unit 5 facial bones (procedure/positioning)

CR 15º caudad to IR; EXITS at nasion

CR for PA axial facial bones (caldwell)

OML perpendicular to IR

for a PA axial facial bones (caldwell) what will be perpendicular to the IR

OML perpendicular & a 15º

cephalad angle. CR ENTERS

nasion

CR for a AP axial facial bones (caldwell)

Positioning:

Petrous ridges projected

in lower 1/3 of orbits;

superior orbital fissures

symmetric; no rotation -

equal distance between

midlateral orbital margin &

lateral cortex of cranium

on each side

Anatomy demonstrated:

-Orbital rim, maxillae, nasal

septum, zygomatic bones

& anterior nasal spine

Optimal exposure factors

evaluation criteria for PA axial facial bones (caldwell)

CR to IR; exits at acanthion

CR for a PA Parietoacanthial Facial Bones

(Waters Method)

Adjust head until MML perpendicular to IR

OML forms a 37º angle to the IR

for a PA parietoacanthial facial bones (waters) what is perpendicular

MML perpendicular & CR entering the acanthion

CR for AP parietoacanthial facial bones (reverse waters)

Positioning:

-Petrous ridges projected just

inferior to maxillary sinuses

-No rotation - equal distance

between midlateral orbital

margin & lateral cortex of

cranium on each side

Anatomy demonstrated:

-Infraorbital margins (inferior

rim of orbits), maxillae, nasal

septum, zygomatic bones &

arches, anterior nasal spine

Optimal exposure factors

evaluation criteria for a PA parietoacanthial facial bones (waters)

CR to IR; exits at acanthion

CR for a PA Modified Parietoacanthial Facial

Bones (Modified Waters Method)

MML perpendicular & CR entering the acanthion

CR for a AP Modified Parietoacanthial Facial Bones ("Reverse" Modified Waters Method)

Positioning:

-Petrous ridges projected into lower

half of maxillary sinuses

-No rotation - equal distance

between midlateral orbital margin

& lateral cortex of cranium on each

side

Anatomy demonstrated:

-Less distorted view of entire orbital

rims - ideal projection to

demonstrate possible orbital

fractures

Optimal exposure factors

evaluation criteria for a PA Modified Parietoacanthial Facial

Bones (Modified Waters Method)

CR to zygoma; enters midway between outer canthus & EAM

CR for lateral facial bones

MSP

what is parallel to the IR on a lateral facial bone

IPL

what is perpendicular to the IR on a lateral facial bone

IOML

what will be perpendicular to the edge of the IR for a lateral facial bone

true

True or False: you will put the affected side closer to the IR on a lateral facial bone

RAO

what position will you use for a right lateral facial bone

LAO

what position will you use for a left lateral facial bone

false, if patient has difficulty with positioning a horizontal beam can be used

True or False: you cannot use a horizontal beam for a lateral facial bone

Positioning:

Bilateral structures should be

superimposed such as the

mandibular rami, greater

wings of the sphenoid, sella

turcica, & orbital plates (roofs)

Anatomy demonstrated:

Superimposed facial bones to

include mandible

Optimal exposure factors

evaluation criteria for a lateral facial bone

false, always a bilateral exam

True or False: a lateral nasal bone is never a bilateral exam

CR to nose; enters ½" inferior to nasion

CR for a lateral nasal bone

MSP

what will be parallel for a lateral nasal bone

IPL

what will be perpendicular to the IR for lateral nasal bone

IOML

what will be perpendicular to the edge of the IR for a lateral nasal bone

RAO

what position will you use for a right lateral nasal bone

LAO

what position will you use for a left lateral nasal bone

true

True or False: optional horizontal beam lateral can be done for patient who cannot assume position

Positioning:

-Nasal bones in center of

image; no rotation/symmetrical

Anatomy demonstrated:

-Nasal bones, frontonasal

suture, anterior nasal spine, &

soft tissue structures

(cartilage)

Optimal exposure factors

evaluation criteria for a lateral nasal bone

CR midway between zygomatic arches; enters 1.5" inferior to mandibular symphysis

CR for a Submentovertical (SMV)

Zygomatic Arches

IOML

what will be parallel to the IR for a Submentovertical (SMV)

Zygomatic Arches

IOML

If patient cannot fully extend neck on a Submentovertical (SMV) Zygomatic Arches angle the CR cephalic until perpendicular to _________

MSP

what will perpendicular for a Submentovertical (SMV)

Zygomatic Arches

Positioning:

-Mandibular symphysis

superimposed on frontal

bone

-No rotation - zygomatic

arches equally symmetrical

Anatomy demonstrated:

-Inferosuperior view of both

zygomatic arches projected

laterally away from

mandibular rami

Optimal exposure factors

evaluation criteria for a Submentovertical (SMV)

Zygomatic Arches

CR midway between zygomatic arches; enters at a point that skims the mandibular ramus

