Skull Anatomy PDF

PREPARED BY: skull ALDRIN LOPEZ, RRT, MSRT 9/3/20XX Presentation Title 1 SKULL PLANES, POINTS & LINE Midsagittal plane (MSP) Interpupillary line (IPL) Acanthion...

PREPARED BY: skull ALDRIN LOPEZ, RRT, MSRT 9/3/20XX Presentation Title 1 SKULL PLANES, POINTS & LINE Midsagittal plane (MSP) Interpupillary line (IPL) Acanthion Outer canthus Infraorbital margin External acoustic meatus (EAM) Orbitalmeatal line (OML) Infraorbitomeatal line (IOML)/Frankpurt Line Presentation Title  Acanthiomeatal line (AML) Mentomeatal line (MML) Between OML & IOML: 7o difference Between OML & GML: 8o difference Presentation Title PATHOLOGY 1. ) Basal Fx Fx located at the base of the skull 2) Blowout Fx Fx of the floor of the orbit 3.) Contre-Coup Fx Fx to one side of a structure caused by trauma to the other side 4.) Depressed Fx Fx causing a portion of the skull to be depressed into the cranial cavity Presentation Title  5.) Le Fort Fx Bilateral horizontal fxs of the maxillae 6.) Linear Fx Irregular or jagged fx of the skull 7.) Tripod Fx Fx of the zygomatic arch & orbital floor/rim & dislocation of the frontozygomatic suture Presentation Title  8.) Mastoiditis Inflammation of mastoid antrum & air cells 9.) Paget’s Disease Thick, soft bone marked by bowing fxs 10.) Sinusitis Inflammation of one or more of the paranasal sinuses 11.) TMJ Syndrome Dysfunction of the temporomandibular joint Presentation Title  SKULL 9/3/20XX Presentation Title 7  PA PROJECTION PP: Prone; forehead & nose against IR; MSP & OML perpendicular to IR RP: Nasion CR: Perpendicular SS: Petrous pyramid completely filled the orbits; frontal bone 9/3/20XX Presentation Title 8 9/3/20XX Presentation Title 9  AP PROJECTION PP: Supine; MSP & OML perpendicular to IR RP: Nasion CR: Perpendicular SS: Same as PA, but the image is MAGNIFIED 9/3/20XX Presentation Title 10 9/3/20XX Presentation Title 11  MODIFIED CALDWELL METHOD PA AXIAL PROJECTION PP: Prone; forehead & nose against IR; OML perpendicular to IR; MSP perpendicular to IR RP: Nasion CR: 15o caudad SS: -General Survey Examination: Anterior & side walls of the cranium Temporal fossae Frontal sinuses & anterior ethmoid sinus Crista galli Upper 2/3 of orbits Petrous pyramid to lower 1/3 of orbit -Superior orbital fissure/sphenoid fissure (20-25o caudad) & foramen rotundum (25-30o caudad) 9/3/20XX Presentation Title 12 9/3/20XX Presentation Title 13 9/3/20XX Presentation Title 14  AP AXIAL PROJECTION PP: Supine; OML perpendicular to IR RP: Nasion CR: 15o cephalad SS: Same as PA axial but orbits are magnified & the distance b/n lateral margin of orbits & temporal bones are less on AP than PA 9/3/20XX Presentation Title 15 9/3/20XX Presentation Title 16  TRUE/ORIGINAL CALDWELL PP: Prone; forehead & nose against IR; GML perpendicular to IR; MSP perpendicular to IR RP: Nasion CR: 23o caudad SS: Same as above 9/3/20XX Presentation Title 17  LATERAL PROJECTION PP: Semiprone; MSP & IOML parallel to IR; IPL perpendicular to IR RP: 2 in. Above EAM or midway b/n inion & glabella CR: Perpendicular SS: -General survey examination Sella turcica Anterior & posterior clinoid processes, Dorsum sellae Superimposed mandibular rami Mastoid region EAM & TMJ 9/3/20XX Presentation Title 18  CROSSTABLE LATERAL PP: Dorsal decubitus (Robinson, Meares & Goree recommendation); MSP perpendicular to IR RP: 2 in. Above EAM CR: Horizontal ER: For traumatic sphenoid sinus effusion (basal skull fx) 9/3/20XX Presentation Title 19  TOWNE/ALTSCHUL/GRASHEY/CHAMBERLAINE METHOD AP AXIAL PROJECTION PP: Supine; OML/IOML & MSP perpendicular to IR; RP: 2.5-3 in. above glabella CR: 30o caudad (OML ┴); 37o caudad (IOML ┴) 9/3/20XX Presentation Title 20  SS: -“SPDOP” Symmetric petrous pyramid Posterior portion of foramen magnum Dorsum sellae & posterior clinoid process w/in shadow of foramen magnum Occipital bone Posterior portion of parietal bone -Tomographic studies of ears, facial canal, jugular foramina & rotundum foramina -Entire foramen magnum jugular foramina (40-60o caudad to OML) -Posterior portion of cranial vault (CR ┴ to midway b/n frontal tuberosities) 9/3/20XX Presentation Title 21 9/3/20XX Presentation Title 22 9/3/20XX Presentation Title 23 9/3/20XX Presentation Title 24  TOWNE/ALTSCHUL/GRASHEY/CHAMBERLAINE METHOD AP AXIAL PROJECTION PP: Lateral decubitus; OML/IOML & MSP perpendicular to IR RP: 2.5-3 in. above glabella CR: 30o caudad (OML ┴); 37o caudad (IOML ┴) SS: Same as above ER: For patient w/ pathologic condition, trauma or deformity (strongly accentuated dorsal kyphosis) 9/3/20XX Presentation Title 25 9/3/20XX Presentation Title 26 9/3/20XX Presentation Title 27 9/3/20XX Presentation Title 28  