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Facial Bones
Anatomy, Projections, Surgery
| Question | Answer |
|---|---|
| Which facial bone helps form the bony nasal septum? | vomer |
| What is another name used for the inferior nasal conchae? | turnbinate |
| Which process of the maxilla is found along the inferior aspect of the body of each maxilla? | alveolar |
| Which joint is the only movable joint in the skull? | temporomandibular (TMJ) |
| The long axis of each orbit forms a 37 degree angle with what? | midsagittal plane |
| How many facial bones are in the skull? | 14 |
| Name the 2 facial bones that don't have a pair. | vomer & mandible |
| what is the largest immovable bone of the face? | maxilla |
| What does the maxilla help form? | 3 cavities (mouth, orbit, nasal) of the face |
| Which cranial bones does the maxilla articulate with? | frontal & ethmoid |
| Each maxilla has four processes, name them. | alveolar, zygomatic, palatine, frontal |
| What is the structure that is the superior union of the maxillae? | anterior nasal spine |
| What forms the anterior portion of the hard palate? | two palatine processes |
| What is another name for the zygomatic bones? | malar bones |
| How is the zygomatic arch formed? | temporal process of zygoma articulates with zygomatic process of the temporal bone |
| Which facial bone is associated with the tear ducts? | lacrimals |
| Which 2 facial bones are the thinnest and most fragile bones in the entire body? | nasal and lacrimal bones |
| Which conchae are part of the facial bones? | inferior |
| What portion of the palatine forms the posterior hard palate? | horizontal portion |
| What is so important about the function of the nasal conchae? | they mix the incoming air so it is warmed as it contacts the mucous membranes of the turbinates before reaching the lungs |
| How is the TMJ formed? | condyle of condyloid process (on mandible) fits into temporomandibular fossa of the temporal bone |
| What does TMJ stand for? | temporomandibular joint |
| What classification is the TMJ? | synovial (movable) |
| What are the 2 parts of the condyloid process? | head and neck |
| What is the vertical portion of the mandible called? | ramus |
| What is the horizontal portion of the mandible called? | body |
| What is the posterior process of the upper ramus called? | condyloid process |
| Which landmark is located just posterior and slightly inferior to the TMJ? | EAM |
| When the mouth is open which way do the TMJs slide? | slide inferior and then anterior |
| What are the two parts of the orbit? | base and apex |
| How is the OML positioned when the long axis of the orbit angles 30 degrees superior to the OML? | parallel for the floor OR perpendicular to the IR |
| Which part of the orbit does the optic nerve pass through? | apex |
| How many bones makeup the orbit? | 7 |
| What is the small root of bone that separates the superior orbital fissure from the optic canal? | sphenoid strut |
| How many degrees does the long axis of the orbit angle towards the MSP when the head is placed in upward frontal or lateral position? | 37 degrees |
| On the parietoacanthial (waters) what happens to the petrous pyramids as the neck is extended (chin raised)? | just below the maxillary sinuses |
| What is the CR parallel to on the parietoacanthial? | MML/mentomeatal line |
| What positioning line is perpendicular to the IR when doing a R or L lateral facial bones? | IPL/ interpupillary line |
| What is the centering for lateral facial bones? | zygoma (prominence of the cheek & midway between outer canthus and EAM) |
| Why do the facial bones projections involve more head positioning and CR angulations at the same time? | so that the dense skull anatomy does not superimpose the facial bones of interest |
| What is another name for the parietoacathial projection? | Waters method |
| What positioning action will make the OML form a 37 degree angle with the table and Bucky surface on the waters? | adjust the head until the MML is perpendicular to the IR. |
| What is the centering for the parietoacanthial projection? | perpendicular to the IR; exit at the acathion |
| What are you looking for on the waters? | inferior orbital rims |
| What is the difference when doing the PA caldwell skull and the PA caldwell for facial bones? | collimation |
| what positioning line is used in the PA caldwell? and how is it positioned? | OML; perpendicular to the IR |
| Where are the petrous ridges in the PA Caldwell facial bones? | petrous ridges are projected into the lower 1/3 of orbits |
| What is another name for the modified parietoacanthial? | modified waters |
| What is most visible on the modified waters? | orbital floors (plates) |
| How do you know if there is correct positioning on the modified waters? | petrous ridge projected into the lower half of the maxillary sinuses below the inferior orbital rim. |
| Between the modified waters and waters; which projection has less distortion? | modified waters; due to less OID from orbits |
| On the lateral nasal bones do you perform both R and L? | yes |
| Which positioning line is used in the lateral nasal bones? | IPL |
