OBJECTIVES
•
•
•
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Skull, Sinus and Orbit anatomy
Vascular anatomy
Neck anatomy
Clinical cases
SKULL ANATOMY
SINUSES
PA view
2
6
4
3
1
5
1.
Nasal Septum
2.
Frontal Sinus
3.
Maxillary Sinus
4.
Ethmoid Sinus
5.
Inferior Turbinate
6.
Superior orbital fissure
1- Superior orbital fissure
2- Inferior orbital foramen
3- Mental foramen
1
2
1
2
3
3
Fissures and foramen have
nerves that show on lab
practicals.
OPTIC CANAL
AP WATERS VIEW
SINUSES
1. Frontal sinus
1
2. Zygomatic-Frontal Suture
3. Maxillary Sinus
4. Inferior orbital margin
2
3
4
This view is angled to project the maxillary sinuses free of the petrous ridge.
Note the opacified right maxillary sinus with fluid
layering dependently indicating sinusitis
WHAT RECTUS MUSCLE CAN BE INJURED
BY EYE TRAUMA?
• Superior
• Inferior
• Medial
• Lateral
ORBITAL FLOOR FRACTURE
Arrow points to bone fragment
displaced into orbit. The inferior
rectus muscle can become
entrapped in fracture
CT FACIAL
CORONAL SCAN
CT scans redemonstrate fracture and edema at site.
1. Frontal Sinus
2. Maxillary Sinus
1
3. Ethmoid Sinus
4. Sphenoid
Sinus
3
2
4
LATERAL SINUS & SKULL
Middle meningeal artery
FRACTURE
EPIDURAL
HEMATOMA
Cause: Laceration of the
meningeal artery adjacent to
inner table.
Sella
CAROTID CANAL
JUGULAR FORAMEN
CT SKULL BASE
PINNA
MANDIBULAR
CONDYLE
MASTOID AIR CELLS
CT SKULL BASE
SKULL BASE
FRACTURE
“RACCOON EYES”
Periorbital ecchymosis is a sign of a basal skull
fracture. Blood tracks along the periosteum and can
collect in soft tissues of the orbital lid.
ZYGOMATIC ARCH
EXTERNAL
AUDITORY
CANAL
CT SKULL BASE
FORAMEN OVALE
PETROUS CAROTID CANAL
FORAMEN
SPINOSUM
CLIVUS
CT SKULL BASE
CAROTID CANAL
OSSICLES
IAC
INTERNAL AUDITORY CANAL
CT SKULL BASE
Acoustic neuroma is a slow growing tumor
that develops on the 8th cranial nerve.
Symptoms include unilateral loss of hearing,
Tinnitus-ringing in ears. dizziness and vertigo.
SINUS AND ORBIT
ANATOMY
SINUSES
PA view
1
3
2
1.
Frontal Sinus
2.
Maxillary Sinus
3.
Ethmoid Sinus
AP WATERS VIEW
SINUSES
1
1.
Frontal sinus
2. Zygomatic-Frontal Suture
2
3. Maxillary sinus
3
4. Inferior orbital margin
4
This view is angled to project the maxillary sinuses free of the petrous ridge.
1. Frontal Sinus
2. Maxillary Sinus
1
3. Ethmoid Sinus
4. Sphenoid Sinus
3
5
4
2
LATERAL SINUS & SKULL
5. Sella Turcica
CT- SINUS
AXIAL VIEW
1
1. Frontal Sinus
Scans start superiorly and are shown going inferiorly
CT SINUS
AXIAL SCAN
normal
Note the destroyed
posterior wall of the left
frontal sinus due to
bacterial invasion.
CT- SINUS
AXIAL VIEW
1
1. Ethmoid sinus
2
3
2. Sphenoid sinus
3. Carotid canal
CT- SINUS
AXIAL VIEW
1
4
5
1. Maxillary sinus
2.
Med. & Lat.
Pterygoid plate
3. Nasopharynx
3
2
4. Nasal septum
5. Inferior
turbinate
CT- SINUS
Coronal sections extending from
anterior to posterior
2
1
1. Fronto-nasal
suture
3
2. Frontal sinus
3. Nasal bones
CT- SINUS
CORONAL VIEW
1
3
1. Ethmoid sinus
2. Maxillary sinus
3. Middle turbinate
CT- SINUS
CORONAL VIEW
Maxillary sinus
CT- SINUS
CORONAL VIEW
3
1
1. Sphenoid sinus
2. Hard palette
3. Anterior clinoid
2
CT ORBIT
AXIAL SCAN
1
2
3
4
1. Retro orbital fat
2. Medial rectus
3. Lens
4. Lateral rectus
5. Optic nerve
5
AXIAL SCAN
Optic
nerves
CORONAL SCAN
Chiasm
MR SCAN
In Biblical liturature who showed
a knowledge of cranial nerve
anatomy?
