Procedures Test 4-Facial bones and sinuses
Terms
undefined, object
copy deck
- Skull is __ bones divided into 2 groups: __ cranial bones + __ facial bones
- 22; 8; 14
- Functions of facial bones
-
-Provide support, structure, and shape for face
-Form protective housing for upper ends of respiratory and digestive tracts
-With several of the cranial bones, form the orbital sockets for protection of the eyes - Names of facial bones
- 2 nasal, 2 lacrimal, 2 maxillary, 2 zygomatic, 2 palatine, 2 inferior nasal conchae (turbinate), 1 mandible, 1 vomer
- Articulations of facial bones, including joints between roots of teeth and jawbones, are ________ _______ and are __________ EXCEPT for ____, which are ______ joints of the ____________ type and are ______
- fibrous gomphoses; immovable; TMJs; synovial; hinge and gliding; freely movable
- TMJ is articulation of ____________ with _____________ of temporal bone
- mandibular condyle; mandibular fossa
- Nasal bones form...
- superior bony wall of nasal cavity (bridge of nose)
- Nasal bones are small, thin, and can vary in ____ and _____
- size; shape
- Nasal bones articulate with each other in _______ and also articulate with...
- MSP; perpendicular plate of ethmoid bone, frontal bone, and maxillae
- What are the smallest bones of the skull?
- Lacrimal bones
- Lacrimal bones are very thin and are situated...
- anterior to medial wall of the orbits between the labyrinth of the ethmoid bone and the maxilla
- Lacrimal bones and maxillae form ___________, which accommodate lacrimal sacs
- lacrimal fossae
- Each lacrimal bone has a ____________ through which a tear duct passes
- lacrimal foramen
- Each lacrimal bone articulates with...
- frontal, ethmoid, maxilla, and inferior nasal concha bones
- Lacrimal bones can be seen on ______ and _______ projections of the skull
- PA; lateral
- What are the largest of the immovable bones of the face?
- Maxillary bones
- Each maxillary bone articulates with...
- all other facial bones except mandible, as well as frontal and ethmoid bones of cranium
- Maxillary bones form part of the lateral walls and most of the floor of the _________, part of the floor of the ______________, and 3/4 of _______________
- nasal cavity; orbital cavities; roof of mouth
- Maxillary bones have _____________ that articulate with ______________ and assist in formation of prominence of cheeks
- zygomatic processes; zygomatic bones
- Large, pyramidal cavity in the body of each maxilla that empties into nasal cavity
- Maxillary sinus
- _______________ on maxillary bone under each orbit serves as a passage through which the infraorbital nerve and artery reach the nose
- Infraorbital foramen
- On what bones are the infraorbital foramina located?
- Maxillary bones
- Thick, spongy ridge at inferior borders of maxillae that supports roots of teeth
- Alveolar process
- Pointed, forward-projecting prominence at junction of maxillary bones in MSP
- Anterior nasal spine
- Midpoint of anterior nasal spine
- Acanthion
- Zygomatic bones form...
- prominence of cheeks and part of orbital cavities (form part of floor and most of lateral wall of orbital cavities)
- ___________ of zygomatic bone extends posteriorly to unite with ____________ of temporal bone to form ___________
- Temporal process; zygomatic process; zygomatic arch
- Zygomatic bones articulate with...
- frontal, maxilla, temporal, and sphenoid bones
- What bones are L-shaped?
- Palatine bones
- Palatine bones are composed of ________ and __________ plates
- vertical; horizontal
- Horizontal plates of palatine bones articulate with _________ to complete the posterior __________
- maxillae; 1/4 of bony palate (roof of mouth)
- Superior tips of vertical portions of palatine bones assisting in forming the posteromedial bony ________
- orbit
- Inferior nasal conchae extend diagonally and inferiorly from lateral walls of ________ at approximately its lower ____
- nasal cavity; 1/3
- Which bones are long, narrow, extremely thin, and curl laterally (giving them a scroll-like appearance)?
- Inferior nasal conchae (turbinate)
- The upper 2 nasal conchae are processes of the _______ bone
- ethmoid
- The 3 nasal conchae divide the sides of the nasal cavity into ________, __________, and _________ _________
- superior, middle, and inferior meatuses
- What is a thin plate of bone in the MSP of the floor of the nasal cavity?
