Extraoral Radiography 牙科放射線學(2) Extraoral Radiography 口外放射線攝影術 陳玉昆副教授: 高雄醫學大學 口腔病理科 07-3121101~2755 yukkwa@kmu.edu.tw

學 習 目 標 - 知道口外片攝影術的名稱 -了解口外片攝影術的適應症 - 明白口外片攝影術的方法

參考資料 References: 1. Eric Whaites: Essentials of dental radiography & radiology 3rd edition, Chapters 11-13, p. 117-151. 2. White & Pharoah: Oral radiology: principle & interpretation, 5th edition, Chapter 6, p. 94-109 3. Harring JI & Jansen L: Dental radiography- principle & techniques 2nd edition, Chapter 23, p. 363-382 4. Farman AG. Increasing the diagnostic role of the cephalometric attachment. Panoramic Imaging News, volume 2, issue 4, www.pancorp.com

上學期已講解 Main Maxillofacial / Skull Projections Standard occipitomental (0o OM) (Water’s view) 30o occipitomental (30o OM) (Water’s view) Postero-anterior of the skull (PA skull) Postero-anterior of the jaw (PA jaw) Reverse Towne’s True lateral skull Oblique lateral Submento-vertex (SMV) Cephalometric radiography Panoramic radiogaraphy External auditory meatus Outer canthus of the eye Radiographic baseline 上學期已講解 Ref. 2

Main indications Standard Occipitomental (0o OM) 頭往上仰 This projection shows the facial skeleton & maxillary antra & avoids superimposition of the dense bones of the skull base 頭往上仰 Main indications Investigation of maxillary antra Detecting middle facial fractures: Le Fort I Le Fort II Le Fort III Zygomatic complex Naso-ethomoidal complex Orbital blow-out Coronoid process fractures Investigation of frontal & ethmoidal sinuses Investigation of sphenoidal sinus Ref. 1

Main indications 30o Occiptomental (30o OM) This projection shows the facial skeleton, but from a different angle from the 0oOM, enabling certain bony displacements to be detected 頭往上仰 Main indications Detecting the following middle third facial fractures: Le Fort I Le Fort II Le Fort III Coronoid process fracture Ref. 1

Main indications Posterio-Anterior of Skull (PA skull) 頭往前傾 平行地面 This projection shows the skull vault, primarily the frontal bones and jaws Main indications Fractures of the skull vault Investigation of the frontal sinuses Conditions affecting the cranium Paget’s disease Multiple myeloma Hyperparathyrodism Intracranial calcification Ref. 1

Main indications Posterio-Anterior of Jaw (PA jaw) 頭往前傾 This projection shows the posterior parts of the mandible It is not suitable for showing the facial skeleton because of superimposition of the base of the skull & nasal bones 頭往前傾 Main indications Lesions such as cysts or tumors in the posterior third of the body or rami to note any medio-lateral expansion Mandibular hypoplasia or hyperplasia maxillofacial deformities Fractures of the mandible involving the Posterior third of the body Angles Rami Low condylar necks Ref. 1

Reverse Towne’s Main indications High fracture of the condylar neck 頭往前傾 This projection shows the condylar heads & necks The original Towne’s view is an AP projection, however, all skull views used in dentistry are taken conventionally in the PA direction, the Reverse Town’s (a PA projection) is used Main indications High fracture of the condylar neck Intracapsular fracture of the TMJ Investigation of the quality of the articular surfaces of the condylar head in TMD Condylar hypoplasia or hyperplasia Ref. 1

Reverse Towne’s Radiography Refs. 1, 3, 4

True Lateral Skull Main indications This projection shows the skull vault & facial skeleton from lateral aspect This view is used when a single lateral view of skull is required Main indications Fractures of cranium & cranial base Middle third facial fractures Investigation of frontal, sphenoidal & maxillary sinuses Paget’s disease Multiple myeloma Hyperparathyroidism Conditions affecting sella turcica Tumor of pituitary gland in acromegaly Ref. 1

Oblique Lateral Radiography True lateral Oblique lateral Refs. 1, 4

Submental-Vertex (SMV) This projection shows the skull base, spenoidal sinuses and facial skeleton from above Main indications Destructive/expansive lesions affecting palate, pterygoid region or skull base Investigation of sphenodal sinus Assessment of the thickness (medio-lateral) of the posterior part of the mandible before osteotomy Fracture of zygomatic arches Refs. 1, 4

Submental-Vertex (SMV) (Median Sagital Plane) Ref. 3

Cephalometric Radiography True cephalometric lateral skull 1.5-1.8 m Refs. 2, 3, 4

Cephalometric postero- anterior of the jaws (PA jaws) Refs. 2, 3

Summaries Main Maxillofacial / Skull Projections Standard occipitomental (0o OM) 30o occipitomental (30o OM) Postero-anterior of the skull (PA skull) Postero-anterior of the jaw (PA jaw) Reverse Towne’s True lateral skull Oblique lateral Submento-vertex (SMV) Cephalometric radiography 以上的拍攝方式名稱已記好了嗎？

Summaries - Technical aspects of extraoral radiography & resultant images Lat Ceph SMV Waters PA Ceph Reverse Towne Oblique lateral Body Ramus Ref. 2