104 skull, mandible & the facial bones.ppt

A Video Review of Skull and Mandible Anatomy

Gives information on skull structures

Gives information on certain endocrine and metabolic disorders, metastasis and fractures

no value for patients suspected of having neurological disease

PLAIN SKULL RADIOGRAPHY

Routine Method of Study of Skull Radiographs… WHAT TO TAKE NOTE?

shape of the skull as a whole

especially the relationship of the vault to the base in all views

outline of the skull as a whole

noting the thickness of the inner and outer tables

lines, impressions, channels and sutures

Routine Method of Study of Skull Radiographs… WHAT TO TAKE NOTE?

Check for calcifications

Carefully define the sella turcica, its anterior and posterior clinoid processes and tuberculum sellae

Examine the petrous ridges, orbits, sphenoid ridges, temporal bones and facial bones

X-Ray examination consists of multiple exposures with the patient in different positions:

Minimum requirement –

1. Posteroanterior

2. Lateral View

Normal Skull

Routine Radiographic Procedures of Skull

PA view with 15 degree tilt of the tube caudally

Permits visualization of the:

1. orbital structures 2. superior orbital fissures with

surrounding lesser and greater wings of the sphenoid

Sagittal suture

Frontal Sinus

Orbit

Maxillary Sinus

Odontoid Process of C2 Vertebra

Lesser Wing of Sphenoid bone

Greater Wing of the Sphenoid

Superior Orbital Fissure

Ethmoid Air Cells

Nasal Septum

Petrous Ridge

Permits visualization of the petrous ridges which are projected into the orbits

AP view with a 30 degree tilt of the tube caudally

Demonstrates the entire occipital bone, foramen magnum and dorsum sellae

Lambdoid Suture Foramen

Magnum

Mastoid air cells

Condyle of theMandible

Dens

Posterior arch of the atlas

Occipital crest

Occipital protruberance

Sulcus of the transverse sinus

Demonstrates the bones of the calvarium and base of the skull in the lateral perspective

The sellae turcica is best visualized in this view

Diploe Groove for middle meningeal vessels

Lambdoid Suture

Frontal Sinus

Frontal Process of Zygoma

Arch of Zygoma

Ethmoid Air Cells

Sphenoid Sinus

Maxillary Sinus

Coronal Suture

Ramus of Mandible

Sella Turcica

Posterior Clinoid Process

Anterior Clinoid Process

Anterior Arch Of Atlas

Condyle of Mandible

Coronoid Process of Mandible

Greater Wing of Sphenoid

Mastoid Air Cells

Palatine Process of Maxilla

Axial view of the skull

- Allows direct visualization of the base of the skull and various foramina

- Provides view of the petrous ridges, ethmoid, sphenoid along with the facial bones and orbits

Occipital Condyle

Mastoid Air Cells

Posterior Wall of Maxillary Sinus

Posterior Wall of Orbit


Anterior Arch of Atlas

Odontoid Process Foramen Magnum

Perpendicular plate of Ethmoid

Vomer

Mandibular Head

Foramen Ovale

Foramen Spinosum

Foramen Lacerum

Auditory Canal

Carotid Canal Jugular Foramen

Chin up position

Orbitomeatal line should be adjusted to make an angle of 37 degrees with the plane of the film

Shows the sinuses well

Frontal Sinus

Nasal Septum

Ethmoid Air Cells

Maxillary Sinus

Lesser Wing of Sphenoid


Frontal Process of Zygomatic bone

Frontozygomatic Suture

Condyle of Mandible

The Paranasal Sinuses

Paranasal Sinuses- are paired cavities lined by mucous

membrane (mucoperiosteum)

- arise as outpouchings from the nasal fossa

- extends into the maxillary, ethmoid, sphenoid and frontal bones

- named according to the bones in which they develop

Paranasal SinusesMethods of Examination:• Standard Positions

- Water’s (occipitomental) projection- Caldwell’s (occipitofrontal) position- Lateral position- Submentovertical (SMV) projection

• Special Methods– Contrast studies– Tomography– Computerized Tomography

Paranasal SinusesMAXILLARY SINUS

- first PNS to appear in fetal life

- arise as outpouchings from the anterior recess of the middle meatus

- at birth; small, vertically ovoid cavities located in the maxillae on either side of the midline

- growth/aeration is complete at 12 years of age

Paranasal SinusesMaxillary Antra/Sinus

- when fully developed = each sinus is shaped by the body of the maxillary bone

- considered to have a roof, a floor and 3 walls = nasal, facial and infratemporal

- floor is often irregular due to alveolar process of the maxilla

- bony or membranous septa occasionally divide the antrum into two or more compartments

Paranasal SinusesFRONTAL SINUS- usually present at birth but

incompletely aerated and lie adjacent to the anterior ethmoid cells in the orbital plate of the frontal bone

- visible at 2 years of age - reach their extent of growth

when the child is 10 to 12 years of age

Paranasal SinusesFrontal Sinuses

- may extend high into the vertical portion of the frontal bone and backward into the orbital plate

