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Temporal
Os &
Mastoid
Petrosum
 Group 1
■ ENGGAR GALIH WIJAYA P1337430219007
■ M. FADLI NAJMUL FALAH P1337430219008
ALKAHFI
P1337430219011
■ I MADE MAHARTA ANANTAWIJAYA
P1337430219107
■ ANNISA NURIANTY RACHMA
P1337430219116
■ BIANDA AMANDIATRE CASTA
P1337430219124
■ ITA RUSELA
P1337430219127
■ AWALIA PUTERI NARESWARI
P1337430219137
■ SHONIA GHINA ZAHARA
P1337430219144
■ ANGEL AYU SYAFIRA
 Temporal Anatomy
■ Mastoid portion: posterior part of the
temporal bone to the external
acoustic meatus (MAE)
■ Petrous portion: part of the temporal
os that forms a bulge inward which is
often called the petrous pyramid
■ Squamous portion: the largest area of
the temporal bone on the upper side of the
skull

■ Petramastoid portion: the area where the

mastoid portion meets the petrous
portion.

■ The styloid is a long sharp process that is

directed downward, forward, and medial
between the parotid gland and the
internal jugular vein of the main article.
The styloid process is inferior to
the tympanic and is shaped like a
 Mastoid &
Petrosum
Mastoidis an air-filled cavity
contained in the temporal bone that is
connected to the nasopharynx through
the eustachian tube and is connected to
the mastoid aircell (mastoid cavity)
through the tympanic antrum (aditus ad
antrum).

Petrosumis the part that is often

referred to as wellpetrous pyramid, is the
solid bone in the cranium , conical or
pyramidal and thick. This part of the
temporal bone contains the organs of
hearing and balance. The petrosal is seen
medially and anteriorly between the greater
wings of the sphenoid and occipital bones
to the body of the sphenoid bone at the
apex of the articulation.
Image of the internal surface of the temporal
bone
1. Processus Zygomaticum
2.Fossa articulation with
Mandibular condyle
3. Processus Styloideus
4. MAE
5. Mastoid process
6. Jugular fossa
7. Carotid Canal
8. Petrosum
9. Eustachian tube
 Mastoid & petrous bone
pathology
1. Mastoiditis

Mastoiditis is an infection of the bony prominence behind the ear/mastoid bone.

This disease can destroy bones and cause hearing loss. This disease can happen to anyone,
but usually occurs in infants aged 6-13 months or people who have a weak immune system.

a. Signs and symptoms of mastoiditis

▪ Purulent ear
▪ Ears feel uncomfortable pain
▪ Sudden high fever
▪ Headache
▪ Decreased hearing ability
▪ There is swelling and redness of the ear
b. Causes of mastoiditis
▪ Experiencing an infection by bacteria such asHaemophilus influenza, Staphylococcus,
Streptococcus

▪ Experiencing otitis or inflammation of the ear but not being treated immediately
completely
Advanced
…
2. Cholesteatoma
Cholesteatoma is an epidermoid cyst which
histologically has an inner layer consisting of squamous
epithelium and an outer layer consisting of subepithelial
supporting tissue.
Cholesteatoma is a benign tumor that often occurs in
the middle
ear or in the secondary mastoid area.

3. Otosclerosis
Destruction of the spongy bone formation in the middle
and inner portion of the auditory area.
 Radiation
Protection
Patient protection.
Adequate collimation by reducing the area of the irradiation
field.
Use proper exposure factors.
No repetition of photos due to errors. The
shortest possible irradiation time.
The patient wears an apron.
Pregnant patients in the first trimester should be deferred.

Protection for officers.

Do not use X-ray beams that point to officers. Take shelter
in screens/curtains, when doing exposure.

Protection for the community.

The inspection door was tightly
closed.
Do not direct the X-ray
source beam into public
spaces.
 Temporal Os Examination
Procedure (Mastoid and Petrosum)
A. Patient preparation
In the temporal radiographic examination there is no special preparation for the patient. Only
Of course, all objects that can interfere with the radiograph are removed first, such as:
necklaces, earrings, piercings, glasses, hair bands, etc. It is important to explain the
examination procedure to be carried out and the reasons for removing objects that may
interfere with the radiograph

B. Tool Preparation

The tools that need to be prepared for radiographic examination of the temporal
bone
(mastoid and petrosum are:
1. X-ray machine
2. Cassette, film, and hanger measuring 24 x 30 cm

3. Marker, tape, and scissors

4. Pb sheet
5. Meter
Advanced…
C. Shooting technique

The projections used in radiological examination of the temporal bone

(mastoid and petrosum) are AP Axial (Towne Method), Submentovertex (SMV),
Axiolateral Mastoid (Schuller Method), Axiolateral oblique (law method), axiolateral
oblique (stenvers method), Axiolateral oblique projections. (mayer method owen
modification)
1. AP Axial Projection (Towne Method)
1. Patient Position (PP)

■ The patient is supine on the examination

table

■ The MSP of the body is in the middle of

the examination table.