- Vomer
- Vomer forms...
- inferior part of nasal septum
- Nasal conchae are covered with a ___________ to warm, moisten, and cleanse inhaled air
- mucous membrane
- Vomer articulates with...
- sphenoid and perpendicular plate of ethmoid bone
- The posterior border of the _______ is free
- vomer
- What is the largest and densest bone of the face?
- Mandible
- 3 parts of mandible
- Body, rami, and symphysis
- Curved horizontal portion of mandible from angle to symphysis
- Body
- 2 vertical portions of mandible, from condyles to angles
- Rami
- Mandibular rami unite with body at __________
- angle of mandible (gonion)
- Lateroposterior aspect of mandible
- Gonion
- The surface of the rami form an ______ angle of...
- obtuse; 110-120 degrees
- Each ramus has 2 processes at its upper extremity that are separated by ____________. ___________ is anterior, and ___________ is posterior
- mandibular notch; coronoid process; condylar process
- Condylar process consists of a constricted area (______) and broad, thick, almost transversely placed _________ that articulates with ____________ of temporal bone
- neck; condyle; mandibular fossa
- TMJ slants posteriorly __ degrees and inferiorly and medially __ degrees
- 15; 15
- TMJ is immediately in front of ____
- EAM
- At birth, the mandible consists of bilateral pieces held together by a fibrous symphysis that ossifies in...
- 1st year of life
- Triangular prominence at bottom of ridge of ossification
- Mental protuberance
- Midpoint of mental prominence; anterior aspect of mandible where the 2 mandibular bodies join together
- Mental point
- Most anterior and central point of mandible, where right and left halves of mandible have fused
- Symphysis
- Superior border of body of mandible; consists of spongy bone and supports roots of teeth
- Alveolar portion
- 2 ____________ in mandible allow transmission of nerves and blood vessels
- mental foramina
- U-shaped bone at base of tongue
- Hyoid
- Where is hyoid located?
- At base of tongue
- Hyoid is an accessory bone of the ______ skeleton
- axial
- Hyoid is made of _____, 2 __________, and 2 __________
- body; greater cornua; lesser cornua
- ________ serves as an attachment for certain muscles of the larynx and tongue
- Hyoid
- Hyoid is easily palpated just above...
- larynx
- Cone-shaped, bony-walled cavities on each side of MSP of head
- Orbits
- Bony sockets that hold the eyeballs and structures associated with them, as well as blood vessels and nerves
- Orbits
- What 7 bones make up each orbit?
-
Lacrimal, maxillary, zygoma, palatine, frontal, ethmoid, sphenoid
(LET MAD ZEBRAS PLAY FOR EVERY SPORT) - Circumference of orbit (outer rim area) is made of...
- frontal, zygoma, and maxilla bones
- Each orbit has a ___, a ______, a _________, and a ______
- roof; medial wall; lateral wall; floor
- Easily palpable, quadrilateral-shaped anterior circumference of orbit
- Base
- Apex of orbit corresponds with...
- optic foramen
- Long axis of each orbit is directed obliquely, posteriorly, and medially at an angle of __ degrees to MSP of head and also superiorly at an angle of about __ degrees from OML
- 37; 30
- The major and frequently radiographed openings of the orbits are...
- optic foramina and superior and inferior orbital sulci
- Cleft between greater and lesser wings of sphenoid bone
- Superior orbital fissure
- Narrow cleft extending from lower anterolateral aspect of sphenoid body anteriorly and laterally between floor and lateral wall of orbit
- Inferior orbital fissure
- Walls of orbits are _____ and subject to ______
- thin; fracture
- When struck on eyeball, eyeball is forced into orbit and "______ ___" the thin bony _____ of the orbit
- blows out; floor
- Eye consists of ________, _________, _______, and accessory organs such as _______, _________, and ________
- eyeball; optic nerve; blood vessels; extrinsic muscles; lacrimal apparatus; eyelids
- What connects eyeball to brain?
