Cranium and Facial Bones Marilyn Rose

Ground Rules This room is all we have. We need to find a way to make it work, so we can do what we're here to do. 1. Absolutely no food or drink consumption in the classroom. 2. No open liquid containers in the classroom. They must be kept outside. 3. No conversing during lecture. 4. If you can't hear the instructor or another student during lecture or question and answer, please politely say so. 5. If you're sitting in the back and having difficulty hearing, move to the front of the classroom next time. 6. Dial down your drama. If you're anxious about this class, find something constructive to do about it.

Cranium 8 bones 8 bones Occipital Occipital Temporal- Temporal- Sphenoid Sphenoid Ethmoid Ethmoid Parietal- vertex Parietal- vertex Frontal Frontal

Occipital Protuberance internal external

Temporal Bone Petrous portion EAM

Sphenoid Bone Level of dorsum sellae = A square portion of bone on the body of the sphenoid posterior to the sella turcica or hypophysial fossa

Ethmoid Bone Blunt Trauma- most common cause of A deviated septum Any impact can potentially detach perpendicular plate of ethmoid bone from nasal septum wall, allowing septum to deviate from one side to other.

Parietal Bone

Frontal Bone sinus-fx-1.jpg The patient was admitted to the emergency room for polytrauma with severe cranioencephalic trauma with fracture and a depressed fronto-orbital fracture with external communication

14 Facial Bones Nasal 2x Nasal 2x Lacrimal 2x Lacrimal 2x Maxilla 2x Maxilla 2x Palatine Palatine Zygoma 2x Zygoma 2x Inferior nasal conchae 2x Inferior nasal conchae 2x Vomer- Where is it?? Vomer- Where is it?? mandible mandible

Paranasal Sinuses Ethmoid Ethmoid Maxillary Maxillary Sphenoid Sphenoid Frontal Frontal

Temporomandibular Joint Hinge of masticaction Hinge of masticaction

TMJ Closed Closed y.jpg Open

LPCH CT-guided imaging at LPCH for treatment of juvenile idiopathic arthritis: The a rrow shows the trajectory of the needle for placement of steroid medication into the temporomandibular joint. CT-guided imaging at LPCH for treatment of juvenile idiopathic arthritis: The a rrow shows the trajectory of the needle for placement of steroid medication into the temporomandibular joint.

Orbit 1. Frontal bone 2. Ethmoid bone 3. Palatine bone 4. Zygomatic bone 5. Lacrimal bone 6. Maxillary bone

Orbit What seven bones make up the orbit? What seven bones make up the orbit? frontal, sphenoid, ethmoid (cranium) frontal, sphenoid, ethmoid (cranium) Lacrimal, maxillary, palatine and zygomatic (facial) Lacrimal, maxillary, palatine and zygomatic (facial) The posterior obit has a what canal? The posterior obit has a what canal? Optic- optic nerve Optic- optic nerve A blow-out fracture can cause diplopia, what does that mean? A blow-out fracture can cause diplopia, what does that mean? Floor of orbit, herniation of orbital contents= doublevisiondoublevision Floor of orbit, herniation of orbital contents= doublevisiondoublevision

Name 5 anatomic structures you can see. Ethmoid sinus orbit vertex EAM TMJ

What is wrong? Rt Frontal bone- axial- orbital contents in maxillary sinus

What level is this? Petrous Ridge

What are the points at the posterior aspect? Internal/External Occipital Protuberance

What is the foreign object? What is now communicating with the external environment? Bullet Frontal Sinus open to external environment.

What is this bone? Parietal Bone Sphenoid Where is the fracture?

Describe these two views. Axial- Air/ Fluid levels in the sinus Pencil- Nasal cavity, ethmoid, sphenoid sinus with air/fluid (no CSF leak)

What is wrong here? CSF is in this space= Normal Medulla and Cerebellar tonsils in foramen magnum= Chiari 1 malformation- Spina Bifida causing herniation of medulla inferior.

Frontal Sinus Sphenoidal Sinus Pons Optic Nerve Mastoid Air Cells

1 Frontal Sinus 1 Frontal Sinus 2 Ethmoid Sinus 2 Ethmoid Sinus 3 Sphenoid Sinus 3 Sphenoid Sinus 4 Maxillary Sinus 4 Maxillary Sinus

1 Sphenoid Sinus 1 Sphenoid Sinus 2 Cribiform Plate 2 Cribiform Plate 11 2 Name the structures

1 Maxillary sinus 1 Maxillary sinus 2 Frontal sinus 2 Frontal sinus 3 Ethmoid sinus 3 Ethmoid sinus Before Multiplanar reconstruction the 2 planes used to ACQUIRE Sinus images were AXIAL and CORONAL planes