HAAS METHOD PA AXIAL PROJECTION PP: Prone; MSP & OML perpendicular to IR; forehead & nose against the table; IR center 1 in. to nasion RP: 1.5 in. below inion (entrance); 1.5 in. superior to nasion (exit) CR: 25o cephalad to OML SS: Occipital bone Symmetric petrous pyramid Dorsum sellae & posterior clinoid processes w/in shadow of foramen magnum ER: For obtaining image of sellar structures (DS & PCP) w/in FM on hypersthenic & obese patient 9/3/20XX Presentation Title 29 9/3/20XX Presentation Title 30 9/3/20XX Presentation Title 31 9/3/20XX Presentation Title 32 9/3/20XX Presentation Title 33  SCHULLER/PFEIFFER METHOD SUBMENTOVERTICAL PROJECTION PP: Supine or Seated-upright (more comfortable); IOML parallel to IR; MSP perpendicular to IR; head rested on vertex; neck hyperextended RP: ¾ in. anterior to EAM (sella turcica) CR: Perpendicular to IOML; MSP of throat b/n gonion (entrance) 9/3/20XX Presentation Title 34  SS: Cranial base Foramen ovale & spinosum (best demonstrated) Symmetric petrosae Mastoid processes Carotid canals Sphenoidal & ethmoidal sinuses Mandible Bony nasal septum Dens of axis Occipital bone Maxillary sinus superimposed over the mandible Zygomatic arches (well demonstrated if exposure factors are decreased) Axial tomography of orbits, optic canals, ethmoid bone, maxillary sinuses & mastoid processes 9/3/20XX Presentation Title 35 9/3/20XX Presentation Title 36 9/3/20XX Presentation Title 37 9/3/20XX Presentation Title 38  SCHULLER METHOD VERTICOSUBMENTAL PROJECTION PP: Prone; chin fully hyperextended; MSP perpendicular to IR RP: ¾ in. anterior to EAM (sella turcica)\ CR: Perpendicular to IOML; MSP of throat b/n gonion (entrance) SS: Same as SMV Distorted & magnified basal structures Useful for anterior cranial base & sphenoidal sinuses o IR in contact with the throat o Reduces magnification & distortion 9/3/20XX Presentation Title 39 9/3/20XX Presentation Title 40 9/3/20XX Presentation Title 41  LYSHOLM METHOD AXIOLATERAL METHOD PP: Semiprone; MSP parallel to IR; IOML parallel to transverse axis of IR; IPL perpendicular to IR RP: 1 in. distal to lower EAM (exit) CR: 30-35o caudad SS: Oblique position of lateral aspect of cranial base closest to IR ER: For patients who cannot extend their head enough for a satisfactory SMV projection 9/3/20XX Presentation Title 42  VALDINI METHOD PA AXIAL PROJECTION PP: Recumbent or seated-erect (more comfortable); upper frontal region of skull against IR; MSP perpendicular to IR; head acutely flexed; IOML 50o/OML 50o; line extending from inion to 0.5 cm distal to nasion form 28o to CR RP: 0.5 cm distal to nasion (dorsum sellae); foramen magnum/slightly above level of EAM (petrosae) CR: Perpendicular; inion (entrance); 0.5 cm distal to nasion (exit) 9/3/20XX Presentation Title 43  SS: DILA (IOML 50o): Dorsum sellae; Internal Auditory Meatus (IAM); LAbyrinth ETB “EaT Bulaga” (OML 50o): External auditory meatus; Tymphanic cavity; Bony part of Eustachian tube Dorsum sellae & posterior clinod processes within or above shadow of foramen magnum Tubeculum sellae, anterior clinoid processes & sella turcica below shadow of foramen magnum Mastoid pneumatization 9/3/20XX Presentation Title 44  SELLA TURCICA 9/3/20XX Presentation Title 45  LATERAL PROJECTION PP: Semiprone; MSP & IOML parallel to IR; IPL perpendicular to IR RP: ¾ in. anterior & ¾ in. superior to EAM CR: Perpendicular SS: Superimposed anterior & posterior clinoid processes; dorsum sellae 9/3/20XX Presentation Title 46 9/3/20XX Presentation Title 47 9/3/20XX Presentation Title 48  TOWNE METHOD PP: Supine; OML/IOML & MSP perpendicular to IR; RP: 2.5-3 in. above glabella CR: 30o caudad (OML ┴); 37o caudad (IOML ┴) SS: Sellar region Dorsum sellae, tuberculum sellae & anterior clinoid processes through occipital bone above shadow of foramen magnum (30o caudad) Dorsum sellae & posterior clinoid processes w/in shadow of foramen magnum (37o caudad) Symmetric petrous pyramid 9/3/20XX Presentation Title 49 9/3/20XX Presentation Title 50 9/3/20XX Presentation Title 51 9/3/20XX Presentation Title 52  HAAS METHOD PA AXIAL PROJECTION PP: Prone; MSP & OML perpendicular to IR; forehead & nose against the table; IR center 1 in. to nasion RP: 1.5 in. below inion (entrance); 1.5 in. superior to nasion (exit) CR: 25o cephalad to OML SS: Dorsum sellae & posterior clinoid processes w/in shadow of foramen magnum Symmetric petrous pyramid ER: For obtaining image of sellar structures (DS & PCP) w/in FM on hypersthenic & obese patients 9/3/20XX Presentation Title 53  PA PROJECTION PP: Prone; forehead & nose against IR; MSP & OML perpendicular to IR RP: Glabella CR: 10o cephalad SS: Dorsum sellae, tuberculum