RADT 1522 RADT 1522 Orbits, Facial Orbits, Facial Bones and Nasal Bones and Nasal Bones Bones Wynn Harrison, MEd Wynn Harrison, MEd
Jan 03, 2016
RADT 1522RADT 1522Orbits, Facial Bones and Orbits, Facial Bones and
Nasal BonesNasal Bones
Wynn Harrison, MEdWynn Harrison, MEd
Facial AnatomyFacial Anatomy
14 facial bones (How Many of Each)14 facial bones (How Many of Each)– Maxilla Maxilla - Vomer- Vomer– Zygomatic Zygomatic - Mandible- Mandible– PalatinePalatine– NasalNasal– LacrimalLacrimal– Inferior Nasal ConchaeInferior Nasal Conchae
Mid-saggital viewMid-saggital view
New WordsNew Words
Blow-Out FractureBlow-Out Fracture – Impact – Impact fracture (Trauma) of the orbital floor fracture (Trauma) of the orbital floor
resulting in orbital intrusion into resulting in orbital intrusion into the maxillary sinus.the maxillary sinus.
*** Look at the orbits carefully, since *** Look at the orbits carefully, since
60 - 70 % of all facial fractures 60 - 70 % of all facial fractures involve the orbit in some way involve the orbit in some way
Le Fort I - tooth bearing portion separated Le Fort I - tooth bearing portion separated from upper maxilla from upper maxilla
Le Fort II - fracture across orbital floor and Le Fort II - fracture across orbital floor and nasal bridge (pyramidal fracture) nasal bridge (pyramidal fracture)
Le Fort III - fracture across Le Fort III - fracture across frontozygomatic suture line, entire orbit frontozygomatic suture line, entire orbit and nasal bridge (craniofacial separation) and nasal bridge (craniofacial separation)
LeFort Type ILeFort Type I
LeFort Type IILeFort Type II
LeFort Type IIILeFort Type III
Tripod FractureTripod Fracture – – A fracture in which A fracture in which the zygoma is the zygoma is separated from its separated from its attachment to the attachment to the maxilla, frontal and maxilla, frontal and temporal bonestemporal bones
Bell’s PalsyBell’s Palsy - Bell's palsy is a - Bell's palsy is a weakness or paralysis of the muscles weakness or paralysis of the muscles that control expression on one side that control expression on one side of your face.of your face.
OrbitsOrbits Rhese View- Midsagittal plane forms Rhese View- Midsagittal plane forms
a 53 degree angle with IR. Chin, a 53 degree angle with IR. Chin, cheek and nose on the table (three-cheek and nose on the table (three-point landing!) Acanthiomeatal line point landing!) Acanthiomeatal line perpendicular to IR. Optic foramen perpendicular to IR. Optic foramen should be seen in center of image.should be seen in center of image.
Foreign Body Foreign Body
PA and Lateral views PA and Lateral views are performed to look are performed to look for foreign body in the for foreign body in the orbit. orbit.
What do you think you What do you think you need to have them do need to have them do differently for this differently for this exam?exam?
Look UP, Look Down Look UP, Look Down
Nasolacrimal SystemNasolacrimal System
Injection Site
Lateral image post injection
Facial Bones ImagingFacial Bones Imaging
Caldwell or PA imageCaldwell or PA image
LateralLateral
WatersWaters
Radiographic ViewsRadiographic ViewsPA (Caldwell)PA (Caldwell)
Tuck patient’s chin; nose and Tuck patient’s chin; nose and
forehead on table/wall buckyforehead on table/wall bucky
OML perpendicular to IROML perpendicular to IR
15 degree caudal angulation15 degree caudal angulation
Petrous pyramids BELOW inferior Petrous pyramids BELOW inferior orbital marginorbital margin
Caldwell (use horizontal ray)Caldwell (use horizontal ray)
Caldwell for facial bonesCaldwell for facial bones
PA (Caldwell)PA (Caldwell)
Calcified meningioma
Lateral Lateral – External auditory meatus – External auditory meatus externally and mandible inferiorly externally and mandible inferiorly with supracillary arch superiorly in with supracillary arch superiorly in view. view.
