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11 Cards in this Set
- Front
- Back
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What are the routine views of the zygomatic arches?
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SMV (1), AP axial Modified Towne(1), Tangential oblique inferosuperior(2), Parietoacanthial Waters(1)
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Submentovertex (SMV)
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8x10 IR crosswise
Pt. pos.: erect or supine Part pos: hyperextend neck until IOML is parallel w/ IR & rest vertex on IR, Enter CR: 1" posterier to outer canthus & Exit vertex, Tube angle: none perpendicular to IOML Anatomy seen: **zygomatic arches, zygoma, zygomatic process of temporal bone, temporal process of zygoma, soft tissue outline of skull Evaluation criteria: zygomatic arches free from overlying structures, sygomatic arches symmetric & w/o foreshortening |
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ZYGOMATIC ARCHES SMV
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SID: 48” Film size: 8x10”
Pt.pos: seated upright or supine position Part pos.: Hyperextend pt’s neck completely, IOML perpendicular to IR, rest vertex of pt’s head on IR, MSP perpendicular to plane of IR Central ray: Enter perpendicular to IOML 1” posterior to outer canthus Exit vertex Anatomy seen: Zygomatic arches*, zygoma, zygomatic process of temporal bone, soft tissue outline of skull , temporal process of the zygoma Evaluation criteria: Zygomatic arches free from overlying structures Zygomatic arches symmetric and w/o foreshortening Technique: 60-70 kVp |
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ZYGOMATIC ARCHES-AP axial (Modified Towne)
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SID: 48 inches Film size: 8x10 crosswise
little piece of bone - chin doesn’t have to be on film Pt position: Erect or supine Part position: OML perpendicular to IR, Use IOML (perp. to the IR) if pt. cannot move head CR: Enter:Glabella Exit:pass through b/t the arches Tube angulation:30° caudad for OML, 37° caudad for IOML Anatomy seen: Zygomatic arches*(temporal process of zygomatic bone zygomatic process of the temporal bone), mastoids, ramus and occipital bone Evaluation criteria: No overlap of zygomatic arches by mandible No rotation evident because arches are symmetricZygomatic arches projected lateral to mandibular rami Technique: 60-70 kVp |
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ZYGOMATIC ARCHES-TANGENTIAL Oblique Inferosuperior
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Film size: 8x10 (2 separate or 2 on one film) Pt. Position: Erect or supine Part position: Hyperextend neck to make the IOML parallel to the IR (to start out). Erect- Rotate the MSP 15° towards the side of interest. Tilt the chin 15°away from the side of interest. Supine then rotate and tilt 15°toward the side of interest. (hard to stay in this position) Central ray: Enter-perpendicular to IOML skimming the parietal and mandible (side of face) Exit- towards the IR (shooting x-ray through the hole to pop it out even more. BILATERAL EXAM CR: perpendicular to IOML Enter: centered to zygomatic arch 1” posterior to outer canthus, Exit: towards IR Tube angle: None Anatomy seen: **Zygomatic arches**, Zygomatic process of temporal bone and temporal process of the zygoma Evaluation criteria: Zygomatic arch free from overlying structure, Zygomatic arch not overexposed
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Parietoacanthial (Waters) Zygomatic arches
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SID: 48 inches Film size: 8 x 10 in (18 x 24 cm) length wise
Pt pos: Erect or prone Part position: Adjust neck so that the OML forms a 37°angle with the IR, MML perpendicular to IR, MSP perpendicular to IR CR: Enter- halfway b/t vertex and occiput Exit- Acanthion Tube angulation: None Anatomy seen: Oblique view of facial bones Orbits, **Zygoma**, Mandible, nasal septum , anterior nasal spine, maxillary sinus, inferior orbital rim Evaluation Criteria: Distance between the bony nasal septum and the lateral border of the skull should be equal on both sides Petrous ridges projected immediately below maxillary sinuses Distance between orbits & lateral border of skull should be equal on both sides |
