Facial Bone Facial Bone Anatomy & Anatomy & Positioning Positioning RTEC 233 RTEC 233
Anterior Aspect of Facial Anterior Aspect of Facial BonesBones
2 Maxillae2 Maxillae
2 Zygomatic bones2 Zygomatic bones
2 Lacrimal bones2 Lacrimal bones
2 Nasal bones2 Nasal bones
2 Inferior nasal conchae2 Inferior nasal conchae
2 Palatine bones (not 2 Palatine bones (not visualizedvisualized
1 vomer1 vomer
1 mandible1 mandible
Palatine BonesPalatine Bones
L-shaped bonesL-shaped bones
Horizontal portion forms Horizontal portion forms posterior hard palateposterior hard palate
Vertical portion extends Vertical portion extends between 1maxillae and 1 between 1maxillae and 1 pterygoid plate of pterygoid plate of sphenoid bonesphenoid bone
Articulates with 2 cranial Articulates with 2 cranial bones and 4 facial bonesbones and 4 facial bones
Zygomatic BonesZygomatic Bones
Forms cheeksForms cheeks Forms lower outer Forms lower outer
margin of orbitsmargin of orbits Articulates with 3 Articulates with 3
cranial bonescranial bones FrontalFrontal SphenoidSphenoid TemporalTemporal
Articulates with Articulates with maxillaemaxillae
Inferior Nasal CochaeInferior Nasal Cochae
The only pair of The only pair of conchae that are conchae that are separate facial bonesseparate facial bones
Articulates with 1 Articulates with 1 cranial bone and 3 cranial bone and 3 facial bonesfacial bones
Covered with Covered with mucous membranes mucous membranes to warm, moisten to warm, moisten and cleanse inhaled and cleanse inhaled airair
Lacrimal BonesLacrimal Bones About the size & About the size &
shape of a fingernailshape of a fingernail
Lacrimal foramen for Lacrimal foramen for tear ducttear duct
Lie anteriorly on the Lie anteriorly on the medial side of orbitmedial side of orbit
Can be seen on PA Can be seen on PA and lateral projectionsand lateral projections
Articulates with 2 Articulates with 2 cranial bones and 2 cranial bones and 2 facial bonesfacial bones
Nasal BonesNasal Bones
Fused and form Fused and form bridge of nosebridge of nose
Vary in size Vary in size considerablyconsiderably
The point of junction The point of junction with the frontal bone with the frontal bone is the nasion is the nasion
Articulates with 2 Articulates with 2 cranial and 2 facial cranial and 2 facial bonesbones
VomerVomer
Forms inferosuperior Forms inferosuperior part of nasal septumpart of nasal septum
Deviated nasal Deviated nasal septumseptum
Depressions for blood Depressions for blood vesselsvessels
Articulates with 2 Articulates with 2 cranial bones & 4 cranial bones & 4 facial bonesfacial bones
MandibleMandible
Only movable bone Only movable bone in the skullin the skull
Densest & largest Densest & largest facial bonefacial bone
2 bones at birth2 bones at birth
Contains mental Contains mental foraminaforamina
Pathologic Indications for Pathologic Indications for Facial RadiographyFacial Radiography
FracturesFractures BlowoutBlowout TripodTripod LeFortLeFort CoutrecoupCoutrecoup
Foreign Body Foreign Body
OsteomyelitisOsteomyelitis
NeoplasmsNeoplasms
Secondary Secondary OsteomyelitisOsteomyelitis
TMJ SyndromeTMJ Syndrome
Copyright ©1994 BMJ Publishing Group Ltd.
Hodgkinson, D W et al. BMJ 1994;308:46-50
FIG 3 - LeFort lines used for classifying fractures of the middle third of the face.
Positioning: Lateral Positioning: Lateral Facial bonesFacial bones
Semiprone or seatedSemiprone or seated
MSP parallelMSP parallel
IPL perpendicularIPL perpendicular
Suspend respirationSuspend respiration
CR is perp and CR is perp and enters lateral enters lateral zygomatic bone ½ zygomatic bone ½ way between outer way between outer canthus and EAM.canthus and EAM.