- often asymmetric and vary widely in size

- agenesis of one or both is quite frequent

- communicate with the middle nasal meatus by means of the nasofrontal duct

Paranasal SinusesEthmoid Sinuses

- consists of two groups of cells lying on either side of the midline in the ethmoid bone

- they form the medial wall of the orbit and lateral wall of the upper half of the nasal cavity

- vary from 3 or 4 up to 18 or more in number

- distribution varies; may extend into the adjacent sinuses

Paranasal SinusesEthmoid Sinuses

- frontal anterior ethmoids - open into the frontal recess

- infundibular anterior cells - ethmoid infundibulum

- bullar anterior cells - above the ethmoidal bulla

- posterior ethmoid cells communicate with the superior nasal meatus

- fully developed at 10 to 12 years of age

Paranasal Sinuses

SPHENOID SINUS

- lie in the body of the sphenoid bone

- communicate with the sphenoethmoid recess in the posterior superior portion of the nasal cavity

- development is somewhat slower andgrowth continues into young adult life

- if not visible by age 10 = disease is suspected

The Mastoids

Mastoids

- important in the diagnosis of middle ear and mastoid diseases

Mastoids- temporal bone = complex

structure- contains the external

auditory canal, middle and internal ear as well as the vestibular apparatus

- bone consists of : a) squamousb) tympanicc) pertomastoid- petrous part – internal ear

- mastoid part – mastoid air cells

d) styloid process

Mastoids- mastoid cells develop as

saclike extensions from the mastoid antrum

- process begins at birth and is complete by puberty

- considerable amount of pneumatization

Schuller view

Xray of the Orbits

OrbitsMethods of Examination

a) PA Projection - superior orbital fissures, superior and lateral orbital margins

b) Modified Waters Projection- orbital floors, superior and inferior orbital margins

Orbits

Methods of Examination

c) Rhese (parieto-orbital oblique) Projection -

right and left optic foramina are usually taken for comparison

- optic canal,superior and lateral orbital margins

THE Nasal Bone

Nasal BoneMethods of Examination

a) Waters Projection - best for showing deviated bony nasal septum

b) Lateral Projection- right and left are generally taken for comparison

Water’s view

Nasal BoneMethods of Examination

a) Waters Projection - best for showing deviated

bony nasal septum

b) Lateral Projection- right and left are generally

taken for comparison

Lateral Projection

The Facial Bones

Facial Bones

• Methods of Examination

a) Waters Projection b) Lateral Projectionc) Towne Projection

d) SMV Projectione) Oblique Tangential

Facial Bones

Methods of Examination

a) Waters Projection b) Lateral Projectionc) Towne Projection d) SMV Projectione) Oblique Tangential

Facial Bones

Methods of Examinationa) Waters Projection b) Lateral Projectionc) Towne Projection d) SMV Projectione) Oblique Tangential

The Mandible

Mandible Methods of Examination

a) Reverse Towne Projection - condylar process

b) PA Projection – mandibular rami and body

c) AP Oblique Projection - mandibular body and ramus, condylar process, coronoid process and symphysis

d) Panoramic View of the mandible

Reverse Towne projection

Mandible

PA Projection

Methods of Examinationa) Reverse Towne Projection - condylar process




Mandible

Oblique projection

Methods of Examinationa) Reverse Towne Projection - condylar process




Panoramic View of the Mandible

The Temporomandibular Joints

Temporomandibular Joints- examined with the

patient’s mouth open and closed

- use of special projections and tomography

- Normal- articular surfaces are smooth

- Mandibular condyles move forward out of the glenoid fossa when the mouth is open

This 11-month old infant fell and struck his head on a hard surface This 11-month old infant fell and struck his head on

Case: This 11-month old infant fell and struck his head on a hard surface.

INTERPRETATION:

Linear fracture of the posterior portion of the right parietal bone extending across the lambdoidal suture into the occipital bone inear fracture

There is a depressed skull fracture over the posterior right parietal bone. The hyperdense (sclerotic) appearance of the skull abnormality indicates the presence of a depressed skull fracture.

Child hit by a stone by his playmate

Case: 18 y.o. female presented with nasal congestion more in the right side associated with fever and headache and tenderness over the right maxillary area.

Acute right sided maxillary sinusitis showing opacification of right maxillary sinus and normal-appearing left maxillary sinus

Compare the right and left maxillary sinus

Case: 22 y.o. male involved in a motorcycle accident (no helmet). Identify the fractured parts of the mandible?

Latero-lateral radiograph of the skull: Well-defined osteolytic areas are visible in the bone of the calvaria (classical 'raindrop' lesions)

Case: 65 year old male diagnosed with Multiple Myeloma

A case of a 19 y.o. college student mauled by unknown assailants.

Look at his nasal bone?

Is there are fracture?

104 skull, mandible & the facial bones.ppt

Documents