EXTRA ORAL RADIOLOGY

Class taken by: Dr Vineetha Manu
The main clinical indications requiring radiographs of the skull and maxillofacial skeleton include: • When intraoral radiographs are unobtainable as during trismus • To examine the extent of large lesions • When jaws or other facial bones have to be examined for evidence of lesions & other pathologies • To evaluate skeletal growth & development • To evaluate the status of impacted teeth • To evaluate trauma • To evaluate TMJ, antrum, skull base & vault EXTRA- ORAL RADIOLOGY • X-ray source and the image receptor both are placed outside the mouth Requirements – Cassettes – Intensifying screen – Grids in certain cases – Films – Specialized equipment Differences INTRAORAL RADIOGRAPHY • • • • • • • • • • • • • • EXTRA- ORAL RADIOGRAPHY •

Film placed inside the mouth Smaller film size Covers 2 or 3 teeth and surrounding periapical areas Cassettes not required Intensifying screens and grids not used Less radiation exposure Requires less technical expertise

Film placed outside the mouth Large size films Broader coverage of area

Cassettes mandatory Intensifying screens and grids used More radiation exposure Comparatively Difficult procedure

Common extra-oral radiographs • Panoramic radiographs • Lateral oblique views • Paranasal sinus view

Screening radiograph for gross teeth / bone status 2. Condylar evaluation 5. . LATERAL OBLIQUE MANDIBLE • Extraoral views of the jaws that can be taken using a dental X-ray set . To assess large bony pathologies 6. Antral disease — particularly to the floor. posterior and medial walls of the antra 8. The structures seen on a panoramic image are primarily those located within the image layer. called the image layer / focal trough in which the object of interest is located 3D curved zone: image layer or focal trough is a three-dImensional curve zone (or focal trough) in which the structures lying within the layer are reasonably well defined on final panoramic image. As part of an assessment of periodontal bone support 3. Estimation of dental age Principle • Reciprocal movement of an x-ray source and an image receptor around a central point or plane. Before the development of dental panoramic equipment they were the routine extra-oral radiographs used. Fractures of all parts of the mandible except the anterior region 7.an unobstructed or complete view of a region in every direction • Technique for producing a single tomographic image of the facial structures that includes – Both the maxillary and mandibular dental arches and – Their supporting structures Indications of panoramic radiography 1. To assessment the location of third molars 4.• • • • Submentovertex view PA skull and mandible Lateral cephalogram TMJ views What you should know? • WHY these projections are taken? • HOW these projections are taken? • WHAT the resultant radiograph should look like? PANORAMIC RADIOGRAPH • Derived from the word ‘panorama’.

naso-ethmoidal complex • Coronoid process Fracture • Sphenoid sinus can be visualized – if mouth is opened Posterio-Anterior views PA Skull PA mandible PA CEPHALOGRAM . III. II.Ramus projection and body projection INDICATIONS • Assessment of the presence and/or position of unerupted teeth • Detection of fractures of the mandible • Evaluation of lesions or conditions affecting the jaws • As an alternative when intraoral views are unobtainable • As specific views of the salivary glands or TMJ PARANASAL SINUS VIEW (WATER’S VIEW) • Occipito-mental projection • PA view modification • Centered on maxillary sinuses INDICATIONS –PNS VIEW • Maxillary sinus evaluation • Detecting the following middle third facial fracture – Le Fort I.

Rami)  Low condylar necks  Lesions such as cysts or tumours in the posterior third of the body or rami to note any medio-lateral expansion  Mandibular hypoplasia or hyperplasia  Maxillofacial deformities Technique and positioning Exactly the same position as for the PA skull. the radiographic baseline horizontal & perpendicular to the film in the forehead-nose position RADIOGRAPHY OF BASE OF SKULL SUBMENTOVERTEX VIEW: This projection shows the base of the skull. to show these thin bones the SMV is taken with reducedexposure factors to almost one third of normal exposure(Jug handle view) .Shows the posterior part of the mandible: body & ramus Symphysis not seen well Not suitable for showing the facial skeleton because of superimposition of the base of the skull & the nasal bones INDICATIONS  Fractures of the mandible involving the following sites: ( Posterior third of the body. i. sphenoidal sinuses and facial skeleton from below • • • INDICATIONS • Investigation of the sphenoidal sinus • Assessment of the thickness (medio-lateral) of the posterior part of the mandible before o osteotomies • Destructive/ expansile lesions affecting the palate. the head tipped forward.e.Angle. pterygoid region or base of the skull • Fractures of the zygomatic arches.

