107 – Face
109 – Tongue
Axial 15
67 – C1 Atlas-posterior arch/ tubercle
70 – C2 Axis-body
82 – Mandibular first molar (Root)
85 – Mandibular second
bi-cuspid (Crown)
87 – Mandibular second molar (Crown)
89 – Mandibular third molar (Crown)
107 – Face
109 – Tongue
16 Axial
9 – Mandible-body
13 – Maxilla-alveolar bone
52 – Incisive canal
65 – C1 Atlas-body
67 – C1 Atlas-posterior arch/tubercle
69 – C2 Axis-dens
92 – Maxillary central incisor teeth (Root)
94 – Maxillary cuspid (Root)
96 – Maxillary first bi-cuspid (Root)
100 – Maxillary lateral incisor teeth (Root)
104 – Maxillary second molar (Root)
106 – Maxillary third molar (Root)
107 – Face
Axial 17
9 – Mandible-body
13 – Maxilla-alveolar bone
52 – Incisive canal
65 – C1 Atlas-body
67 – C1 Atlas-posterior arch/tubercle
69 – C2 Axis-dens
92 – Maxillary central incisor teeth (Root)
94 – Maxillary cuspid (Root)
96 – Maxillary first bi-cuspid (Root)
100 – Maxillary lateral incisor teeth (Root)
104 – Maxillary second molar (Root)
106 – Maxillary third molar (Root)
107 – Face
18 Axial
10 – Mandible-condyle
14 – Maxilla-anterior
15 – Maxilla-anterior nasal spine
24 – Palatine bone-vomer
32 – Temporal bone
39 – Mastoid air cells
40 – Maxillary sinus
Axial 19
10 – Mandible-condyle
14 – Maxilla-anterior
15 – Maxilla-anterior nasal spine
24 – Palatine bone-vomer
32 – Temporal bone
39 – Mastoid air cells
40 – Maxillary sinus
20 Axial
10 – Mandible-condyle
16 – Maxilla-zygomatic process
20 – Nasal septum
24 – Palatine bone-vomer
31 – Sphenoid bone
33 – Temporal bone-styloid process
39 – Mastoid air cells
40 – Maxillary sinus
50 – Auricular canal
107 – Face
Axial 21
10 – Mandible-condyle
16 – Maxilla-zygomatic process
20 – Nasal septum
24 – Palatine bone -vomer
31 – Sphenoid bone
33 – Temporal bone-styloid process
39 – Mastoid air cells
40 – Maxillary sinus
50 – Auricular canal
107 – Face
22 Axial
3 − Concha-superior
20 − Nasal septum
24 − Palatine bone-vomer
34 − Zygoma
40 − Maxillary sinus
48 − Sphenoid sinus
53 − Internal carotid artery
Axial 23
3 − Concha-superior
20 − Nasal septum
24 − Palatine bone-vomer
34 − Zygoma
40 − Maxillary sinus
48 − Sphenoid sinus
53 − Internal carotid artery
24 Axial
19 − Nasal bone
31 − Sphenoid bone
32 − Temporal bone
34 − Zygoma
36 − Ethmoid sinus
53 − Internal carotid artery
58 − Orbit
107 − Face
Axial 25
19 − Nasal bone
31 − Sphenoid bone
32 − Temporal bone
34 − Zygoma
36 − Ethmoid sinus
53 − Internal carotid artery
58 − Orbit
107 − Face
26 Axial
4 − Ethmoid bone-crista galli
19 − Nasal bone
31 − Sphenoid bone
32 − Temporal bone
34 − Zygoma
36 − Ethmoid sinus
56 − Optic nerve canals
107 − Face
Axial 27
4 − Ethmoid bone-Crista galli
19 − Nasal bone
31 − Sphenoid bone
32 − Temporal bone
34 − Zygoma
36 − Ethmoid sinus
56 − Optic nerve canals
107 − Face
28 Axial
5 − Frontal bone
32 − Temporal bone
37 − Frontal sinus
107 − Face
Axial 29
5 − Frontal bone
32 − Temporal bone
37 − Frontal sinus
107 − Face

Coronal
C.H. Kau et al., Cone Beam CT of the Head and Neck,
DOI: 10.1007/978-3-642-12704-5_3, © Springer-Verlag Berlin Heidelberg 2011
32 Coronal
1 − Concha-inferior
9 − Mandible-body
19 − Nasal bone
20 − Nasal septum
75 − Mandibular central incisor teeth
(Crown)
76 − Mandibular central incisor teeth
(Root)
77 − Mandibular cuspid (Crown)
83 − Mandibular lateral incisor teeth
