Facial Bones and Sinuses Positioning

SID:

• 40”

Respiration:

• Suspension

Basic Facial Anatomy:

• L & R nasal

• L & R zygomatic

• L & R lacrimal

• L & R maxillary

• L & R Palatine

• L & R Inferior Nasal COnchae

• Vomer

• Mandible

*Hyoid not included

Facial Bones Series:

• Routing

  • Lateral (left or right)

  • Parietoacanthial (Waters)

  • PA Axial (Caldwell)

• Special

  • Modified parietoacanthial (modified waters) orbital fox

  • Acanthioparietal (Reverse waters) trauma

• Lateral Facial Bones Projection

  • CR: halfway between EAM and outer canthus

  • IOML parallel to floor (perpendicular to IR)

  • CR enters around zygoma

  • IPL perpendicular to IR

  • Collimation:

    • Slightly above gabella

    • Through mandible symphysis

  • Evaluation

    • Superimposition of L & R facial bones

    • Rami superimposed almost perfectly

• PA Axial (Caldwell) Facial Bones

  • CR: 15 degrees caudad, exits nation

  • Forehead and nose against IR

  • OML perpendicular to IR

  • Evaluation

    • Petrous ridges fill lower 1/3 of orbit

• Parietoacanthial (Waters) Facial Bones:

  • CR exits acanthion; perpendicular

  • MML perpendicular to IR

  • Evaluation:

    • Petrous ridges below maxillary sinuses

• Modified Parietoacanthial (Modified Waters( Facial Bones)

  • Best for blowout fractures of orbital base

  • CR exits acanthion

• Acanthioparietal (Reverse Waters) Facial Bones

  • Cr enters a cation

  • MML perpendicular to IR

Paranasal Sinuses

• Routine

  • Lateral - L or R

  • PA (Caldwell)

  • Parietoacanthial (Waters)

  • Submentovertex “SMV”

• Special

  • Parietoacanthial Transoral (Open mouth waters)

• Lateral Sinuses

  • CR: enters between EAM and outer canthus; perpendicular

  • IOML perpendicular

  • Evaluation

    • All 4 sinuses demonstrated

    • Air fluid levels shown

• PA (Caldwell) Sinuses

  • CR: exits nasion

  • OML 15 degrees

  • Frontal and anterior ethmoid demonstrated

  • Angle IR or anatomy

• Evaluation:

  • Frontal and anterior ethmoid sinuses shown

  • Petrous ridges filling lower third of orbit

• Parietoacanthial (Waters) Sinuses

  • CR: exits acanthion

  • MML perpendicular

  • Maxillary sinuses best demonstrated

• Evaluation:

  • Petrous ridges below maxillary

• Submentovertical “SMV” Sinuses

  • CR: enters between onions

  • IOML parallel to IR

  • Ethmoid and Sphenoid demonstrated

• Evaluation:

  • Ethmoid and sphenoid sinuses shown

  • Mandibular condyles anterior to Petrous ridges

  • Insufficient neck extension → mandible superimpose over ethmoid sinus

• Parietoacanthial Transoral (Open Mouth Waters) Sinuses

  • CR: exits acanthion

  • MML 37 degrees from IR

  • Maxillary and Sphenoid demonstrated

• Evaluation:

  • Petrous ridges below maxillary sinuses