The PA skull projection is the second most common skull radiograph used in dentistry. It involves positioning the patient so that the Frankfurt plane is perpendicular to the image receptor with the canthomeatal line forming a 9-degree angle to the horizontal plane. The central x-ray beam is directed perpendicular from the posterior to the anterior at the level of the bridge of the nose. This should result in a symmetric skull image divided by the midsagittal plane with the superior border of the petrous ridge in the lower third of the orbit, allowing for evaluation of facial asymmetries and assessment of orthognathic surgery outcomes.