A Video Review of Skull and Mandible Anatomy

PLAIN SKULL RADIOGRAPHY

Gives

information on skull structures information on certain endocrine and metabolic disorders, metastasis and fractures

Gives

no

value for patients suspected of having neurological disease

Routine Method of Study of Skull Radiographs WHAT TO TAKE NOTE?

shape of the skull as a whole
especially the relationship of the vault to the base in all views

outline of the skull as a whole

noting the thickness of the inner and outer tables

lines, impressions, channels and sutures

Routine Method of Study of Skull Radiographs WHAT TO TAKE NOTE?

Check for calcifications

Carefully define the sella turcica, its anterior and posterior clinoid processes and tuberculum sellae

Examine the petrous ridges, orbits, sphenoid ridges, temporal bones and facial bones

Normal Skull

X-Ray examination consists of multiple exposures with the patient in different positions: Minimum requirement 1. Posteroanterior 2. Lateral View

Routine Radiographic Procedures of Skull

PA view with 15 degree tilt of the tube caudally Permits visualization of the: 1. orbital structures 2. superior orbital fissures with surrounding lesser and greater wings of the sphenoid

Sagittal suture
Lesser Wing of Sphenoid bone Frontal Sinus

Orbit

Greater Wing of the Sphenoid

Ethmoid Air CellsPetrous Ridge

Maxillary Sinus Odontoid Process of C2 Vertebra Nasal Septum

Superior Orbital Fissure

Permits visualization of the petrous ridges which are projected into the orbits

AP view with a 30 degree tilt of the tube caudally

Demonstrates the entire occipital bone, foramen magnum and dorsum sellae

Lambdoid Suture
Sulcus of the transverse sinus

Occipital protruberance Foramen Magnum

Mastoid air cells Occipital crest Dens

Posterior arch of the atlas

Condyle of theMandible

Demonstrates the bones of the calvarium and base of the skull in the lateral perspective The sellae turcica is best visualized in this view

Diploe Coronal Suture Ethmoid Air Cells

Groove for middle meningeal vessels Greater Wing of Sphenoid Posterior Clinoid Process Lambdoid Suture

Frontal Sinus

Frontal Process of Zygoma

Arch of Zygoma

Sella Turcica
Condyle of Mandible Ramus of Mandibl Anterior Arch Of e Atlas Mastoid Air Cells Coronoid Process of Mandible

Maxillary Sinus Anterior Clinoid Process Palatine Process of Maxilla Sphenoid Sinus

Axial view of the skull

- Allows direct visualization of the base of the skull and various foramina - Provides view of the petrous ridges, ethmoid, sphenoid along with the facial bones and orbits

Carotid Canal

Jugular Foramen

Posterior Wall of Maxillary Sinus

Perpendicular plate of Ethmoid Vomer

Foramen Ovale

Foramen Spinosum Posterior Wall of Orbit Greater Wing of Sphenoid

Foramen Lacerum Occipital Condyle

Mandibular Head Auditory Canal

Mastoid Air Cells Anterior Arch of Atlas

Odontoid Process

Foramen Magnum

Chin up position Orbitomeatal line should be adjusted to make an angle of 37 degrees with the plane of the film Shows the sinuses well

Frontal Sinus Nasal Septum

Frontozygomatic Suture Ethmoid Air Cells Frontal Process of Zygomatic bone Greater Wing of Sphenoid Maxillary Sinus

Lesser Wing of Sphenoid

Condyle of Mandible

The Paranasal Sinuses

Paranasal Sinuses
- are paired cavities lined by mucous membrane (mucoperiosteum) - arise as outpouchings from the nasal fossa - extends into the maxillary, ethmoid, sphenoid and frontal bones - named according to the bones in which they develop

Paranasal Sinuses
Methods of Examination: Standard Positions - Waters (occipitomental) projection - Caldwells (occipitofrontal) position - Lateral position - Submentovertical (SMV) projection Special Methods Contrast studies Tomography Computerized Tomography

Paranasal Sinuses
MAXILLARY SINUS
- first PNS to appear in fetal life - arise as outpouchings from the anterior recess of the middle meatus - at birth; small, vertically ovoid cavities located in the maxillae on either side of the midline - growth/aeration is complete at 12 years of age

Paranasal Sinuses
Maxillary Antra/Sinus
- when fully developed = each sinus is shaped by the body of the maxillary bone

- considered to have a roof, a floor and 3 walls = nasal, facial and infratemporal
- floor is often irregular due to alveolar process of the maxilla - bony or membranous septa occasionally divide the antrum into two or more compartments

Paranasal Sinuses
FRONTAL SINUS - usually present at birth but incompletely aerated and lie adjacent to the anterior ethmoid cells in the orbital plate of the frontal bone - visible at 2 years of age - reach their extent of growth when the child is 10 to 12 years of age

Paranasal Sinuses
Frontal Sinuses - may extend high into the vertical
portion of the frontal bone and backward into the orbital plate - often asymmetric and vary widely in size - agenesis of one or both is quite frequent - communicate with the middle nasal meatus by means of the nasofrontal duct

