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外傷及感染之放射線影像檢查 Radiographic Interpretation of Trauma and Infection

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Presentation on theme: "外傷及感染之放射線影像檢查 Radiographic Interpretation of Trauma and Infection"— Presentation transcript:

1 外傷及感染之放射線影像檢查 Radiographic Interpretation of Trauma and Infection

2 內容綱要 顎顏面外傷之影像檢查 技術 顎顏面外傷分類 判讀 感染的影像檢查 軟硬組織感染

3 影像檢查在顎顏面外傷的應用 Plays a critical role
Identify the location and orientation of fractures Indicate the degree of separation or displacement

4 顎顏面外傷常用 放射線影像檢查技術 -I Routine view bones 2. Lateral view of facial bone
1. Posterior-anterior (PA) view of facial bones 2. Lateral view of facial bone 3. Panorex 4. Water’s ( Occipitomental ) Suspect mid-face fracture

5 顎顏面外傷常用 放射線影像檢查技術-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 顎顏面外傷常用 放射線影像檢查技術-III
9. Tomography 10. Towne’s 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 Mandible, maxilla, dentition,
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 Town’s 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 顎顏面外傷之影像檢查判讀 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
Malocclusion Step Angle and symphysis fracture

28 Condyle and symphysis fracture
Overlap , discontinuity and displacement Asymmetry Comminuted

29 Coronoid and ramus fracture
Gap, Discontinuity Step , Displacement

30 Condyle Deviation Displacement Dislocation Displacement Undisplaced

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


40 Le Fort II fracture

41 Le Fort III fracture

42 Blow-out fracture


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 感染的影像檢查技術 Plain film radiography CT scan MRI Nuclear bone scans
Tomography Ultrasonography

51 齒源性感染的常用影像檢查 Plain film radiography 根尖片 : 對於根尖及早期病變的顯示最佳
咬合片 : (Axial) Garrie’s osteomyelitis 全口片 (panoex) 有張口困難的病人, 同時對牙齒的情況做,骨頭的破壞檢查,

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 對骨的細部變化 space infection, presence of pus, cavitation TMJ abscess

54 選擇的要領 Plain film : 一般診斷及治療反應後的追蹤
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 % After infection :5 -14 days

56 感染部位與描述名稱 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 (骨髓炎 ) Acute suppurative osteomyelitis
Trabeculae: fuzzy, diffuse destruction﹐ Radiolucent area Poor demarcation Irregular border

59 Chronic suppurative osteomyelitis
Necrotic Bone Moth eaten* Radiolucent area with poor demarcation Necrotic bone Sequestrum Radiopaque with peripheral rediolucent area Rarefaction

60 Moth eaten


62 Sequestrum Radiopaque with peripheral radiolucent area


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。


69 Garre’s proliferative periostitis (Osteomyelitis)
Subperiosteal reaction: onion skinning﹐ Duplication of the cortical layer of bone

70 ORN ( Osteo-Radio Necrosis )
No remodeling


72 Bone necrosis due to Arsenic
Tooth germ, nerve damage…

73 軟組織感染 Infections involving soft tissues are not readily
Demonstrated by many imaging techniques Gas producing organism

74 Infratemporal space Submasseteric space

75 Air way


77 MRI of TMJ space abscess

78 Sinusitis Cloudy Air-Fluid level

79 下 課

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