Quantification of the distortion present in the postero-anterior skull radiograph

Introduction: It is universally accepted that the posteroanterior skull radiograph shows a lower degree of distortion than other radiographic images, so that measurements on it are considered reliable. Objective: To determine the percentage of distortion in the different facial regions of the postero-anterior skull radiograph. Methods: Thirty human skulls with their jaws were divided by three horizontal and four vertical planes into fifteen quadrants; there were ten in the skull and five in the jaw. On each of them a steel wire was placed in vertical and horizontal positions and their length (actual measurement) was measured. Each set was X-rayed in posteroanterior projection and the length of the wires was measured in the image (radiographic measurement). Results: It was not possible to measure in the lateral quadrants of the skull. The horizontal measurement in the right and left lower intermediate quadrants of the skull and in the intermediate and lateral quadrants of both sides of the mandible is not reliable; in the median quadrant of the mandible it is minimized; in the right and left upper intermediate and median quadrants of the skull and in the median of the mandible it is magnified. Vertical measurements in all quadrants are reliable; in the right and left upper intermediate and left upper and middle quadrants of the skull and in the right and left middle and lateral quadrants of the mandible it is magnified; in the lower intermediate and upper and lower middle quadrants of the skull and median of the mandible it is minimized. The least distortion for both measurements occurs in the upper median quadrant of the skull. Percentages of distortion are reported for each quadrant. Conclusions: Distortion is present in the posteroanterior skull radiograph and varies from one region of the face to another.