ORAL AND MAXILLOFACIAL IMAGING

ROLE OF IMAGING IN MAXILLOFACIAL SURGERY

 Identification of abnormality in size,

shape, site, nature and its relation with
other structure
 Surgical planning
 Post operative result
 Foreign body
TYPES OF IMAGING
1. Invasive
2. Non invasive
 Invasive; used for therapeutic, diagnostic and

curative purpose i.e. embolization, cytotoxic

drugs, angiography, angioplasty and lithotripsy
 Non invasive; two types

1.Plan radiograph; i) conventional ii)

contrast
2.Specialisd
2. SPECIALIZED
 C T scan
 MRI
 Ultra sound
 Scintigraphy
 Positron emission tomography (PET
scan)
PLAN RADIOGRAPHY
Advantages
 Easily available

 Used for primary screening

 No special preparation needed

 No skilled person needed

Disadvantages
 Shows 2 dimension of a 3 dimensional object

 Superimposition of object

 Poor deference between normal and abnormal

 Small lesions can not be detected

MODALITIES OF PLANE X--RAYS
Intra oral
1. Periapical

2. Occulusal; i) anterior ii) true iii) vertex

3. bite wing

Extra oral
4. cervical series

5. Head

6. Facial series i) mandibular series ii) mid

and upper face series
CERVICAL SERIES
 Cross table lateral view
 Swimmers view
 Anteroposterior view
 Open mouth odontoid peg view

X—rays for head

 Anteroposterior view

 Lateral view
FACIAL SERIES

 Face is divided in ;
1. upper 3rd
2. middle 3rd
i) central and
ii) lateral

3. lower 3rd
MANDIBULAR SERIES
 2 x—rays 1. Posteroanterior view
2. O.P.G
 3 x—rays; 1. posteroanterior view
2. Right and
3. Left lateral oblique
 5 x—rays; 1. posteroanterior view

2. two lateral oblique view

3. two off-center posteroanterior
views
PLANES AND LINES IN FACIAL IMAGING
 Sagittal plane; parallel to mid
sagittal plane
 Coronal plane; perpendicular to
orbitomeatal line
 Axial plane; parallel to orbitomeatal
line
 Orbitomeatal line; imaginary line
running from outer canthus of eye to
external auditory meatus
MIDDLE AND UPPER FACE

Upper face;
 Occipitofrontal view 10—150
 Modified Caldwell view 250

Used for frontal sinus and orbital roof

Mid face
 Waters projection(Occipitofrontal 35 o )

used for maxillary sinus and orbital

floor
MID FACE
 Occipitomental view 100 ; used for lateral sinus
walls and for zygomatico frontal fracture
 Occipitomental view 300 ; used for zygomatic

arch and infra orbital margin

 Occipitomental view 400 ; used for blow out

fracture
 Lateral projections

1. true lateral
2. lateral oblique
MID FACE
 Reverse towns view ; Occipitofrontal
projection with the tube directed 30o up
ward 4 cm above the superior orbital
margin .it is used for condylar fracture
 Panoramic x—rays;
 intra oral ; tube and film are static
 Extra oral
 Zonography; x—ray of mandible in spine
position
SEARCH PATTERN IN X—RAY

4 s principals
 Sharpness
 Symmetry
 Sinus

 Soft tissue
CAMPBELL'S AND TRIPNELLS LINES
 1. suppra orb
 DOLANS LINES
1. Orbital line
2. Zygomatic line
3. Maxillary line
SIGN OF FRACTURE ON X--RAY

Direct sign;
 Separation sign

 Sutural diastasis sign

 Overlap sign

 Abnormal linear density

 Abnormal angulation

 Step deformity

 displacement
INDIRECT SIGN
 Soft tissue swelling
 Sinus opacification
 Air in soft tissue
 Intra orbital air
 Pnumocephalus
 Chang in occlusion
 Dental injury
COMPUTERIZED TOMOGRAPHY (CT SCAN)
 Considered as gold standard in medical
imaging
 X-rays emitting through a tube placed
in a squire machine known as gentry
 Patient is placed in side the hole in the
gentry
 Ct scan provide cross sectional image
 Axil view is considered as a stander
view
MODULATES
 Plane
 Contrast enhanced
 Simple vs. high resolution
 Reconstruction ,axil, coronal and
sagittal
New modulates
 3-d
 Dent scan
 Multi planer real time
ADVANTAGES
 No special patient preparation needed
 Quick—reduce motion artifact

 Used in emergency ,trauma and child patient

 Scan time less then one minute

 Simon soft wear program used to convert 2d

in to 3d
Disadvantages
 Patient cooperation needed

 Body motion degrade image

 Radiation burden

 Allergic reaction to contrast

OUTSTANDING FEATURES
 Complex anatomic structure lock like
anatomic dissection
 Delineate abnormal bony anatomy
 Give information about size, site,
relation with anatomic structures
 Facilitate in surgical paining
 Good teaching aid
 Helpful in communication
ULTRA SOUND
 Sound waves are used which reflect in
the form of image of internal organ
Advantages
1. Non invasive
2. Economical

3. Quick

4. Pain less
5. Moveable equpment
DISADVANTAGES
 Sonographic knowledge needed
 Operator dependent
 Bone can not be seen

Uses ;
1. Cervical lymph nodes for occult Mets, skip
Mets
2. Nature of lesions in the neck i.e. solid or
cystic
3. Ultrasound guided aspiration biopsy
MAGNETIC RESONANCE IMAGING -MRI
 New modulaty
 Use radio frequency radiation in the
presence of strong magnetic field
 Produce cross sectional imaging
 Show superior soft tissue contrast
 Record small masses 100%
 Decreased artifact due to metallic
filling ,crown, bridge
LIMITATIONS
 Metallic implant in CNS, CVS are
attracted which leads to death of
patients
 Bone can not be scanned
 MRI anatomical knowledge needed
 Motion artifact due to prolong scanning
time
 Clustered phobia
 Skilled person needed
SCINTIGRAPHY
 Radio nucleotide, technetium phosphate or gallium,
is used by intra venous injection
 50% deposited in bone50% dispersed in soft tissue in

one hour
 Take up of radioactivity recorded by gamma camera

or by SPECT(single photon emission computed

tomography) or by scintillating camera
 In SPECT detector rotate at 360 0 and acquire 180

images in deferent angulations

INDICATIONS
 Skeletal growth assessment
 Mets in skeleton
 Detection of osseous lesions
,metabolic activity in bone
 Hot lesion- increase up take
 Cold lesion- decrease up take
ADVANTAGES
 Availability
 Un expensive

 Low radiation

 Short time required

 Ideal for child

 No patient special preparation

Dis advantage
1. Radiation hazard