Lateral Facial Lateral Facial RadiographRadiograph
All facial bones in All facial bones in with zygomatic bone with zygomatic bone in centerin center
Almost SI mandibular Almost SI mandibular
ramirami
SI orbital roofs (no SI orbital roofs (no tilt)tilt)
No rotation of sella No rotation of sella turcicaturcica
Radiograph AnatomyRadiograph Anatomy E) Anterior nasal E) Anterior nasal
spinespine F) Alveolar process of F) Alveolar process of
maxillamaxilla G) Alveolar process of G) Alveolar process of
mandiblemandible H) Mentum H) Mentum J) Body of mandibleJ) Body of mandible K) Angle of mandib leK) Angle of mandib le L) Ramus of mandibleL) Ramus of mandible M) Coronoid processM) Coronoid process O) Neck of O) Neck of
mandibular condylemandibular condyle
P) Condyle or neck of P) Condyle or neck of mandiblemandible
Q) EAMQ) EAM R) Temporalmandibular R) Temporalmandibular
fossa of temporal bonefossa of temporal bone S) Greater wings of S) Greater wings of
sphenoidsphenoid T) Lesser wings of T) Lesser wings of
sphenoidsphenoid U) Ethmoid sinuses U) Ethmoid sinuses
between orbitsbetween orbits V) Body of maxilla V) Body of maxilla
containing maxillary containing maxillary sinusessinuses
Lateral Skull AnatomyLateral Skull Anatomy A) zygomatic archA) zygomatic arch B) RT zygomatic B) RT zygomatic
bonebone C) RT nasal boneC) RT nasal bone D) Frontal process D) Frontal process
of maxillaof maxilla E) Anterior nasal E) Anterior nasal
spinespine F) Alveolar process F) Alveolar process
of maxillaof maxilla G) Alveolar process G) Alveolar process
of mandibleof mandible H) MentumH) Mentum I) Mental foramenI) Mental foramen
J) Body of mandibleJ) Body of mandible K) Angle (gonion)K) Angle (gonion) L) Ramus of L) Ramus of
mandiblemandible M) Coronoid processM) Coronoid process N) Mandibular notchN) Mandibular notch O) Neck of O) Neck of
mandibular condylemandibular condyle P) Condyle or head P) Condyle or head
of mandibleof mandible Q) EAMQ) EAM
Positioning: Waters Positioning: Waters
Prone or seated uprightProne or seated upright
Chin on bucky -OML 37 Chin on bucky -OML 37 angle with plane of angle with plane of cassettecassette
MML & MSP perpMML & MSP perp
Nose 3/4 inch from IRNose 3/4 inch from IR
Suspend respirationSuspend respiration
CR perpendicular to CR perpendicular to exit acanthionexit acanthion
Waters RadiographWaters Radiograph
Distance from Distance from lateral border of lateral border of skull and orbit skull and orbit equal on each sideequal on each side
Petrous ridges Petrous ridges projected projected immediately below immediately below maxillary sinusesmaxillary sinuses
Reverse WatersReverse Waters
SupineSupine
Extend neck so OML Extend neck so OML is 37 degree with is 37 degree with plane of IRplane of IR
MML and MSP perpMML and MSP perp
Suspend respirationSuspend respiration
CR perpendicular and CR perpendicular and enters acanthionenters acanthion
Reverse Waters Reverse Waters RadiographRadiograph
Distance from Distance from lateral border of lateral border of skull and orbit skull and orbit equal on each sideequal on each side
Petrous ridges Petrous ridges projected projected immediately below immediately below maxillary sinusesmaxillary sinuses
Modified WatersModified Waters
OML 55 degree OML 55 degree angle from plane angle from plane of IRof IR
MSP perpMSP perp
CR perpendicular CR perpendicular and exits and exits acanthionacanthion
Modified Waters Modified Waters RadiographRadiograph
Petrous ridges Petrous ridges projected projected immediately below immediately below the inferior border the inferior border of the orbitsof the orbits
Equal distance Equal distance from lateral orbit from lateral orbit to lateral skull on to lateral skull on both sidesboth sides
PA Axial - CaldwellPA Axial - Caldwell Prone or seated Prone or seated
uprightupright
Forehead & nose Forehead & nose against grid deviceagainst grid device
OML perpendicularOML perpendicular
CR 15 caudal to CR 15 caudal to exit nasionexit nasion
Suspend respirationSuspend respiration
PA Axial- Caldwell PA Axial- Caldwell RadiographRadiograph
Equal distance from Equal distance from lat skull to lat orbitlat skull to lat orbit
Symmetric petrous Symmetric petrous ridges in lower 1/3 ridges in lower 1/3 orbitorbit
Penetration of frontal Penetration of frontal bone without bone without excessive density at excessive density at lateral borders of lateral borders of skull.skull.
Lateral Nasal BonesLateral Nasal Bones
SemiproneSemiprone
MSP & IOML parallelMSP & IOML parallel
IPL perpendicularIPL perpendicular
CR perpendicular to CR perpendicular to the bridge of nose at the bridge of nose at a point 1” distal to a point 1” distal to the nasionthe nasion
Lateral Nasal bones Lateral Nasal bones RadiographRadiograph
No rotation of No rotation of nasal bone and soft nasal bone and soft tissuetissue
Anterior nasal Anterior nasal spine and spine and frontonasal suture frontonasal suture evidentevident
Close collimationClose collimation