????????????? Radiographic Interpretation of Trauma and Infection

1
????????????? Radiographic Interpretation of
Trauma and Infection
2
????

• ??????????
• ??
• ???????
• ??
• ???????
• ??????
• ??

3
?????????????

• Plays a critical role
• Identify the location and orientation of
  fractures
• Indicate the degree of separation or displacement

4
???????????????? -I

• Routine view
• 1. Posterior-anterior (PA) view of facial
• bones
• 2. Lateral view of facial bone
• 3. Panorex
• 4. Waters ( Occipitomental )
• Suspect mid-face fracture

5
????????????????-II

• 5. Periapical view
• 6. Occlusal view
• Occlusal view of nasal bone
• Occlusal view of mandible
• 7. Submental-vertex view
• 8. Lateral view of nasal bone

6
????????????????-III

• 9. Tomography
• 10. Townes view
• 11. PA view of mandible
• 12. Oblique view of mandible

7
1. PA view

• Skull
• Jaws

8
2. Lateral view

• Skull
• Jaws
• Neck

9
3. Panex
Mandible, maxilla, dentition, 70 of mid-face
fracture
10
4. Water view(Occipito-mental )

• Maxillary fracture
• Orbital fracture
• Frontal bone / sinus

11
5. Periapical view

• Tooth and alveolar injury

12
6. Occlusal view - Mandible

• Fracture line , direction
• Axial section

13
6. Occlusal view - Maxilla
14
7. Submental vertex view

• Zygomatic arch fracture
• Coronoid fracture

15
8. Lateral nasal view
16
9. Tomography
Blow out fracture TMJ fracture
185
180
17
175
170
18
165
160
19
10. Modified Towns view

• Condylar fracture
• Mandibular angle fracture

20
11.PA symphysis view
21
12. Oblique lateral view

• Was replaced by Panoex
• Used when patient can not sit or stand

22
CT scan
23
Reconstructive 3-D CT scan
24
????????????

• General interpretation of fracture line
• Condyle and other mandibular fracture
• Middle facial fracture
• Cavity sinus, orbital
• Dento-alveolar fracture

25
General interpretation of fracture line

• Displacement ( deviation, dislocation )
• Step, gap, overlapping
• Discontinuity
• Asymmetry
• Comminuted
• Malocclusion
• Cavity (air-fluid level )
• Degree and direction

26
Mandibular fracture
27
Angle and symphysis fracture
28
Condyle and symphysis fracture
29
Coronoid and ramus fracture

• Gap, Discontinuity
• Step , Displacement

30
Condyle

• Deviation
• Displacement
• Dislocation

Displacement
Deviation
Undisplaced
Dislocation
31
condyle fracture
Displacement
32
Bilateral condyle fracture
33
Bone gap
34
Split fracture
Coronoid fracture
35
Chin horizontal fracture
36
Mid-facial trauma

• Cavity sinus, hernia of orbital soft tissue
• Tomography of orbital fracture
• CT
• Air-emphysema
• Middle fracture ( Le Fort I, II, III )
• ZMC fracture
• Basilar skull fracture air-fluid level in
  sphenoid sinus

37
Le fort I fracture
38
Air-fluid level
39
(No Transcript)
40
Le Fort IIfracture
41
Le Fort III fracture
42
Blow-out fracture
43
(No Transcript)
44
Zygomatic arch fracture
45
Zygomatico-maxillary complex ( ZMC) fracture
46
Classification of dentoalveolar injuries
A. Tooth structures B. Supporting structures

• 1. Crown craze or crack
• 2. Crown fracture
• 1) Enamel
• 2) Enamel-Dentin
• 3) Enamel-Dentin- Pulp
• 3. Crown and root fracture
• 1) Pulp involvement
• 2) No pulp involvement

47
Classification of dentoalveolar injuries

• 4. Root fracture
• 1) Apical third
• 2) Middle third
• 3) Cervical third
• Shift to another angle

48
B. Supporting Structure

• 1. Sensitivity ( concussion )
• percussion pain
• no displacement
• no mobility
• Image ? widening of PDL space
• 2. Subluxation
• loosening, no displacement,
• Image ? portion of PDL widening

49
Classification of dentoalveolar injuries

• 3. Tooth displacement
• 1) Intrusion
• 2) Extrusion
• 3) Labial displacement
• 4) Lingual displacement
• 5) Lateral displacement
• 4. Avulsion
• 5. Alveolar process fracture

50
?????????

• Plain film radiography
• CT scan
• MRI
• Nuclear bone scans
• Tomography
• Ultrasonography

51
????????????

• Plain film radiography
• ??? ??????????????
• ??? (Axial) Garries osteomyelitis
• ??? (panoex)
• ????????,
• ?????????,???????,

52
CT Scan

• Space infection
• Neck Air way, pharynx
• Sinus
• Orbit
• Intracranial abscess
• Soft tissue

53
MRI

• Noninvasion, no radiation, high soft tissue
  resolution?high sensitivity and specificity
• ???????
• space infection, presence of pus, cavitation
• TMJ abscess

54
?????

• Plain film ?????????????
• CT / MRI Extension into soft tissue ,
• air way
• Bone scan Response to treatment

55
Image finding and Bone changes

• Difficult to visualize by conventional techniques
  in early stage
• Until substantial mineral .. removed 35 - 50
  
• After infection 5 -14 days

56
?????????

• Margin well or poor demarcation / defined
• Lesion radiolucent / radiopaque
• Periapical changes PDL , trabeculae .
• Cavity (sinus) cloudy, air-fluid level
• Osteomyelitis periosteal reaction?moth eaten ,
  rarefaction, .
• Sinus tract ( fistula )

57
1. Periapical Infection

• ( acute / chronic )
• Widening of PDL
• Lamina dura discontinuity
• Trabeculae destruction
• Chronic
• Periapical abscess
• Periapical granuloma
• Fistula
• Root resorption

58
2. Osteomyelitis (??? )

• Acute suppurative osteomyelitis
• Trabeculae fuzzy, diffuse destruction?
• Radiolucent area
• Poor demarcation
• Irregular border

59
Chronic suppurative osteomyelitis

• Moth eaten
• Radiolucent area
• with poor demarcation
• Necrotic bone
• Sequestrum
• Radiopaque with
• peripheral
• rediolucent area
• Rarefaction

60
(No Transcript)
61
(No Transcript)
62
Radiopaque with peripheral radiolucent area
63
(No Transcript)
64
Pathologic fracture
65
Expansion
Rarefaction
66
Sclerosing Osteomyelitis

• Focal type
• Increasing density ( disposition of the bone )
  rarefaction
• Periapical area
• Thickening of PDL
• Bone scar

67
Sclerosing Osteomyelitis

• Diffuse type
• Border between normal and sclerosis .. poor
  defined
• Cotton wool appearance?

68
(No Transcript)
69
Garres proliferative periostitis (Osteomyelitis)

• Subperiosteal reaction onion skinning?
• Duplication of the cortical layer of bone

70
ORN ( Osteo-Radio Necrosis )
No remodeling
71
(No Transcript)
72
Bone necrosis due to Arsenic

• Tooth germ, nerve damage

73
?????

• Infections involving soft tissues are not readily
  
• Demonstrated by many imaging techniques
• Gas producing organism

74
Infratemporal space
Submasseteric space
75
(No Transcript)
76
(No Transcript)
77
MRI of TMJ space abscess
78
Sinusitis
Cloudy Air-Fluid level
79
? ?