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Radiography of the Orbits

Radiography of the Orbits. Fall 2009 FINAL. Function of Orbits. Serve as bony sockets for the eyeballs Openings for nerves and blood vessels. Bones of the Orbits - 7. A. B. C. D. E. I. F. G. H. ________________ Primarily composed of orbital plate of frontal bone

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Radiography of the Orbits

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  1. Radiography of the Orbits Fall 2009 FINAL

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

  3. Bones of the Orbits - 7 A B C D E I F G H

  4. ________________ Primarily composed of orbital plate of frontal bone ________________ Zygoma (small amount) Maxilla Palatine 3. _______________ Medial Lacrimal Lateral Zygoma (large amount) Division of the Orbits

  5. Base of the Orbit The circumference is made of 3 bones: • _________________ • _________________ • _________________

  6. Openings in Posterior Orbit • ______________ • Optic canal • Sphenoid strut • ______________ • ______________

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

  8. Indications for Orbit and Eye Radiography • Possible Fractures • Blowout • Tripod • Lefort • Foreign body of the eye

  9. Mechanisms producing Orbital Fractures • Auto accidents • Assault • Falls, sports, and industrial accidents

  10. Blowout Fracture

  11. Blowout Fracture • Blow to the eye • Orbital floor is fractured • Soft tissue herniates into maxillary sinuses • Often have ocular injury Ponsell, 2003

  12. _____________________

  13. Blowout Fracture

  14. ______________________

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

  16. LeFort Fractures LeFort types II & III involve the orbits Richardson, 2000

  17. Lefort II and III

  18. Type II Separation through: frontal processes lacrimal bones orbit floors, zygomaticomaxillary suture line lateral wall of maxillary sinuses pterygoid Complications ____________ system obstruction Infraorbital nerve anesthesia ____________ Malocclusion LeFort Fractures

  19. Lefort 2

  20. Type III Separation of mid third of face at: zygomaticotemporal naso-frontal sutures and across orbital floors Complications _________________ Mal-union _________________ Lenthening of mid face _________________ system obstruction LeFort Fractures

  21. LEFORT 3

  22. LEFORT 3

  23. Orbits Basic _________________ _________________ Special _________________ Eyes Basic _______________ _______________ _______________ Basic and Special Projections

  24. Parietoacanthial ProjectionWaters Method • Positioning • ____________ • ____________ • Lines and planes: • ____________ • ____________ • CR: • ___________ Ballinger & Frank, 1999, pg 317

  25. Parietoacanthial ProjectionWaters Method Radiograph • Distance from lateral border of skull and orbit equal on each side • Petrous ridges projected immediately below maxillary sinuses

  26. Parietoacanthial Projection Modified Waters • Positioning: • _____________ • Lines and planes • _____________ • _____________ • CR • ____________

  27. Modified Waters Radiographs • Petrous ridges projected immediately below the inferior border of the orbits • Equal distance from lateral orbit to lateral skull on both sides

  28. Modified Parietoacanthial Modified Waters method

  29. Modified Waters Radiograph & Diagram

  30. Acanthioparietal ProjectionReverse Waters Method • Positioning • _______________ • Lines and planes • _______________ • _______________ • CR • _______________ Ballinger & Frank, 1999, pg 320

  31. Reverse Waters Radiograph • Distance from lateral border of skull and orbit equal on each side • Petrous ridges projected immediately below maxillary sinuses

  32. Parietoorbital Projection (Rhese Method)(PA) Optic Canal and Foramen • Positioning • ______________ • ______________ • Lines and planes: • ______________ • ______________ • PA- CR: • enters 1”superior and posterior to TEA • PA- CR: • exits through the affected orbit Ballinger & Frank, 1999, pg 290

  33. Parietoorbital Projection (Rhese Method)(PA) Optic Canal and Foramen Radiograph • 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

  34. Rhese Diagram and Radiograph

  35. Rhese Method(AP) Optic Canal and Foramen • Positioning: • _______________ • _______________ • Lines and planes: • _______________ • _______________ • AP- CR: • _______________ Ballinger & Frank, 1999, pg 292

  36. Rhese Method(AP) Optic Canal and Foramen Radiograph • 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

  37. Rhese Radiograph and Diagram

  38. Foreign objects in the EYE

  39. Lateral Projection (EYE) • Positioning: • Semiprone or seated upright • Affected eye closest to cassette • ___________________ • Lines and planes: • MSP parallel • IPL perpendicular • CR: • ___________________

  40. Lateral Eye for Foreign Body • Density & contrast permitting optimal visibility of orbit and foreign bodies • SI orbital roofs • Close beam restriction

  41. PA Axial (EYE) • Positioning • Forehead & nose on IR. • Center IR ¾ “ distal to nasion • ________________ • Lines and planes: • ________________ • CR: • Through center of orbits, 30 degrees caudal

  42. PA Axial Eye Radiograph • Petrous pyramids lying below orbital shadows • No rotation of cranium • Close beam restriction

  43. Modified Waters (EYE) • Positioning: • IR at level of orbits • Rest pt’s chin on IR • Instruct pt to close eyes and hold eyes still • Lines and planes: • MSP perp • OML 50 degrees • CR: • Perp through mid-orbits

  44. Modified Waters Radiograph • Petrous Pyramids lying well below orbital shadows • Symmetric visualization of orbits • Close beam restriction

  45. LETS REVIEW

  46. Seven Bones of the Orbit

  47. Openings and Supporting Structures of Openings of the Orbit

  48. Parietoorbital Oblique Projection of Orbits

  49. References Ballinger, P.W. & Frank, E.D. (1999). Merrill’s 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

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