RAD 309 Calvarium. Dr. Charles Newell, Chairperson Department of Radiologic Sciences

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1 RAD 309 Calvarium Dr. Charles Newell, Chairperson Department of Radiologic Sciences

2 Facial Bones Dr. Charles W. Newell, Chairperson Department of Radiologic Sciences

3 Facial Bone Images Facial bone injuries will range from the simple (black eye, broken nose) to the more complex (tri-malar fracture, infra orbital blow-out fracture, bi-lateral facial bone compression fractures). Regardless of the type and degree of complexity, all facial injuries have one thing in common and that is there is usually copious hemorrhage. So, prepare yourself to face unpleasant patient appearances often in the most simple fractures. I recommend two thoughts to keep in mind: (1) do not panic just follow the routine position requirements and be prepared to improvise. (2) above all, do not communicate your shock when you view the soft tissue damage. The patient must not interpret the degree of their injury based on your facial expression. The next slide is solely intended as examples of superficial appearances.

4 B & F

5 F I K N G H J L M Bontrager/Newell Is this picture similar to a Caldwell? Demonstrates a lot of facial bone anatomy!

6 SMV and/or VSM? D X E Bontrager

7 L M I H F J G K The Waters position demonstrates more facial bone anatomy than any other position. N P O Bontrager

8 Bontrager Plan A Waters/Parietoacanthial: MSP, OML 37 0 to the plane of the table

11 Bontrager Plan B A reverse Waters: MSP, Mentomeatal line, CR

12 Note: Plan B image is very similar t0 Plan A, but does a difference exist? SOM Lt. Nasal Bone R

13 Plan C Reverse Waters: MSP, IOML and CR angled 30 0 Cephalic. CR is with the mentomeatal line. Merrill Note: Cervical Collar

14 Plan C Plan C provides an obvious distorted projection. However, this position does show the major facial anatomical structures without endangering the patient with possible C-spine injuries.

15 Plan A CR Plan C: CR 30 0 cephalic When to use?

16 Modified Caldwell MSP, OML and CR angled 15 0 Caudal Bontrager

17 Lesser Wing Greater Wing Lateral Rim SOM

18 Lesser Wing of Sphenoid Great Wing of Sphenoid

19 Name of this position? Calcification of Falx Cerebri Frontal Sinus Lesser Wing Greater Wing Ethmoid Cells Frontal Process of zygomatic bone Nasal Conchae Mastoid Tip Floor of Maxillary sinus L

20 R?

22 R Ant. Clinoid Post. Clinoid Dorsum Sellae Sphenoid

23 1 maxillary sinus 2 orbit 10. Nasal floor 3 hard palate 11. roof of oral cavity 15. anterior nasal spine 8 posterior part of floor of orbit 11

24 Bontrager

25 Fracture: Nasal Bone SOM Nasal Bones Medial Border Z Nasal Septum IOM Lateral Rim

26 Bontrager Plan A SMV for zygomatic arches: MSP ; CR to IOML

27 The position is the same as in a SMV, but the technical factors must change. Zygomatic arches should be performed table-top, non-grid...alara. Bontrager

28 Mandibular Symphysis Zygoma Zygomatic Arch Temporal Bone Maintaining the MSP and the CR to the IOML are essential to producing a great image as demonstrated above.

29 Plan B Townes for zygomatic arches Bontrager

30 Plan B

31 Alternate, but less frequently used approach. Bontrager Head rotation to the affected side no more than 10 0 with CR to IOML/Zygomatic Arch.

32 Bontrager Axial Oblique Projection

33 Common Depressed Zygomatic Arch Fractures R L R

34 What do you see?

35 The right arch is not plainly visible. Why? R

36 MANDIBLE Dr. Charles W. Newell, Chairperson Department of Radiologic Sciences

37 The architecture of the mandible is such that an external force applied to one side of the mandible may result in a fracture to the side receiving the impact as well as the opposite side. Alternately, the side receiving the external blow may not fracture, while the other side may. It is not uncommon to see evidence of a patient who complains of a pain to the symphysis, but the symphysis is not fractured, while the ramus or neck on one side is fractured. Thus, it is important to assure that the entire mandible is visible on all radiographs appropriate to the various positions responsible for demonstrating specific anatomic parts of the mandible.

38 Common Fracture Sites

39 CR for AP or PA Note: mandible is slightly foreshortened and the mandibular neck is not visible. Department of Radiologic Sciences - Newell

40 Pt. PA; CR Cephalic Survey AP mage or Pt. AP; CR Caudal Note: elongation of mandible with radiographic visibility including all of the ramus and neck. The condyles are obscured by the mastoid processes. Compare appearance to CR. Note: edentulous patient

42 Degree CR Angulation?

43 Open Mouth Townes demonstrating the mandibular condyles This is the best method to demonstrate the mandibular condyles Department of Radiologic Sciences - Newell

44 Oblique Pt. Supine; CR Cephalic; Pt s. head turned to his/her right with the mandibular body near to plane of table. Bontrager

45 Oblique Symphysis Menti Pt. Supine; CR Cephalic Body Away from IR Coronoid Process Condyle Body Angle Neck

46 Zygomatic Arch Oblique Neck

48 A Method for Cross-Table Oblique of the Mandible

49 B A C G F E

50 L

51 R

52 Is the CR angled on this image?

54 TEMPROMANDIBULAR ARTICULATIONS Dr. Charles W. Newell, Chairperson Department od Radiologic Sciences

Objectives AXIAL SKELETON. 1. Frontal Bone. 2. Parietal Bones. 3. Temporal Bones. CRANIAL BONES (8 total flat bones w/ 2 paired)

Objectives AXIAL SKELETON. 1. Frontal Bone. 2. Parietal Bones. 3. Temporal Bones. CRANIAL BONES (8 total flat bones w/ 2 paired) Objectives AXIAL SKELETON SKULL 1. On a skull or diagram, identify and name the bones of the skull 2. Identify the structure and function of the bones of the skull 3. Describe how a fetal skull differs