The axiolateral oblique mandible view allows for visualization of the mandibular body, mandibular ramus, condylar process and mentum.

Indications

This projection is useful in identifying structural changes and displaced fractures of the mandible in a trauma setting, and in neoplastic or inflammatory changes. Given that this view is performed bilaterally, it allows for comparison of both sides of the mandible too.

Patient position

• the patient is seated upright with the side of interest closest to the detector

• the head is first placed in a true lateral position

  • interpupillary line (IPL) perpendicular and midsagittal plane (MSP) parallel to the detector

• then, the neck is sufficiently extended to prevent superimposing the mandibular rami over the cervical spine

• the vertex (top of the head) is lastly tilted towards the detector to

  • demonstrate the region of the mandible of interest

  • prevent superimposing the opposite side

Technical factors

• left and right axiolateral oblique

• centering point

  • central ray 25-30º cephalic, beam to exit at mandibular region of interest

• collimation

  • no more than 10 x 10 cm with mandible of interest in the middle of the image

• orientation

  • portrait

• detector size

  • 18 cm x 24 cm

• exposure

  • 70-75 kVp

  • 16-25 mAs

• SID

  • 100 cm

• grid

  • yes

Image technical evaluation

• the ramus of interest is shown with no superimposition of the opposite mandible

• the mandibular ramus is not superimposed over the cervical spine

Practical points

• set up the x-ray tube and detector in advance; due to neck extension and tilt, patients may struggle to remain in the particular position for long, hence reducing image stability