- Optic nerve
- Optic nerve connects _______ and ______
- eyeball; brain
- Eyeball is situated in _______ part of orbital cavity
- anterior
- Thin mucous membrane that covers the exposed part of the eyeball and lines part of the eyelids
- Conjunctiva
- Conjunctiva is kept moist by ________ from ________
- tear secretions; lacrimal gland
- Outer supporting coat of eyeball is a firm, fibrous membrane consisting of anterior segment called ________ and posterior segment called _______
- cornea; sclera
- What is known as the "white of the eye"?
- Sclera
- ________ is in front of iris, with its center point corresponding to the pupil
- Cornea
- Inner coat of eyeball; is contiguous with optic nerve
- Retina
- Is composed of nervous tissue and several million receptor organs (rods and cones)
- Retina
- What do rods and cones do?
- Transmit light impulses to brain
- What may be used to locate foreign bodies in the eye, and what is NOT used?
- US and CT, and sometimes radiography are used. MRI is not used
- In what bones are the paranasal sinuses located?
- Frontal, ethmoid, sphenoid, and maxillary bones
- Air-containing cavities in the frontal, ethmoidal, and sphenoidal bones of cranium and maxillary bones of face
- Paranasal sinuses
- Functions of paranasal sinuses
-
-Serve as a resonating chamber for voice
-Decrease weight of skull by containing air
-Help warm and moisten inhaled air
-Act as shock absorbers in trauma
-Possibly control immune system - Which sinuses are usually well developed and aerated enough at birth to be demonstrated radiographically?
- Maxillary sinuses
- By what age are the frontal and sphenoidal sinuses distinguishable from ethmoidal air cells?
- 6-7
- When do ethmoidal air cells develop?
- Puberty
- At what age are the sinuses completely developed?
- 17-18
- When fully developed, each of the sinuses communicates with...
- the others and with the nasal cavity
- Which are the largest sinuses?
- Maxillary sinuses
- There are generally __ of each type of sinus (sinuses are _________)
- 2; paired
- Where are maxillary sinuses located?
- In body of each maxilla
- Maxillary sinuses appear _________ in lateral image, but are ___________ in shape and have only __ walls
- rectangular; pyramidal; 3
- Maxillary and frontal sinuses drain into _________. Anterior and middle ethmoidal air cells drain into ________. Posterior ethmoidal air cells drain into _________. Sphenoidal sinuses open into ____________.
- middle nasal meatus; middle nasal meatus; superior nasal meatus; sphenoethmoidal recess of nasal cavity
- What are the second-largest sinuses?
- Frontal sinuses
- Where are frontal sinuses located?
- Between tables of vertical plate of frontal bone
- Which sinuses have several elevations on their floors which correspond to the roots of the subjacent teeth?
- Maxillary sinuses
- Which sinuses are occasionally absent?
- Frontal sinuses
- Because ___________ is usually deviated from the midline, _________ are rarely symmetric
- intersinus septum; frontal sinuses
- Where are ethmoidal sinuses located?
- Within lateral masses of labyrinths of ethmoid bone
- Ethmoidal sinuses are composed of a varying number of air cells that are divided into 3 main groups: _____________________
- anterior, middle, and posterior
- Anterior and middle ethmoidal cells vary in number from ____; posterior ethmoidal cells vary in number from ____
- 2-8; 2-6
- Where are sphenoidal sinuses located?
- Body of sphenoid bone
- Often, only 1 sphenoidal sinus is present, but there are never more than __ sphenoidal sinuses
- 2
- Sphenoidal sinuses lie immediately below ___________ and extend between _________ and ____________
- sella turcica; dorsum sellae; posterior ethmoidal air cells
- Paranasal sinuses should be radiographed with patient in _______ position
- upright
- Why should be sinuses be radiographed with patient upright?
- To demonstrate presence or absence of fluid and differentiate between fluid and other pathologic conditions
- What size FS should be used for sinuses?
- Small
- When head is repositioned for sinuses, __________ should be allowed to pass before exposure is made to allow exudate to shift position
- several minutes
- What are the breathing instructions for all headwork?
- Suspend respiration
- Gowning for all headwork
- Remove everything from upper shoulders up, including necklaces, hair accessories, pins, jewelry, glasses, weaves, teeth, retainers, etc.
