RADT 1522 Orbits, Facial Bones and Nasal Bones

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RADT 1522Orbits, Facial Bones and Nasal Bones

• Wynn Harrison, MEd

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Facial Anatomy

• 14 facial bones (How Many of Each)
• Maxilla - Vomer
• Zygomatic - Mandible
• Palatine
• Nasal
• Lacrimal
• Inferior Nasal Conchae

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Mid-saggital view
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New Words

• Blow-Out Fracture Impact fracture (Trauma) of
  the orbital floor resulting in orbital intrusion
  into the maxillary sinus.
• Look at the orbits carefully, since
• 60 - 70 of all facial fractures involve the
  orbit in some way

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• Le Fort I - tooth bearing portion separated from
  upper maxilla
• Le Fort II - fracture across orbital floor and
  nasal bridge (pyramidal fracture)
• Le Fort III - fracture across frontozygomatic
  suture line, entire orbit and nasal bridge
  (craniofacial separation)

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• LeFort Type I
• LeFort Type II
• LeFort Type III

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• Tripod Fracture A fracture in which the zygoma
  is separated from its attachment to the maxilla,
  frontal and temporal bones

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• Bells Palsy - Bell's palsy is a weakness or
  paralysis of the muscles that control expression
  on one side of your face.

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Orbits

• Rhese View- Midsagittal plane forms a 53 degree
  angle with IR. Chin, cheek and nose on the table
  (three-point landing!) Acanthiomeatal line
  perpendicular to IR. Optic foramen should be
  seen in center of image.

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Foreign Body

• PA and Lateral views are performed to look for
  foreign body in the orbit.
• What do you think you need to have them do
  differently for this exam?
• Look UP, Look Down

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Nasolacrimal System
Lateral image post injection
Injection Site
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Facial Bones Imaging

• Caldwell or PA image
• Lateral
• Waters

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Radiographic ViewsPA (Caldwell)

• Tuck patients chin nose and forehead on
  table/wall bucky
• OML perpendicular to IR
• 15 degree caudal angulation
• Petrous pyramids BELOW inferior orbital margin

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Caldwell for facial bones
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Caldwell for facial bones
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PA (Caldwell)
Calcified meningioma
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• Lateral External auditory meatus externally and
  mandible inferiorly with supracillary arch
  superiorly in view.
• CR centered to zygoma, midway between outer
  canthus and EAM
• Midsagittal plane is parallel to IR
• IPL is perpendicular to IR

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Lateral facial bones
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What Bout Technique!!!

• Would you increase or decrease technique for
  lateral facial bones compared to a lateral skull?

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Waters View

• Midsagittal plane perpendicular to IR
• IPL parallel to IR
• OML makes 37 degree angle with IR
• COLLIMATE!!!!

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Waters for facial bones
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Modified Parietoacanthial (Modified Waters)

• OML 55 degrees to the IR
• Chin and nose on table
• Petrous pyramids are seen mid-maxillary sinus
• CR exits acanthion
• See pg. 355 (Merrills 12th Edition)

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Reverse Waters View

• Used when patient cannot be placed in prone
  position.
• Mentalmeatal line perpendicular to IR
• CR perpendicular enters acanthion
• CR parallel to acanthiomeatal line
• Merrills pg. 332-3 (12th Ed)

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Nasal BonesLateral and Superior/Inferior Views

• Lateral Position exactly like you would for a
  lateral skull CR ½ inch inferior to nasion.
• CR Perpendicular to IR
• COLLIMATE

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Hyper extended waters
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Axial Nasal Bones

• Use occlusal film. Patient holds film in teeth.
  NOT DONE ANYMORE. ?
• CR perpendicular to film

CR
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Zygomatic Arches
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Bilateral Arches - SMV

• IOML parallel to IR and perpendicular to CR
• CR midsaggital and collimate to outer edges of
  zygoma

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fracture
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Oblique Tangential

• Same position as SMV except head tilt 15 degrees
  toward side of interest
• (Merrills p. 337 12 ed)

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May View (tangential)

• PA positioning IOML perpendicular to CR, head
  tilt 15 degrees away from the area of interest.
• CR bisects zygomatic arch
• Shows single zygomatic arch, free of
  superimposition
• (P. 341-2, 12 Ed. Merrills )

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Unilateral arch view
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C-arm tangential image
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