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Skull and Nasal Cavity

Skull and Nasal Cavity. Dr. LeeAnn Pack Dipl. ACVR. Radiography of the Skull. Anesthesia required Perfect positioning is critical (especially for lateral and DV) Evaluate for asymmetry Obtain special views as needed Radiographs are nice but they are no CT or MRI image :-). Skull Types.

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Skull and Nasal Cavity

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  1. Skull and Nasal Cavity Dr. LeeAnn Pack Dipl. ACVR

  2. Radiography of the Skull • Anesthesia required • Perfect positioning is critical (especially for lateral and DV) • Evaluate for asymmetry • Obtain special views as needed • Radiographs are nice but they are no CT or MRI image :-)

  3. Skull Types

  4. Lateral Views of the Skull and Nasal Cavity

  5. Closed Mouth DV

  6. Special or Additional Views • Intraoral DV or VD/ open mouth VD • Eliminates superimposition of mandibles/ maxilla

  7. Intra Oral DV Open Mouth DV

  8. Special or Additional Views • Rostrocaudal frontal sinus • Neoplasia, sinusitis, trauma

  9. Open mouth rostrocaudal Evaluation of bullae Variation (30 degree VD) in Cats Special or Additional Views

  10. Special or Additional Views • Oblique views • Bullae, maxilla, mandible • Left dorsal-right ventral • Right dorsal-left ventral • Labeling can get confusing

  11. Shots Summary • Nasal Series • Minimum = *VD open mouth and lateral • Special = rostro-caudal frontal sinus • Special = *intra –oral • * these provide the best evaluation of the nasal cavity in general • Knowing normal anatomy is critical

  12. Nasal Disease • Neoplasia, infection, foreign body, fracture, fungal • History of nasal discharge • Unilateral or bilateral • Serous, purulent, hemorrhagic

  13. Radiographic Interpretation • Change in opacity • Bony lysis • Increased soft tissue or fluid • Or BOTH • Are the nasal turbinates still visualized? • Use the opposite side for comparison of increased opacity • Radiographic changes are not always specific for a specific disease

  14. Frontal Sinuses

  15. Rhinitis / Infectious • Acute • Viral, bacterial, allergic, FB (usu. not seen) • Increased opacity (exudate in nasal cavity or thickening of mucosal turbinate covering) without turbinate destruction • Chronic • Usu. seen in cats with a viral upper respiratory disease • Turbinates may be deformed but not destroyed

  16. Rhinitis

  17. Destructive Rhinitis • Aspergillus sp. Infection • Young animals • Medium and long nosed dogs • Rarely seen in brachycephalic • Fungal rhinitis usually causes focal turbinate destruction

  18. Destructive Rhinitis • Nasal aspergillosis • Saprophytic fungal organism • Destructive rhinitis/ sinusitis • Radiographic findings • Lysis of turbinates • Increased intranasal ST • Ddx neoplasia usu= ST mass, adjacent bony lysis, frontal sinus opacity • Cryptococcus neoformans • Usually cats and nondestructive

  19. Neoplasia – Nasal Tumors • Nasal Tumors • 1-2% of all tumors in dogs and cats • 2/3 are carcinomas (Adenocarcinoma, SCC) • 1/3 are sarcomas (FSA, OSA, chondrosarcoma) • Intranasal lymphoma (more commonly cats) • Diagnosis usually occurs late • Hemorrhage often seen

  20. Aspergillosis

  21. Nasal Tumors • Radiographic findings • Increased intranasal soft tissue opacity • Soft tissue mass or accumulation of nasal exudate • Lysis of nasal turbinates • +/- Lysis of cribriform plate= extent into brain • Does it involve one side or has it crossed the nasal septum? • Often begin in the region of the ethmoid turbinates • CT great for nasal tumors

  22. Moderate Maxillary Lysis

  23. Nasal Tumors

  24. Nasal Adenocarcinoma Septal Deviation

  25. Nasal Adenocarcinoma

  26. Shots Summary - Skull • Minimum = lateral and DV view • Special = obliques • Special = teeth, tympanic bullae, TMJ’s, foramen magnum, nasal cavity and frontal sinus (as per nasal shots) • Knowing anatomy is critical • Very complex area • Does not evaluate the brain

