The posteriorly tilted dens. A normal variation mimicking a fractured dens.

The normal dens occasionally can be posteriorly tilted and in such cases, can mimic a fractured, posteriorly tilted, dens. Differentiation of the two conditions depends on: [1] knowledge that this normal variation of the dens occurs, and [2] demonstrating that no fracture exists. In many cases, this latter determination can be accomplished on plain films, but in other cases, laminography is required.