- History questions for headwork
-
-Any trauma? When?
-Any pain? Where? Sharp or dull pain?
-Headaches or congestion?
-Dizziness?
-Any surgery?
-Any teeth problems?
-Etc. - Routine for facial bones
- PA axial (Caldwell), regular Waters, lateral
- Position for PA axial (Caldwell) facial bones
- Prone or seated. Rest forehead and nose on table or upright Bucky. OML and MSP perp to IR, IP parallel to IR
- IR for PA axial (Caldwell) facial bones
- 10x12 LW
- CR for PA axial (Caldwell) facial bones
- 15 caudal, exiting nasion
- Structures shown for PA axial (Caldwell) facial bones
- Orbital rims, maxillae, nasal septum, zygomatic bones, and anterior nasal spine
- When CR is angled 15 caudad, petrous ridges appear...
- in lower 1/3 of orbits
- When CR is angled 30 caudad, petrous ridges appear...
- below inferior margins of orbits
- For PA axial (Caldwell) facial bones, where should petrous pyramids appear?
- In lower 1/3 of orbit
- Eval criteria for PA axial (Caldwell) facial bones
-
-Symmetric petrous pyramids in lower 1/3 of orbits
-Entire cranial perimeter showing 3 distinct tables of squamous bone
-Equal distance from lateral border of skull to lateral border of orbit on both sides
-Penetration of frontal bone without excessive density at lateral borders of skull, which will then demonstrate facial bones - IR for parietoacanthial (PA; regular Waters method) facial bones
- 8x10 LW
- CR for parietoacanthial (PA; regular Waters method) facial bones
- Perp, exiting acanthion
- Structures shown for parietoacanthial (PA; regular Waters method) facial bones
-
-Axial image of facial bones
-Orbits, maxillae, zygomatic arches - Eval criteria for parietoacanthial (PA; regular Waters method) facial bones
-
-Distance between lateral border of skull and orbit equal on each side
-Petrous ridges projected immediately below (inferior to) maxillary sinuses - Position for lateral facial bones
- Semiprone or obliquely seated, in PA oblique body position with affected side closest to IR. IOML and MSP parallel to IR (IOML perp to front edge of IR). IP perp to IR
- IR for lateral facial bones
- 8x10 LW (clinically, 10x12 LW)
- CR for lateral facial bones
- Perp, entering lateral surface of zygomatic bone midway between outer canthus and EAM
- Structures shown for lateral facial bones
- -Lateral projection of face, with right and left halves superimposed
- Eval criteria for lateral facial bones
-
-All facial bones in their entirety, with zygomatic bone in center
-Almost perfectly superimposed mandibular rami
-Superimposed orbital roofs
-No rotation of sella turcica - Position for modified ("shallow") Waters facial bones
- Prone or seated. Nose and chin on table or upright Bucky. Extend neck so OML forms a 55 degree angle with IR. MSP perp to IR
- CR for modified ("shallow") Waters facial bones
- Perp, exiting acanthion
- Structures shown for modified ("shallow") Waters facial bones
-
-Demonstrates facial bones with less axial angulation than Waters
-Good for demonstrating floor of orbits and blowout fractures. Places orbital floor perp to IR and parallel to CR, demonstrating inferior displacement of orbital floor and the commonly associated opacified maxillary sinus - What projection is good for demonstrating floor of orbits and blowout fractures?
- Modified ("shallow") Waters
- Eval criteria for modified ("shallow") Waters facial bones
- -Petrous ridges immediately below inferior border of orbits and at a level midway through (in lower half of) maxillary sinuses
- Position for acanthioparietal (reverse Waters) facial bones
- Supine. Extend neck so OML forms a 37-degree angle with IR. MML and MSP perp to IR
- IR for acanthioparietal (reverse Waters) facial bones
- 10x12 LW
- CR for acanthioparietal (reverse Waters) facial bones
- Perp, entering acanthion
- Structures shown for acanthioparietal (reverse Waters) facial bones
-
-Demonstrates superior facial bones
-Appears similar to Waters, but facial structures are considerably magnified - Eval criteria for acanthioparietal (reverse Waters) facial bones
-
-Distance between lateral border of skull and orbit equal on each side
-Petrous ridges below maxillary sinuses - Routine for orbits
- PA axial (CR angled 30 degrees caudal), modified Waters, and lateral. Tomographic study may be included after routine series
- All orbits projections are done ______, except for RHESE which is done ________
- TT; in table Bucky
- What are patient instructions for exams of orbits?
