Facial Bone Anatomy
& Positioning
RTEC 233
Anterior Aspect of Facial Bones
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2 Maxillae
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2 Zygomatic bones
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2 Lacrimal bones
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2 Nasal bones
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2 Inferior nasal conchae
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2 Palatine bones (not visualized
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1 vomer
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1 mandible
Palatine Bones
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L-shaped bones
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Horizontal portion forms
posterior hard palate
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Vertical portion extends
between 1maxillae and 1
pterygoid plate of sphenoid
bone
Articulates with 2 cranial
bones and 4 facial bones
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Zygomatic Bones
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Forms cheeks
Forms lower outer
margin of orbits
Articulates with 3 cranial
bones
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Frontal
Sphenoid
Temporal
Articulates with maxillae
Inferior Nasal Cochae
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The only pair of conchae
that are separate facial
bones
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Articulates with 1 cranial
bone and 3 facial bones
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Covered with mucous
membranes to warm,
moisten and cleanse
inhaled air
Lacrimal Bones
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About the size & shape of a
fingernail
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Lacrimal foramen for tear
duct
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Lie anteriorly on the medial
side of orbit
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Can be seen on PA and
lateral projections
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Articulates with 2 cranial
bones and 2 facial bones
Nasal Bones
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Fused and form bridge
of nose
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Vary in size considerably
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The point of junction
with the frontal bone is
the nasion
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Articulates with 2 cranial
and 2 facial bones
Vomer
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Forms inferosuperior
part of nasal septum
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Deviated nasal septum
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Depressions for blood
vessels
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Articulates with 2 cranial
bones & 4 facial bones
Mandible
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Only movable bone in
the skull
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Densest & largest facial
bone
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2 bones at birth
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Contains mental
foramina
Pathologic Indications for
Facial Radiography
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Fractures
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Blowout
Tripod
LeFort
Coutrecoup
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Foreign Body
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Osteomyelitis
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Neoplasms
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Secondary
Osteomyelitis
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TMJ Syndrome
Tri-pod Fracture
Blow out fracture
LeFort Fractures
FIG 3 - LeFort lines used for classifying fractures of the middle third of the face.
Hodgkinson, D W et al. BMJ 1994;308:46-50
Copyright ©1994 BMJ Publishing Group Ltd.
Positioning: Lateral Facial bones
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Semiprone or seated
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MSP parallel
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IPL perpendicular
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Suspend respiration
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CR is perp and enters
lateral zygomatic bone ½
way between outer
canthus and EAM.
Lateral Facial Radiograph
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All facial bones in with
zygomatic bone in center
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Almost SI mandibular
rami
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SI orbital roofs (no tilt)
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No rotation of sella
turcica
Anatomy Identity
Radiograph Anatomy
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E) Anterior nasal spine
F) Alveolar process of
maxilla
G) Alveolar process of
mandible
H) Mentum
J) Body of mandible
K) Angle of mandib le
L) Ramus of mandible
M) Coronoid process
O) Neck of mandibular
condyle
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P) Condyle or neck of
mandible
Q) EAM
R) Temporalmandibular fossa
of temporal bone
S) Greater wings of sphenoid
T) Lesser wings of sphenoid
U) Ethmoid sinuses between
orbits
V) Body of maxilla
containing maxillary sinuses
Anatomy Identity
Lateral Skull Anatomy
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A) zygomatic arch
B) RT zygomatic bone
C) RT nasal bone
D) Frontal process of
maxilla
E) Anterior nasal spine
F) Alveolar process of
maxilla
G) Alveolar process of
mandible
H) Mentum
I) Mental foramen
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J) Body of mandible
K) Angle (gonion)
L) Ramus of mandible
M) Coronoid process
N) Mandibular notch
O) Neck of mandibular
condyle
P) Condyle or head of
mandible
Q) EAM
Positioning: Waters
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Prone or seated upright
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Chin on bucky -OML 37
angle with plane of cassette
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MML & MSP perp
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Nose 3/4 inch from IR
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Suspend respiration
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CR perpendicular to exit
acanthion
Waters Radiograph
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Distance from lateral
border of skull and orbit
equal on each side
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Petrous ridges projected
immediately below
maxillary sinuses
Trauma
Reverse Waters
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Supine
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Extend neck so OML is 37
degree with plane of IR
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MML and MSP perp
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Suspend respiration
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CR perpendicular and enters
acanthion
Reverse Waters Radiograph
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Distance from lateral
border of skull and orbit
equal on each side
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Petrous ridges projected
immediately below
maxillary sinuses
Modified Waters
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OML 55 degree angle
from plane of IR
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MSP perp
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CR perpendicular and
exits acanthion
Modified Waters Radiograph
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Petrous ridges projected
immediately below the
inferior border of the
orbits
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Equal distance from
lateral orbit to lateral
skull on both sides
PA Axial - Caldwell
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Prone or seated upright
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Forehead & nose against
grid device
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OML perpendicular
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CR 15 caudal to exit
nasion
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Suspend respiration
PA Axial- Caldwell Radiograph
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Equal distance from lat
skull to lat orbit
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Symmetric petrous ridges
in lower 1/3 orbit
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Penetration of frontal
bone without excessive
density at lateral borders
of skull.
Lateral Nasal Bones
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Semiprone
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MSP & IOML parallel
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IPL perpendicular
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CR perpendicular to the
bridge of nose at a point
1” distal to the nasion
Lateral Nasal bones Radiograph
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No rotation of nasal
bone and soft tissue
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Anterior nasal spine and
frontonasal suture
evident
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Close collimation