skull and maxillofacial radiography
TRANSCRIPT
DR MUHAMMAD YOUNAS KHANPGR
ORAL & MAXILLOFACIAL SURGERY KCD
MAXILLOFACIAL RADIOGRAPHY(Radiological Interpretation)
Objectives
To identify the presence are absence of disease
To provide information on the nature and extent of disease
To enable the formation of a differential diagnosis
Requirements for Interpretation
Optimum viewing condition
Understanding the nature and limitation of radiographic image
Detailed knowledge of normal anatomy & pathological condition
Systematic approach
Indications
Fracture of the maxillofacial skeleton
Fracture of the skull
Investigation of the antra
Disease affecting the skull base and vault
TMJ disorder
Main Maxillofacial/Skull Projections
Standard occipitomental (0o OM)30o occipitomenatal (37o, 45o, 14o)PA SkullPostero-anterior of the jawsReverse towne’s Rotated PATrue lateral skullSubmento vertex SMVTranscranialTranspharyangeal
Indications (0o OM)
Investigation of the maxillary antra
Detecting the middle third facial fracture (Le Fort fracture + Zmc + Noe + Orbital blowout fracture)
Coronoid process fractures
Investigation of frontal, ethmoidal and sphenoidal sinuses
Middle Third Fracture of the FaceInterpretation by (0o OM)
SYSTEMATIC APPROACH
a. McGrigor & Campbell (1950)
b. Trapnell line
c. Dolen line
Campbell’s Lines
Line 1: Rt ZF Suture Rt Supra-orbital ridge frontal sinus Lt supra-orbital ridge Lt ZFS
Line 2: Rt zygomatic arch Rt body of zygoma Rt infra orbital margin nasal complex Lt infra orbital margins Lt body of zygoma Lt Z arch
Line 3: Rt condylar neck Rt cronoid precces lateral wall of Rt antrum base of nasal complex lateral wall of Lt antrum Lt CP Lt CN
Campbell’s Line
Line 4: Rt angle of Mandible Line of occlusal plane Lt angle of mandible
Trapnell Line
Lower border of the mandible
Standard Waters view. 1 = Superior orbital rim; 2 = frontal sinus;3 = zygomaticofrontal suture
line; 4 = medial wall of the orbit;5 = ethmoid sinus;6 = zygomatic body; 7 = inferior orbital rim; 8 = floor of the orbit; 9 = medial and lateral walls of
the maxillary sinus; and 10 = nasal septum.
Dolen’s Curve
Curve 1
Lateral wall of the antrum – inferior surface of the body of zygoma – zygomatic arch (maxillary line)
Curve 2
Superior margin of zygomatic arch – lateral aspect of the body of zygoma – orbital margin (zygomatic line)
Dolen’s Curve
Curve 3
Iner aspect of the orbital rim (orbital line)
Curve 4
Outer curvature of the nasal complex (nasal line)
Interpretations
Step 1
Compare both side of Campbell’s line
Step 2
Compare both side of Dolen’s curve
Step 3
Examination of antrum
1. LINE 1 LOOK FOR: Fractures Widening of the zygomatic-frontal suture Fluid level (haemorrhage) in a frontal sinus2. LINE 2 LOOK FOR: Fractures of the zygomatic arch A fracture through the inferior rim of the orbit A soft tissue shadow in the roof of the maxillary antrum3. LINE 3 LOOK FOR: Fractures of the zygoma and of the lateral aspect of the
maxillary antrum A fluid level in the maxillary antrum.
Look for(In step 1 and step 2)
Alteration or asymmetry in bony outline/shapeStep deformitiesWidening of suture linesPresence of radiolucent fracture linesFracture line directionsDegree of separationRadiopaque lines
Particulare
Zygomatico-frontal sutures
Fronto-nsal sutures
Zygomatico-temporal sutures
Inferior margins of orbits
Lateral margins of antrum
Nasal septum and complex
Radiographic Signs of Bone Fracture
Direct1. Separation sign2. Overlap sign3. Suture diastasis4. Bony steps5. Periodontal ligament widening6. Abnormal linear density7. Disappearing fragment sign8. Abnormal angulation / curve9. Displaced bone
Indirect
1. Tear drop sign (hanging drop)
2. Sinus opacification
3. Air in soft tissues
4. Occlusal plane changes
5. Dental injuries
30o Occipitomental(water view)
INDICATIONS:
detecting the middle third facial fractureLe Fort ILe Fort IILe Fort III
Coronoid process fractures
Orthopentomogram(DPT/OPG)
All the teeth and their supporting structures
Reasonably simple
Radiation dose is low
Indications
Assessment of dentitions (primary, mixed, and permanent)Orthodontic assessmentAssessment for bony lesionAssessment of periodontal boneThird molar statusMandible fracturesAntral disease (floor, posterior, medial walls)Disease of the TMJVertical alveolar bone height
Interpretation of the OPG
The entire radiograph
Specific lesion
General view of the entire film
Note the chronological and developmental age of patient
To trace the out line of normal and antomical shadows
Real or Actual Shadows
Hard tissue shadows
1. Teeth
2. Mandible
3. Maxilla
4. Zygomatic arches
5. Styloid processes
6. Nasal septum and conchae
7. Base of skull
AIR SHADOWS
1. Mouth/oral opening
2. Oropharynx
SOFT TISSUE SHADOWS
1. Ear lobes
2. Nasal cartilages
3. Soft palate
4. Dorsum of tongue
5. Lips and cheeks
General View
TEETH
1. Number of teeth
2. Stage of development
3. Condition of crown
4. Position of teeth
5. Condition of root
6. Apical tissue
Mandible
Both TMJ/coronoid process
Body ramus of mandible
Shape
Outline
Thickness of the lower border
Trabeculae pattern
Radiolucent/radiopeque areas
Panoramic view.
1 = Condylar process;2 = coronoid process3 = ramus4= angle of the mandible5 = body of the mandible6 = symphysis
Others Structures
Antrum (floor anterior, posterior wall, radio density)
Nasal cavity
Styloid processes
Specific Lesion
Site
Size
Shape
Outline
Relative radio-density
Internal structure
Effect on adjacent surrounding structures
Ghost Shadows
Survical vertebrae
Body angle, ramus of contralateral side
Palate
ANY QUESTION
Any one want to add some suggestions
please
THANKS