- Gently close eyes and keep eyes still. Hold your breath
- IR for all orbits
- 8x10 or 10x12 LW
- Position for parietoorbital oblique (RHESE method) optic canal and foramen
- Semiprone or seated upright. Center affected orbit to unmasked half of IR. Rest zygoma (cheek), nose, and chin on table or upright Bucky. AML perp to IR. MSP at 53-degree angle with IR
- CR for parietoorbital oblique (RHESE method) optic canal and foramen
- Perp, entering 1" superior and posterior to upside TEA, and exiting through affected orbit closest to IR
- Structures shown for parietoorbital oblique (RHESE method) optic canal and foramen
-
-Demonstrates optic canal "on end" and optic foramen lying in inferior and lateral quadrant of projected orbit
-Lateral deviation indicates incorrect head rotation. Longitudinal deviation indicates incorrect angulation of AML
-Both sides are examined for comparison
-Shows parietoorbital projection of ethmoidal, sphenoidal, and frontal sinuses - Eval criteria for parietoorbital oblique (RHESE method) optic canal and foramen
-
-Optic canal and foramen visible at end of sphenoid ridge in inferior and lateral quadrant of orbit
-Entire orbital rim
-Supraorbital margins lying in same horizontal line
-Close beam restriction to orbital region - Position for PA axial eye
- Rest forehead and nose on IR. OML and MSP perp to IR. IP parallel to IR
- CR for PA axial eye
- 30 caudal, entering outer canthus and directed through center of orbits, exiting 3/4" distal to nasion
- Eval criteria for PA axial eye
-
-Petrous pyramids below inferior orbital rim (orbital shadows)
-No rotation of cranium
-Close beam restriction centered to orbital region - Position for parietoacanthial (modified/"shallow" Waters) eye
- Rest chin on IR holder. MSP perp to IR, and OML forming a 55-degree angle with IR
- CR for parietoacanthial (modified/"shallow" Waters) eye
- Perp through midorbits (outer canthus)
- What is parietoacanthial (modified/"shallow" Waters) projection of eye good for demonstrating?
- Blowout fractures
- Eval criteria for parietoacanthial (modified/"shallow" Waters) eye
-
-Petrous pyramids well below orbital shadows and halfway filling maxillary sinus
-Symmetric visualization of orbits, indicating no rotation of cranium
-Close beam restriction centered to orbital region - Position for lateral eye
- Semiprone or seated. Outer canthus of affected eye adjacent to and centered over midpoint of IR. IOML perp to front edge of IR. MSP parallel to IR. IP perp to IR
- CR for lateral eye
- Perp, entering outer canthus of side up
- Eval criteria for lateral eye
-
-Density and contrast permitting optimal visibility of orbit and eye for localization of foreign bodies
-Superimposed orbital roofs
-Close beam restriction centered to orbital region - For lateral eye, patient should be told to...
