1. Basic Skull Positioning- Parts 1 and 2 6/5/2014 Skull Positioning DMI 55

2. -form protective housing of brain (cranial vault) 14 Facial 2 types of Skull bones 8 Cranial -provides structure, shape & support for face -protective housing for upper ends of respiratory & digestive tracts - with cranial-forms eye sockets

3. The Cranium The Brain Of Jane Stays mainly In her Cran(ium)

5. 8 Cranial Bones are: 1 Frontal 2 Parietal 1 Occipital 1 Ethmoid 1 Sphenoid 2 Temporal

6. Top of skull = skull cap = Calvarium Made up of 4 bones: Frontal L & R Parietal Occipital

7. Frontal bone

8. 2 parietal bones

9. Occipital Floor of Cranium

10. Floor of Cranium is made of 4 bones (The four on the floor!) Ethmoid Sphenoid Left & Right Temporal bones

11. 1 Ethmoid Bone

12. 1 Sphenoid bone

13. 2 Temporal bones

15. Temporal Bones LATERAL AP PETROUS RIDGE

16. Temporal bones contain the organs of hearing and balance!

17. 14 Facial Bones 2 maxillary bones 2 nasal 2 lacrimal 2 Zygoma (malar) 2 palatine 2 inferior nasal conchae 1 vomer 1 mandible

18. 2 Maxillary bones

19. 2 nasal bones 2 lacrimal bones

20. 2 Zygomas

21. 2 Palatine bones

22. 2 inferior nasal conchae

23. 1 Vomer

24. 1 Mandible

25. At approximately what age does the human eyeball reach maturity?

27. What are fontanels? Six areas of incomplete ossification in newborn

28. Mastoid fontanel (asterion) Sphenoidal fontanel (pterion)

29. At what age do the fontanels close? Posterior and sphenoidal fontanels close during first 1-3 months after birth Anterior and mastoid fontanels close during 2 nd year of life

30. Radiographic Landmarks

32. Landmarks

34. Radiographic baselines

35. All skull positions are based on 3 factors Rotation Tilt Flexio n- Extension

36. 3 types of Skull Position change 1st type - Rotation - your head is rotating on an axis-your neck The “NO” position

37. 2 nd type of skull position change Flexion-extension Also called “Yes” position Extension Flexion

38. 3 rd type of skull position change Tilt Or “Maybe” position

39. Skull Morphology Meso cephalic Brachy cephalic Dolicho cephalic

40. Average Skull

41. Brachycephalic- (Broad ) Dolichocephalic- (thin) Skull Morphology M eso cephalic- (middle-average)

43. Review A-Vomer B-Perp.plate ethmoid C-Nasion D- inferior nasal conchae E- Anterior nasal spine

44. A b Lateral Skull a-sphenoid b-squamous suture c-temporal d-occipital e-EAM f-mastoid process g-styloid process h-TMJ i-zygoma c d e f g h h i a a b (suture)

45. Landmarks Midsagittal plane Glabella Interpupillary line Inner Canthus Nasion Acanthion Mentum Outer Canthus Gonion Infraorbitlal margin a b c d e f g h i j

46. Generally 5 basic positions in “Skull Series” PA PA Axial (Caldwell) Lateral AP Axial (Towne) SMV (Submentovertical) All use 40” SID and 10X12 IR

47. PA projection

48. Forehead and nose touch IR CR perpendicular to IR (0 deg. Angle) Exit at nasion Cassette 10x12 lengthwise O degrees

49. Alternate PA skull projections Decub style AP

50. PA Skull- Evaluation Criteria Entire Cranium included Equal distance from lateral border of skull to lateral border of orbit on both sides Symmetric petrous pyramids filling orbits ! R

51. At approximately what age does human skull reach full size? ___ years old?

52. PA Axial –Caldwell method

53. PA Axial-Caldwell Exactly same as PA, except CR angled 15 degrees down !

54. PA Axial- Caldwell Evaluation Criteria Same as PA except petrous ridges fill the lower 1/3 of orbits!

55. Which PA Axial projection is best? A B

56. Compare the difference! PA PA Axial

57. What is TREPANATION? Intentional drilling of holes through skull to improve mental functions open up cranial vault so brain can once again bathe directly in cosmic energy that it has been sealed off from since fontanels closed up

58. Lateral projection of Skull

59. 10x12 CW CR 2” superior to EAM Midsagittal plane parallel to IR Interpupillary line perpendicular to IR (IOML parallel to long axis of IR)

60. Lateral Skull- Evaluation Criteria Entire cranium without tilt or rotation Superimposed orbital roofs, and EAMs, TMJs Sella Turcica in profile No overlap of C-spine by mandible

61. What is wrong with this lateral?

62. Other ways to perform Lateral Dorsal Decubitus Erect Semi- prone

63. What projection and what is wrong? R

64. AP Axial- ( Towne Method)

65. AP Axial- Towne method CR 30 deg. Cauduad to OML (37 deg to IOML) CR enters 2 ½” above glabella, passing through level EAM

66. AP Axial (Towne Method) - Evaluation Criteria No rotation (equal distance from lateral border of skull to lateral margin of foramen magnum) Symmetric petrous ridges Dorsum sellae and posterior clinoids visible in foramen

67. Alternate ways to perform Towne Erect Lateral Decubitus

68. Submentovertical projection (SMV)

69. SMV CR-through Sella turcica (3/4” anterior to EAM) Perpendicular to IOML IOML parallel to IR 10x12 cassette lengthwise

70. SMV- alternate position

71. SMV- Evaluation Criteria Equal distance from lateral border of skull to mandibular condyles on both sides (no tilt) Superimposition of mental protuberance over frontal bone Mandibular condyles anterior to petrous pyramids

72. What’s wrong with this SMV projection?

73. Which is best SMV projection? AB

74. Which SMV projection is the best? A B

75. ? ?