CR for a Oblique Inferosuperior Tangential

Zygomatic Arches

IOML

what will be parallel for a Oblique Inferosuperior Tangential

Zygomatic Arches

15º

for a Oblique Inferosuperior Tangential

Zygomatic Arches you will Rotate head _____ toward arch of interest & tilt chin _____ toward

arch of interest

Positioning:

-Zygomatic arch seen

without superimposition of

mandible or parietal bone

Anatomy demonstrated:

Elongated inferosuperior

view of a zygomatic arch

Optimal exposure factors

evaluation criteria for a Oblique Inferosuperior Tangential

Zygomatic Arches

CR to IR; exits at junction of lips

CR for a PA mandible

OML

what will be perpendicular to the IR for a PA mandible

OML, junction of lips

Optional AP mandible can be done with ______ perpendicular & CR entering ____________

Positioning:

Mid body & mentum

superimposed on C-spine

-No rotation - mandibular

rami symmetric

Anatomy demonstrated:

Mandibular rami & lateral

portions of body

Optimal exposure factors

evaluation criteria for PA mandible

CR 35º caudad to IR; enters 1" superior to glabella

CR AP axial mandible

OML

what will be perpendicular to the IR for a AP axial mandible

42º caudad (+ 7º)

If patient cannot tuck chin well on a AP axial mandible, use IOML & angle the CR _____________________

Positioning:

-Mid body & mentum

superimposed on C-spine

-No rotation - condyloid

processes symmetric

Anatomy demonstrated:

Elongated mandibular

rami, condyloid processes

& temporomandibular

fossae

Optimal exposure factors

evaluation criteria for a AP axial mandible

CR 25º cephalad if head lateral; enters mandibular body closest to IR

1. Employ a combination of CR angle &

head tilt = 25º (ex.: 15º CR angle + 10º

head tilt)

2. Employ a cross-table technique (trauma)

with the patient supine; 25º cephalad

angle with an additional 5º-10º posterior

angle

what are the CR option for a Axiolateral Oblique Mandible

true

True or False: for an axiolateral oblique mandible is it always a bilateral

Positioning:

-One side of the mandible free of

superimposition from the opposite side

-No superimposition of the ramus on C-

spine

Anatomy demonstrated:

-Body, ramus, & condyloid & coronoid

process

• True lateral demonstrates ramus

• 10º-15º demonstrates a general survey

(pictured)

• 30º demonstrates body

• 45º demonstrates mentum

Optimal exposure factors

evaluation criteria axiolateral oblique mandible

Panoramic Tomography(Orthopantomography)

A 2-D exam of the mandible, TMJs, & teeth

Panoramic Tomography(Orthopantomography)

Commonly found in dentist & oral surgeon offices & somehospitals/outpatient centers

-Ability to image the entire mouth in 1 exposure

-Lower radiation dose

-Provides a sectional view of the anatomy

Advantages over plain mandible & tooth images for a Panoramic Tomography (Orthopantomography)

IOML

(Panoramic Tomography (Orthopantomography)) Head guided into unit with chin placed in holder & head adjusted until ___________ parallel with floor

Positioning:

-Entire mandible seen without rotation - TMJs on same horizontal plane;

mandibular symphysis slightly below angles; no superimposition of teeth

Anatomy demonstrated:

-Single image of entire mandible, TMJs, maxillae, & teeth

Optimal exposure factors

evaluation criteria for Panoramic Tomography (Orthopantomography)

CR 15° caudad, enters 1.5" (4 cm) superior to upside EAM

CR for a Axiolateral Oblique TMJ

(Modified Law Method)

bilateral

Closed & open-mouth projections done usually a _______________ exam

IOML

on a Axiolateral Oblique TMJ(Modified Law Method) what is perpendicular to the front edge of the IR

RAO

on a Axiolateral Oblique TMJ(Modified Law Method) what position will the patient be in for a R TMJ

LAO

on a Axiolateral Oblique TMJ(Modified Law Method) what position will the patient be in for a L TMJ

15°

on a Axiolateral Oblique TMJ (Modified Law Method), From lateral position, rotate face toward table/upright Bucky _______

Positioning:

-TMJ closest to IR demonstrated

without superimposition of

opposite TMJ

Anatomy demonstrated:

-Condyle within mandibular fossa

(closed position)

-Condyle to anterior region of

mandibular fossa

(open position)

Optimal exposure factors

evaluation criteria axiolateral Oblique TMJ

(Modified Law Method)

false, affected side closest to IR

True or False: for a axiolateral TMJ you will put the affected side furthest away from the IR

CR 25°-30° caudad; enters 2" (5 cm) superior to upside EAM

CR for a Axiolateral TMJ (Schuller Method)

IPL

what be perpendicular to the IR on a Axiolateral TMJ (Schuller Method)

MSP

what is parallel to the IR on a Axiolateral TMJ (Schuller Method)