- Look straight ahead for the exposure with eyes open or gently closed
- Routine for sinuses
- PA axial (Caldwell), regular Waters, lateral
- Position for PA axial (Caldwell) sinuses
-
Upright. OML forming an angle of 15 degrees with horizontal CR. MSP perp to IR
OR
Can tilt vertical grid device down so a 15-degree angle is obtained. Rest nose and forehead on IR. OML and MSP perp to IR - CR for PA axial (Caldwell) sinuses
- Perp and horizontal, exiting nasion
- Structures shown for PA axial (Caldwell) sinuses
-
-Frontal sinuses superior to frontonasal suture
-Anterior ethmoidal air cells lying on each side of nasal fossae and immediately inferior to frontal sinuses
-Sphenoidal sinuses projected through nasal fossae just inferior to or between ethmoidal air cells
-Petrous pyramids extending from inferior 1/3 of orbit inferiorly to obscure superior 1/3 of maxillary sinus - Eval criteria for PA axial (Caldwell) sinuses
-
-Symmetric petrous pyramids in lower 1/3 of orbits
-Frontal and anterior ethmoidal air cells
-Equal distance from lateral border of skull to lateral border of orbit on both sides, indicating no rotation
-Frontal sinuses lying above frontonasal suture and anterior ethmoidal air cells lying above petrous ridges
-Clearly visible air-fluid levels, if present
-Close beam restriction of sinus area - Position for parietoacanthial (Waters) sinuses
- Upright. Hyperextend neck and rest chin on grid device. MSP and MML perp to IR. OML forming a 37-degree angle with IR
- CR for parietoacanthial (Waters) sinuses
- Perp, exiting acanthion
- If neck is not extended enough for parietoacanthial (Waters) sinuses...
- petrosae are projected over inferior parts of maxillary sinuses
- Structures shown for parietoacanthial (Waters) sinuses
-
-Axial image of facial bones, orbits, maxillae, and zygomatic arches
-Parietoacanthial projection of maxillary sinuses, with petrous ridges inferior to floor of sinuses
-Frontal and ethmoidal air cells distorted
-Foramen rotundum - Eval criteria for parietoacanthial (Waters) sinuses
-
-Petrous ridges just beneath antral floor, inferior to maxillary sinuses
-Equal distance between lateral border of skull and lateral border of orbit on both sides, indicating no rotation
-Orbits and maxillary sinuses symmetric on each side
-Maxillary sinuses
-Close beam restriction of sinus area
-Clearly visible air-fluid levels, if present - Position for lateral sinuses
- Seated in RAO or LAO position. Head in true lateral position. IOML perp to front edge of IR. MSP and IOML parallel to IR. IP perp to IR
- CR for lateral sinuses
- Perp, entering midway between outer canthus and EAM (book says 1/2-1" posterior to outer canthus)
- What is the only projection that shows all 4 sets of sinuses?
- Lateral
- Structures shown for lateral sinuses
-
-AP and superoinferior dimensions of paranasal sinuses, their relationship to surrounding structures, and thickness of outer table of frontal bone
- When used for preoperative measurements, lateral sinuses should be done at __" to reduce magnification and distortion
- 72
- Eval criteria for lateral sinuses
-
-All 4 sinus groups, but sphenoidal sinus is of primary importance
-No rotation of sella turcica
-Superimposed orbital roofs
-Superimposed mandibular rami
-Clearly visible sinuses
-Close beam restriction of sinus area
-Clearly visible air-fluid levels, if present - CR for parietoacanthial (open-mouth Waters; Pirie) maxillary and sphenoidal sinuses
- Perp, exiting acanthion
- Breathing instructions for parietoacanthial (open-mouth Waters; Pirie) maxillary and sphenoidal sinuses
- "Say ahh and hold your breath" (to immobilize tongue at floor of mouth during exposure)
- Structures shown for parietoacanthial (open-mouth Waters; Pirie) maxillary and sphenoidal sinuses
-
-Sphenoidal sinuses within the open mouth
-Maxillary sinuses - Eval criteria for parietoacanthial (open-mouth Waters; Pirie) maxillary and sphenoidal sinuses
-
-Petrous pyramids immediately inferior to floor of maxillary sinuses
-Equal distance between lateral border of skull and lateral border of orbit on both sides, indicating no rotation
-Orbits and maxillary sinuses symmetric on each side
-Maxillary sinuses
-Close beam restriction of sinus area
-Clearly visible air-fluid levels, if present
-Sphenoidal sinuses projected through open mouth without overlap of upper dental arch
-Shadow of tongue not superimposing sphenoidal sinuses - Position for submentovertical (SMV) ethmoidal and sphenoidal sinuses
- Seated. Hyperextend neck and rest head on vertex. Mouth closed. IOML parallel to IR (vertical). MSP perp to IR
