Head and Neck Division Radiology Department Faculty of Medicine University of Indonesia / Cipto Mangunkusumo Hospital

Few indications remain for ear and eye plain radiography USG is indicated in opaque ocular media due to funduscopy is impossible in the assement of the posterior segment.

The role of CT and MRI are complimentary in many areas of head and neck :

- CT provides a superior bone image
- MRI provides soft tissue characteristic




Plain/Conventional Radiography Modality imaging : USG CT Scan MRI .

.Very limited applications mainly used in the management of :    Suspected foreign bodies Fractures A few cases of bone disease (e.g. Fibrous dysplasia).

Foreign Body  Comberg .

Blow Out Fracture  waters position .

An imaging method that uses high frequency sound waves to produce precise imaging of structures These images often provide information that's valuable in diagnosing and treating a variety of diseases and conditions. safe. reliable investigation . Cheap.

These images or pictures are useful in the diagnosis of retinal detachment. .USG of the Eye A piece of equipment used to produce an image or photograph of your retina. vitreous hemorrhage and intraocular tumors.

jelly and the transducer head held over a closed eye  Serial scan : transverse and sagital  Patient was instructed to move the eye ball upwards. nasal and temporal side for delineating better anatomy of the eye ball and motility of intraocular lesion . downwards.5 – 10 MHz until 100 Mhz Methods :  Supine position.USG of the Eye B scan : 7.



Vitreous Haemorrhage .

Cataract .




Multi Slice Computed Tomography  Suited examinations of the orbit  orbital walls and soft tissue structures have high natural radiography   Performed with and without IV contrast media The adjacent paranasal sinuses should be covered  Is often helpful to have both bone and soft tissue windows .

Magnetic Resonance Imaging  Does not use radiation  save imaging modality (no oncogenic potential is known to this date)  Paramagnetic contrast material should be used for suspected tumors. other specific or non specific orbital masses and optic nerve lesions . pseudotumors.

Evaluation of orbital trauma  Detection of foreign body  Detection of calcification  Evaluation of osseius. cartilagenous and fibroosseous disease  Evaluation of orbital soft tissue lesion with suspicious of bony erosion or detection  Contraindication to MRI  .

Acute Proptosis  Suspicious of optic nerve sheath complex lesion  Intraocular tumor with extraocular extension  Detection of wound foreign body  Contraindication CT scan  .






Orbita Fracture .


Well circumscribed cystic lesions .

enlarge left covernous sinus .Carotid Covernous Fistula : Enlarge intra orbital vein.

destruksi inferior orbita to maksilary sinus lymphoma Lymphoma involving lateral retrobulber intrakonal .intraconal.Ill Defined Solid Orbital Lesion Lymphoma : involving inferior rectus . retrobulber .

Bilateral retinoblastoma .

sagital and coronal view Trilateral disease: Orbita bilateral and pituitary gland metastasis .Retinoblastomas On MRI o MRI provides soft tissue characteristic. CT provides a superior bone image o Performed with and without IV contrast media o Needs axial.

.Lymphoma (A) Coronal precontrast and (B) postcontrast T1W fatsupresi an infiltrative lesion involving the superior rectus and levator palpebrae superioris muscles and the surrounding orbital fat. Incisional biopsy confirmed the diagnosis of B-cell malignant lymphoma.

Ear discharge  Middle ear infection  Deafness  Imaging ? .

Anatomy middle ear .

Conventional x-ray  CT Scan  MRI  .

2 mm thick contiguous sections ideally axial and coronal planes MRI  improve soft tissue resolution  .Conventional x-ray (plain x-ray examination) initial assessment  showing the extent and condition of mastoid air cell  CT and MRI: principal radiological investigation for assessing petrous bone pathology CT  HRCT technique. comparising 1.

 Submentovertical view .

 Half axial (Towne’s) view .

 Lateral view plain Mastoid X-ray .

Schuller methode / Mastoid Projection simple radiology examination .





CT Anatomy of the Ear

Koronal :Oval window Koronal : N 7, Long incus maleus

Axial: stapes

Acute otitis media and acute mastoiditis
are common infections.

Imaging is only required if complications are suspected.

Benign : cholesteatom (-) Malignant: cholesteatom (+) .

Epidermoids of the petrous bone. composed of keratinizing stratified squamous epithelium which constantly desquamates keratin Associated with prior otitis media Occur anywhere within the middle ear Typically originate laterally in the epitympanum between the scutum and malleus .

Radiological diagnosis  cavity & extending HRCT the (mass occupying the middle ear into mastoid antrum) .

Chronic Otitis Media: • CT scan can assess the location and extension of the tissue • MR can also assess soft tissue • Retroauricular US unable to assess the presence of granulation tissue • CT able to assess the damage to the bone .

Erosive cholesteatoma: CT can evaluate N VII .

Extensive cholesteatoma with tegmen erosion The best modality to evaluation of bone Evaluate the location and extention of adjacent To evaluate bony involvement of granulation .

 To exclude intracranial complication (contrast enhanced CT also can be used)  Intracranial complication:  Perforation of the tegmen tympany  Epidural empyema  Temporal / cerebellar abscess .

Maybe use for DD/  Cholesteatoma  Granuloma  Fluid .

To difference soft tissue mass Recurrent cholesteatoma 5 yo boy on DWI MR .

The sound is sent to the speech processor (2). The implant converts the code into electrical signals (4). . The electrical impulse travels normally along the remaining auditory pathway (6). which sends the code across the skin to the internal implant (3). The coded signals are sent to the transmitter.Cochlear implant Illustrate cochlear implant function. The signals are sent to the electrodes to stimulate the nondegenerated cochlear nerve spiral ganglia-axons (5). The microphone receives the sound (1).

• Audiologic examination  • Both CT scan and MRI of temporal bones  • Trial of high-powered hearing aids  • Psychological evaluation  • Medical evaluation  • Any workup necessary to discover etiology of hearing loss  .

congenital)  .To depict cochlear nerve agenesis and cochlear anomalies  To detect occult an acoustic nerve tumour  To detect brainstem anomalies (trauma.