sellae, anterior & posterior clinoid processes through frontal bone above ethmoidal sinuses 9/3/20XX Presentation Title 54 9/3/20XX Presentation Title 55 9/3/20XX Presentation Title 56  OPTIC CANAL/FORAMEN 9/3/20XX Presentation Title 57  RHESE METHOD PARIETO-ORBITAL OBLIQUE PROJECTION PP: Prone; affected orbit closest to IR; zygoma, nose & chin against IR (3-pt Lower Landing); AML perpendicular to IR; MSP 53o angle to IR RP: Affected orbit closest to IR CR: Perpendicular SS: Optic canal/foramen (inferior & lateral quadrant of orbital shadow) PAZAM: Prone; Affected orbit against IR; Zynoch; AML ┴; MSP 53o to IR 9/3/20XX Presentation Title 58 9/3/20XX Presentation Title 59 9/3/20XX Presentation Title 60 9/3/20XX Presentation Title 61 9/3/20XX Presentation Title 62  RHESE METHOD ORBITO-PARIETAL OBLIQUE PROJECTION PP: Supine; affected orbit away from IR; AML perpendicular to IR; MSP 53o angle to IR RP: Inferior and lateral margin of uppermost orbit CR: Perpendicular SS: Magnified optic canal/foramen Increased radiation dose to lens of eye 9/3/20XX Presentation Title 63 9/3/20XX Presentation Title 64 9/3/20XX Presentation Title 65  ALEXANDER METHOD ORBITO-PARIETAL OBLIQUE PROJECTION PP: Erect/supine; IR 15o angle from vertical; MSP 40o to IR; AML perpendicular to IR RP: Inferior and lateral margin of uppermost orbit CR: Perpendicular SS: Optic canal/foramen 9/3/20XX Presentation Title 66  MODIFIED LYSHOLM METHOD ECCENTRIC ANGLE PARIETO-ORBITAL OBLIQUE PROJECTION PP: Prone; forehead & nose against IR; IOML perpendicular to IR; MSP 20o from vertical; RP: Affected orbit (exit) CR: 20o caudad or 30o caudad SS: Optic canal/foramen & anterior clinoid processes (20o); superior orbital fissure (30o) 9/3/20XX Presentation Title 67  SPHENOID STRUT 9/3/20XX Presentation Title 68  HOUGH METHOD PARIETO-ORBITAL OBLIQUE PROJECTION PP: Prone; superciliary ridge/arch & side of the nose against IR; IOML perpendicular to IR; MSP 20o from vertical; MSP 20o toward the side of interest RP: Affected orbit (exit) CR: 7o caudad SS: Unobstructed & undistorted image of the sphenoid strut (lie b/n sphenoidal sinus & combined shadows of anterior clinoid processes & lesser wing of sphenoid bone) 9/3/20XX Presentation Title 69  SUPERIOR ORBITAL/SPHENOID FISSURES 9/3/20XX Presentation Title 70  CALDWELL METHOD PA AXIAL PROJECTION PP: Prone; forehead & nose against IR; OML perpendicular to IR RP: Nasion CR: 20-25o caudad or 15o caudad SS: Superior orbital fissures Lying on the medial side of orbits b/n greater & lesser wings of sphenoid) Well demonstrated at 15o caudal angle (Caldwell) Petrous portions at or below the inferior orbital margin 9/3/20XX Presentation Title 71 9/3/20XX Presentation Title 72 9/3/20XX Presentation Title 73  INFERIOR ORBITAL FISSURES 9/3/20XX Presentation Title 74  BERTEL METHOD PA AXIAL PROJECTION PP: Prone; forehead & nose against IR; IOML perpendicular to IR RP: Nasion CR: 20-25o cephalad SS: Inferior orbital fissures b/n shadows of pterygoid process of sphenoid bone & mandibular ramus Anterior image of each orbital floor 9/3/20XX Presentation Title 75 9/3/20XX Presentation Title 76 9/3/20XX Presentation Title 77  EYE- FOREIGN BODY LOCALIZATION 9/3/20XX Presentation Title 78 Presentation Title 9/3/20XX Presentation Title 80  LATERAL PROJECTION PP: Semiprone; MSP parallel to IR; IPL perpendicular to IR; instruct patient to look straight ahead during exposure RP: Outer canthus CR: Perpendicular SS: Superimposed orbital roofs 9/3/20XX Presentation Title 81 9/3/20XX Presentation Title 82 9/3/20XX Presentation Title 83  PA AXIAL PROJECTION PP: Prone; forehead & nose against IR; MSP & OML perpendicular to IR; instruct patient to close the eyes RP: Midorbits CR: 30o caudad SS: Petrous pyramids lying below orbital shadows 9/3/20XX Presentation Title 84 9/3/20XX Presentation Title 85  MODIFIED WATERS METHOD PARIETOACANTHIAL PROJECTION PP: Prone; chin against IR; MSP perpendicular to IR; OML 50o to IR (new); OML 25-37o to IR (old); instruct patient to close the eyes RP: Midorbits CR: Perpendicular SS: Petrous pyramids lying well below orbital shadows 9/3/20XX Presentation Title 86 9/3/20XX Presentation Title 87 9/3/20XX Presentation Title 88  VOGT-BONE-FREE POSITION Taken to detect small or low density foreign particles located in the anterior segment of the eyeball/eyelids 2 Projections: lateral & superoinferior 2 Movements: o Vertical: 2 exposures (for lateral) ▪ Look up as far as possible ▪ Look down as far as possible o Horizontal: 2 exposures (for superoinferior) ▪ Look to extreme right ▪ Look to extreme left 9/3/20XX Presentation Title 89 9/3/20XX Presentation Title 90  PARALLAX METHOD First