m-1 radiology head and neck. objectives skull, sinus and orbit anatomy vascular anatomy neck anatomy...
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M-1
RADIOLOGY Head and Neck
OBJECTIVES
• Skull, Sinus and Orbit anatomy
• Vascular anatomy
• Neck anatomy
• Clinical cases
SKULL ANATOMY
SINUSES PA view
1. Nasal Septum
2. Frontal Sinus
3. Maxillary Sinus
4. Ethmoid Sinus
5. Inferior Turbinate
6. Superior orbital fissure
2
1
4
3
5
6
1- Superior orbital fissure
2- Inferior orbital foramen
3- Mental foramen
1
2
3
1
2
3
Fissures and foramen havenerves that show on labpracticals.
OPTIC CANAL
SINUSES1. Frontal sinus
2. Zygomatic-Frontal Suture
3. Maxillary Sinus
4. Inferior orbital margin
1
3
4
2
AP WATERS VIEW
This view is angled to project the maxillary sinuses free of the petrous ridge.
Note the opacified right maxillary sinus with fluid layering dependently indicating sinusitis
• Superior
• Inferior
• Medial
• Lateral
WHAT RECTUS MUSCLE CAN BE INJURED
BY EYE TRAUMA?
ORBITAL FLOOR FRACTURE
Arrow points to bone fragment displaced into orbit. The inferior
rectus muscle can become entrapped in fracture
CORONAL SCANCT FACIAL
CT scans redemonstrate fracture and edema at site.
1. Frontal Sinus
2. Maxillary Sinus
3. Ethmoid Sinus
4. Sphenoid Sinus
1
2
3
4
LATERAL SINUS & SKULL
Middle meningeal artery
FRACTUREEPIDURAL
HEMATOMA
Cause: Laceration of the meningeal artery adjacent to
inner table.
Normal skull
Sella
CT SKULL BASE
CAROTID CANAL
JUGULAR FORAMEN
CT SKULL BASE
MANDIBULAR
CONDYLE
MASTOID AIR CELLS
PINNA
SKULL BASE FRACTURE
“RACCOON EYES” Periorbital ecchymosis is a sign of a basal skull fracture. Blood tracks along the periosteum and can collect in soft tissues of the orbital lid.
CT SKULL BASE
ZYGOMATIC ARCH
EXTERNAL
AUDITORY CANAL
CT SKULL BASE
FORAMEN OVALE
FORAMEN
SPINOSUM
PETROUS CAROTID CANAL
CLIVUS
CT SKULL BASE
IACINTERNAL AUDITORY CANAL
CAROTID CANAL
OSSICLES
Acoustic neuroma is a slow growing tumor that develops on the 8th cranial nerve. Symptoms include unilateral loss of hearing, Tinnitus-ringing in ears. dizziness and vertigo.
SINUS AND ORBIT ANATOMY
SINUSES
PA view
1. Frontal Sinus
2. Maxillary Sinus
3. Ethmoid Sinus
1
3
2
SINUSES
1. Frontal sinus
2. Zygomatic-Frontal Suture
3. Maxillary sinus
4. Inferior orbital margin
1
3
4
2
AP WATERS VIEW
This view is angled to project the maxillary sinuses free of the petrous ridge.
1. Frontal Sinus
2. Maxillary Sinus
3. Ethmoid Sinus
4. Sphenoid Sinus
5. Sella Turcica
1
2
3
4
5
LATERAL SINUS & SKULL
1
1. Frontal Sinus
CT- SINUSAXIAL VIEW
Scans start superiorly and are shown going inferiorly
CT SINUSAXIAL SCAN
normal
Note the destroyed posterior wall of the left frontal sinus due to bacterial invasion.
1. Ethmoid sinus
2. Sphenoid sinus
3. Carotid canal
1
2
3
CT- SINUSAXIAL VIEW
1. Maxillary sinus
2. Med. & Lat. Pterygoid plate
3. Nasopharynx
4. Nasal septum
5. Inferior turbinate
1
23
4
5
CT- SINUSAXIAL VIEW
1. Fronto-nasal suture
2. Frontal sinus
3. Nasal bones
1
2
3
CT- SINUSCoronal sections extending from
anterior to posterior
1. Ethmoid sinus
2. Maxillary sinus
3. Middle turbinate
1
3
CT- SINUSCORONAL VIEW
CT- SINUSCORONAL VIEW
Maxillary sinus
1. Sphenoid sinus
2. Hard palette
3. Anterior clinoid
1
CT- SINUSCORONAL VIEW
2
3
1. Retro orbital fat
2. Medial rectus
3. Lens
4. Lateral rectus
5. Optic nerve5
1 32 4
CT ORBITAXIAL SCAN
CORONAL SCAN
AXIAL SCAN
MR SCAN
Chiasm
Opticnerves
In Biblical liturature who showed
a knowledge of cranial nerve
anatomy?