but also showed the condyles. so that the vertex of the skull touches the film. So ideal for follow up studies Wedge filter on the anterior aspect of beam.Technique and positioning:The patient is positioned facing away from the film. The head is tipped backwards as far as possible. since all skull views used in dentistry are taken conventionally in the PA direction. especially fracture of the odontoid peg REVERSE TOWNE’S VIEW • This projection shows the condylar heads and necks • The original Towne's view (an AP projection) was designed to show the occipital region. the reverse Towne's (a PA projection) is used • INDICATIONS • High fractures of the condylar necks • Intracapsular fractures of the TMJ • Evaluation of the articular surfaces of the condylar head • Condylar hypoplasia or hyperplasia LATERAL CEPHALOGRAM • • • • ALWAYS taken in standardized position.However. so soft tissue profile also can be studied Centered to external auditory meatus SPECIAL TMJ VIEWS:  Transcranial view  Transpharyngeal view  Transorbital view TRANSCRANIAL VIEW . IMPORTANT: this position is contraindicated in patients with neck injuries. Consistent and accurate positioning of patient’s head in relation to a fixed position of tube head.

condylar head & neck visible: condylar neck fractures. 30° through ipsilateral orbit & centered over the TMJ of interest RADIOGRAPHS USEFUL FOR CONDYLAR EVALUATION :      Panoramic radiograph Lateral oblique ramus PA mandible Reverse towne SMV . displaced condylar fractures & range of motion ( open mouth view) Technique and positioning • The beam is directed downward from the opposite side through the cranium & above the petrous ridge of the temporal bone at 25° centered through the joint • Beam is angled 20° anteriorly • TRANSPHARYNGEAL / INFRACRANIAL/ McQUEEN/ PARMA VIEW • Provides sagital view of the medial pole of the condyle • Limited information. gross degenerative changes • • • • Technique and positioning Canthomeatal line is adjusted horizontal Beam is directed downward 10° from front of the patient.Provides a sagittal view of the lateral aspects of the condyle & the temporal component Post auricular or LINDBLOM technique is the most common Gross osseous changes on lateral aspect of the joint only. as temporal component not imaged well • Erosive changes of the condyle rather than subtle changes • Technique and positioning • Beam directed superiorly at -5° through the sigmoid notch of the opposite side & 7-8° from the anterior • Mouth opened maximally to avoid superimposition of the condyle on the temporal component TRANSORBITAL/ ZIMMER VIEW • Provides an anterior view of the TMJ perpendicular to transcranial & transpharyngeal views • Entire mediolateral dimensions of the articular eminence.

superior margins of orbit. vertical. composed of panoramic juxt apositioning of two separate bones • Lower half: thin cortical outline of the posterior surface of the zygomatic process of maxilla. radiopaque line in the posterior third of the sinus.   Transcranial Transorbital Transpharyngeal Mc GRIGOR & CAMPBELL LINES • They described a search pattern of four lines when examining the PNS projection • Fifth line is known as Trapnell’s line • These lines allow the examination of all those parts of the face where fractures are most likely to be found LINE 1: Across frontozygomatic sutures. passing along the frontal process of zygoma to the ZF suture MAXILLARY LINE: inerior margin of the zygomatic arch. passing over the nasal arch ZYGOMATIC LINE: superior margin of the arch & body of zygoma. coronoid process & maxillary sinuses LINE 4: Crosses the ramus & occlusal plane LINE 5: Inferior border of mandible from angle to angle ADJUNCT LINES OF DOLAN & JACOBY ORBITAL LINE: extends along the inner margins of the lateral. upper half: posterior surface of frontal process of zygoma l . inferior margin of the body & buttress of zygoma & the lateral wall of maxillary sinus PANORAMIC INNOMINATE LINE • Thin. inferior orbital margin & nasal bones LINE 3: crosses the condyles. frontal sinuses LINE 2: along zygomatic arches. zygomatic body. inferior & medial walls of the orbit.

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