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bontrager chptr 13
Facial bones & sinuses
| Question | Answer |
|---|---|
| How many facial bones are there? | 14 |
| How many pairs, How many single and what are they called. | 6 Pairs, 2 singles. Paired: nasal, lacrimal, zygoma, maxilla, inferior nasal conchae, palantine. Single: Mandible, Vomer |
| What is the primary facial bone as well as the largest immovable bone? | Mandible |
| What three cavities does the maxilla form? | Oral (mouth), Nasal, Orbit |
| List the four processes of the maxilla? | The Frontal Process, Zygomatic, Alveolar & Palatine Process. |
| The majority of the hard palate is made of what bone? | Maxillary Bone |
| Where both maxillary bones unite and can be seen on a lateral view is called: | The anterior nasal spine. |
| The exit point for a Waters View. | The acanthion. |
| What forms the cheeks? | The Zygomatic bones |
| What makes up the lower portion of the orbits? | The Zygomatic bones. |
| The delicate zygomatic arch is located anteriorly to the __________ & Posteriorly to the ____________. | Zygoma - anteriorly Temporal- posteriorly |
| The zygomatic prominence is considered what? | A Positioning Landmark |
| The Zygomatic arch is formed by____&____ | zygomatic process of temporal and temporal process of zygomatic |
| What paired facial bone lies anterior on the medial side of each orbit? | The Lacrimal bones. |
| The Lacrimal bones are considered the ____& most _____ bones of the body. | Thinnest & Fragile |
| Lacrimal means:_____ It is closely associated with the _____ _____ | Tear Tear Ducts |
| The Lacrimal bone is the size and shape of a: | Fingernail |
| These paired bones fuse together to form the Nasion. | The rt & lt nasal bones. |
| What lies anterior and superomedial to the frontal process of the maxilla and inferior to the frontal bone? | The rt & lt nasal bones. |
| What is covered with mucus membranes and helps mix and warm the air that enters the cavity before entering the lungs? | The rt & lt inferior nasal conchae. |
| What projects medially from the lateral walls of the nasal cavity? | The rt & lt inferior nasal conchae. |
| The _______ & ________ nasal conchae are part of the Ethmoid bone, but the _____ nasal conchae is considered a separate facial bone. | Superior & Middle Inferior |
| The conchae are described as _______ & ________ bones. | Thin & curved |
| This pair of bones is located internally and shaped like an "L". | The RT & LT Palatine bones. |
| The __________ portion of the "L" extends upward between one __________ and one Pterygoid plate of the __________ bone. | Vertical Maxilla Sphenoid |
| The _______ portion of the "L" helps to make up the _________ portion of the hard palate. | Horizontal Posterior |
| Nosebleeds originate in this thin, triangular shaped bone. | In the Vomer. |
| What makes up the bony nasal septum? | The Vomer and the Ethmoid. |
| The Vomer bone has depressions for the: | Blood vessels |
| The vomer means: | Plowshare |
| The Vomer forms the inferosuperior part of the __________ ____________. | The Nasal Septum. |
| What is formed superiorly by the perpendicular plate of the ethmoid and inferiorly by the single vomer? | The septum. |
| What can be deformed for a diagnosis of a deviated nasal septum? | The septal cartilage. |
| The largest and only moveable bone is the: | The MANDIBLE |
| The two divisions of the mandible are: | The body and the ramus. |
| The horizontal portion of the mandible is : | The body |
| The vertical or upper portion of the mandible is: | The Ramus |
| The ________ separates the two divisions. | The Gonion |
| What is the process that the lower teeth attach on the mandible and the upper teeth on the maxilla. | The Alveolar Process |
| The junction of the two halves of the body of the mandible that fuse together. | The symphysis menti. |
| A flat triangular shaped area below the symphysis and projects forward on the body of the mandible. | The mentum aka the mentum protuberance |
| The center of the mentum is called the: | mental point |
| An opening on each side of the body of the mandible that is a passage way for nerves and blood vessels. | Mental foramen |
| The vertical portion of the ramus that terminates in a "U" shaped notch called the : | The Mandibular notch |
| The anterior process of the ramus is the: | The Coronoid process |
| The posterior process of the ramus. | The Condyloid process. |
| The Condyloid process has _______ aka (Condyloid) and a ________. | Head Neck |
| The ________ process fits into the ______________ notch to form the TMJ __________. | Condyloid temperomandibular joint |
| The bony nasal septum can be clearly seen on what view? | The Waters view. |
| What is the name of the fracture that results from a direct blow to the orbit leading to a disruption of the inferior orbital margin? | A blow out fracture. |
| The best view to visualize the blow out fracture is: | The Modified Waters |
| There is what degree of difference between the OML and the IOML. | 7 - 8 degrees |