• Moses
• Noah
• David
• Goliath
Normal
Sella Mass
Compare the normal with the enlarged pituitary adenoma. The mass
impinges on the optic chiasm to create the visual disturbance.
NECK ANATOMY
3
LATERAL
NECK
1
2
4
5
1. Hard palate
2. Soft palate
3. Nasopharynx
4. Oropharynx
5.
Epiglottis
AIRWAY
1. Calcified tracheal
cartilage rings
3
2. Hyoid bone
3. Epiglottis
4. Thyroid cartilage
2
5. Cricoid cartilage
5
4
1
LATERAL VIEW OF NECK
3
AIRWAY
1. Calcified tracheal
cartilage rings
2
2. Hyoid bone
5
3. Epiglottis
4. Thyroid cartilage
4
5. Cricoid cartilage
1
LATERAL VIEW OF NECK
Where do you insert the tube at an
emergency tracheostomy?
Cricothyroid membrane
LATERAL VIEW OF NECK
LT
MAXILLARY SINUSES
SCAN LEVEL
ZYGOMA
ZYGOMA
SPHENOID
SINUS
Sections from the skull base
extending inferiorly through the
neck.
MANDIBULAR
CONDYLE
MAXILLA
LT
SCAN LEVEL
EXTERNAL
AUDITORY
MEATUS
NASOPHARYNX
MASTOIDS
MANDIBLE
SCAN LEVEL
MASSETER
MUSCLE
LT
MASSETER
MUSCLE
PTERYGOID
MUSCLES
PAROTID
GLAND
SUBMANDIBULAR
GLAND
SCAN LEVEL
EPIGLOTTIS
STERNOCLEIDOMASTOID
MUSCLE
SUBCUTANEOUS
FAT
LT
LT
HYOID BONE
SCAN LEVEL
VALLECULA
PYRIFORM SINUS
JUGULAR
VEIN
JUGULAR
VEIN
COMMON CAROTID
ARTERIES
LT
SCAN LEVEL
THYROID CARTILAGE
VOCAL CORD
THYROID CARTILAGE
LT
SCAN LEVEL
COMMON CAROTID
ARTERY
JUGULAR
VEIN
CRICOID
CARTILAGE
LT
SCAN LEVEL
THYROID
GLAND
CLAVICLE
CLAVICLE
TRACHEA
ESOPHAGUS
SWALLOWING
STUDY
1
2
3
4
Note hyoid bone moves anteriorly and superiorly with swallowing.
THYROID
SCAN
Nuclear Medicine
SAGITTAL
THYROID
SCAN
SAGITTAL SCANS
LEFT LOBE
RIGHT LOBE
NUCLEAR MEDICINE
THYROID SCAN
Normal
Hypo-functional
PATIENT PRESENTS WITH WHEEZING
AND NECK MASS IN MIDLINE AT
STERNAL NOTCH
Chest x-ray showing superior
Mediastinal mass with displacement
of the trachea to the right. Nuclear
Medicine I123 thyroid scan shows
lobular mass extending inferiorly
from the thyroid indicating a thyroid
goiter accounting for displacement
on chest x-ray.
THYROID
SCAN
Nuclear Medicine
CORONAL CT SCANS SHOWS THYROID LESION.
ARTERIOGRAM
2
1. Internal carotid
artery
2. Intracranial carotid
3. Maxillary artery
4. Occipital artery
3
4
7
1
5. External carotid
artery
6. Common carotid
artery
7. Facial artery
5
6
WHAT VESSEL HAS TO BE LIGATED OR
EMBOLIZED TO CONTROL EPISTAXIS IF
PACKING NOSE FAILS?
• Maxillary
• Facial
• Lingual
• Superficial temporal
Here injection into the external
carotid shows extravasation of
blood from a branch of the maxillary
artery compared with the normal.
normal
Maxillary artery
EMBOLIZATION
Radiologist has directed a coil
through the catheter to occlude
vessels that were bleeding.
ASYMPTOMATIC
BRUIT ON
PHYSICAL EXAM
Normal
Abnormal
Normal
Ultrasound and arteriogram show high grade narrowing
of internal carotid artery due to atherosclerosis.
HOARSENESS
ASPIRATION
NORMAL
A small amount of barium has spilled anteriorly with aspiration into the airway.
Hiatal hernia and reflux.
Here two patients with masses in their chest have involvement of the
recurrent laryngeal nerve causing hoarseness due to vocal cord paralysis.
LARGE THORACIC
ANEURYSM
LUNG
MALIGNANCY
Amoebic meningitis can be contracted in
southern states from swimming in
warm lake water in summer by what
route?
• Ear infection
• Aspiration into airway
• Mosquito bite
• Ethmoid transmission