described by Richards It determines whether the foreign body is located within the eyeball requires no special apparatus Not considered as precision localization procedure Widely used as preliminary check only 2 Projections: o Lateral: 2 exposures o PA: 2 exposures 9/3/20XX Presentation Title 91  SWEET METHOD It determines the exact location of a foreign body by use of a geometric calculations Apparatus: o Sweet localizing device o Sweet film pedestal 1 Projection: o Lateral: 2 exposures ▪ CR perpendicular ▪ CR 15-25o cephalad 9/3/20XX Presentation Title 92  PFEIFFER-COMBERG METHOD A leaded contact lens is placed directly over the cornea Apparatus: o Contact lens localization device o Pedestal type of film holder 2 Projections: o Waters Method: ▪ CR horizontal o Lateral: ▪ CR perpendicular 9/3/20XX Presentation Title 93  FACIAL BONE 9/3/20XX Presentation Title 94  LATERAL PROJECTION PP: Semiprone; MSP & IOML parallel to IR; IPL perpendicular to IR RP: Zygoma/malar bone CR: Perpendicular SS: Superimposed facial bones Superimposed mandibular rami & orbital roofs 9/3/20XX Presentation Title 95 9/3/20XX Presentation Title 96 9/3/20XX Presentation Title 97 9/3/20XX Presentation Title 98 9/3/20XX Presentation Title 99  WATERS METHOD PARIETO-ACANTHIAL PROJECTION PP: Prone; MSP & MML perpendicular to IR; OML 37o to IR; nose ¾ in. (1.9 cm) away from IR RP: Acanthion (exit) CR: Perpendicular SS: Orbits, maxillae & zygomatic arches Best projection for facial bones Petrous ridges below the maxillae Blow out fractures 9/3/20XX Presentation Title 100 9/3/20XX Presentation Title 101  MODIFIED WATERS PP: Prone; MSP & MML perpendicular to IR; OML 55o to IR RP: Acanthion (exit) CR: Perpendicular SS: Facial bones w/ less axial angulation Petrous ridges below the inferior border of orbits 9/3/20XX Presentation Title 102 9/3/20XX Presentation Title 103 9/3/20XX Presentation Title 104  REVERSE WATERS METHOD AP AXIAL PROJECTION PP: Supine; MSP & MML perpendicular to IR; OML 37o to IR; chin up RP: Acanthion (exit) CR: Perpendicular SS: Superior facial bones; same as True/Original Waters, but the image is MAGNIFIED ER: For patient who cannot be placed in the prone position 9/3/20XX Presentation Title 105 9/3/20XX Presentation Title 106  CALDWELL METHOD PA AXIAL PROJECTION PP: Prone; forehead & nose against IR; OML perpendicular to IR RP: Nasion CR: 15o caudad or 30o caudad (Exaggerated Caldwell) SS: Orbital rims, maxillae, nasal septum, zygomatic bones & anterior nasal spine Petrous ridges at lower third of orbits (15o caudad) Petrous ridges below the inferior orbital margins (30o caudad) Orbital floors (30o caudad) 9/3/20XX Presentation Title 107 9/3/20XX Presentation Title 108  LAW METHOD PA OBLIQUE AXIAL PROJECTION PP: Semiprone; zygoma, nose & chin against IR; unaffected side against IR; OML perpendicular to IR; Center IR 2 in. above floor of maxillary sinuses RP: Lower antrum CR: 25-30o cephalad; posterior to gonion (entrance) SS: Floor & posterior wall of maxillary sinus (antrum) of side down External orbital wall Zygomatic bone Anterior wall of maxillary sinus of side up 9/3/20XX Presentation Title 109  NASAL BONE 9/3/20XX Presentation Title 110  LATERAL PROJECTION PP: Semiprone; MSP & IOML parallel to IR; IPL perpendicular to IR RP: ¾ in. (old) or ½ in. (new) distal to nasion CR: Perpendicular SS: Nasal bones of side down & soft tissue structures 9/3/20XX Presentation Title 111 9/3/20XX Presentation Title 112 9/3/20XX Presentation Title 113  TANGENTIAL PROJECTION PP: Extraoral Film (Cassette): prone; chin rested on sandbags; chin fully extended; MSP & GAL perpendicular to IR Intraoral Film (Occlusal Film): supine; head elevated; MSP perpendicular to sponge; GAL parallel to sponge & perpendicular to film RP: Glabelloalveolar line CR: Perpendicular SS: Nasal bones with minimal superimposition ER: For demonstration of any medial or lateral displacement of fragments in fractures Contraindications: Children or adults who have very short nasal bones, concave face or protruding upper teeth 9/3/20XX Presentation Title 114 9/3/20XX Presentation Title 115 9/3/20XX Presentation Title 116  WATERS METHOD PARIETO-ACANTHIAL PROJECTION PP: Prone; MSP & MML perpendicular to IR; OML 37o to IR; nose ¾ in. (1.9 cm) away from IR RP: Acanthion (exit) CR: Perpendicular ER: Displacement of bony nasal septum & depressed fx of nasal wings 9/3/20XX Presentation Title 117  ZYGOMATIC ARCHES 9/3/20XX Presentation Title 118  SCHULLER/PFEIFFER METHOD SUBMENTOVERTICAL PROJECTION PP: Supine or Seated-upright (more comfortable); IOML parallel to IR; MSP perpendicular to IR; head rested on vertex; neck hyperextended RP: 1 in. posterior to