2. Object Position (PO)

■ Head down so that the OML (Orbito

Meatal Line) is perpendicular to the
cassette
■ For patients who cannot lower their head,
adjust the IOML (Infraorbitomeatal Line)
perpendicular to the cassette and
increase the beam angle 7ocaudad
■ No head movement during exposure
 Advanced…
3. Beam
setting
■ Central Ray :
for OML or 370caudad for
(CR) 300caudad
IOML
■ Central Point : 2 ½ inches
(CP) cm) superior (6.4
nasi
: 100 cm
■ Factor Film
: 70-80
Distance (FFD)
kVp,
■ Exposure Factor
: Hold
26 mAs
breath
■ Respiration
: 18x24cm,
■ Cassette
longitudinal :
(+)
■ Grids
 Advanced…
4. Radiographic criteria
• Petrous pyramid looks symmetrical
•View of the entire petrous
and mastoid
• View of dorsum sellae
with foramen magnum
• Mastoid sinuses seen
• The distance from the foramen magnum to the
lateral side of the cranium is the same on both
sides
 3. Axiolateral Mastoid Projection
(Schuller Method)
1. Patient Position (PP)

■ Semi-prone or recumbent patient on examination table. If

the right is examined, the right hand is placed behind the
body, the left leg is flexed anteriorly.

■ The affected part of the hand is placed posterior to the body

■ One leg is placed anterior to the body, while the other

leg is flexed

2. Object Position (PO)

■ Position head in true lateral;

■ Place the lateral side of the head on the examination

table; the desired side is close to the cassette.

■ The head is rotated so that the MSP head is parallel to

the examination table

■ Position the patient's IPL (Interpupillary Line) perpendicular to the

examination table

■Bend the auricle forward so that it does not overlap

the mastoid
Advanced…
3. Beam
setting
■ Central Ray (CR) : the direction of the ray axis forms
– 30 degrees 25
caudad
: protruding from the lower mastoid
■ Central Point
approximately (CP)superior and posterior
1 ½ inches
(approx.to the
MAE)
■ Factor Film Distance (FFD) : 100
cm
: 70-80 kVp, 26 mAs,
■ Exposure Factor
: Hold your breath during the
■ Respiration exposure

■ Grid +
Advanced…
4. Radiographic criteria

■ Lateral view of the mastoid air cells and

bony labyrinths on the side adjacent to
the cassette.
■ The mastoid bone and part of the petrous
bone are visible in the middle of the film

■ Mastoid air cells are seen on the

posterior petrous ridge
■ The mastoid and petrosum on the other side
are not in superposition with the mastoid and
petrosal being examined. And projected on
the inferior part of the mastoid and
examined petrous
■ The auricle is not superimposed on the mastoid
2. Submentovertex Projection
(SMV)
1. Patient Position (PP)

■ The patient is positioned standing (erect) in front of

the buckystand

■ The head MSP is set at the mid-

buckystand

2. Object Position (PO)

■ Chin extended

■ hyperextend the neck if possible to the

IOML parallel to the cassette

■ The vertex head attaches to the cassette

3. Beam
setting
■ Central Ray (CR) : perpendicular to the IOML
■ Central Point : in the second half of the mandibular angle
(CP) ormandibular
2.5-3 inches (6-8 cm) inferior to the
symphysis

■ Factor Film Distance (FFD) : 100 cm

: 70-80 kVp, 26 mAs
■ exposure factor :

■ Respiration Breath Resistant

■ Grid +
Advanced…
4. Radiographic criteria

■ Bilateral view of the petrous pyramids

■ View of the internal acoustic canal

■ The foramen ovale and foramen

spinosum are visible

■ View of the mandibular condyle

anterior to the MAE canal
■ Cranium does not rotate
■ Symmetrical petrous pyramid

■ Density and contrast

adequately describe the
petrous pyramid
4. Axiolateral oblique projection
(law method)dextra
1. Patient Position (PP):
■ Semi prone patient, bend the right auricle
to prevent superimposition with the
mastoid,

2. Object Position (PO)

■ head rotated to the right on the
examination table with the right side close
to the IR;

■ MSP head parallel to examination table,

from lateral position rotate MSP head 15° to
IR.

Hold the interpupillary line perpendicular to

the examination table.

■ Set the head with the IOML perpendicular to

the front of the IR border
Advanced…
3.Setting the beam axis
and exposure
■ Ray direction/central ray
(CR)
: 15° caudad
■ Aim point/central point
(CP)
: Mid CR out
2.5 cm posterior and superior to
the top of the MAE.