| T or F All facial bones can be done at the Wall or Table bucky except for the Nasal bones. | TRUE |
| T or F The standard routines for Facial Bones is Lateral, Parietocanthial(Waters), & PA Axial (Caldwell) | True |
| A special view for Facial Bones is: | Modified Parietocanthial (Waters) |
| T or F When doing a lateral on skulls you do both sides, but when doing facial bones lateral you only do the affected side. | True |
| What is the universal controls to get a true lateral. | To control tilt, have no rotation, no flexion or extension. |
| How do you control tilt? | By making sure the IPL is perpendicular to the IR |
| How do you make sure that there is no rotation ? | By making sure the MSP is parallel to the IR |
| How do make sure there is no extension or flexion? | By making the IOML is perpendicular to the edge of the cassette or table. |
| Is this correct? True Lateral Facial Bones 10X12 L.W. 40" SID Affected side to IR IOML perpendicular to IR Center to zygoma, midway btwn outer canthus and EAM. | Yes this is correct |
| What are you looking at when doing a lateral facial bone to make sure its diagnostic? | Mandibular Rami & Orbital Roofs are superimposed on each other. |
| The Lateral F.B. shows what? | The four sinus groups. |
| What are the four sinus groups? Which are cranial bones, which are facial bones if any? | The 3 sinus groups in cranial bones are: Frontal, Ethmoid, Sphenoid The 1 sinus in the facial bone is the Maxillary. |
| The best view for the frontal sinuses is: | The Parietocanthial Projection also known as the Waters view. |
| T or F For a waters view the patient is supine or AP Erect | False The patient should be prone or PA erect. |
| 40" SID MML perpendicular to IR Chin to Bucky - Pt erect or Prone Nose 1" above IR - Exit at Acanthion Collimate to Lateral Edges No rotation, MSP & outer orbital margins symmetric. What projection is this? | Parietoacanthial Projection - Waters View |
| When the MML is perpendicular to the IR the OML will form what degree of angle with the bucky or table. | 37 degrees |
| The PA Axial Projection is also known as: | The Caldwell view |
| The Caldwell method is best for what sinuses? | The frontal and sphenoid sinuses |
| What projection is this? 40" SID - 10x12 L.W. - PA or prone Nose and forehead against bucky Tube angled 15 degrees caudad Exits at the nasion - Collimate in laterally | The PA Axial, Caldwell |
| What projection or view has the petrous ridges just below or inferior to the maxillary sinuses. | The Waters View, Parietoacanthial |
| What projection or view has the petrous ridges in the lower one third of the orbits. | The Caldwell view, PA Axial |
| What modification is made to the Parietocanthial for a special view. | The positioning line is the LML The Lips meatal line The patient kisses the table |
| What is the Modified Waters standard for? | The orbits |
| When the petrous ridges are in the lower half of the maxillary sinuses what view is it? | The Modified Waters, The Modified Parietacanthial |
| When the LML is perpendicular with the IR the OML forms what degree of angle with the surface? | 55 degrees |
| Which Waters view has more flexion which has more extension? | The modified waters has more flexion. The regular has more extention. |
| What paired bone forms the superior aspect of the nasal cavity? | The nasal bones |
| What two cranial bones and what two Facial bones do the nasal bones articulate with? | The 2 Cranial bones are: Frontal, Ethmoid The 2 Facial bones are: Maxilla and the other Nasal bone |
| Are nasal bones symmetrical and similarly sized? | No they vary in size and shape |
| What are the standard views for Nasal Bones? | Lateral Waters, Parietoacanthial |
| What is a special view for Nasal bones? | The PA Axial, (Caldwell) |
| Do you do one lateral or two? | Two and you mark the side down. |
| What is different about Nasal Bone Lateral? | They are done Table Top no AEC so no chambers are used on the control panel |
| Where do you center for a Lateral Nasal Bone? | One half inch below the nasion. |
| What technique do you use for a lateral nasal bone? | Use a finger technique, 50-60 kV |
| What does the Parietoacanthial (Waters) for nasal bones demonstrate? | The bony nasal septum (vomer & perpendicular plate). It also shows the anterior nasal spine which is just above the acanthion. |
| The Petrous ridges will appear where in the Waters for Nasal Bones? | They will be below the maxillary sinus. |
| What is different for Waters for Nasal Bones than other waters? | the collimation. Collimate in more, no lower than upper lips. |
| The PA Axial (Caldwell) for nasal bones shows the bony nasal septum but what shows it better? | the Waters view |
| Paranasal Sinuses can contain fluid. What stipulations are required to demonstrate this. | They must be done erect, a horizontal beam is needed. |
| Large air-filled cavities lined w/mucus membranes. | Paranasal sinuses |
| Do Sinuses communicate with each other? | Yes, infection can spread |
