1. Anatomy of the Maxillofacial Region in the Three Planes of Section
Christos Angelopoulos, DDS, MS 
Dental Clinics 
Volume 58, Issue 3, Pages (July 2014)
DOI: /j.cden
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2. Fig. 1
(A) The 3 standard planes of section: axial, coronal, and sagittal of the maxillofacial region. These sectional images are the first to be reconstructed by any CBCT or MSCT (multislice CT) scanner and serve as the basis for numerous other reconstructions based on the diagnostic needs. Vertical and horizontal lines across the images guide the user at of the actual location of each section. (B) Panoramic reconstruction and related cross-sectional image. These images can be generated with very simple functions using the CBCT scanner’s software applications. Their goal is to approach the region of concern from all perspectives.
Dental Clinics  , DOI: ( /j.cden )
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3. Fig. 2
Coronal section of the face, approximately at the molar level, depicting the nasal cavity at its best. The nasal septum, in this case, is deviated to the left, causing a marked asymmetry between the right and left nasal cavities, this often affects the patency of the nasal passageways and may also be affected by the shape and size of the nasal turbinates as well as the mucosal lining of the turbinates (seen as a dotted line). The white arrow shows the left maxillary sinus ostium (draining site of the sinus cavity). EB, ethmoid bulla, the inferior-most ethmoid air cell; INT, inferior nasal turbinate; MNT, middle nasal turbinate (in this case, this is pneumatized and called concha bullosa); O, orbits.
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4. Fig. 3
Coronal section of the face, at approximately the premolar level. The structures visualized at this level are the orbits (O), frontal sinuses (FS), the oral cavity (OC), the anterior walls of the right (R) and left (L) maxillary sinuses and nasolacrimal ducts, marked by the green arrows.
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5. Fig. 4
(A) Panoramic reconstruction and related cross-sectional images of the right posterior maxilla for the assessment of the lateral wall of the maxillary sinuses before a grafting procedure. The small, low-density (almost pinhead in size) area (red arrows) is the osseous canal for the posterior superior alveolar (PSA) neurovascular bundle (artery, vein, and nerve). (B) Panoramic reconstructions along the lateral wall of the maxillary sinus illustrate clearly the course of neurovascular canal of PSA (red arrows) from posterior to anterior. The bleeding potential of any vessel is proportional to its diameter.
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6. Fig. 5
(A, B) Coronal section of the face, at the level of maxillary sinuses/nasal cavity (approximate maxillary molar level) depicting the maxillary sinuses at best. These images are optimal for the evaluation of the integrity of the floor and walls of the sinuses and nasal cavities. The draining site of the maxillary sinus is known as ostium (red arrows) and is narrow, opening on the medial wall of the maxillary sinus to the medial nasal meatus (chamber). The medial wall ends in a pointy osseous projection known as uncinate process (stars). The ostium opens into a narrow canal, the ethmoidal infundibulum (green dotted line). Part of the infundibulum is a thin curved canal, the shape of which is affected by its proximity to the ethmoid bulla; this is the hiatus semilunaris (white dotted line). All of the above participate in a broader unit often identified as ostiomeatal complex or unit (green dash-marked cycle), including the draining sites of the maxillary sinuses, frontal sinuses, and anterior and middle ethmoid sinuses (all drain in the middle nasal meatus). EB, ethmoid bulla; INT, inferior nasal turbinate; MNT, middle nasal turbinate.
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7. Fig. 6
(A) Coronal sections through the maxillary sinuses showing the presence of inflammatory tissue (collection of soft tissue in density content) in the left maxillary sinus and thickening of the mucosal lining of the floor and walls of the right maxillary sinus. Note the inflammatory tissue is rather extensive and has blocked draining passageway (ostium) (green arrow). (B) Coronal section through the sinuses showing extensive inflammatory changes in the sinus cavities of the right and left maxillary sinuses. Flat surfaces on the (soft in density) content of sinuses may indicate coexistence of fluid in sinus cavity (air/fluid level) (red arrows). In this case, however, the evaluation of the maxillary sinuses is incomplete and a more extended field of view should be used.
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8. Fig. 7
Coronal section of the maxillary sinuses (approximate maxillary molar level): the nasal architecture as well as the ethmoid sinuses is dramatically altered; in addition, the ostia of the right and left maxillary sinuses are widened to facilitate drainage, the result of extensive sinonasal surgery.
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9. Fig. 8
(A–C) Axial (A), coronal (B), and sagittal (C) views of the ethmoid sinuses and sphenoid sinuses (A, C). The ethmoid sinuses are composed of numerous, thin-walled air cells the complexity of which gave them the name of ethmoid labyrinth. Other structures visualized included the sphenoid sinuses (SS), the lamina papyracea (thin wall separating the ethmoid sinuses from the orbit, green arrow), the inferior nasal turbinate (INT), and the middle nasal turbinate (MNT).