outer canthi CR: Perpendicular to IOML; MSP of throat b/n gonion (entrance) SS: Best demonstrates bilateral symmetric zygomatic arches Presentation Title 9/3/20XX Presentation Title 120 9/3/20XX Presentation Title 121  MODIFIED TITTERINGTON METHOD PA AXIAL (SUPEROINFIOR) PROJECTION PP: Prone; nose & chin against IR; MSP perpendicular to IR RP: Vertex midway b/n zygomatic arches CR: 23-38o caudad SS: Well shown zygomatic arches Presentation Title  MAY METHOD TANGENTIAL PROJECTION PP: Prone/seated; neck fully extended; IOML parallel to IR; MSP rotated 15o toward the side of interest; head tilted 15o RP: Zygomatic arch at 1.5 in. posterior to outer canthus CR: Perpendicular to IOML SS: Zygomatic arch free of superimposition ER: Useful with patients who have depressed fractures or flat cheekbones Presentation Title 9/3/20XX Presentation Title 124 9/3/20XX Presentation Title 125 9/3/20XX Presentation Title 126  MODIFIED TOWNE METHOD AP AXIAL PROJECTION JUG HANDLE VIEW PP: Supine; OML/IOML & MSP perpendicular to IR; RP: Glabella (1 in. above nasion) CR: 30o caudad (OML ┴); 37o caudad (IOML ┴) SS: Bilateral symmetric zygomatic arches free of superimposition Presentation Title 9/3/20XX Presentation Title 128  MANDIBLE Presentation Title  PA PROJECTION PP: Prone; forehead & nose against IR; OML & MSP perpendicular to IR RP: Acanthion (exit) CR: Perpendicular SS: Mandibular rami ER: To demonstrate any medial or lateral displacement of fragments in fractures of the rami Presentation Title 9/3/20XX Presentation Title 131  PA AXIAL PROJECTION PP: Prone; forehead & nose against IR; OML & MSP perpendicular to IR RP: Acanthion (exit) CR: 20 or 25o cephalad SS: Condylar processes; mandibular rami ER: To demonstrate any medial or lateral displacement of fragments in fractures of the rami Presentation Title 9/3/20XX Presentation Title 133  PA PROJECTION PP: Prone; nose & chin against IR; AML & MSP perpendicular to IR RP: Level of lips CR: Perpendicular SS: Mandibular body Presentation Title 9/3/20XX Presentation Title 135 9/3/20XX Presentation Title 136  PA AXIAL PROJECTION PP: Prone; nose & chin against IR; AML & MSP perpendicular to IR; fill the mouth with air to obtained better contrast around TMJs (Zanelli recommendation) RP: Midway b/n TMJs CR: 30o cephalad SS: Mandibular body; TMJs; condylar processes Presentation Title 9/3/20XX Presentation Title 138 9/3/20XX Presentation Title 139  AXIOLATERAL OBLIQUE PROJECTION PP: Seated/semiprone/semisupine; head in true lateral & IPL perpendicular to IR (ramus); head rotated 30o toward IR (body); head rotated 45o toward IR (symphysis); head rotated 10-15o toward IR (general survey); mouth closed; neck extended (prevent superimposition of cervical spine) RP: Mandibular region of interest CR: 25o cephalad SS: Mandibular body & TMJs ER: To place the desired portion of the mandible parallel with the IR Muscular/Hypersthenic Patients: MSP 15o & CR 10o cephalad To reduce the possibility of projecting shoulder over the mandible Presentation Title 9/3/20XX Presentation Title 141  SCHULLER/PFEIFFER METHOD SUBMENTOVERTICAL PROJECTION PP: Supine or Seated-upright (more comfortable); IOML parallel to IR; MSP perpendicular to IR; head rested on vertex; neck hyperextended RP: Midway b/n gonions CR: Perpendicular to IOML SS: Mandibular body; coronoid & condyloid processes of rami 9/3/20XX Presentation Title 142 9/3/20XX Presentation Title 143  SCHULLER METHOD VERTICOSUBMENTAL PROJECTION PP: Prone; chin fully hyperextended; IR against throat; MSP perpendicular to IR RP: Level just posterior to outer canthi CR: Perpendicular to IOML or occlusal plane SS: Condyle & neck of condylar processes are better shown (CR ┴ occlusal plane) 9/3/20XX Presentation Title 144 9/3/20XX Presentation Title 145 9/3/20XX Presentation Title 146  PANORAMIC TOMOGRAHY/ PANTOMOGRAPHY/ROTATIONAL TOMOGRAPHY -technique employed to produced tomograms of curved surfaces- Provides panoramic image of the entire mandible, TMJ, dental arches Provides distortion-free lateral image of the entire mandible Patients who sustained severe mandibular or TMJ trauma Useful for general survey studies of dental abnormalities Adjuvant for pre-bone marrow transplant 9/3/20XX Presentation Title 147 9/3/20XX Presentation Title 148 9/3/20XX Presentation Title 149  TEMPOROMANDIBULAR JOINTS Presentation Title  TOWNE METHOD AP AXIAL PROJECTION PP: Supine; MSP & OML perpendicular to IR Closed-mouth Position: posterior teeth in contact not incisors o Rationale: prevents mandibular protrusion & condyles to be carried out of mandibular fossae Opened-mouth Position: open as wide as possible o Mandible not protruded (jutted forward) o