Facial Bone Facial Bone Anatomy & Anatomy & PositioningPositioning

RTEC 233RTEC 233

Anterior Aspect of Facial Anterior Aspect of Facial BonesBones

2 Maxillae2 Maxillae

2 Zygomatic bones2 Zygomatic bones

2 Lacrimal bones2 Lacrimal bones

2 Nasal bones2 Nasal bones

2 Inferior nasal conchae2 Inferior nasal conchae

2 Palatine bones (not 2 Palatine bones (not visualizedvisualized

1 vomer1 vomer

1 mandible1 mandible

Palatine BonesPalatine Bones

L-shaped bonesL-shaped bones

Horizontal portion forms Horizontal portion forms posterior hard palateposterior hard palate

Vertical portion extends Vertical portion extends between 1maxillae and 1 between 1maxillae and 1 pterygoid plate of pterygoid plate of sphenoid bonesphenoid bone

Articulates with 2 cranial Articulates with 2 cranial bones and 4 facial bonesbones and 4 facial bones

Zygomatic BonesZygomatic Bones

Forms cheeksForms cheeks Forms lower outer Forms lower outer

margin of orbitsmargin of orbits Articulates with 3 Articulates with 3

cranial bonescranial bones FrontalFrontal SphenoidSphenoid TemporalTemporal

Articulates with Articulates with maxillaemaxillae

Inferior Nasal CochaeInferior Nasal Cochae

The only pair of The only pair of conchae that are conchae that are separate facial bonesseparate facial bones

Articulates with 1 Articulates with 1 cranial bone and 3 cranial bone and 3 facial bonesfacial bones

Covered with Covered with mucous membranes mucous membranes to warm, moisten to warm, moisten and cleanse inhaled and cleanse inhaled airair

Lacrimal BonesLacrimal Bones About the size & About the size &

shape of a fingernailshape of a fingernail

Lacrimal foramen for Lacrimal foramen for tear ducttear duct

Lie anteriorly on the Lie anteriorly on the medial side of orbitmedial side of orbit

Can be seen on PA Can be seen on PA and lateral projectionsand lateral projections

Articulates with 2 Articulates with 2 cranial bones and 2 cranial bones and 2 facial bonesfacial bones

Nasal BonesNasal Bones

Fused and form Fused and form bridge of nosebridge of nose

Vary in size Vary in size considerablyconsiderably

The point of junction The point of junction with the frontal bone with the frontal bone is the nasion is the nasion

Articulates with 2 Articulates with 2 cranial and 2 facial cranial and 2 facial bonesbones

VomerVomer

Forms inferosuperior Forms inferosuperior part of nasal septumpart of nasal septum

Deviated nasal Deviated nasal septumseptum

Depressions for blood Depressions for blood vesselsvessels

Articulates with 2 Articulates with 2 cranial bones & 4 cranial bones & 4 facial bonesfacial bones

MandibleMandible

Only movable bone Only movable bone in the skullin the skull

Densest & largest Densest & largest facial bonefacial bone

2 bones at birth2 bones at birth

Contains mental Contains mental foraminaforamina

Pathologic Indications for Pathologic Indications for Facial RadiographyFacial Radiography

FracturesFractures BlowoutBlowout TripodTripod LeFortLeFort CoutrecoupCoutrecoup

Foreign Body Foreign Body

OsteomyelitisOsteomyelitis

NeoplasmsNeoplasms

Secondary Secondary OsteomyelitisOsteomyelitis

TMJ SyndromeTMJ Syndrome

Tri-pod FractureTri-pod Fracture

Blow out fractureBlow out fracture

LeFort FracturesLeFort Fractures

Copyright ©1994 BMJ Publishing Group Ltd.

Hodgkinson, D W et al. BMJ 1994;308:46-50

FIG 3 - LeFort lines used for classifying fractures of the middle third of the face.

Positioning: Lateral Positioning: Lateral Facial bonesFacial bones

Semiprone or seatedSemiprone or seated

MSP parallelMSP parallel

IPL perpendicularIPL perpendicular

Suspend respirationSuspend respiration

CR is perp and CR is perp and enters lateral enters lateral zygomatic bone ½ zygomatic bone ½ way between outer way between outer canthus and EAM.canthus and EAM.