| Which line must be perpendicular to the front edge of the IR when doing the lateral nasal bone? | IOML |
| What technique is used when doing a lateral nasal bone? | finger technique |
| Which sims must be completed for the zygomatic arches? | submentovertex (SMV) & oblique inferosuperior (tangential) |
| In the SMV zygomatic arches what line is parallel to the IR? | IOML |
| What if the patient cannot extend their neck enough for the SMV zygomatic arches? | angle CR perpendicular to the IOML. |
| What is the centering for lateral nasal bone? | 1/2" inferior to nasion |
| What is the centering for the SMV zygomatic arches? | midway between the arches; at a level 1 1/2" inferior to mandibular symphysis |
| What is the difference between when performing the SMV skull and SMV zygomatic arches? | more KV is used on the skull than the zygomatic arches so you penetrate all the skull tissue and bones. On the skull the arches will be burnt out because the increase in technique |
| What is the positioning for an oblique inferosuperior tangetial of zygomatic arches? | raise chin, hyperextending neck until IOML is parallel to IR. Rotate head 15 degrees towards side to be examined; then tilt chin 15 degrees towards side of interest |
| What is another name for the AP axial zygomatic arches? | modified towne/ "jug handle view" |
| What is the centering for the oblique inferosuperior tangetial? | zygomatic arch (CR skims the mandibular ramus, passes through the arch and skims the parietal eminence on the down side) |
| What is the centering for the AP axial zygomatic arches? | 1" superior to glabella (pass through mid arches) |
| What is the orientation of the IR for the oblique inferosuperior tangetial projection? | LW |
| What is the orientation of the IR for the SMV for zygomatic arches? | CW |
| Which projection demonstrates the optic foramina? | parietoorbital oblique projection |
| what is another name for the parietoorbital oblique projection? | Rhese method |
| Which positioning line is perpendicular for the parietoorbital oblique projection? | AML |
| How is the head positioned for the Rhese method? | adjust the head so that the chin, cheek and nose will be touching the bucky/IR surface |
| What features of the head are considered the "3-point" landing position? | chin, cheek and nose |
| What is the centering for the Rhese method? | perpendicular at the midpoint of the downside orbit |
| Where does the optic foramen appear on the Rhese method? | into the lower outer quadrant of the orbit |
| Which 2 projections are required for the mandible routine? | axiolateral oblique & PA 0 degrees |
| How is the IR oriented for the axiolateral oblique projection? | CW |
| What is the relationship between the IPL & CR in the axiolateral oblique projection? | 25 degrees |
| What is the CR for the axiolateral oblique mandible when the patient can do a true lateral? | angle CR 25 degrees cephalad from IPL |
| A 30 degree rotation of the head towards the IR demonstrates what part of the mandible? | body of the mandible |
| A 45 degree rotation of the head best demonstrates what part of the mandible? | mentum |
| Which sinuses are located directly below the sella turcica? | sphenoid |
| Where does the maxillary sinuses begin to drain? | infundibulum |
| All of the paranasal sinusses communicate with one another and with what? | nasal cavity |
| The parietoacanthial projection best demonstrates which sinuses? | maxillary sinuses |
| Which paranasal sinus is the last one to develop? | ethmoid |
| All sinus groups are clearly demonstrated w/o distortion on the ______ projection. | lateral |
| The older term "Antrum of Highmore" describes which sinus? | maxillary |
| To accurately assess air-fluid levels, the CR must be ______ and the patient must be ______. | horizontal; erect |
| The ethmoid & sphenoid sinuses are superimposed on the ______ projection of the sinuses. | PA Caldwell |
| Specifically, where are the frontal sinuses located? | between the inner and outer tables of the skull; posterior to the glabella |
| The drainage pathway for the paranasal sinuses is called what? | osteomeatal complex |
| Which sinus will be best projected through the open mouth w/ a PA axial transoral prjection? | sphenoid |
| What is the name of the passage between the maxillary sinuses and the middle nasal meatus? | infundibulum |
| T/F: the common basic PA axial projection for facial bones requires a 15 degree caudad angle of the CR which projects petrous ridges into the lower 1/3 portion of the orbits. | True |
| Where is the CR placement for lateral facial bones? | zygoma |
| What is the proper method name for the parietoacanthial projection of the facial bones? | waters method |
| Which facial bones are best demonstrated with the parietoacanthial projection? | inferior orbital rims, maxilla, nasal septum, zygomatic bones/arches & anterior nasal spine |
| What CR angle must be used to project the petrous ridges just below the orbital floor on the PA axial Caldwell? (facial bones) | 30 degrees caudad |
| Which structures are specifically visualized better with the modified parietoacanthial (waters) compared to the basic waters? | entire orbital floors are less distorted on the modified waters |