(Crown)
84 − Mandibular lateral incisor teeth
(Root)
94 − Maxillary cuspid teeth (Root)
93 − Maxillary cuspid (Crown)
100 − Maxillary lateral incisor teeth (Root)
Coronal 33
1 − Concha-inferior
9 − Mandible-body
19 − Nasal bone
20 − Nasal septum
75 − Mandibular central incisor teeth
(Crown)
76 − Mandibular central incisor teeth
(Root)
77 − Mandibular cuspid (Crown)
83 − Mandibular lateral incisor teeth
(Crown)
84 − Mandibular lateral incisor teeth
(Root)
94 − Maxillary cuspid teeth ( Root)
93 − Maxillary cuspid (Crown)
100 − Maxillary lateral lncisor teeth (Root)
34 Coronal
3 − Concha-superior
5 − Frontal bone
8 − Mandible-alveolar bone
9 − Mandible-body
13 − Maxilla-alveolar bone
20 − Nasal septum
37 − Frontal sinus
40 − Maxillary sinus
55 − Mid palatal suture
57 − Oral cavity
58 − Orbit
85 − Mandibular second bi-cuspid (Crown)
86 − Mandibular second bi-cuspid (Root)
102 − Maxillary second bi-cuspid (Root)
103 − Maxillary second molar (Crown)
107 − Face
Coronal 35
3 − Concha-superior
5 − Frontal bone
8 − Mandible-alveolar bone
9 − Mandible-body
13 − Maxilla-alveolar bone
20 − Nasal septum
37 − Frontal sinus
40 − Maxillary sinus
55 − Mid palatal suture
57 − Oral cavity
58 − Orbit
85 − Mandibular second bi-cuspid (Crown)
86 − Mandibular second bi-cuspid (Root)
102 − Maxillary second bi-cuspid (Root)
103 − Maxillary second molar (Crown)
107 − Face
36 Coronal
5 − Frontal bone
9 − Mandible-body
13 − Maxilla-alveolar bone
26 − Perpendicular plate of the ethmoid
sinus
35 − Zygomatic arch
36 − Ethmoid sinus
40 − Maxillary sinus
42 − Nasal septum
58 − Orbit
96 − Maxillary first bi-cuspid (Root)
97 − Maxillary first molar (Crown)
Coronal 37
5 − Frontal bone
9 − Mandible-body
13 − Maxilla-alveolar bone
26 − Perpendicular plate of the ethmoid
sinus
35 − Zygomatic arch
36 − Ethmoid sinus
40 − Maxillary sinus
42 − Nasal septum
58 − Orbit
96 − Maxillary first bi-cuspid (Root)
97 − Maxillary first molar (Crown)
38 Coronal
5 − Frontal bone
6 − Hyoid
7 − Lateral pterygoid plate
9 − Mandible-body
18 − Medial pterygoid plate
31 − Sphenoid bone
32 − Temporal bone
35 − Zygomatic arch
48 − Sphenoid sinus
56 − Optic nerve canals
57 − Oral cavity
109 − Tongue
Coronal 39
5 − Frontal bone
6 − Hyoid
7 − Lateral pterygoid plate
9 − Mandible-body
18 − Medial pterygoid plate
31 − Sphenoid bone
32 − Temporal bone
35 − Zygomatic arch
48 − Sphenoid sinus
56 − Optic nerve canals
57 − Oral cavity
109 − Tongue
40 Coronal
2 − Concha-middle
5 − Frontal bone
11 − Mandible-coronoid process
24 − Palatine bone-vomer
35 − Zygomatic arch
36 − Ethmoid sinus
40 − Maxillary sinus
43 − Nasal sinus
109 − Tongue
Coronal 41
2 − Concha-middle
5 − Frontal bone
11 − Mandible-coronoid process
24 − Palatine bone-vomer
35 − Zygomatic arch
36 − Ethmoid sinus
40 − Maxillary sinus
43 − Nasal sinus
109 − Tongue
42 Coronal
25 − Parietal bone
39 − Mastoid air cells
50 − Auricular canal
69 − C2 Axis-dens
70 − C2 Axis-body
72 − C3-body
74 − C3-transverse process
107 − Face
Coronal 43
25 − Parietal bone
39 − Mastoid air cells
50 − Auricular canal
69 − C2 Axis-dens
70 − C2 Axis-body
72 − C3-body
74 − C3-transverse process
107 − Face
44 Coronal
5 − Frontal bone
10 − Mandible-condyle
31 − Spehnoid bone
48 − Sphenoid sinus
Coronal 45
5 – Frontal bone
10 – Mandible-condyle
31 – Spehnoid bone