- CR for submentovertical (SMV) ethmoidal and sphenoidal sinuses
- Perp to IOML through sella turcica, entering midway between zygomatic arches at a level of 1.5-2" inferior to mandibular symphysis (according to book, entering MSP 3/4" anterior to level of EAM)
- Structures shown for submentovertical (SMV) ethmoidal and sphenoidal sinuses
-
-Symmetric image of anterior portion of base of skull
-Sphenoidal and ethmoidal air cells - Eval criteria for submentovertical (SMV) ethmoidal and sphenoidal sinuses
-
-Mandibular condyles anterior to petrous ridges
-Equal distance from lateral border of skull to mandibular condyles on both sides, indicating MSP is perp (no tilt)
-Anterior frontal bone superimposed by mental protuberance, indicating IOML is parallel (full extension)
-Clearly visible air-fluid levels, if present - Routine for nasal bones
- PA axial (Caldwell), exaggerated Waters, both laterals
- Position for PA axial (Caldwell) nasal bones
- Rest forehead and nose on table or upright Bucky. OML and MSP perp to IR. IP parallel to IR
- CR for PA axial (Caldwell) nasal bones
- 15 caudal, exiting nasion
- Position for exaggerated Waters nasal bones
- Chin on table or vertical bucky. Hyperextend neck to place OML at 30-degree angle with IR. Nose comes off IR about 2-2.5" or so
- When OML is at a 30-degree angle with IR for exaggerated Waters projection, petrous ridges appear...
- 1.5-2" below maxillary sinuses
- CR for exaggerated Waters nasal bones
- Perp, exiting acanthion
- Position for lateral nasal bones
- Semiprone, with body in PA oblique position. IOML and MSP parallel to IR (IOML perp to front edge of IR). IP perp to IR
- IR for lateral nasal bones
- 8x10 or 10x12 CW, 2 on 1. Lead off 1/2 the IR, make 1 exposure, then flip the lead strip to lead off the other 1/2 and make the 2nd exposure. Mark each side for 2 on 1
- CR for lateral nasal bones
- Perp to bridge of nose, entering 1/2" distal to nasion
- Structures shown for lateral nasal bones
-
-Demonstrates side nearer IR and soft structures of nose
-Both sides are examined for comparison - Eval criteria for lateral nasal bones
-
-No rotation of nasal bone and soft tissue
-Anterior nasal spine and frontonasal suture - Position for submentovertical (SMV) bilateral zygomatic arches
- Supine or seated. Hyperextend neck so IOML is parallel to IR (vertical). MSP perp to IR
- CR for submentovertical (SMV) bilateral zygomatic arches
-
Perp to IOML, entering MSP of throat 1" posterior to outer canthi (midway between zygomatic arches at a level of 1.5" inferior to mandibular symphysis)
-May have to angle CR to be perp to IOML - Structures shown for submentovertical (SMV) bilateral zygomatic arches
-
-Bilateral symmetric SMV images of zygomatic arches, projected free of superimposed structures
-Unless very flat or traumatically depressed, arches are projected beyond the parietal eminences by the divergent x-ray beam - Eval criteria for submentovertical (SMV) bilateral zygomatic arches
-
-Frontal bone and mandibular symphysis superimposed
-Zygomatic arches free from overlying structures
-Zygomatic arches symmetric and without foreshortening
-No rotation of head - Position for AP axial (modified Towne) bilateral zygomatic arches
- OML or IOML perp to IR. MSP perp to IR
- CR for AP axial (modified Towne) bilateral zygomatic arches
- 30 caudal if OML perp, 37 caudal if IOML perp, entering glabella (1" above nasion)
- Structures shown for AP axial (modified Towne) bilateral zygomatic arches
- Symmetric AP axial projection of both zygomatic arches, free of superimposition
- Eval criteria for AP axial (modified Towne) bilateral zygomatic arches
-
-No overlap of zygomatic arches by mandible
-Zygomatic arches lateral to mandibular rami
-No rotation evident because arches are symmetric - Position for tangential unilateral zygomatic arch
- Hyperextend neck and rest head on vertex. IOML parallel with IR. Rotate MSP 15 degrees toward side being examined, and tilt top of head 15 degrees away from side being examined
- CR for tangential unilateral zygomatic arch
- Perp to IOML, centered to zygomatic arch at a point 1" posterior to outer canthus of affected side
- Structures shown for tangential unilateral zygomatic arch
-
-Tangential image of one zygomatic arch free of superimposition
-This projection is useful in patients with depressed fractures or flat cheekbones - Eval criteria for tangential unilateral zygomatic arch
-
-Zygomatic arch free from overlying structures
-Zygomatic arch not overexposed - Routine for mandible
- For area of interest: PA, axiolateral, and lateral (?)