| What are 2 reasons the facial bones are performed PA rather than AP? | 1. less thyroid dose 2. less OID/distortion when done PA |
| On the waters for facial bones, the _____ line will be perpendicular to the IR; which places the OML @ a ____ degree angle to the tabletop/IR. | MML (mentomeatal line); 37 degrees |
| Where does the CR exit for a parietoacanthial waters for the facial bones? | exits at the acanthion |
| Where does the CR exit for a 15 degree PA axial Caldwell projection for the facial bones? | nasion |
| For the modified waters facial bones, it requires the _____ line to be perpendicular to the IR which places the OML @ a ____ degree angle to the tabletop/IR | LML (lips-meatal line); 55 degrees |
| T/F: lateral projections of the nasal bones generally are taken bilateral for comparison. | true |
| For a PA waters sinus projection, the petrous ridges should be projected directly below _____ & projected into the lower half of the maxillary sinuses or below the ______ for a modified waters projection. | maxillary sinuses; inferior orbital rims |
| Where is the CR placement for an AP axial (towne) for zygomatic arches? | 1" superior to glabella |
| What is the method name for the parietoorbital oblique projection? | Rhese method; three-point landing position |
| Which 3 aspects should be in contact with the tabletop when beginning to position for the parieto-orbital oblique projection? | chin, cheek, nose |
| On the parieto-orbital oblique projection, when you have your 3 point landing correct the ______line should be perpendicular to the IR. This also places the optic foramen in the _____ quandrant of the orbit. | AML; lower outer quandrant |
| Which projection of the facial bone best demonstrates the floor of the orbits (blowout fractures)? | modified parietoacanthial projection |
| Which projection best demonstrates the optic foramina? | parieto-orbital oblique (Rhese method) |
| Which projection best demonstrates the single view of a zygomatic arch? | oblique inferosuperior (tangential) projection |
| Which projection best demonstrates the profile image of nasal bones & septum? | lateral nasal bones |
| Which projection best demonstrates inferior orbital rim, maxillae, nasal septum, nasal spine and zygomatic bone and arches? | waters/ parietoacanthial projection |
| What must be done to prevent the ramus from being superimposed over the c-spine with an axiolateral oblique projection? | extend the neck/ chin |
| How much skull rotation (from lateral) toward the IR is required w/ axiolateral oblique mandible to demonstrate the mentum? | 45 degree rotation |
| How much skull rotation (from lateral) toward the IR is required w/ axiolateral oblique mandible to demonstrate the body of the mandible? | 30 degrees |
| How much skull rotation (from lateral) toward the IR is required w/ axiolateral oblique mandible to demonstrate the general survey of the mandible? | 10-15 degrees |
| What positioning error is present if both sides of the mandible are superimposed w/ axiolateral oblique? | insufficient cephalic CR angulation or head tilt |
| Which skull positioning line is placed perpendicular to the IR for a PA or PA axial of mandible? | OML |
| T/F: the CR should be angles 20-25 degrees caudad for the PA axial mandible. | false; 20-25 degrees cephalic |
| Which aspect of the mandible is visualized w/AP axial mandible (towne)? | condyloid processes |
| What CR angle is required for AP axial mandible if OML is perpendicular to IR? | 35 degrees caudad |
| A radiograph of a lateral projection of the facial bones reveals that the mandibular rami are not superimposed. What positioning error led to this? | head is rotated |
| A radiograph of a parietoacanthial (waters) projection reveals that the petrous ridges are projected within the maxillary sinuses. Is this an acceptable image? if not, what must be done to improve the image during a repeat? | no needs to be repeated; the petrous ridges should be BELOW the maxillary sinuses. the neck/head should be extended more. |
| A radiograph of a parietoacanthial (waters) projection reveals that the distance between the lateral margins of the orbits and the lateral aspect of the skull is not equal. What type of positioning error led to this? | the head is rotated |
| A radiograph of a 30 degree PA axial projection of facial bones reveals that the petrous ridges are projected at the level of the inferior orbital margins. Is this acceptable? | yes this is acceptable; you use a 30 degree caudad angulation when the orbital floors are the area of interest |
| A lateral radiograph of the facial bones demonstrates that the bodies of the mandible are not superimposed; one is able 1 cm superior to the other. How would this be corrected on the repeat? | the head is tilted; make sure the MSP is parallel to the IR. |
| A radiograph of the parietoorbital oblique (Rhese) reveals that the optic foramen is located in the upper outer quadrant of the orbit. Is this acceptable? | no; the optic foramen should be in the lower outer quandrant; the repeat correction is increase the extension of head and neck. Also make sure the AML is perpendicular to the IR. |
