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Mika Mattila, Specialist in oral and
maxillofacial radiology at Pantomo Oy,
uses Planmeca ProMax® 3D to scan the
patients referred to him by Seppo Villanen.

Villanen and Mikkonen state that the
upper neck is a relatively new area of interest
in imaging and medicine. “The upper neck Patient case
has been somewhat of a no-man’s land, even
though it is one of the most mobile joint A 58-year-old woman, generally
systems in the body. A neuroradiologist healthy. During the past two
examines the brain, while a radiologist years, her neck has become so
usually examines the area below the C3 sore and stiff that she can no
longer turn her head. Dizziness
vertebra. Treatment of a neck injury patient spells. A lot of soreness on
is a challenging multidisciplinary effort that the right side, at the vertebral
requires a clinician, a physiotherapist and a level C1/C2. No inflammatory
22 radiologist. If a brain or spinal injury is also arthritis found.

suspected, the team needs a neurologist and Picture 1. Marked loss of height at the right atlanto-axial joint
a neuropsychologist as well.” (C1–C2). Calcification and small bone cysts present in the bone
A CBCT scan is an economical imaging under the articular surface. The structure of the bone is clearly
visible.

method for which many insurance
companies have agreed to cover the costs,
describes Villanen.

A new standard of resolution Picture 2. Marked loss of height and osteophyte formation at the
right atlanto-axial joint. A cyst under the articular surface on the
CBCT images are also useful in examining side of the C2 vertebra.
osteoporosis and degenerative changes,
since thin slices provide an accurate insight CBCT imaging indications Picture 3a. The dens has Picture 3b. A large anterior
into bone structure. “Compared to the for the neck area moved to the left in relation to osteophyte in the atlanto-axial
resolution of CT images, CBCT images are the C1 vertebra. Osteophytes joint.
on a whole new level”, states Villanen. • Determining the bony anatomy in the atlanto-axial joint.
of the upper neck on levels
The Planmeca Romexis® software C0–C4 (not indicated for imaging
suite is an effective working tool for the ligaments)
radiologists: “The software is fast, visual
and easy to use, and various measurements • Fractures of the upper neck
and scrollings work well. It is also a very • Avulsion injuries of the upper neck
visual tool in the training of physicians and • Differential diagnostics of
physiotherapists.”
arthrosis/rheumatoid arthritis
Pantomo too is very happy about this of the upper neck
cooperation that has been going on for a few • Subluxation and abnormal rotation
years now. What started as a pilot experiment positions of the upper neck
now provides genuine benefits. “It is great to
discover new applications for this imaging
method, since we can now obtain additional
information and examine the cause of a
patient’s problems”, says Mattila.