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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

C
D

E
I

G
H

Division of the Orbits


1. ________________

Primarily composed
of orbital plate of
frontal bone

2. ________________

Zygoma (small
amount)
Maxilla
Palatine

3. _______________
Medial

Lacrimal

Lateral

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,

_____________________

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. Complications
1. _________________

1. Separation of mid third of


face at:
zygomaticotemporal
naso-frontal sutures
and across orbital floors

2. Mal-union
3. _________________
4. Lenthening of mid face
5. _________________
system obstruction

LEFORT 3

LEFORT 3

Basic and Special Projections


1. Orbits

1. Eyes
1. Basic

1. Basic

_________________
_________________

1. Special

_________________

_______________

_______________

_______________

Parietoacanthial Projection
Waters Method
1. Positioning
1. ____________
2. ____________

2. Lines and planes:


1. ____________
2. ____________

3. CR:
1. ___________

Ballinger & Frank, 1999, pg 3

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 3

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 2

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

2.

Entire orbital rim

3.

Supraorbital margins lying in


same horizontal plane

4.

Close beam restriction to the


orbital region

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 2

Rhese Method
(AP) Optic Canal and Foramen
Radiograph
1.

Optic canal & foramen visible


at end of sphenoid ridge in
inferior & lateral quadrant of
orbit

2.

Entire orbital rim

3.

Supraorbital margins lying in


same horizontal plane

4.

Close beam restriction top


the orbital region

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. ________________

2. Lines and planes:


1. ________________

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

PA Axial (EYE)

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

2. Lines and planes:


1. MSP perp
2. OML 50 degrees

3. CR:
1. Perp through mid-orbits

Modified Waters
(EYE)

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