Not perform in trauma patients RP: 3 in. above nasion CR: 35o caudad SS: Mandibular condyles & mandibular fossae of temporal bones Closed-mouth: condyle lying in mandibular fossa Opened-mouth: condyles lying inferior to articular tubercle Presentation Title 9/3/20XX Presentation Title 152 9/3/20XX Presentation Title 153  AXIOLATERAL PROJECTION PP: Semiprone; head in lateral position; IPL perpendicular to IR; MSP parallel to IR; closed-mouth & opened-mouth position RP: 0.5 in. anterior & 2 in. superior to upside EAM CR: 25-30o caudad SS: TMJ anterior to EAM Closed-mouth: condyle lying in mandibular fossa Opened-mouth: condyles lying inferior to articular tubercle Presentation Title 9/3/20XX Presentation Title 155 9/3/20XX Presentation Title 156 9/3/20XX Presentation Title 157  SCHULLER METHOD AXIOLATERAL OBLIQUE/LATERAL TRANSCRANIAL/AXIAL TRANSCRANIAL PROJECTION PP: Semiprone; MSP rotated 15o toward the IR; AML parallel to transverse axis of IR; RP: 1.5 in. superior to upside EAM CR: 15o caudad; TMJ of sidedown (exit) SS: Condyles & neck of the mandible Closed-mouth: fracture of the neck & condyle of ramus Opened-mouth: mandibular fossa; inferior & anterior excursion of the condyle Presentation Title 9/3/20XX Presentation Title 159 9/3/20XX Presentation Title 160  INFEROSUPERIOR TRANSFACIAL POSITION PP: Semiprone; head in true lateral; IPL 10-15o from perpendicular; MSP 15o from IR RP: Uppermost gonion CR: 30o cephalad SS: TMJ Presentation Title  ALBERS-SCHONBERG METHOD LATERAL TRANSFACIAL POSITION PP: Semiprone; head in true lateral; IPL perpendicular to IR; MSP parallel to IR; IOML parallel to transverse axis of IR RP: TMJ closes to IR (exit) CR: 20o cephalad SS: TMJ 9/3/20XX Presentation Title 162  ZANELLI METHOD LATERAL TRANSFACIAL POSITION PP: Lateral recumbent; head in true lateral; head resting on parietal region; MSP 30o to IR RP: Uppermost gonion (entrance) CR: Perpendicular SS: TMJ 9/3/20XX Presentation Title 163  SINUSES 9/3/20XX Presentation Title 164  Cross & Flecker: pointed out the value of erect position To demonstrate presence or absence of fluid To differentiate between shadows caused by fluid & those caused by pathology Presentation Title  LATERAL PROJECTION PP: Upright RAO/LAO or dorsal decubitus (can’t assume upright); head in true lateral; MSP parallel to IR; IPL perpendicular to IR; IOML parallel to transverse axis of IR; RP: 0.5-1 in. posterior to outer canthus CR: Perpendicular SS: All paranasal sinuses Presentation Title 9/3/20XX Presentation Title 167  PA PROJECTION PP: Upright; forehead & nose against IR; MSP & OML perpendicular to IR RP: Nasion (┴); glabella (10o cephalad); midregion of maxillary sinuses (┴) CR: Perpendicular; 10o cephalad; perpendicular SS: Posterior ethmoid sinuses inferior to cranial bones & superior to anterior ethmoid sinuses (┴) Sphenoidal sinuses through frontal bone & superior to frontal & ethmoid sinuses Maxillary sinuses inferior to cranial base Presentation Title 9/3/20XX Presentation Title 169  CALDWELL METHOD PA AXIAL PROJECTION PP: Upright Angle grid technique: nose & forehead against IR; IR tilted 15o; MSP & OML perpendicular to IR Vertical grip technique: nose against IR; OML 15o from IR; sponge b/n forehead & IR; MSP perpendicular to IR RP: Nasion CR: Horizontal SS: Frontal sinuses & anterior ethmoidal sinuses 9/3/20XX Presentation Title 170 9/3/20XX Presentation Title 171 9/3/20XX Presentation Title 172  WATERS METHOD PARIETOACANTHIAL PROJECTION PP: Upright; neck hyperextended & rested against IR; OML 37o to IR; MML perpendicular to IR RP: Acanthion CR: Horizontal SS: Maxillary sinuses Petrous pyramids inferior to floor of maxillary sinus Foramen rotundum Distorted frontal & ethmoidal sinuses 9/3/20XX Presentation Title 173 9/3/20XX Presentation Title 174 9/3/20XX Presentation Title 175  OPEN-MOUTH WATERS METHOD PARIETOACANTHIAL PROJECTION PP: Upright; neck hyperextended & rested against IR; OML 37o to IR; MML perpendicular to IR; mouth wide open RP: Acanthion CR: Horizontal SS: Sphenoidal sinuses projected through open mouth Petrous pyramids inferior to floor of maxillary sinus ER: For the patients who cannot be placed in position for SMV 9/3/20XX Presentation Title 176 9/3/20XX Presentation Title 177  SCHULLER METHOD SUBMENTOVERTICAL PROJECTION PP: Upright; IOML parallel to IR; MSP perpendicular to IR; head rested on vertex; neck hyperextended RP: ¾ in. anterior to EAM (sella turcica) CR: Perpendicular to IOML; MSP of throat b/n gonion (entrance) SS: Sphenoidal & ethmoidal sinuses Anterior portion of the base of the skull 9/3/20XX Presentation Title 178 9/3/20XX Presentation Title 179  SCHULLER METHOD VERTICOSUBMENTAL