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10. Fig. 9
(A, B) The drainage path of the anterior ethmoid air cells (white dotted line) and middle ethmoid air cells (green dotted line) is depicted in coronal (A) and in sagittal (B) sections of the anterior/middle ethmoid air cells. This path clearly opens to the middle nasal meatus.
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11. Fig. 10
(A–C) Axial (A), coronal (B), and sagittal (C) views of the sphenoid sinuses (SS). The green dotted line shows the draining path of the sphenoid sinuses to the superior nasal meatus through a narrow opening on the anterior wall known as sphenoethmoidal recess (green arrow).
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12. Fig. 11
(A, B) Coronal (A) and sagittal (B) views through the floor of the orbits and maxillary sinuses. Ovoid osseous canals seen on the floor of the orbits are the infraorbital foramina (green arrows). Also notice the inflammation in the left maxillary sinus. Nasolacrimal canal (stars).
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13. Fig. 12
(A) Axial CBCT image at the level of the hyoid/C3 vertebra. (B) The same axial image as the one on the left with some identifiable neck anatomic structures outlined. (Despite the fact that the soft tissue contrast of cone-beam tomography is not optimal for the diagnosis of soft tissue pathologic abnormality, some of the neck anatomic landmarks are visualized.) The neck spaces, because they are mainly occupied by fat, appear of a lower density in comparison to the neighboring musculature. Note that this is the approximate location of the major blood vessels of the neck; their precise location cannot be clearly seen without the utilization of intravenous administration of contrast media. Knowledge of the topographic location of the major neck anatomic structures will assist the diagnostician to determine the origin of the various pathologic entities that may develop on the neck. C3, an axial section of the third cervical vertebra; CA, carotid arteries; E, epiglottis; F, fatty tissue; GH, geniohyoid muscle; H, hyoid bone (note the almost modular appearance of the hyoid bone that can imitate a fracture); IJV, internal jugular vein; M, inferior border of the anterior mandible; S/M, submandibular salivary glands.
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14. Fig. 13
Axial section of the neck at the level of C3/C4 vertebral bodies with contrast-enhanced CT. The circulating contrast medium is depicted with a high-density fact that makes the blood vessels and other anatomic structures supplied by the blood with contrast well-identifiable. ECA, external carotid arteries; EJV, external jugular vein; F, subcutaneous fat; GH, geniohyoid muscle; ICA, internal carotid arteries; IJV, internal jugular vein; MH, mylohyoid muscle; SMG, submandibular salivary gland; VA, vertebral arteries.
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15. Fig. 14
Axial section of the neck at the level of C3/C4 vertebral bodies showing an atheromatous plaque (green arrow) in the left common carotid artery almost tangential to the anteromedial aspect of the left SCM (red dotted outline). The other smaller calcifications seen on either side of the airway are calcifications in the thyroid cartilage complex (yellow arrows).
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16. Fig. 15
Axial section (A) and coronal section (B) of the neck at the level of C3/C4 vertebral bodies showing atheromatous plaques (green arrows) in the common carotid arteries bilaterally. Variation as far as size and shape is frequent.
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17. Fig. 16
Bilateral calcifications at the level of the floor of the mouth (axial and coronal images) (arrows). Note the superficial location of the calcifications in relationship to the airway. These were tonsilar calcifications or tonsiloliths and have been associated with recurrent inflammation of the tonsils as well as halitosis.
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18. Fig. 17
Single, round calcification in the left submandibular space (arrows); this was a silaolith in the left submandibular salivary gland.
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19. Fig. 18
Axial cut of the mandible toward the lower half of the mandibular body. At that level, the C3 vertebra is depicted. The red arrows mark the right and left transverse foramen (or foramen transversarium). Contiguous transverse foramina form a canal that hosts the vertebral artery during its ascending course toward the endocranium. Note that due to inadequate soft tissue contrast, it is impossible to distinguish different soft tissue structures in the mouth. FOM, floor of the mouth; VF, vertebral foramen.
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20. Fig. 19
(A) Midsagittal cut of the face and neck. Sagittal sections are best for the evaluation of the visible portion of the cervical spine and the airway. C2, 2nd cervical vertebral axis; the superior end of C2 is the odontoid process, which is articulated with the atlas (C1) and the skull base; C3, third; C4, fourth. FS, frontal sinus; NPC, nasopalatine canal; S, sella turcica; SS, sphenoid sinus. The yellow arrows mark the hard palate and the green arrows mark the soft palate. The elongated, slightly curved, low-density area anterior to the cervical spine is the airway. (B) Sagittal image of the cervical spine and the airway; large osseous masses (green arrows) on the ventral aspect of the C4, C5 are osteophytes, signs of degenerative joint disease in the visible portion of the cervical spine. Other signs of degenerative joint disease (arthritis) include loss of intervertebral space, erosive changes, subchondral cyst formation, and sclerosis.
