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