Paranasal Sinuses
Ethmoid Sinuses
- consists of two groups of cells lying on either side of the midline in the ethmoid bone
- they form the medial wall of the orbit and lateral wall of the upper half of the nasal cavity - vary from 3 or 4 up to 18 or more in number - distribution varies; may extend into the adjacent sinuses

Paranasal Sinuses
Ethmoid Sinuses
- frontal anterior ethmoids open into the frontal recess - infundibular anterior cells ethmoid infundibulum - bullar anterior cells - above the ethmoidal bulla - posterior ethmoid cells communicate with the superior nasal meatus - fully developed at 10 to 12 years of age

Paranasal Sinuses
SPHENOID SINUS - lie in the body of the sphenoid bone - communicate with the sphenoethmoid recess in the posterior superior portion of the nasal cavity - development is somewhat slower and growth continues into young adult life - if not visible by age 10 = disease is suspected

The Mastoids

Mastoids
- important in the diagnosis of middle ear and mastoid diseases

Mastoids
temporal bone = complex structure contains the external auditory canal, middle and internal ear as well as the vestibular apparatus bone consists of : a) squamous b) tympanic c) pertomastoid - petrous part internal ear - mastoid part mastoid air cells d) styloid process

Mastoids
- mastoid cells develop as saclike extensions from the mastoid antrum

- process begins at birth and is complete by puberty - considerable amount of pneumatization

Schuller view

Xray of the Orbits

Orbits
Methods of Examination a) PA Projection - superior orbital fissures, superior and lateral orbital margins b) Modified Waters Projection - orbital floors, superior and inferior orbital margins

Orbits
Methods of Examination
c) Rhese (parieto-orbital oblique) Projection right and left optic foramina are usually taken for comparison - optic canal,superior and lateral orbital margins

THE Nasal Bone

Nasal Bone
Methods of Examination a) Waters Projection - best for showing deviated bony nasal septum b) Lateral Projection - right and left are generally taken for comparison

Waters view

Nasal Bone
Methods of Examination a) Waters Projection - best for showing deviated bony nasal septum b) Lateral Projection - right and left are generally taken for comparison

Lateral Projection

The Facial Bones

Facial Bones
Methods of Examination a) Waters Projection b) Lateral Projection c) Towne Projection d) SMV Projection e) Oblique Tangential

Facial Bones
Methods of Examination a) Waters Projection b) Lateral Projection c) Towne Projection d) SMV Projection e) Oblique Tangential

Facial Bones
Methods of Examination a) Waters Projection b) Lateral Projection c) Towne Projection d) SMV Projection e) Oblique Tangential

Facial Bones
Methods of Examination a) Waters Projection b) Lateral Projection c) Towne Projection d) SMV Projection e) Oblique Tangential

The Mandible

Mandible
Methods of Examination a) Reverse Towne Projection - condylar process b) PA Projection mandibular rami and body c) AP Oblique Projection mandibular body and ramus, condylar process, coronoid process and symphysis
d) Panoramic View of the mandible
Reverse Towne projection

Mandible
Methods of Examination a) Reverse Towne Projection - condylar process b) PA Projection mandibular rami and body c) AP Oblique Projection mandibular body and ramus, condylar process, coronoid process and symphysis
d) Panoramic View of the mandible
PA Projection

Mandible
Methods of Examination a) Reverse Towne Projection - condylar process b) PA Projection mandibular rami and body c) AP Oblique Projection mandibular body and ramus, condylar process, coronoid process and symphysis
d) Panoramic View of the mandible
Oblique projection

Panoramic View of the Mandible

The Temporomandibular Joints

Temporomandibular Joints
- examined with the patients mouth open and closed - use of special projections and tomography - Normal- articular surfaces are smooth - Mandibular condyles move forward out of the glenoid fossa when the mouth is open

Temporomandibular Joints
- examined with the patients mouth open and closed - use of special projections and tomography - Normal- articular surfaces are smooth - Mandibular condyles move forward out of the glenoid fossa when the mouth is open

This 11-month old infant fell and struck his head on a hard surface

Case: This 11-month old infant fell and struck his head on a hard surface.

INTERPRETATION:

Linear fracture of the posterior portion of the right parietal bone extending across the lambdoidal suture into the occipital bone inear fracture

Child hit by a stone by his playmate

There is a depressed skull fracture over the posterior right parietal bone. The hyperdense (sclerotic) appearance of the skull abnormality indicates the presence of a depressed skull fracture.

Compare the right and left maxillary sinus

Case: 18 y.o. female presented with nasal congestion more in the right side associated with fever and headache and tenderness over the right maxillary area.

Acute right sided maxillary sinusitis showing opacification of right maxillary sinus and normal-appearing left maxillary sinus

Case: 22 y.o. male involved in a motorcycle accident (no helmet). Identify the fractured parts of the mandible?

Case: 65 year old male diagnosed with Multiple Myeloma

Latero-lateral radiograph of the skull: Well-defined osteolytic areas are visible in the bone of the calvaria (classical 'raindrop' lesions)

A case of a 19 y.o. college student mauled by unknown assailants.

Look at his nasal bone? Is there are fracture?