- Position for PA mandibular rami
- Rest forehead and nose on IR. OML and MSP perp to IR
- CR for PA mandibular rami
- Perp, exiting acanthion
- Eval criteria for PA mandibular rami
-
-Mandibular body and rami symmetric on each side
-Entire mandible - Position for PA axial mandibular rami
- Rest forehead and nose on IR. OML and MSP perp to IR
- CR for PA axial mandibular rami
- 20-25 cephalad, exiting acanthion
- Eval criteria for PA axial mandibular rami
-
-Mandibular body and rami symmetric on each side
-Entire mandible
-Condylar processes - Position for PA mandibular body
- Rest head on nose and chin so anterior surface of mandibular symphysis is parallel with IR. AML nearly perp to IR
- CR for PA mandibular body
- Perp to level of closed lips
- Eval criteria for PA mandibular body
- Mandibular body symmetric on each side
- Position for PA axial mandibular body
- Rest nose and chin on IR. AML nearly perp to IR. MSP perp to IR
- CR for PA axial mandibular body
- 30 cephalic, exiting midway between TMJs
- Eval criteria for PA axial mandibular body
-
-TMJs just inferior to mastoid process
-Symmetric rami - Position of head for axiolateral oblique mandibular ramus
- True lateral
- Position of head for axiolateral oblique mandibular body
- Rotate head 30 degrees toward IR
- Position for axiolateral oblique mandibular symphysis
- Rotate head 45 degrees toward IR
- CR for axiolateral oblique mandible
- 25 cephalic, passing through mandibular region of interest
- Eval criteria for axiolateral oblique mandibular ramus and for axiolateral oblique mandibular body
-
-No overlap of ramus by opposite side of mandible
-No elongation or foreshortening of ramus or body
-No superimposition of ramus by C-spine - Eval criteria for axiolateral oblique mandibular symphysis
-
-No overlap of mentum region by opposite side of mandible
-No foreshortening of mentum region - Routine for TMJs
- Open and closed axiolateral and open and closed axiolateral oblique
- What looks similar to AP axial TMJs?
- AP axial (modified Towne) bilateral zygomatic arches
- Position for AP axial TMJs
- OML and MSP perp to IR. One with mouth closed and one with mouth open (do NOT try open-mouth position in trauma patients)
- CR for AP axial TMJs
- 35 caudal, centered midway between TMJs, and entering a point 3" above nasion
- Eval criteria for AP axial TMJs
-
-No rotation of head
-Minimal superimposition of petrosa on condyle in closed-mouth exam
-Condyle and TMJ below pars petrosa in open-mouth exam - How many projections are done for axiolateral TMJs?
- 4. Right and left, open and closed
- Position for axiolateral TMJs
- Oblique body position. MSP parallel with IR and IP perp to IR
- CR for axiolateral TMJs
- 25-30 degrees caudal, entering 1/2" anterior and 2" superior to upside EAM
- Eval criteria for axiolateral TMJs
-
-TMJ anterior to EAM
-Condyle lying in mandibular fossa in closed-mouth exam
-Condyle lying inferior to articular tubercle in open-mouth exam for normal patients - How many projections are done for axiolateral oblique TMJs?
- 4. Right and left, open and closed
- Position for axiolateral oblique TMJs
- Oblique body, with head in true lateral position. MSP of head rotated 15 degrees toward IR. AML parallel with IR
- CR for axiolateral oblique TMJs
- 15 caudal, entering 1/2" anterior and 1.5" superior to upside EAM, exiting TMJ closest to IR
- Eval criteria for axiolateral oblique TMJs
-
-TMJ
-Condyle lying in mandibular fossa in closed-mouth exam
-Condyle lying inferior to articular tubercle in open-mouth exam for normal patient