CR centered to zygoma, midway CR centered to zygoma, midway between outer canthus and EAMbetween outer canthus and EAM
Midsagittal plane is parallel to IRMidsagittal plane is parallel to IR IPL is perpendicular to IRIPL is perpendicular to IR
Lateral facial bonesLateral facial bones
What ‘Bout Technique!!!What ‘Bout Technique!!!
Would you increase or Would you increase or decrease technique for decrease technique for lateral facial bones lateral facial bones compared to a lateral compared to a lateral skull?skull?
Water’s ViewWater’s View Midsagittal plane Midsagittal plane
perpendicular to IRperpendicular to IR IPL parallel to IRIPL parallel to IR OML makes 37 OML makes 37
degree angle with IRdegree angle with IR
COLLIMATE!!!!COLLIMATE!!!!
Waters for facial bonesWaters for facial bones
Modified Parietoacanthial Modified Parietoacanthial (Modified Waters)(Modified Waters)
OML 55 degrees to the IROML 55 degrees to the IR Chin and nose on tableChin and nose on table Petrous pyramids are seen mid-Petrous pyramids are seen mid-
maxillary sinusmaxillary sinus CR exits acanthionCR exits acanthion
See pg. 355 (Merrill’s 12See pg. 355 (Merrill’s 12thth Edition) Edition)
Reverse Water’s ViewReverse Water’s View
Used when patient cannot be placed Used when patient cannot be placed in prone position.in prone position.
Mentalmeatal line perpendicular to IRMentalmeatal line perpendicular to IR CR perpendicular; enters acanthionCR perpendicular; enters acanthion CR parallel to acanthiomeatal lineCR parallel to acanthiomeatal line
Merrill’s pg. 332-3 (12Merrill’s pg. 332-3 (12thth Ed) Ed)
Nasal BonesNasal BonesLateral and Superior/Inferior ViewsLateral and Superior/Inferior Views
Lateral: Position exactly like Lateral: Position exactly like you would for a lateral skull … you would for a lateral skull … CR ½ inch inferior to nasion. CR ½ inch inferior to nasion.
CR Perpendicular to IRCR Perpendicular to IR
COLLIMATECOLLIMATE
Hyper extended watersHyper extended waters
Axial Nasal BonesAxial Nasal Bones
Use occlusal film. Patient holds film Use occlusal film. Patient holds film in teeth. NOT DONE ANYMORE. in teeth. NOT DONE ANYMORE.
CR perpendicular to film CR perpendicular to film
CR
Zygomatic ArchesZygomatic Arches
Bilateral Arches - SMVBilateral Arches - SMV
IOML parallel to IR and perpendicular IOML parallel to IR and perpendicular to CRto CR
CR midsaggital and collimate to CR midsaggital and collimate to outer edges of zygomaouter edges of zygoma
fracture
Oblique TangentialOblique Tangential
Same position as Same position as SMV except head SMV except head tilt 15 degrees tilt 15 degrees toward side of toward side of interestinterest
(Merrill’s p. 337 12 (Merrill’s p. 337 12 ed)ed)
May View (tangential)May View (tangential) PA positioning; IOML perpendicular to CR, PA positioning; IOML perpendicular to CR,
head tilt 15 degrees away from the area of head tilt 15 degrees away from the area of interest. interest.
CR bisects zygomatic archCR bisects zygomatic arch
Shows single zygomatic arch, free of Shows single zygomatic arch, free of superimpositionsuperimposition
(P. 341-2, 12 Ed. Merrill’s )(P. 341-2, 12 Ed. Merrill’s )
Unilateral arch viewUnilateral arch view
C-arm tangential imageC-arm tangential image