Radiography of the Orbits

Fall 2009 FINAL

Function of Orbits
1. Serve as bony sockets for the eyeballs 2. Openings for nerves and blood vessels

Bones of the Orbits - 7

A B C D

E I

G H

Division of the Orbits

1. ________________
Primarily composed of orbital plate of frontal bone

3. _______________
Medial
Lacrimal

Lateral

2. ________________

Zygoma (small amount) Maxilla Palatine

Zygoma (large amount)

Base of the Orbit

The circumference is made of 3 bones:
1. _________________ 2. _________________ 3. _________________

Openings in Posterior Orbit

1. ______________
Optic canal Sphenoid strut

2. ______________ 3. ______________

ANGLE OF ORBITS
1. Each orbit projects
30 degrees superiorly 37 degrees toward MSP

Indications for Orbit and Eye Radiography

1. Possible Fractures
1. Blowout 2. Tripod 3. Lefort

2. Foreign body of the eye

Mechanisms producing Orbital Fractures

1. Auto accidents 2. Assault
3. Falls, sports, and industrial accidents

Blowout Fracture

Blowout Fracture
1. Blow to the eye 2. Orbital floor is fractured

3. Soft tissue herniates into maxillary sinuses

4. Often have ocular injury

Ponsell, 2003

_____________________

Blowout Fracture

______________________

Tripod Fracture
1. Direct blow to zygoma 2. Visual concave abnormalities 3. Usually orbits are involved 4. Free floating zygoma
Ponsell, 2003

LeFort Fractures

LeFort types II & III involve the orbits

Richardson, 2000

Lefort II and III

LeFort Fractures
1. Type II
1. Separation through:
frontal processes lacrimal bones orbit floors, zygomaticomaxillary suture line lateral wall of maxillary sinuses pterygoid

1. Complications
1. ____________ system obstruction 2. Infraorbital nerve anesthesia
3. ____________ 4. Malocclusion

Lefort 2

LeFort Fractures
1. Type III
1. Separation of mid third of face at:
zygomaticotemporal naso-frontal sutures and across orbital floors

1. Complications
1. _________________
2. Mal-union

3. _________________
4. Lenthening of mid face

5. _________________ system obstruction

LEFORT 3

LEFORT 3

Basic and Special Projections

1. Eyes

1. Orbits
1. Basic 1. Basic
_________________ _________________ _______________ _______________ _______________

2. Special
_________________

Parietoacanthial Projection Waters Method

1. Positioning
1. ____________ 2. ____________

2. Lines and planes:

1. ____________ 2. ____________

3. CR:
1. ___________

Ballinger & Frank, 1999, pg 317

Parietoacanthial Projection Waters Method Radiograph

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

2. Petrous ridges projected immediately below maxillary sinuses

Parietoacanthial Projection Modified Waters

1. Positioning:
1. _____________

2. Lines and planes

1. _____________ 2. _____________

3. CR
1. ____________

Modified Waters Radiographs

1. Petrous ridges projected immediately below the inferior border of the orbits 2. Equal distance from lateral orbit to lateral skull on both sides

Modified Parietoacanthial Modified Waters method

Modified Waters Radiograph & Diagram

Acanthioparietal Projection Reverse Waters Method 1. Positioning

_______________

2. Lines and planes

_______________ _______________

3. CR
_______________

Ballinger & Frank, 1999, pg 320

Reverse Waters Radiograph

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

2. Petrous ridges projected immediately below maxillary sinuses

Parietoorbital Projection (Rhese Method) (PA) Optic Canal and Foramen

1. Positioning
1. ______________ 2. ______________

2. Lines and planes:

1. ______________ 2. ______________

3. PA- CR:
1. enters 1superior and posterior to TEA

4. PA- CR:
1. exits through the affected orbit
Ballinger & Frank, 1999, pg 290

Parietoorbital Projection (Rhese Method) (PA) Optic Canal and Foramen Radiograph
1. Optic canal & foramen visible at end of sphenoid ridge in inferior & lateral quadrant of orbit Entire orbital rim
Supraorbital margins lying in same horizontal plane Close beam restriction to the orbital region

2.
3.

4.

Rhese Diagram and Radiograph

Rhese Method (AP) Optic Canal and Foramen

1. Positioning:
1. _______________ 2. _______________

2. Lines and planes:

1. _______________ 2. _______________

3. AP- CR:
1. _______________

Ballinger & Frank, 1999, pg 292

Rhese Method (AP) Optic Canal and Foramen Radiograph

1. Optic canal & foramen visible at end of sphenoid ridge in inferior & lateral quadrant of orbit Entire orbital rim Supraorbital margins lying in same horizontal plane Close beam restriction top the orbital region

2. 3.

4.

Rhese Radiograph and Diagram

Foreign objects in the EYE

Lateral Projection (EYE)

1. Positioning:
1. Semiprone or seated upright 2. Affected eye closest to cassette 3. ___________________

2. Lines and planes:

1. MSP parallel 2. IPL perpendicular

3. CR:
1. ___________________

Lateral Eye for Foreign Body

1. Density & contrast permitting optimal visibility of orbit and foreign bodies 2. SI orbital roofs 3. Close beam restriction

1. Positioning
1. Forehead & nose on IR. 2. Center IR distal to nasion 3. ________________

PA Axial (EYE)

2. Lines and planes:

1. ________________

3. CR:
1. Through center of orbits, 30 degrees caudal

PA Axial Eye Radiograph

1. Petrous pyramids lying below orbital shadows 2. No rotation of cranium 3. Close beam restriction

1. Positioning:
1. IR at level of orbits 2. Rest pts chin on IR 3. Instruct pt to close eyes and hold eyes still

Modified Waters (EYE)

2. Lines and planes:

1. MSP perp 2. OML 50 degrees

3. CR:
1. Perp through mid-orbits

Modified Waters Radiograph

1. Petrous Pyramids lying well below orbital shadows 2. Symmetric visualization of orbits 3. Close beam restriction

LETS REVIEW

Seven Bones of the Orbit

Openings and Supporting Structures of Openings of the Orbit

Parietoorbital Oblique Projection of Orbits

References
Ballinger, P.W. & Frank, E.D. (1999). Merrills atlas of radiographic positions and radiologic procedures. V2. New York: Mosby Ponsell, M.R. (2003). Assessing facial fractures in the emergency room. New Jersey Richardson, M.L. (2000). Facial and mandibular fractures. Retrieved May 5, 2007 from: http//www.rad.washington.edu/mskbook/facialfx.html