RADT 1522 Orbits, Facial Bones and Nasal Bones

1. RADT 1522Orbits, Facial Bones and Nasal Bones Wynn Harrison, MEd

3. Facial Anatomy • 14 facial bones (How Many of Each) • Maxilla - Vomer • Zygomatic - Mandible • Palatine • Nasal • Lacrimal • Inferior Nasal Conchae

4. New Words • Blow-Out Fracture – Impact fracture (Trauma) of the orbital floor resulting in orbital intrusion into the maxillary sinus. *** Look at the orbits carefully, since 60 - 70 % of all facial fractures involve the orbit in some way

5. Le Fort I - tooth bearing portion separated from upper maxilla • Le Fort II - fracture across orbital floor and nasal bridge (pyramidal fracture) • Le Fort III - fracture across frontozygomatic suture line, entire orbit and nasal bridge (craniofacial separation)

6. LeFort Type I • LeFort Type II • LeFort Type III

7. Tripod Fracture – A fracture in which the zygoma is separated from its attachment to the maxilla, frontal and temporal bones

8. Bell’s Palsy - Bell's palsy is a weakness or paralysis of the muscles that control expression on one side of your face.

10. Orbits • Rhese View- Midsagittal plane forms a 53 degree angle with IR. Chin, cheek and nose on the table (three-point landing!) Acanthiomeatal line perpendicular to IR. Optic foramen should be seen in center of image.

11. Foreign Body • PA and Lateral views are performed to look for foreign body in the orbit. • What do you think you need to have them do differently for this exam? • Look UP, Look Down

12. Nasolacrimal System Lateral image post injection Injection Site

13. Facial Bones

17. Radiographic ViewsPA Axial (Caldwell) • Tuck patient’s chin; nose and forehead on table/wall bucky • OML perpendicular to IR • 15 degree caudal angulation • Petrous pyramids BELOW inferior orbital margin

18. PA Axial (Caldwell) Calcified meningioma

20. Lateral – External auditory meatus externally and mandible inferiorly with supracillary arch superiorly in view. • CR centered to zygoma, midway between outer canthus and EAM • Midsagittal plane is parallel to IR • IPL is perpendicular to IR

22. ParietoacanthialWater’s View • Midsagittal plane perpendicular to IR • IPL parallel to IR • OML makes 37 degree angle with IR • COLLIMATE!!!! • Merrill’s pg. 353 (12th Ed)

25. Hyper extended waters

26. Modified Parietoacanthial (Modified Waters) • OML 55 degrees to the IR • Chin and nose on table • Petrous pyramids are seen mid-maxillary sinus • CR exits acanthion • See pg. 355 (Merrill’s 12th Edition)

28. What ‘Bout Technique!!! • Would you increase or decrease technique for lateral facial bones compared to a lateral skull?

29. Reverse Water’s View • Used when patient cannot be placed in prone position. • Mentalmeatal line perpendicular to IR • CR perpendicular; enters acanthion • Merrill’s pg. 334-5 (12th Ed)

31. Nasal BonesLateral and Superior/Inferior Views • Lateral: Position exactly like you would for a lateral skull … CR ½ inch inferior to nasion. • CR Perpendicular to IR • COLLIMATE

33. Axial Nasal Bones • Use occlusal film. Patient holds film in teeth. • CR perpendicular to film CR

35. Zygomatic Arches

36. Bilateral Arches - SMV • IOML parallel to IR and perpendicular to CR • CR midsaggital and collimate to outer edges of zygoma

38. fracture

39. Oblique Tangential • Same position as SMV except head tilt 15 degrees toward side of interest (Merrill’s p. 362 12 ed)

40. May View (tangential) • PA positioning; IOML perpendicular to CR, head tilt 15 degrees away from the area of interest. • CR bisects zygomatic arch Shows single zygomatic arch, free of superimposition • (Not in 12 Ed. Merrill’s )

43. C-arm tangential image

45. Film Critique

46. Critical thinking

48. Beautiful Hawaii