MANDIBLE, SINUSES, TEMPORAL BONE Wynn Harrison, MEd NEW WORDS • Sinusitis: Inflammation of the sinuses • Mucocele: Enlargement of the lacrimal sac. Cystic disease of the air cavities – causes erosion of the bone • Retention Cyst: A cyst retaining the secretion of a gland, ie: mucosal or sebaceous cyst Mastoiditis: Inflammation of the mastoid sinus • Otitis: Inflammation of the ear: ie: otitis media; can be internal or external • Acoustic Neuroma: benign tumor of the eighth cranial nerve. Symptoms = hearing loss, pain, headache, balance problems. Mandible Mandible Projections • Axiolateral--head lat. position with tilt 15 degree to IR. 15 degree ceph angle of CR • PA skull-- CR at lips • Townes-- coned to Ramus • SMV of mandible AP Semi-Axial (Townes) • OML = 30 degrees • IOML = 37 degrees • Center midramus Townes view for rami PA Mandible • OML perpendicular to IR • Center midmandible PA Mandible Nice axiolateral mandible Axiolateral Mandible • Head tilt 15 degrees • CR 15 degrees cephalic SMV Mandible, (Shuller, full Axial view) • IOML parallel to IR and perpendicular to CR. • Image mentum skimming frontal bone • Merrill’s 12 th Ed. p. 351 Temporomandibular joints Two types of Schuller views FIRST is full Axial (SMV) Second is true lateral with 15 degree Caudal angle (3 similar views: Henshen 15 degree caud. , Shuller 25 degree caud. , Lysholm 35 degree caud. angle) Schullers Projection • The Schullers Projection can be used to evaluate the temporal mandibular joints and mastoid air cells and inner ear. Schullers Protection for TMJ • Open and closed mouth view are taken of both TM joints. • The TMJ closest to the Bucky will be the one seen at the center or top of the film. • Accurate positioning is essential to being able to compare joints. Cone-Down of TMJ • Relaxed Lateral with 15 degree caudal angulation (Laws Position) Open & closed mouth (Laws position) TMJ Syndrome • Clicking, pain in TMJ • May indicate dysfunction of the TMJ • Caused by inflammation, stress, muscle spasm, etc. Paranasal Sinuses Lateral Sinus Sinuses: Caldwell Frontal Ethmoid Maxillar y Water’s view (sinuses) Maxillary Sinus Petrous Pyramids Waters Projection • Waters projection demonstrates: • Cloudy maxillary sinuses worse on left. • Sinus infection that needed antibiotics. OPEN MOUTH WATERS FOR SINUSES: SHOWS SPHENOID SINUS IN OPEN MOUTH SMV - Sinuses • Demonstrates sphenoid sinus • Merrill’s p. 379 • 12th Ed. PATHOLOGY Occipital fracture Pencil in 4 yr. old orbit Spear exiting skull Girl 2 wks post shooting Mandibular Ramus Fracture fracture Fracture to Mandible and Zygomatic Arches Panerex--Bilateral Fracture Mandible Mastoid Positions not on test or Registry Not on test Temporal Mandibular Bone & Mastiods • • • • • • Law Method Sheuller Method (SMV view) Arcelin Method-(pyramid on end) Meyers Method- (on end) Owen Method(in profile) Hickey Method- (in profile) Law (15 degrees to the nose and 15 to the toes) Head in relaxed lateral position Saggital plane 15 degrees to nose CR 15 degrees caudal Schuller Full Axial view IOML perpendicular to CR Visualized petrous pyramids in profile Arcelin PT in AP position OML perpendicular to table Head rotated 45 obl CR 12 caudal Collimate to ear side up) Arcelin position Stenvers Method Pt. PA Head rotation 45 degrees Center over side up Stenvers Meyers • • • • • PT AP OML perpendicular to IR Head rotated 45 degrees CR 45 degrees caudal Image ear side down Owens • PT in AP position • OML perpendicular to IR • Head rotated to 30 degree angle to IR • Image ear side down Owens Petrous pyramid Henschen Hickey Position • • • • Nose and forehead an table 45 degree head rotation to IR 15 degree cephalic angle CR over side down