■ exposure factor
: 70-80 kVp, 26 mAs
■ Focus Film Distance (FFD)
: 100 cm
■ During the exposure

: Respiration (breath holding)

■ Grid +
Advanced…
4. Radiographic criteria

■ Air on the mastoid cells and

bony labyrinth close to the IR is
seen
■ The processus mastoideus is close to the cassette
along with the Air Cells in the center of the
cassette

■ The opposite mastoid process is not

superimposed but is thrown down and
slightly forward from the part of the mastoid
being examined
■ Auricle is not superimposed on the
Mastoid Process
■ MAI and MAE superimposition
5. Oblique axiolateral projection
(stenvers method)
dextra

1. Patient Position (PP)

■ Semiprone on an examination
table or sitting
2. Object Position (PO)

■ Adjust the MSP of the head so that the IOML

is perpendicular to the front of the IR
boundary

■ Rotate MSP Head 45⁰

(mesochepalad) with right side close
to IR.

■ Place the right mastoid side in the

midline on the IR
Advanced
…
3. Light and exposure
settings:
■ The direction of the beam axis / central ray : 12°
(CR) chepalad
■ Shooting point / central point (CP):3-4 inches (7.6-10
cm)
posterior and 0.5 (1.3 cm) left from MAEgo
inferior on the right mastoid out
process.
■ exposure factor : 70-80 kVp, 26
mAs
■ Focus film distance
(FFD) :102 cm

■ Cassette : 24x30 cm
■ Exposure : hold your
breath
■ Grids
(+)
 Advanced…
4. Radiographic criteria

■ The petrous mastoid is visible

without distortion.
■ Mastoid below the cranium margin
■ The posterior border of the mandibular
ramus is superimposed on the cervical
column

notes :
5. To obtain sharp detailed images of
temporal bone structures, use a small
focal spot and collimation covers the
desired area.

6. Comparison of dextra and sinistra is made

6 . Axiolateral oblique projection
(mayer method owen modification)
1. Position of the patient

Supine patient
2. Object position:

■ The head is tilted so that the IOML is perpendicular to

the cassette

■ Rotate the MSP head 45 degrees to the side to

be photographed.
3. Setting the beam axis and exposure
■ Central ray (CR) : 45º caudad
■ Central point (CP): at 7.5 cm above the
superciliary arch, past 2.5 cm above the
MAE
■ FFD : 102 cm
■ exposure : 70-80 kVp, 26 mAs
factor
: breathing or holding
■ During the exposure breath
■ Grid +
Advanced…
4. Radiographic criteria

■ Petrosum is located in the inferior

part of the mastoid air cells

■ MAE seen adjacent to & in front of

the petrosum
■ The auricle is not superimposed
with the petrosum or with the
mastoid air cells
■ Enough collimation
Cas
e
A patient came to the hospital with complaints of pain/discomfort in the right
ear, festering ears, and decreased hearing ability. Diagnosis of mastoiditis or
inflammation of the ear. The doctor asked for photos of the temporal bones: the
mastoid bone and the petrous bone.

Case presentation & discussion

In this case of mastoiditis, a radiological examination was carried out using the AP
Axial projection (Towne Method) and the Axiolateral Mastoid Projection (Schuller Method)
dextra et. left
AP Axial Projection (Towne Method)
1. Patient Position (PP)

The patient is supine on the

examining table with the MSP of the body in
the middle of the examining table.

2. Object Position (PO)

■ Flexes the head so that the OML

(Orbito Meatal Line) is perpendicular
to the cassette
■ For patients unable to flex the
head, adjust the IOML
(Infraorbitomeatal Line)
perpendicular to the cassette
and change the beam angle 37o
caudad
■No head movement
during exposure
Advanced…
3. Beam setting
■ Central Ray (CR) : 300caudad for OML or 370for IOML
■ Central Point (CP) : on MSP head 2 inches (5 cm) superior to
The glabella falls 2.5 cm posterior to the MAE
■ Factor Film Distance
: 102 cm
(FFD)
: 70-80 kVp, 26 mAs, stationary or moving
■ Exposure Factor
grid : Hold breath
■ Respiration

■ Grid +
Axiolateral Mastoid Projection
(Schuller Method)
1. Patient Position (PP)
■ Semi-prone or recumbent patient on
examination table. If the right is examined, the
right hand is placed behind the body, the left leg
is flexed anteriorly.
2. Object Position (PO)
■ Placing the lateral side of the head on the
examination table; the side being checked is close
to the cassette
■ The head is rotated so that the MSP head is parallel to the
examination table. And point 1 inch posterior to the MAE
in the middle of the examination table.

■ The patient's IPL (Interpupillary Line) is perpendicular to

the examination table

■ Bend the auricle forward so that it is

not superimposed on the mastoid
Advanced
…
3. Beam
setting
■ Central Ray : the direction of the beam axis forms 25-30
(CR) caudad degrees

■ MAE superior and : protruding from the lower mastoid (approximately 1 ½

posterior Central Point inches

(CP).
■ Film Factor Distance (FFD): 102
cm
: 70-80 kVp, 26 mAs
■ Exposure Factor
: Hold your breath during the
■ Respiration exposure

■ Grid +
Results of radiographs of mastoiditis by the Schuller
projection method
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