  27. Hydrocephalus • Excess CSF within skull • Congenital or acquired • Maltese, Yorkie, Chihuahua • Radiographic Signs • Doming and cortical thinning of calvarium • Open fontanelle • Lateral projection best • Ground glass look

  28. Occipital Dysplasia • Congenital malformation of the foramen magnum (keyhole shape) – may be seen with AA sub lux and hydrocephalus • Mini and Toy breeds • Special view = rostrodorsal – caudoventral of foramen magnum

  29. Feline Mucopolysaccharidosis • Inherited lysosomal storage disease • Siamese (VI) • Skull deformity – broad flat face with widely spaced eyes • Epiphyseal dysplasia, short maxilla, small frontal sinus, thick nasal turbinates, small dens and hyoid bones • Also have vertebral abnormalities

  30. Neoplasia - Skull • Osteosarcoma – 10-15% arise from the skull • Usually productive, well marginated • Osteoma • Slow growing, benign • Dense, homogenous, well marginated

  31. Osteosarcoma

  32. Multilobular Osteochondrosarcoma • Neoplasia • Aka Multilobular tumor of bone, Multilobular osteoma • Often arise from temporo-occipital area • Granular, osteoproductive mass with lysis

  33. Skull Trauma • HBC, fights, gunshot wounds • Often see depression skull fractures • May cause cerebral edema, epistaxis and neurologic signs • Fairly rare to see skull fractures

  34. Trauma – Depressed Skull Fx

  35. Metabolic Abnormalities • Primary hyperparathyroidism • Parathyroid nodule or parathyroid hyperplasia • Secondary hyperparathyroidism • Nutritional or renal causes (Ca and P levels messed up) • Both situations lead to increased PTH and bone resorption • Radiographic findings • Loss of lamina dura • Demineralization of mandible and maxilla = “floating teeth” “rubber jaw”

  36. Hyperparathyroidism

  37. Neoplasia Mandibular or Maxillary • Squamous Cell Carcinoma • More aggressive/ worse prognosis in cats • Rostral mandible - dogs • FSA, OSA, Chondrosarcoma • Malignant melanoma • Epulis= benign tumor of periodontal ligament (dogs) • Fibromatous, Ossifying= Osteoproductive • Acanthomatous= Invasive, Lytic

  38. Dentigerous Cyst - Odontoma

  39. Acanthomatous Epulis

  40. Otitis Externa • Otitis externa • Stenosis or mineralization of external ear canal • VD view best

  41. Otitis Externa

  42. Mineralized Ear Canals

  43. Otitis Media • Otitis media • Increased opacity in bulla • Thickening of bulla walls • Obliques or open mouth rostrocaudal views • **25% of dogs with normal bulla rads had otitis media at surgery • Nasopharyngeal polyp • Cats - sneezing

  44. Nasopharyngeal Polyp • Non neoplastic • Originate from mucous membrane of auditory tube or middle ear • Younger cats – can extend into external ear canal, osseous bulla or the nasopharynx

  45. Tooth Root Abscess • Tooth root (periapical) abscess • Lysis of periapical alveolar bone • Resorption of tooth root • Widening of periodontal space • Sclerosis surrounding apex • Loss of lamina dura • Dogs - 4th maxillary premolar (carnassial tooth) • External fistulous tract below eye

  46. Normal Dental Formulas • Cat • Deciduous 2 x (I 3/3 C 1/1 P 3/2) = 26 • Permanent 2 x (I 3/3 C 1/1 P 3/2 M 1/1) = 30 • Dog • Deciduous 2 x (I 3/3 C 1/1 P 3/3) = 28 • Permanent 2 x ( I 3/3 C 1/1 P 4/4 M 2/3) = 42

  47. Root Canal

  48. More Trauma • Fractures • Additional views as needed • Temporomandibular joint (TMJ) luxations • Often rostrodorsal and concurrent with fractures • Usu. unilateral • Malocclusion

  49. Cranial Mandibular Osteopathy • Westies, Scotties, Cairn, Boston terriers • Autosomal recessive in Westies • +/- Link to hypertrophic osteodystrophy (HOD) • Young dogs (3-8 months) • Mandibular swelling • Difficulty/ pain chewing • Pyrexia, Self- limiting • Radiographic signs • Bony proliferation on mandibles, bulla, petrous temporal bone, calvarium

  50. CMO

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