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

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

5. Mid-saggital view

6. 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

7.  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)

8.  LeFort Type I  LeFort Type II  LeFort Type III

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

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

11. 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.

12. 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

13. Nasolacrimal System Injection Site Lateral image post injection

14. Facial Bones Imaging Caldwell or PA image LateralWaters

15. Radiographic Views PA (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

16. Caldwell (use horizontal ray)

17. Caldwell for facial bones

18. PA (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

21. Lateral facial bones

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

23. Water’s View  Midsagittal plane perpendicular to IR  IPL parallel to IR  OML makes 37 degree angle with IR  COLLIMATE!!!!

24. Waters for facial bones

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. Reverse Water’s View  Used when patient cannot be placed in prone position.  Mentalmeatal line perpendicular to IR  CR perpendicular; enters acanthion  CR parallel to acanthiomeatal line  Merrill’s pg. 332-3 (12 th Ed)

29. 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

31. Hyper extended waters

32. Axial Nasal Bones  Use occlusal film. Patient holds film in teeth. NOT DONE ANYMORE.  Use occlusal film. Patient holds film in teeth. NOT DONE ANYMORE.  CR perpendicular to film CR

33. Zygomatic Arches

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

36. fracture

37. Oblique Tangential  Same position as SMV except head tilt 15 degrees toward side of interest (Merrill’s p. 337 12 ed)

38. 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  (P. 341-2, 12 Ed. Merrill’s )

39. Unilateral arch view

42. C-arm tangential image