PROJECTION PP: Seated-erect; chin fully hyperextended; MSP perpendicular to IR RP: ¾ in. anterior to EAM (sella turcica) CR: Perpendicular to IOML; MSP of throat b/n gonion (entrance) SS: Sphenoidal sinuses Posterior ethmoidal sinuses Maxillary sinuses Nasal fossae Presentation Title 9/3/20XX Presentation Title 181  PIRIE METHOD AXIAL TRANSORAL POSITION PP: Upright (prone; nose & chin against IR; mouth wide open; MSP perpendicular to IR; phonate “ah” during exposure RP: ¾ in. anterior to EAM (sella turcica) CR: Perpendicular SS: Sphenoidal sinuses projected through open mouth Maxillary sinuses Nasal fossae 9/3/20XX Presentation Title 182  RHESE METHOD PA OBLIQUE POSITION PP: Seated-erect; zygoma, nose & chin against IR; AML perpendicular to IR; MSP 53o from IR RP: Upper parietal region CR: Perpendicular SS: Oblique image of posterior & anterior ethmoidal sinuses Frontal & sphenoidal sinuses Profile image of the optic canal a Presentation Title  LAW METHOD PA OBLIQUE POSITION PP: Seated-erect; zygoma, nose & chin against IR; neck fully extended RP: Uppermost gonion CR: 25-30o cephalad SS: Relationship of teeth to maxillary sinuses 9/3/20XX Presentation Title 184  MASTOID Presentation Title  LAW METHOD AXIOLATERAL POSITION Double Angulation Method PP: Prone; head in true lateral; tape auricle forward; MSP & IOML parallel to IR; IPL perpendicular to IR RP: 2 in. posterior & 2 in. superior to uppermost EAM CR: 15o caudad & 15o anterior Lange Recommendations: 25o caudad & 20o anterior Auricles taped forward Single Angulation Method PP: Prone; tape auricle forward; MSP rotated 15o toward IR RP: 2 in. posterior & 2 in. superior to uppermost EAM CR: 15o caudad Presentation Title 9/3/20XX Presentation Title 187  Part Angulation Method PP: Prone; head rested on flat surface of cheek; tape auricle forward; MSP rotated 15o towards IR; IPL 15o from vertical RP: 2 in. posterior & 2 in. superior to uppermost EAM CR: 15o caudad & 15o anterior SS: Mastoid cells Sigmoid sinus Lateral portion of pars petrosa Tegmen tymphani Superimposed internal & external auditory meatuses Mastoid emissary vessel (when present) Presentation Title  MODIFIED HICKEY METHOD AP TANGENTIAL POSITION PP: Supine; tape auricles forward; face rotated away from side of interest; MSP 55o from IR or 35o from vertical; IOML perpendicular to IR; IR caudally inclined 15o RP: 1 in. superior to tip of mastoid process CR: 15o caudad SS: Mastoid process free of superimposition Projected below the shadow of occipital bone Presentation Title  PA TANGENTIAL POSITION PP: Prone; IR cranially inclined 15o; tape auricles forward; cheek against IR; face rotated away from side of interest; MSP 55o from IR or 35o from vertical; IOML perpendicular to IR RP: 1 in. superior to tip of mastoid process CR: 15o cephalad SS: Mastoid process free of superimposition Projected below the shadow of occipital bone Presentation Title  TOWNE METHOD AP AXIAL PROJECTION PP: Supine; OML/IOML & MSP perpendicular to IR; RP: 2 in. above glabella or 2.5 in. above nasion CR: 30o caudad (OML ┴); 37o caudad (IOML ┴) SS: Internal auditory canals Petrous portion of temporal bone Labyrinths Mastoid antrum Middle ears Dorsum sellae w/in foramen magnum Presentation Title  HENSCHEN, SCHULLER, & LYSHOLM METHODS AXIOLATERAL POSITIONS PP: Semiprone; head in true lateral; MSP parallel to IR; IPL perpendicular to IR; IOML parallel to transverse axis of IR; auricles taped forward RP: Dependent EAM closest to IR CR: 15o caudad (Henschen/Cushing); 25o caudad (Schuller); 35o caudad (Lysholm/Runstrom II) SS: Mastoid & petrous portion Mastoid cells, mastoid antrum, IAM & EAM & tegmen tympani (Henschen) Tumors of the acoustic nerve (Cushing) Pneumatic structures of mastoid process, mastoid antrum, tegmen tympani, IAM & EAM, sinus & dural plates & mastoid emissary when present (Schuller) Mastoid cells, matoid antrum, IAM & EAM, tegmen tympani, labyrinthine area & carotid canal (Lysholm/Runstrom II) Runstrom Recommendation: Exposure made with open mouth For visualization of petrous apex between anterior wall of EAM & mandibular condyle 9/3/20XX Presentation Title 192 9/3/20XX Presentation Title 193  PETROUS PORTION 9/3/20XX Presentation Title 194  TOWNE METHOD AP AXIAL PROJECTION PP: Supine; OML/IOML & MSP perpendicular to IR; RP: MSP b/n EAMs CR: 30o caudad (OML ┴); 37o caudad (IOML ┴) SS: Petrosae above base of the skull IAM Arcuate eminences Labyrinths Mastoid antrum Middle ears Dorsum sellae w/in shadow of foramen magnum 9/3/20XX Presentation Title 195  HAAS METHOD PA AXIAL PROJECTION PP: Prone; MSP & OML perpendicular to IR; forehead & nose against the table; IR center 1 in. to nasion RP: Nasion CR: 25o cephalad SS: Symmetric axial frontal image of petrous portions projected above the base of the skull IAM Labyrinths Mastoid antrums Middle ears Dorsum sellae & posterior clinoid processes w/in shadow of foramen magnum ER: For patients who cannot assume AP axial position 9/3/20XX Presentation Title 196  VALDINI METHOD PA AXIAL PROJECTION PP: Recumbent or seated-erect (more comfortable); upper frontal region of skull against IR; MSP perpendicular to IR; head acutely flexed; IOML 50o/OML 50o; line extending from inion to 0.5 cm distal to nasion form 28o to CR RP: 0.5 cm distal to nasion (dorsum sellae); foramen magnum at or slightly above level of EAM (petrosae) CR: Perpendicular; inion (entrance); 0.5 cm distal to nasion (exit) SS: DILA (IOML 50o): Dorsum sellae; Internal Auditory Meatus (IAM); LAbyrinth ETB “EaT Bulaga” (OML 50o): External auditory meatus; Tymphanic cavity; Bony part of Eustachian tube 9/3/20XX Presentation Title 197  SCHULLER/PFEIFFER METHOD SUBMENTOVERTICAL (SUBBASAL) PROJECTION PP: Supine or Seated-upright (more comfortable); OML parallel to IR or CR perpendicular to OML (cannot fully extend the neck) or supraorbitomeatal line (SOML) parallel to IR; MSP perpendicular to IR; head rested on vertex; neck hyperextended RP: ¾ in. anterior to EAM (sella turcica) CR: Perpendicular to OML at midway b/n EAMs or 15-20o anteriorly at MSP of throat 1 in. anterior to EAMs SS: Symmetric petrosae Mastoid processes Labyrinths EAMs Tympanic cavities Acoustic/auditory ossicles Hirtz Method: RP: Midway b/n & 1 in. anterior to EAMs CR: 5o anteriorly 9/3/20XX Presentation Title 198  MAYER METHOD AXIOLATERAL OBLIQUE PROJECTION PP: Supine; auricles taped forward; outer side of IR elevated (reduces part-film distance); MSP 45o from IR; chin depressed; IOML parallel to IR RP: Dependent EAM CR: 45o caudad SS: Axial oblique of petrosa Petrosa inferior to mastoid air cells EAM Tympanic cavity & ossicles Epitympanic recess (attic) Aditus Mastoid antrum 9/3/20XX Presentation Title 199  Owen Modifications: cited by Pendergrass, Schaeffer & Hodes PP: MSP 40o to IR; IR & head angled 10o caudally CR: 28o caudally Owen Modifications: described by Etter & Cross PP: MSP 30o to IR CR: 25-30o caudally Owen Modifications: described by Compere PP: MSP 30-45o to IR CR: 30o caudally Owen Modifications: used by Zizmor PP: MSP 15o to IR CR: 35o caudally 9/3/20XX Presentation Title 200 9/3/20XX Presentation Title 201 9/3/20XX Presentation Title 202  STENVERS METHOD POSTERIOR PROFILE POSITION PP: Prone; forehead, nose & zygoma against IR (3-pt Upper Landing); IOML parallel to transverse axis of IR; face rotated away from side of interest; MSP 45o to IR RP: 1 in. anterior to EAM closest to IR (exit) CR: 12o cephalad SS: Pars petrosa closest to IR Petrous ridge Cellular structure of mastoid process Mastoid antrum Area of tympanic cavity Labyrinth IAM Cellular structure of petrous apex 9/3/20XX Presentation Title 203 9/3/20XX Presentation Title 204  ARCELIN METHOD ANTERIOR PROFILE POSITION REVERSE STENVERS METHOD PP: Supine; IOML perpendicular to IR; face rotated away from side of interest; MSP 45o to IR RP: 1 in. anterior & ¾ in. superior to EAM closest to IR (exit) CR: 10o caudad SS: Magnified pars petrosa away from IR ER: Useful with children & with adults who cannot be position for Stenvers Method 9/3/20XX Presentation Title 205 9/3/20XX Presentation Title 206  MODIFIED LAW METHOD AXIOLATERAL POSITION Single Angulation Method PP: Prone; taped auricle forward; Head rotated 15o toward IR; MSP 15o RP: 2 in. posterior & 2 in. superior to uppermost EAM CR: 15o caudad SS: Mastoid cells Lateral portion of pars petrosa Superimposed IAM & EAM Mastoid emissary vessel (when present) 9/3/20XX Presentation Title 207  Styloid process of temporal bone 9/3/20XX Presentation Title 208  PA AXIAL PROJECTION CAHOON METHOD PP: prone; forehead and nose ; OML perpendicular CR: 25 cephalad SS: styloid process of temporal bone 9/3/20XX Presentation Title 209 9/3/20XX Presentation Title 210  Jugular Foramina 9/3/20XX Presentation Title 211  SUBMENTOVERTICAL AXIAL PROJECTION KEMP HARPER M ETHOD ERASO MODIFICATION2 PP: OML is parallel to IR CR: 25 caudad RR: EAM Eraso modification: OML 25 degree to IR CR: 2 inches distal to mandibular symphesis 9/3/20XX Presentation Title 212 9/3/20XX Presentation Title 213  Hypoglossal Canal 9/3/20XX Presentation Title 214  AXIOLATERAL OBLIQUE PROJECTION MILLER METHOD Anterior profile PP: supine position; head 45 degrees away from the side being examined; OML // to IR CR: 12 caudad ; 1inch inferior of EAM SS: hypoglossal canal 9/3/20XX Presentation Title 215 9/3/20XX Presentation Title 216