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TMJ’S-AP AXIAL Modified TOWNE open & closed mouth
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SID: 48 inches Film size: 8 x 10 lengthwise Pt. Position: Supine or Erect Part position: OML perpendicular to IR
CR: Enter 3” above the nasion Exit b/t the TMJs Tube angulation: 35°caudad closed/open mouth For relationship b/t condyle & fossae go up 5° Anatomy seen: TMJs*, condyles, TM fossae, ramus Evaluation criteria: Condyles symmetric & lateral to C-spine Clear visualization of condyle & fossa relationship. Minimal superimposition of pars petrosa on the condyle in the closed-mouth exam Condyle and temporomandibular articulation below pars petrosa in open-mouthed position |
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TMJ’s-Axiolateral Transcranial (Schüller) Open and close mouth
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SID: 48 inches Film size: 8 x10 crosswise Pt. Position: Semi prone or semi PA Part position: Place patient in lateral position (IOML parallel to the cross axis of film & IPL perpendicular to IR) CR: Enter-1/2” anterior & 2” superior to upside EAM,Exit- down side TMJ Tube angulation: 25-30°caudad Anatomy seen: **TMJ*, Condyle, TM fossa, mastoids and orbital margins Evaluation criteria: Condyle will be elongated Temporomandibular articulations lying anterior to the EAM Condyle lying in mandibular fossa in closed-mouth examination Condyle lying inferior to articular tubercle in the open-mouth examination if the patient is normal and able to open mouth widely
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MASTOIDS/TEMPORAL BONE AXIOLATERAL OBLIQUE MODIFIED LAW
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SID: 48 inches Film size: 8x10 Crosswise
Pt. Position: Prone or Upright, tape auricles forward Part position: Lateral to start, rotate patient’s head toward IR to make MSP 15° CR: Enter 2” posterior &2” superior to up side EAM, Exit downside mastoid tip Tube angulation: 15°caudad Anatomy seen: Mastoid cells*, petrous ridges, IAM, and EAM, bony labyrinths, and TMJ Evaluation Criteria: Mastoid process closest to IR with air cells centered to IR Opposite mastoid process not superimposed but lying inferior and slightly anterior to mastoid process of interest Auricle of ear not superimposing mastoid process, Superimposition of IAM and EAM, TMJ visible anterior to mastoid process |
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MASTOID/TEMPORAL BONE AXIOLATERAL OBLIQUE-STENVERS POSTERIOR PROFILE
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SID: 48 “ Film size: 8x10 Lengthwise Pt. Position: Prone or Upright Part position: Lateral to start, rotate patient’s head toward IR MSP will be 45°for mesocephalic, more than 45°for dolichocephalic and for brachycephalic less than 45°
CR Enter:3-4”posterior & ½” inferior to upside EAM Exit:1 “ anterior to the downside EAM Tube angulation: 12° cephalad Anatomy seen: **Mastoid cells*, petrous ridges, bony labyrinths, tympanic cavity and IAC Evaluation criteria: IAC, Cochlea, and bony labyrinths below the petrous portions, Petromastoid portion in profile w/o distortion, Petrous ridge extended to a point aprx. 2/3 up the lateral border of orbit, (Dangling Grape effect!), Mastoid process in profile below margin of cranium (air cells not well visualized when internal aspects of the petrosa are properly exposed, Posterior margin of mandibular ramus superimposing lateral border of cervical column Mandibular condyle projecting over the atlas near petrosa |
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AP Axial Towne Mastoid/Temporal
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SID 48”
Film 10x12” lengthwise Pt. position: erect or supine Part pos.OML perp. to IR, MSP perp.to IR (use IOML if pt. can’t move head) Tube angle: 30 degrees caudal for OML and 37degrees caudal for IOML Anatomy seen:**mastoid air cells,*petrous portion, *dorsum sellae, *posterior clinoid process, *foramen magnum, *bony labyrinths Evaluation criteria: petrous portion symmetric, dorsum sellae seen w/in the foramen magnum, entire petrous ridges and mastoids visible, equal distance from lateral border of skull to lateral border of foramen magnum |