| The sinuses are broke into four groups named for the bones they are contained in. What are they and what number of cavities do they have? | Maxillary (2) Frontal (2) Ethmoid (many little air bubbles) Sphenoid (1 or 2) |
| When do the sinuses develop? | Maxillary sinuses by birth Sphenoid & Frontal by 6-7 yrs Ethmoid develop in late teen years |
| Of the 4 groups how many are facial and how many are cranial? | 3 Cranial and 1 Facial (Maxillary) |
| What projection shows all the sinuses without superimposition? | Lateral |
| What is the usual shape & size of the Maxillary sinuses | Shaped like a pyramid from the from the front perspective and a cube from the side. Varies in size for each person but are symmetrical. |
| If you have a tooth infection can it affect the maxillary sinus? | Yes, the roots of the 1st and 2nd upper molars project into the floor of sinus. |
| The frontal sinuses are located where? | They are located between the inner and outer tables of the skull.Posterior to the glabella |
| Are frontal sinuses larger in men than in women? | Yes |
| Are frontal sinuses symmetrical? | Rarely |
| Where are ethmoid sinuses located? | They are contained in the Lateral masses of the ethmoid bone. |
| How are ethmoid sinuses grouped? | Since they are mainly small air pockets they are grouped into Posterior, Middle and Anterior. There are many air pockets. |
| T or F The ethmoid sinuses are the first to develop. | False They are the last to develop, usually in the later teenage years. |
| What are the standard views for sinuses? | Lateral PA Caldwell PA Waters SMV (Submentovertex) |
| What is considered the special view? | PA Open Mouth Waters |
| Do you do both sides on the lateral or only one? | Usually the one side that hurts, but if both sides hurt do both. |
| What should be in profile on a Sinus lateral? | The Sellae Tursica |
| What will a lateral show? | All 4 sinus groups and fluid levels. |
| What modification is made on a PA Caldwell for sinuses? | Instead of angling the tube 15 degrees, the patient's forehead is tilted back the 15 degrees. The tube remains horizontal |
| What does the PA Caldwell show best? | Shows the frontal sinuses the best, although it will show the ethmoid, sphenoid and maxillary a bit. |
| The PA Caldwell for sinuses shows the petrous ridges where? | In the lower one third of the orbits |
| The PA Waters for sinuses shows what sinuses the best? | The Maxillary sinuses |
| If the petrous ridges are not below the maxillary sinuses in a PA Waters what can you do to correct it? | Lift the chin more (more extension) if needed |
| What is another name for Open mouth Waters? | Transoral |
| If MML is perpendicular to IR the OML forms what angle with surface in a Open Mouth Waters? | 37 degrees |
| What sinus is seen best thru the Open Mouth? | The sphenoid is seen the best thru the open mouth. |
| For the SMV the vertex of the skull is against the IR - the IOML is parallel to the IR- the center is 2" below the Mandibular symphysis btwn the gonions T or F | True |
| T or F The SMV shows the Ethmoid and Sphenoid sinus the best. | True |
| Where are the petrous ridges in the SMV? | The petrous ridges are medial to the Maxillary Air Cells below each gonion. |
| For a diagnostic SMV radiograph the Mandible should be symmetric and the mentum should be what? | The mentum should be superimposed over the frontal bone. |
| How are orbits shaped? | Coned |
| Each orbit is angled _____ degrees from MSP and _____ degrees superiorly (upwards) from the OML | 37 30 |
| The base of the Orbit is called the ______, the apex of the Orbit is called the _______. | Rim Point, the posterior portion of the cone. |
| What is the opening at the apex of the orbit and what is it for? | The optic foramen, which allows the optic nerve to pass through. |
| The Orbit is composed of how many bones? | 7 |
| How many of the bones the orbit is composed of cranial and facial. | 3 Cranial: sphenoid, frontal, ethmoid 4 Facial: Zygoma, Maxillae, Lacrimal, Palatine |
| The orbit has a bony anatomy. Describe the 3 bones that comprise the circular base. | Orbital Plate of the frontal bone is the majority of the roof of orbit. The Zygoma makes up the lateral wall & part of the floor The Maxilla makes up the rest of the floor. |
| Describe the 4 bones that make up the cone portion of the orbit. | The Lacrimal bone makes up some of the medial wall. The sphenoid & ethmoid make most of the posterior portion. The Palatine covers a small portion of the inner most posterior portion of the floor. |
| What are the 3 openings in the Posterior orbit? | The Optic foramen - Superior Orbital fissure - Inferior Orbital fissue - |
| What do you call the small piece of bone that separates the superior orbital fissure from the optic foramen? | The sphenoid strut |
| The opening between the greater and lesser wings of the sphenoid that allows transmission for cranial nerves that control eye movement and eye lid is called the: | Superior orbital fissure |