| A radiograph of an axiolateral oblique projection of the mandible reveals that the body of the mandible is severely foreshortened. The body of the mandible is the area of interest. What is the positioning error? | rotation of the head is incorrect; insufficient head rotation should be 30 degrees towards the IR. |
| Which sinuses are demonstrated on the SMV? | sphenoid, maxillary, and ethmoid |
| What are four essential attributes to a successful surgical tech? | confidence, communication, problem-solving and mastery |
| T/F: the technologist may violate the sterile environment in surgery if wearing sterile gloves, mask and surgical scrubs. | false |
| T/F: the surgeon is responsible to maintain a safe radiation environment for all personnel in the OR. | False; its the technologist's responsibility |
| T/F: the technologist has a moral and ethical responsibility to report any violations of the sterile field during surgery even if it was not notified by another member of the surgical team. | true |
| What is known as the absent of infectious organisms? | Asepsis |
| Which parts of a sterile gown are considered sterile? | the shoulders to the level of the sterile field, as well as the sleeve from the cuff to just above the elbow. |
| What consists of the practice and procedures to minimize the level of infectious agenst present in the surgical environment? | surgical asepsis |
| T/F: soft (canvas) shoes should be worn in surgery. | false |
| T/F: the pliable nose stripe of the surgical mask helps prevent fogging of the eye glasses. | true |
| T/F: sterile gloves must be worn when handling a contaminated IR in surgery. | false, when handling contaminated IRs in surgery non-sterile gloves are worn. |
| List 3 methods for maintaining a sterile field with a mobile fluoroscopic procedure. | 1. Drape the C-arm/xray tube/image intensifier 2. drape the patient 3. use a "shower curtain" |
| Which is the best method to reduce dose to the patient and surgical team during a c-arm procedure? | reduce distance between anatomy and image intensifier. This creates a brighter, sharper and less magnified image with reduction in radiation to the immediate area |
| What anatomy is examined during an operative (immediate) cholangiogram? | biliary duct system |
| What is the common name for the special tray device that holds the IR and grid during an operative cholangiogram? | pizza pan |
| How must the IR and grid be aligned if the OR table is tilted during an operative cholangiogram? | CW; to avoid grid cutoff |
| whats the advantage of the laparoscopic cholecystectomy over the traditional cholecystectomy? | the laparoscopic is less invasive approach to remove the gallbladder; reduced hospital time; can be performed outpatient procedure |
| A radiographic examination of the pelvicalyceal system only during surgery is termed what? | retrograde pyelogram |
| What position is the patient placed in during a retrograde urography? | modified lithotomy position |
| Which of the following orthopedic procedures is considered nonsurgical? a)open reduction b)external fixation c)closed reduction d)internal fixation | closed reduction |
| which of the following orthopedic devices is classified as an external fixator? a)intramedullary nail b)cerclage wire c)semitubular plate d)ilizarov device | ilizarov device |
| what is the name of the newer type of prosthetic device to replace a defective hip joint? | modular bipolar hip protheses |
| What is a surgical procedure that is performed to alleviate pain caused by bony neural impingement involving the spine? | laminectomy |
| what position is the patient in during most spinal laminectomies? | prone (AP) |
| T/F: a 30 degree tilt of the C-arm from the vertical perspective will increase the dose by a factor of 3 to the head/neck region. | false; factor of 4 |
| Suctioning, tying, and clamping blood vessels as well as assisting in cutting and suturing tissues are the general duties of the what? | surgical assistant |
| which method of sterilization helps maintain the sterile environment during a C-arm guided hip pinning? | shower curtain |
| What portion of the OR table is considered sterile? | only at the level of the tabletop |
| T/F: scrubs worn in radiology may be also worn in the OR. | false; in the OR, OR scrubs or lent-free scrubs are worn only. |
| T/F: retrograde urography is a functional examination of the urinary system. | false; nonfunctional b/c its retrograde (backwards) |
| ORIF stands for what? | open reduction internal fixation |
| a retograde pyelogram is a specific radiographic examination of the ________ system. | pelvicalyceal |
| What are hip pinning guidewires and cannulated screws used on? | nondisplaced femoral neck fractures |
| What is the CR placement for the waters facial bones? | perpendicular to the IR; exit at the acanthion |
| What line is perpendicular to the IR on the waters facial bones? | MML |
| What is the CR placement for the nasal bones? | 1/2" inferior to the nasion |
Created by:
mokapis
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