pathologies for facial and nasal and special views

Blowout fracture

• is a result of a forceful blow to the orbit (DIRECTLY TO THE ORBIT)

  • Ex)baseball or fist

• It causes ONE or MORE of the ORBITAL walls to fracture (but the rim STAYS INTACT)

RA of blowout fracture

• typically xray is not the modality of choice

• CT is the choice of modality

• But there will be FLUID in the maxillary sinus and ethodial air cells

• TEAR DROP: herniation of the orbital fat inferiorly

Tripod fracture (Zygomaticaomaxiallary complex fracture)

• the fracture is composed of

  • Zygomatic arch

  • Inferior orbital rims, and anterior and posterior max sinus walls

  • Lateral orbital rim

• Fracture may appear as FREE FLOATING

• DIRECT BLOW TO THE CHEEK

Le fort fracture

• bilateral horizontal fracture of the maxillae that causes instability

• 3 levels of fractures

• RA= unstable detached fragment of maxilla

Le fort 1

• separation of the hard palate from the upper maxilla due to a TRANSVERSE fracture running thru the maxilla and pterygoid plates at a level just above the floor of the nose

• FLOATING PALATE (HORIZONTAL)

Le fort 2

• fracture transect the nasal bones, medial- anterior orbital walls, orbital floor, inferior orbital rims and finally transversely fracture the posterior maxilla and pterygoid plates

• FLOATING MAXILLA (PYRAMIDAL)

Le fort 3

• are the HIGHEST level Le fort fracture

• Results in craniofacial disjunction= essentially seperated the maxilla from the skull base

• FLOATING FACE (TRANSVERSE)

Zygomatic arch fracture

• a fracture of the zygomatic arch (simple or comminuted)

• Arch of interest may be depressed (NEED TO DO AN AXIAL OBLIQUE/ tangential) possibly

• 
  

Nasal bone fracture

• fracture to the nasal bones

• Often a TRANSVERSE fracture best seen on a lateral

SV: Modified parietoacanthial

• rest patients head on the tip of extended chin LML is PERP to the IR

• CR is Perpendicular and exits the ACANTHION

• Good to demonstrate BLOW OUT FRACTURE

What is this an image of

• modified parietoacanthial waters FACIAL

SV: PA axial Caldwell (routine for ARRT CONTENT)

FACIAL/NASAL

• Tube angle is 15 degree caudad and CR exits the NASION

• demonstrates the orbital rim, maxillae, nasal septum, zygomatic bones and anterior nasal spine

• OML PERP to IR

What is this an image of

PA axial Caldwell

SV: oblique Inferosuperior tangential (zygo arch)

• hyperextend the neck so that the IOML is nearly parallel with head on it vertex. Rotate the MSP 15 degrees towards THE SIDE BEING EXAMINED and tilt 15 degree AWAY FROM THE SIDE BEING EXAMINED

• shows the arch that is being seen free of superimpostion

What is this an image of

• oblique Inferosuperior tangential

SV:Parietoacanthial waters (orbits)

• close collimation

• OML perp to the IR, patient close eyes to focus on holding still

• Orbits free of superior position from the ridges

• CR goes thru mid orbits

Modified parietoacanthial waters (ORBITS)

• rest head on tip of extended chin

• Flexion so the OML forms a 50 degree angle with plane of IR and LML is perp to IR

• Orbits free of superimpostion of ridges

What is this an image of

Modified parietoacanthial waters

(Orbits) right or left lateral

• Closed collimation

• Lateral view of the orbits

What is this an image of

Right or left lateral

SV: PA axial Caldwell

• closed collimation

• Forehead and nose on the IR and OML perperpendicular to the IR. Instruct patient to close eyes and concentrate on holding them still exposure

• 30 degree caudal angle (this is exaggerated Caldwell) central ray is ¾ inch distal to nasion

• The orbits with ridges projected below the inferior margins of the orbits

What is this an image of

Pa axial Caldwell

Technique for parietoacanthial waters

• 85 kVp, center cell, 8 mAs

PA axial exaggerated Caldwell technique

• 85 kVp, center cell, 7.1 mAs

Left lateral (FACIAL)technique

• 80 kVp, center cell 3.2 mAs

SMV technique

• 80 kVp, 8mAs

Parietoacanthial waters

• 85kVp, center cell, 8mAs

Lateral (nasal)

• 70kVp, 2.5 mAs