| The opening in the sphenoid bone that allows for the passage of the optic nerve is called the: | Optic Foramen |
| An opening between the maxilla, zygoma, and the greater wing of the sphenoid is called the: | Inferior orbital fissure |
| What are the routine projections for Orbits? | Parietorbital Oblique (Rhese) Parietoacanthial (Waters) Modified Waters |
| What is the another name for the Rhese method? | The 3 point Landing |
| What projection is this? LML perpendicular to IR exit at acanthion - pt prone or at wall bucky SID 40" The petrous ridges are in the lower half of the maxillary sinuses Used to see a Blow Out Fracture | The Modified Waters for Orbits |
| What view shows the orbital floor the best? | The Modified Waters for Orbits |
| Is everything the same for the Regular Water for Orbits except that you would collimate in a little more? | Yes, same as facial bones except for collimation. Best for maxillary sinus & nasal septum. |
| What Projection is a cheek, chin and nose patient position - AML is perpendicular to the IR -center the tube to enter at the back of the head to exit at the down side orbit- Use a small focal spot and manual technique of 75kV @18mAs | The Parietoorbital Oblique Projection or Rhese method |
| What angle does the MSP form to the IR in the Rhese method. | A 53 degree angle |
| What is the area of interest and where would it be located in the Rhese method? | The optic foramen, it should be in the lower outer quadrant. |
| How many degrees is the Rhese method of placement from a true PA? | 37 degrees |
| In a trauma situation how would you perform the Rhese method? | Do it AP, use a sheet of paper to represent the IR, position patient in 3 pt landing to paper and enter the orbit of interest. |
| What is located between the temperal process of the zygoma and the zygomatic process of the temporal bone? | The zygomatic arch |
| Where is the zygomatic arch located in relation to the zygomatic prominence? | Behind the zygomatic prominence on the zygoma. |
| How many views are possible to use for the Zygomatic Arches? | Four- SMV, Tangential Oblique, Ap Axial (Towne), Pareitoacanthial (Waters) |
| T or F When doing the Zygomatic Arch it is important to increase density and use the outside chamber only. | False The AEC should not be used at all. The bone is delicate. A soft tissue technique should be used. |
| For the SMV projection of the Z arch where is the central ray centered. | The central ray is perpendicular to the IR and centered 1 1/2" below the madibular symphysis. |
| What technique should be use for the Z arch SMV? | 65 kV @ 6 mAs, if AEC is used lower density to -4. Use a soft tissue technique. |
| T or F The mandibular symphisis should be above the frontal bone. | False The mandibular symphisis should be superimposed on the frontal bone. |
| What view is this? IOML parallel to IR - Use soft tissue tek Patient in SMV position Rotate head 15 degrees and tilt chin 15 degrees to side of interest. Center to arch of interest collimate down skim area | The Tangential Oblique also known as the Inferosuperior Oblique |
| Do you do both sides at once (bi-laterally) or individually? | You image each side individually, due to the angles. |
| What view is this? OML perpendicular to IR - Technique 70 kV @ 30 Patient supine with chin tucked Tube angled 30 degrees caudad to OML Center 1" above glabella | The AP Axial (Townes) for Zygomatic Arches |
| What is another name for the AP Axial (Townes) for Z Arches? | The Jug Handle view. |
| T or F The Waters view for arches is the same as all other Waters views with no soft tissue technique needed. | True |
| T or F A Lateral for Z arches is considered a special view and done just like facial bones. | True |
| The routine Projections for a Mandible are: | Bi-lateral Axiolateral Oblique, PA (no angle), AP Axial (Towne) |
| What are the special views? | PA Semi-Axial and SMV |
| For the Axiolateral Oblique what should be generally done for successful imaging of the Mandible? | Put patient in a true lateral position with affected side down. The area of interest should be parallel to IR. Know what the area of interest is. The tube should be angled 25 degrees cephalic. Lift the chin just a bit. Center btwn angles of mandible. |
| For the Ramus of the Mandible what must be done in the Axiolateral Oblique? | Rami should be parallel to IR. Patient in a True Lateral position, |
| For the Body of the Mandible what must be tweaked in the Axiolateral Oblique? | Patient is in Lateral position to start and then rotate head 30 degrees toward the IR to get body parallel to IR. (Rami are foreshortened) |
| For the Symphisis Menti of the Mandible what must be tweaked in the Axiolateral Oblique? | Patient starts in Lateral position then the head is rotated 45 degrees toward the IR to get symphisis parallel to IR. |
| For a general view of the mandible what should you do in the Axiolateral Oblique? | Start with patient in Lateral position and then rotate the head 10-15 degrees towards the IR. |
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