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OVERVIEW
I. INTRODUCTION
- Maxillofacial trauma
- diagnosis
- communication
A. Facial trauma
B. Pathology
C. Orthodontics
I. DEFINITIONS
The first word of the description of the x-ray is where the tube is; the
second word is where the
film is, i.e. a PA film has the tube at the back of the head [posterior] and
the film is placed by the face [anterior]
kVp - the potential difference between the cathode and anode of an x-ray
tube; the energy of the beam x-rays lower than 65 kVp are seldom used in
dentistry
"Rule of 15" - for every 15% increase in kVp, the density on the x-ray will
double. If the kVp is
¶ Simple - break in bone ONLY and one that does not involve the skin externally
or the
Ë Compound - does involve the skin or the mucous membrane, which enhances
risk of
infection
MAXILLARY FRACTURES
• Midface separation:
Fracture extends through the medial and lateral orbital walls and the zygoma
zygomatic arch, the floor of the orbits, the ethmoids and the lacrimals; CSF LEAK
V. EQUIPMENT
A. X-ray units
-Basic process:
more sensitive to x-rays than film alone. Bottom line is less exposure of radiation
to the patient.
-Film size: Skull films are 8x10 inches. Lateral oblique views of mandible are 5x7
inches.
C. Patient positioning
outer canthus of the eye. Easily visualized by the technician and is used as a
reference
-Zygomatic arches, orbital rims and floors, nasal spine and septum, coronoid
processes.
-Can also be used for evaluating the frontal, maxillary, and sphenoid sinuses.
-example: sagittal plane is perpendicular to the plane of the film; chin is raised
37° so that
canthomeatal line is 37° to the deck; beam is directed at the level of the maxillary
sinus;
75-80 kVp
2. Posterior-anterior:
-can be used to evaluate orbital rim, frontal and ethmoid sinuses, nasal septum,
nasal fossa
3. Submentovertex:
-good visualization of the base of the skull with foramina and the medial and
lateral
pterygoid plates
-example: hyperextend neck backwards as far as possible until the vertex of the
head is
centered on the film; the canthomeatal line is projected 10° past vertical so the
Frankfurt
plane is parallel to the film; beam is directed from below the mandible upward to
the vertex;
75-80 kVp
-NOTE: WHEN WISH TO VIEW THE ZYGOMATIC ARCH, THE EXPOSURE TIME SHOULD BE
-Used to survey the skull and facial bones for evidence of disease, trauma,
developmental
segments.
paranasal sinuses and hard palate; are also delineated in this view
-cassette held by a holding device vertically
-example: head is positioned with left side of face near the cassette and the
midsagittal plane
parallel to the plane of the film; source of beam [the tube] is 60" from the
midsagittal plane of
-use either a wedge filter to reduce the radiation intensity in the anterior region or
a cassette
with intensifying screens which provide reduced fluorescence in the area; 75-80
kVp
2. Lateral Oblique: Excellent for viewing the mandibular body and ramus
Ê BODY OF MANDIBLE
-views premolar, molar and inferior border of the mandible; broader than PA’s
x-ray tube [aimed under right side of mandible] ⇒ head tilted to left
⇒ cassette held against side of face by patient parallel to border of mandible and
extending
Ë RAMUS OF MANDIBLE
-views ramus from the angle of the mandible to the condyle; useful for / ↓ 3rds
-example: Ramus of Left mandible [right to left]
x-ray tube [aimed under right side of mandible] ⇒ head tilted to left until a line
from the right
⇒ cassette held against side of face [ramus] by patient and extending 2 cm below
the
-view can be used to observe condyles, necks, rami and mandibular symphysis
-also visualized: occipital bone, foramen magnum, dorsum sellae and petrous
ridges
-View can be used to observe fractures involving the condylar neck, and also
when
-example: head is centered in front of film with the canthomeatal line projected
25° -30° downward; beam goes through the occipital bone; 75-80 kVp
Caldwell’s Projection
Straight PA
Towne’s Position
- good for occipital bone, foramen magnum, dorsum sellae and petrous ridges;
also status
Water’s Projection - PA view w/ the nose raised 2-3 cm and the chin on the film
-lighter exposure; allows better view of maxilla and zygoma than vertico-
submental
Straight PA
Lateral Oblique
Special views of the TMJ [open and closed mouth]-discussed next section
Occlusal view – Occlusal film placed between teeth, beam from under mandible
1. TMJ VIEWS
¶ Transpharygeal Projection
⇒ rotate head 7° -10° away from the cassette [moves opposite condyle out of the
way]
⇒ cassette held against ear and cheekbone on left side of face by patient
Ë Transorbital Projection
- frontal radiograph
- medial and lateral aspect of condyle, the neck, the eminence and sometimes
the zygomatic arch
patient is seated with midsagittal plane perpendicular to deck and Frankfort plane
⇒ cassette is placed behind the left TMJ ⇒ turn head 20° to the left
⇒ x-ray tube directed +35° , from the front through the floor of the left orbit and
left TMJ
Ì Transcranial Projection
- film-5x7 screen film [usually held vertically] and is hand held by patient
- provides a view down the long axis of the condyle and the relationship of the
condyle
to the fossa
⇒ cassette held against ear and cheekbone on left side of face by patient
⇒ x-ray tube [directed +25,1/2" behind and 2" above the right external auditory
meatus
2. PANOREX
panoramic machine introduced to North America by the S.S. White Co. in 1959
- The area where the images are sharp is a 3D horseshoe shaped zone called
the focal trough,
image layer, zone of sharpness, central image layer; therefore, correct patient
positioning is
critical
- Frankfort plane parallel to the deck, the midsagittal plane, perpendicular to the
deck, and the
- Real image - object lies between the center of rotation and the film
- Ghost image - object lies between the x-ray source and the center of rotation
ERROR RESULT
Chin too low exaggerated smile line; loss of ↓ ant. apices; loss of condyles
Chin too high reverse smile line; hard palate superimposed on apices; condyles lost
on side
XI. SUMMARY
In an operational environment, the comprehensive dentist should be familiar with
the four basic medical views: Waters, Posterior-Anterior, Lateral, and the
Submentovertex for evaluating facial trauma.
References:
Dolan, Jacoby and Smoker; Radiology of Facial Injury, Field and Wood, Inc.,
1988
Goaz and White, Oral Radiology- Principles and Interpretation, C. V. Mosby Co.,
1987
Company, 1982
Miles, Van Dis, Jensen and Ferretti; Radiographic Imaging for Dental Auxiliaries,
W. B. Saunders
Company, 1993