1. RADT 1522 Orbits, 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 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 Injection Site Lateral image post injection

13. Facial Bones

17. Radiographic Views PA 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. Parietoacanthial Water’s View  Midsagittal plane perpendicular to IR  IPL parallel to IR  OML makes 37 degree angle with IR  COLLIMATE!!!!  Merrill’s pg. 353 (12 th 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 12 th 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 (12 th Ed)

31. Nasal Bones Lateral 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 Beautiful Hawaii