IOML

what is perpendicular to the front edge of the IR on a Axiolateral TMJ (Schuller Method)

false, usually a bilateral exam

True or False: the axiolateral TMJ usually is not a bilateral exam

Positioning:

-TMJ closest to IR demonstrated

without rotation &

superimposition of opposite TMJ

Anatomy demonstrated:

-Condyle within mandibular fossa

(closed position - top image)

-Condyle to anterior region of

mandibular fossa

(open position - bottom image)

Optimal exposure factors

Axiolateral TMJ (Schuller Method): Evaluation Criteria

CR exits at the midpoint of the downside orbit

CR for a Parieto-Orbital Oblique Orbits(Rhese Method)

37°, 53°

for a Parieto-Orbital Oblique Orbits (Rhese Method) Rotate head _____° toward the affected side so that the chin, cheek, & nose touch the table/upright Bucky

Forms a ______° between MSP & plane of the IR

AML

what will be perpendicular to the IR for a Parieto-Orbital Oblique Orbits (Rhese Method)

Positioning:

-Optic foramen projected into

the lower outer quadrant of the

orbit

Anatomy demonstrated:

-Non-distorted view of the optic

foramen

-Lateral orbital margins

Optimal exposure factors

evaluation criteria for a Parieto-Orbital Oblique Orbits (Rhese Method)

PA Modified Parietoacanthial FacialBones (Modified Waters Method)

ideal projection to demonstrate possible orbital fractures

15º

Optional PA sinus can be done with forehead & nose against IR that is tilted ____º

CR to IR; exits at nasion

CR PA Sinuses (Caldwell Method)

15º

PA Sinuses (Caldwell Method), Extend neck & elevate chin until OML is _____ from horizontal

Positioning:

-Petrous ridges projected in lower

1/3 of orbits; superior orbital

fissures symmetric; no rotation -

equal distance between midlateral

orbital margin & lateral cortex of

cranium on each side

Anatomy demonstrated:

-Frontal sinuses projected above

frontonasal sutures

-Anterior air cells of ethmoid

sinuses lateral to each nasal bone

Optimal exposure factors

evaluation criteria PA Sinuses (Caldwell Method)

CR to IR; exits at acanthion

CR for a PA Parietoacanthial Sinuses(Waters Method)

MML

what is perpendicular to the IR PA Parietoacanthial Sinuses (Waters Method)

Positioning:

-Petrous ridges projected just

inferior to maxillary sinuses

-No rotation - equal distance

between midlateral orbital

margin & lateral cortex of

cranium on each side

Anatomy demonstrated:

-Maxillary sinuses with inferior

aspects free of superimposition

-Oblique view of frontal sinuses

Optimal exposure factors

evaluation criteria PA Parietoacanthial Sinuses(Waters Method)

37º

PA Parietoacanthial Sinuses(Waters Method), OML forms a _____ angle to the IR

Positioning:

-Petrous ridges projected just

inferior to maxillary sinuses

-No rotation - equal distance

between midlateral orbital

margin & lateral cortex of

cranium on each side

Anatomy demonstrated:

-Maxillary sinuses with inferior

aspects free of superimposition

-Oblique view of frontal sinuses

Optimal exposure factors

evaluation criteria for a PA Parietoacanthial Sinuses(Waters Method)

CR to IR; enters midway between outer canthus & EAM

CR Lateral Sinuses

IOML

what is perpendicular to the front edge of the IR for a lateral sinus

IPL

what is perpendicular to the IR on a lateral sinus

MSP

what is parallel to the IR for a lateral sinus

Positioning:

-Bilateral structures should be

superimposed such as the

mandibular rami, greater wings

of the sphenoid, sella turcica, &

orbital plates (roofs)

Anatomy demonstrated:

-All 4 paranasal groups (frontal,

maxillary, ethmoid, sphenoid)

Optimal exposure factors

evaluation criteria for a lateral sinus

CR midway between angles of mandible; enters 2" inferior to mandibular symphysis

CR for a Submentovertical (SMV)Sinuses

IOML

what is parallel to the IR for a Submentovertical (SMV)Sinuses

Positioning:

-Mandibular mentum anterior to

ethmoid sinuses

-No rotation/tilt - symmetrical;

equal distance between

mandibular ramus & lateral

cranial cortex

Anatomy demonstrated:

-Sphenoid, ethmoid, & maxillary

sinuses

Optimal exposure factors

evaluation criteria for a Submentovertical (SMV)Sinuses

recumbent

Facial bones often done in a ___________ position because images done post-fall & it is easier for elderly patients to hold the positions (geriatric considerations)

seated erect

Sinus x-rays often done in a __________________ position (geriatric considerations)

Blowout fracture of the orbit

caused by object striking the eye resulting in a rupture of the floor of the orbit & collapse of the rectus muscle into the maxillary sinus along with blood

TMJ dislocation

seen on "open mouth" x-rays or panoramic tomography (for which pathology)