Lateral Facial Lateral Facial RadiographRadiograph

All facial bones in All facial bones in with zygomatic bone with zygomatic bone in centerin center

Almost SI mandibular Almost SI mandibular

ramirami

SI orbital roofs (no SI orbital roofs (no tilt)tilt)

No rotation of sella No rotation of sella turcicaturcica

Anatomy IdentityAnatomy Identity

Radiograph AnatomyRadiograph Anatomy E) Anterior nasal E) Anterior nasal

spinespine F) Alveolar process of F) Alveolar process of

maxillamaxilla G) Alveolar process of G) Alveolar process of

mandiblemandible H) Mentum H) Mentum J) Body of mandibleJ) Body of mandible K) Angle of mandib leK) Angle of mandib le L) Ramus of mandibleL) Ramus of mandible M) Coronoid processM) Coronoid process O) Neck of O) Neck of

mandibular condylemandibular condyle

P) Condyle or neck of P) Condyle or neck of mandiblemandible

Q) EAMQ) EAM R) Temporalmandibular R) Temporalmandibular

fossa of temporal bonefossa of temporal bone S) Greater wings of S) Greater wings of

sphenoidsphenoid T) Lesser wings of T) Lesser wings of

sphenoidsphenoid U) Ethmoid sinuses U) Ethmoid sinuses

between orbitsbetween orbits V) Body of maxilla V) Body of maxilla

containing maxillary containing maxillary sinusessinuses

Anatomy IdentityAnatomy Identity

Lateral Skull AnatomyLateral Skull Anatomy A) zygomatic archA) zygomatic arch B) RT zygomatic B) RT zygomatic

bonebone C) RT nasal boneC) RT nasal bone D) Frontal process D) Frontal process

of maxillaof maxilla E) Anterior nasal E) Anterior nasal

spinespine F) Alveolar process F) Alveolar process

of maxillaof maxilla G) Alveolar process G) Alveolar process

of mandibleof mandible H) MentumH) Mentum I) Mental foramenI) Mental foramen

J) Body of mandibleJ) Body of mandible K) Angle (gonion)K) Angle (gonion) L) Ramus of L) Ramus of

mandiblemandible M) Coronoid processM) Coronoid process N) Mandibular notchN) Mandibular notch O) Neck of O) Neck of

mandibular condylemandibular condyle P) Condyle or head P) Condyle or head

of mandibleof mandible Q) EAMQ) EAM

Positioning: Waters Positioning: Waters

Prone or seated uprightProne or seated upright

Chin on bucky -OML 37 Chin on bucky -OML 37 angle with plane of angle with plane of cassettecassette

MML & MSP perpMML & MSP perp

Nose 3/4 inch from IRNose 3/4 inch from IR

Suspend respirationSuspend respiration

CR perpendicular to CR perpendicular to exit acanthionexit acanthion

Waters RadiographWaters Radiograph

Distance from Distance from lateral border of lateral border of skull and orbit skull and orbit equal on each sideequal on each side

Petrous ridges Petrous ridges projected projected immediately below immediately below maxillary sinusesmaxillary sinuses

TraumaTrauma

Reverse WatersReverse Waters

SupineSupine

Extend neck so OML Extend neck so OML is 37 degree with is 37 degree with plane of IRplane of IR

MML and MSP perpMML and MSP perp

Suspend respirationSuspend respiration

CR perpendicular and CR perpendicular and enters acanthionenters acanthion

Reverse Waters Reverse Waters RadiographRadiograph

Distance from Distance from lateral border of lateral border of skull and orbit skull and orbit equal on each sideequal on each side

Petrous ridges Petrous ridges projected projected immediately below immediately below maxillary sinusesmaxillary sinuses

Modified WatersModified Waters

OML 55 degree OML 55 degree angle from plane angle from plane of IRof IR

MSP perpMSP perp

CR perpendicular CR perpendicular and exits and exits acanthionacanthion

Modified Waters Modified Waters RadiographRadiograph

Petrous ridges Petrous ridges projected projected immediately below immediately below the inferior border the inferior border of the orbitsof the orbits

Equal distance Equal distance from lateral orbit from lateral orbit to lateral skull on to lateral skull on both sidesboth sides

PA Axial - CaldwellPA Axial - Caldwell Prone or seated Prone or seated

uprightupright

Forehead & nose Forehead & nose against grid deviceagainst grid device

OML perpendicularOML perpendicular

CR 15 caudal to CR 15 caudal to exit nasionexit nasion

Suspend respirationSuspend respiration

PA Axial- Caldwell PA Axial- Caldwell RadiographRadiograph

Equal distance from Equal distance from lat skull to lat orbitlat skull to lat orbit

Symmetric petrous Symmetric petrous ridges in lower 1/3 ridges in lower 1/3 orbitorbit

Penetration of frontal Penetration of frontal bone without bone without excessive density at excessive density at lateral borders of lateral borders of skull.skull.

Lateral Nasal BonesLateral Nasal Bones

SemiproneSemiprone

MSP & IOML parallelMSP & IOML parallel

IPL perpendicularIPL perpendicular

CR perpendicular to CR perpendicular to the bridge of nose at the bridge of nose at a point 1” distal to a point 1” distal to the nasionthe nasion

Lateral Nasal bones Lateral Nasal bones RadiographRadiograph

No rotation of No rotation of nasal bone and soft nasal bone and soft tissuetissue

Anterior nasal Anterior nasal spine and spine and frontonasal suture frontonasal suture evidentevident

Close collimationClose collimation