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21. Fig. 20
A thick sagittal cut visualized in 3 dimensions to assess the airway (blue). Several software programs (mostly third party) offer specific utilities that simplify airway evaluation as well as measurements, volume, and analysis.
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22. Fig. 21
Axial (top) and coronal (bottom) sections of the airway showing marked asymmetry between the right and left lateral walls with the right posterolateral wall shifted medially. This shift is evident in the coronal view (arrows). Often, airway shape alterations may be associated with soft tissue growths in the region and may require further investigation.
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23. Fig. 22
(left) Axial section at the level of the roots of the maxillary teeth. (right) Axial section slightly superior to the other section, at the level of the floor of the maxillary sinus. The green arrows show the pharyngeal opening of the Eustachian tube, which helps in equalizing the pressure between the 2 sides of the eardrum. The red arrows mark the fossa Rosenmuller. GLPF, greater and lesser palatine foramina; HP, hard palate; MS, maxillary sinus; OC, oral cavity; SF, superior foramina, the starting point of the nasopalatine canal; TT, torus tubarius, a soft tissue process on either side of the nasopharynx (NF) separating the Eustachian tube from the fossa Rosenmuller.
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24. Fig. 23
Axial section at the level of the maxillary sinuses/mandibular rami demonstrating major structures of the maxillary sinus, nasal cavity, and nasopharynx at the axial plane. INT, inferior nasal turbinate; (L)MR, left mandibular ramus; MS, maxillary sinus; N/F, nasopharynx; PP, lateral and medial pterygoid plates; ZP, zygomatic process of the maxilla. The red arrows mark the Eustachian tube, and the round shaded region, the general site of fossa Rossenmuller and torus tubarius.
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25. Fig. 24
Axial section at the level of the maxillary sinuses (superior third) demonstrating major structures of the maxillary sinuses, nasal cavity, and skull base at the axial plane. Co, mandibular condyle; FO, foramen ovale; FS, foramen spinosum; IO, infraorbital canal; JF, jugular foramen (or jugular fossa); Ma, mastoid air cells; MNC, middle nasal concha; NL, nasolacrimal duct; SS, sphenoid sinus; ZA, zygomatic arch. The blue arrow indicates the external auditory canal.
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26. Fig. 25
Axial section at the level of the maxillary sinuses (superior third) (same as Fig. 17, but slightly higher) demonstrating additional anatomic details about the skull base. MNC, middle nasal concha; SS, sphenoid sinus. The green arrows mark the walls of a thin channel known as the “Vidian canal” or pterygoid canal. The yellow arrows mark the course of the carotid canals that appear to be converging toward the base of the sphenoid bone. PPF is a region of importance in the skull base. It is the passageway from the middle cranial fossa to the orbit, face, sinuses, and vice versa. Disease processes may be transferred from the middle cranial fossa to other sites (mentioned above) through the PPF. Similarly, disease originated extracranially may be transferred to the endocranium through the PPF.
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27. Fig. 26
Axial image of the head at level of the orbits (inferior third). The section depicts the roof of the maxillary sinuses (MS) bilaterally and the ethmoid sinuses (ES), just medial to the maxillary sinuses. Note the fine and delicate air cells that form the ethmoid sinuses; this fine and complicated architecture has given the name of ethmoid labyrinth to the ethmoid air cells. The circular depressions toward the posterolateral walls of the sphenoid sinuses (SS), which can be seen in its magnitude in this image, represent the continuation of the carotid canals (CC) as they are entering the cavernous sinus of the lateral border of the base of the sphenoid bone. Note the septations, present in the sphenoid sinus, seen in this image. The section very clearly illustrates the relationship between the PPF, the inferior orbital fissure (IOF), and the temporal fossa (yellow dotted area). Last, the green arrows mark the course of the right and left foramen rotundum. IAC, internal auditory canal; MCF, middle cranial fossa; PCF, posterior cranial fossa.
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28. Fig. 27
Axial section of the head at the level of the orbits (superior half). The posterior opening of the orbits is divided by the superior orbital fissure (SOF) and the optic canal (yellow arrows). The orientation of the optic canals is toward the sella, where the optic chiasma takes place. ACP, anterior clinoid processes; PCP, posterior clinoid processes.
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29. Fig. 28
Coronal section through the sphenoid sinus (SS). CP, coronoid process of the mandible; NP, nasopharynx. The yellow arrows show the Vidian canal (pterygoid canal) and the red arrows show the foramen rotundum.
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30. Fig. 29
Coronal section through the sphenoid sinus (just posterior to section in Fig. 25). NP, naso-pharynx; SS, sphenoid sinus. The dotted lines mark the course of the foramen ovale bilaterally.
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