• Moses
• Noah
• David
• Goliath
Normal
Sella Mass
Compare the normal with the enlarged pituitary adenoma. The mass impinges on the optic chiasm to create the visual disturbance.
NECK ANATOMY
LATERAL NECK
1. Hard palate
2. Soft palate
3. Nasopharynx
4. Oropharynx
5. Epiglottis
12
3
4
5
1
2
3
4
AIRWAY1. Calcified tracheal
cartilage rings
2. Hyoid bone
3. Epiglottis
4. Thyroid cartilage
5. Cricoid cartilage
5
LATERAL VIEW OF NECK
1
2
3
4
AIRWAY
1. Calcified tracheal cartilage rings
2. Hyoid bone
3. Epiglottis
4. Thyroid cartilage
5. Cricoid cartilage
5
LATERAL VIEW OF NECK
Where do you insert the tube at an emergency tracheostomy?
Cricothyroid membrane
LATERAL VIEW OF NECK
SCAN LEVELMAXILLARY SINUSES
ZYGOMA
ZYGOMA
SPHENOIDSINUS
LT
Sections from the skull base extending inferiorly through the
neck.
MASTOIDS
NASOPHARYNX
MAXILLA LT
EXTERNALAUDITORYMEATUS
MANDIBULAR CONDYLE
SCAN LEVEL
SCAN LEVEL
MANDIBLE
PAROTIDGLAND
MASSETER MUSCLE
MASSETER MUSCLE
PTERYGOIDMUSCLES
LT
SCAN LEVEL
SUBCUTANEOUS FAT
SUBMANDIBULARGLAND
EPIGLOTTIS
STERNOCLEIDOMASTOIDMUSCLE
LT
SCAN LEVELHYOID BONE
JUGULARVEIN
JUGULARVEIN
COMMON CAROTID ARTERIES
LT
VALLECULA
PYRIFORM SINUS
SCAN LEVELTHYROID CARTILAGE
VOCAL CORD
STERNOCLEIDOMASTOID
MUSCLE
LT
SCAN LEVELTHYROID CARTILAGE
CRICOID CARTILAGE
JUGULARVEIN
COMMON CAROTIDARTERY
LT
SCAN LEVEL
CLAVICLECLAVICLE
THYROID GLAND
FAT FAT
LT
TRACHEA ESOPHAGUS
SWALLOWING STUDY
1 2
3 4
Note hyoid bone moves anteriorly and superiorly with swallowing.
THYROID SCAN
Nuclear Medicine
THYROID SCAN
SAGITTAL
SAGITTAL SCANS
LEFT LOBE RIGHT LOBE
NUCLEAR MEDICINE
Normal Hypo-functional
THYROID SCAN
PATIENT PRESENTS WITH WHEEZING AND NECK MASS IN MIDLINE AT
STERNAL NOTCH
THYROIDSCAN
Nuclear Medicine
Chest x-ray showing superior Mediastinal mass with displacement of the trachea to the right. Nuclear Medicine I123 thyroid scan shows lobular mass extending inferiorly from the thyroid indicating a thyroid goiter accounting for displacement on chest x-ray.
CORONAL CT SCANS SHOWS THYROID LESION.
5
2
3
6
4
ARTERIOGRAM
1. Internal carotid artery
2. Intracranial carotid
3. Maxillary artery
4. Occipital artery
5. External carotid artery
6. Common carotid artery
7. Facial artery
17
WHAT VESSEL HAS TO BE LIGATED OR EMBOLIZED TO CONTROL EPISTAXIS IF PACKING NOSE FAILS?
• Maxillary
• Facial
• Lingual
• Superficial temporal
Here injection into the external carotid shows extravasation of blood from a branch of the maxillary artery compared with the normal.
Maxillary artery
normal
EMBOLIZATION
Radiologist has directed a coil through the catheter to occlude vessels that were bleeding.
ASYMPTOMATIC BRUIT ON
PHYSICAL EXAM
Abnormal
Normal
Normal
Ultrasound and arteriogram show high grade narrowing of internal carotid artery due to atherosclerosis.
HOARSENESS
NORMAL
ASPIRATION
A small amount of barium has spilled anteriorly with aspiration into the airway.
Hiatal hernia and reflux.
Here two patients with masses in their chest have involvement of the recurrent laryngeal nerve causing hoarseness due to vocal cord paralysis .
LARGE THORACIC ANEURYSM
LUNG MALIGNANCY
Amoebic meningitis can be contracted in southern states from swimming in warm lake water in summer by what
route?
• Ear infection
• Aspiration into airway
• Mosquito bite
• Ethmoid transmission
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