48 – Sphenoid sinus

Sagittal
C.H. Kau et al., Cone Beam CT of the Head and Neck,
DOI: 10.1007/978-3-642-12704-5_4, © Springer-Verlag Berlin Heidelberg 2011
48 Sagittal
Mid-Sagittal: Airspaces
1 − Concha-inferior
2 − Concha-middle
38 − Mandibular vestibule
36 − Ethmoid sinus
37 − Frontal sinus
44 − Nasopharyngeal airspace
45 − Oropharyngeal airspace
46 − Palatoglossal airspace
48 − Sphenoid sinus
Sagittal 49
1 − Concha-inferior
2 − Concha-middle
38 − Mandibular vestibule
36 − Ethmoid sinus
37 − Frontal sinus
44 − Nasopharyngeal airspace
45 − Oropharyngeal airspace
46 − Palatoglossal airspace
48 − Sphenoid sinus
50 Sagittal
Mid-Sagittal at Midline
5 − Frontal bone
6 − Hyoid
9 − Mandible-body
14 − Maxilla-anterior
17 − Maxilla-palatine process
19 − Nasal bone
22 − Occiput-clivus
29 − Sphenoid bone-dorsum sella
30 − Sphenoid bone-tuberculum sella
31 − Sphenoid bone
Sagittal 51
5 − Frontal bone
6 − Hyoid
9 − Mandible-body
14 − Maxilla-anterior
17 − Maxilla-palatine process
19 − Nasal bone
22 − Occiput-clivus
29 − Sphenoid bone-dorsum sella
30 − Sphenoid bone-tuberculum sella
31 − Sphenoid bone
52 Sagittal
Mid-Sagittal Osteology
4 − Ethmoid bone-crista galli
12 − Mandible-genial tubercle
20 − Nasal septum
27 − Septum in spehnoid sinus
28 − Sphenoid-posterior clinoid process
37 − Frontal sinus
47 − Pituitary fossa
52 − Incisive canal
54 − Lingual foramen
Sagittal 53
4 − Ethmoid bone-crista galli
12 − Mandible-genial tubercle
20 − Nasal septum
27 − Septum in spehnoid sinus
28 − Sphenoid-posterior clinoid process
37 − Frontal sinus
47 − Pituitary fossa
52 − Incisive canal
54 − Lingual foramen
54 Sagittal
2.5 cm from Mid-Sagittal
5 − Frontal bone
23 − Occiput-condylar process
32 − Temporal bone
36 − Ethmoid sinus
37 − Frontal sinus
40 − Maxillary sinus
60 − Pterygomaxillary fissure
65 − C1 Atlas-body
67 − C1 Atlas-posterior arch/tubercle
69 − C2 Axis-dens
Sagittal 55
5 − Frontal bone
23 − Occiput-condylar process
32 − Temporal bone
36 − Ethmoid sinus
37 − Frontal sinus
40 − Maxillary sinus
60 − Pterygomaxillary fissure
65 − C1 Atlas-body
67 − C1 Atlas-posterior arch/tubercle
69 − C2 Axis-dens
56 Sagittal
5 cm from Mid-Sagittal (S2)
5 − Frontal bone
9 − Mandible-body
10 − Mandible-condyle
16 − Maxilla-zygomatic process
21 − Occiput
33 − Temporal bone-styloid process
37 − Frontal sinus
40 − Maxillary sinus
59 − Orbital fissure
61 − Temporal bone-petrous ridge
65 − C1 Atlas-body
Sagittal 57
5 − Frontal bone
9 − Mandible-body
10 − Mandible-condyle
16 − Maxilla-zygomatic process
21 − Occiput
33 − Temporal bone-styloid process
37 − Frontal sinus
40 − Maxillary sinus
59 − Orbital fissure
61 − Temporal bone-petrous ridge
65 − C1 Atlas-body
58 Sagittal
7.5 cm from Mid-Sagittal
10 − Mandible-condyle
32 − Temporal bone
49 − Articular eminence
51 − External acoustic meatus
61 − Temporal bone-petrous ridge
63 − Zygomaticofrontal suture
Sagittal 59
10 − Mandible-condyle
32 − Temporal bone
49 − Articular eminence
51 − External acoustic meatus
61 − Temporal bone-petrous ridge
63 − Zygomaticofrontal suture
60 Sagittal
10 cm from Mid-Sagittal
10 − Mandible-condyle
16 − Maxilla-zygomatic process
25 − Parietal bone
32 − Temporal bone
39 − Mastoid air cells
49 − Articular eminence
62 − Temporal fossa
Sagittal 61
10 − Mandible-condyle
16 − Maxilla-zygomatic process
