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 % of all facial fractures involve the orbit in some way % of all facial fractures involve the orbit in some way
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)
LeFort Type I LeFort Type II LeFort Type III
Tripod Fracture – A fracture in which the zygoma is separated from its attachment to the maxilla, frontal and temporal bones
Bell’s Palsy - Bell's palsy is a weakness or paralysis of the muscles that control expression on one side of your face.
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.
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
Nasolacrimal System Injection Site Lateral image post injection
Radiographic Views PA Axial (Caldwell) Tuck patient’s chin; nose and forehead on table/wall bucky OML perpendicular to IR 15 degree caudal angulation Petrous pyramids BELOW inferior orbital margin
PA Axial (Caldwell) Calcified meningioma
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
Parietoacanthial Water’s View Midsagittal plane perpendicular to IR IPL parallel to IR OML makes 37 degree angle with IR COLLIMATE!!!! Merrill’s pg. 353 (12 th Ed)
Hyper extended waters
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 (Merrill’s 12 th Edition)
What ‘Bout Technique!!! Would you increase or decrease technique for lateral facial bones compared to a lateral skull?
Reverse Water’s View Used when patient cannot be placed in prone position. Mentalmeatal line perpendicular to IR CR perpendicular; enters acanthion Merrill’s pg (12 th Ed)
Nasal Bones Lateral 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
Axial Nasal Bones Use occlusal film. Patient holds film in teeth. CR perpendicular to film CR
Bilateral Arches - SMV IOML parallel to IR and perpendicular to CR CR midsaggital and collimate to outer edges of zygoma
Oblique Tangential Same position as SMV except head tilt 15 degrees toward side of interest (Merrill’s p ed)
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 (Not in 12 Ed. Merrill’s )