Evaluation of panoramic radiographs is difficult and often ineffective if a dentist does not understand the anatomical structures captured in the panoramic.  The superimposition of bony structures and soft tissue, in addition to ghost and double images created upon acquisition, make panoramic radiographs challenging to decipher.  Normal anatomy can easily be mistaken as pathology and pathology can also be missed when unfamiliar landmarks are not closely evaluated.

One thing that drastically improved my understanding of panoramic anatomy are these two figures.  Something about seeing the radiographic landmarks referenced on a skull just made everything click.  This increased understanding of anatomy has changed the way I approach panoramic evaluations and has been the deciding factor when detecting pathology in several cases where pathology would have otherwise been missed.

These images come from Interpretation of panoramic radiographs by Perschbacher and Oral Radiology Principles and Interpretation by Mallya and Lam.