25 − Parietal bone
32 − Temporal bone
39 − Mastoid air cells
49 − Articular eminence
62 − Temporal fossa

Master Legends
1.  Concha – Inferior
2.  Concha – Middle
3.  Concha – Superior
4.  Ethmoid bone – Crista galli
5.  Frontal Bone
6.  Hyoid
7.  Lateral pyterygoid plate
8.  Mandible – alveolar bone
9.  Mandible – body
10.  Mandible – condylar process
11.  Mandible – coronoid process
12.  Mandible – Genial tubercle
13.  Maxilla – Alveolar bone
14.  Maxilla – anterior
15.  Maxilla – Anterior nasal spine
16.  Maxilla – zygomatic process
17.  Maxilla- Palatine process
18.  Medial pyterygoid plate
19.  Nasal Bone
20.  Nasal Septum
21.  Occiput
22.  Occiput – Clivus
23.  Occiput -Condylar process
24.  Palatine bone – Vomer
25.  Parietal Bone
26.  Perpendicular plate of the ethmoid sinus
27.  Septum in Sphenoid Sinus
28.  Sphenoid – Posterior Clinoid Process
29.  Sphenoid bone – Dorsum Sella
30.  Sphenoid bone – Tuberculum Sella
31.  Sphenoid bone
32.  Temporal Bone
33.  Temporal bone – Styloid process
Master Legends
34.  Zygoma
35.  Zygomatic arch
36.  Ethmoid Sinus
37.  Frontal Sinus
38.  Mandibular vestibule
39.  Mastoid Air cells
40.  Maxillary Sinus
41.  Maxillary Vestibule
42.  Nasal septum
43.  Nasal Sinus
44.  Nasopharyngeal airspace
45.  Oropharyngeal airspace
46.  Palatoglossal airspace
47.  Pituitary fossa
48.  Sphenoid Sinus
49.  Articular eminence
50.  Auricular Canal
51.  External acoustic meatus
52.  Incisive canal
53.  Internal Carotid artery
54.  Lingual foramen
55.  Mid palatal suture
56.  Optic nerve canals
57.  Oral cavity
58.  Orbit
59.  Orbital fissure
60.  Pterygomaxillary fissure
61.  Temporal Bone – petrous ridge
62.  Temporal fossa
63.  Zygomaticofrontal suture
64.  Zygomaticotemporal suture
65.  C1 Atlas – body
66.  C1 Atlas – anterior arch/tubercle
67.  C1 Atlas – posterior arch/tubercle
68.  C2 Axis – Transverse process
69.  C2 Axis – Dens
Master Legends
70.  C2 Axis – Body
71.  C2 Axis – spine
72.  C3 – Body
73.  C3 – spine
74.  C3 – transverse porcess
75.  Mandibular Central Incisor Teeth (Crown)
76.  Mandibular Central Incisor Teeth (Root)
77.  Mandibular Cuspid (Crown)
78.  Mandibular Cuspid (Root)
79.  Mandibular first bi-cuspid (Crown)
80.  Mandibular first bi-cuspid (Root)
81.  Mandibular first molar (Crown)
82.  Mandibular first molar (Root)
83.  Mandibular Lateral Incisor Teeth (Crown)
84.  Mandibular Lateral Incisor Teeth (Root)
85.  Mandibular second bi-cuspid (Crown)
86.  Mandibular second bi-cuspid (Root)
87.  Mandibular second molar (Crown)
88.  Mandibular second molar (Root)
89.  Mandibular third molar (Crown)
90.  Mandibular third molar (Root)
91.  Maxillary Central Incisor Teeth (Crown)
92.  Maxillary Central Incisor Teeth (Root)
93.  Maxillary Cuspid (Crown)
94.  Maxillary Cuspid (Root)
95.  Maxillary first bi-cuspid (Crown)
96.  Maxillary first bi-cuspid (Root)
97.  Maxillary first molar (Crown)
98.  Maxillary first molar (Root)
99.  Maxillary Lateral Incisor Teeth (Crown)
100.  axillary Lateral Incisor Teeth (Root)
101.  Maxillary second bi-cuspid (Crown)
102.  Maxillary second bi-cuspid (Root)
103.  Maxillary second molar (Crown)
104.  Maxillary second molar (Root)
105.  Maxillary third molar (Crown)
Master Legends
106.  Maxillary third molar (Root)
107.  Face
108.  Lips
109.  Tongue