DR MUHAMMAD YOUNAS KHANPGR

ORAL & MAXILLOFACIAL SURGERY KCD

MAXILLOFACIAL RADIOGRAPHY(Radiological Interpretation)

Objectives

To identify the presence are absence of disease

To provide information on the nature and extent of disease

To enable the formation of a differential diagnosis

Requirements for Interpretation

Optimum viewing condition

Understanding the nature and limitation of radiographic image

Detailed knowledge of normal anatomy & pathological condition

Systematic approach

Indications

Fracture of the maxillofacial skeleton

Fracture of the skull

Investigation of the antra

Disease affecting the skull base and vault

TMJ disorder

Main Maxillofacial/Skull Projections

Standard occipitomental (0o OM)30o occipitomenatal (37o, 45o, 14o)PA SkullPostero-anterior of the jawsReverse towne’s Rotated PATrue lateral skullSubmento vertex SMVTranscranialTranspharyangeal

Indications (0o OM)

Investigation of the maxillary antra

Detecting the middle third facial fracture (Le Fort fracture + Zmc + Noe + Orbital blowout fracture)

Coronoid process fractures

Investigation of frontal, ethmoidal and sphenoidal sinuses

Middle Third Fracture of the FaceInterpretation by (0o OM)

SYSTEMATIC APPROACH

a. McGrigor & Campbell (1950)

b. Trapnell line

c. Dolen line

Campbell’s Lines

Line 1: Rt ZF Suture Rt Supra-orbital ridge frontal sinus Lt supra-orbital ridge Lt ZFS

Line 2: Rt zygomatic arch Rt body of zygoma Rt infra orbital margin nasal complex Lt infra orbital margins Lt body of zygoma Lt Z arch

Line 3: Rt condylar neck Rt cronoid precces lateral wall of Rt antrum base of nasal complex lateral wall of Lt antrum Lt CP Lt CN

Campbell’s Line

Line 4: Rt angle of Mandible Line of occlusal plane Lt angle of mandible

Trapnell Line

Lower border of the mandible

Standard Waters view. 1 = Superior orbital rim; 2 = frontal sinus;3 = zygomaticofrontal suture

line; 4 = medial wall of the orbit;5 = ethmoid sinus;6 = zygomatic body; 7 = inferior orbital rim; 8 = floor of the orbit; 9 = medial and lateral walls of

the maxillary sinus; and 10 = nasal septum.

Dolen’s Curve

Curve 1

Lateral wall of the antrum – inferior surface of the body of zygoma – zygomatic arch (maxillary line)

Curve 2

Superior margin of zygomatic arch – lateral aspect of the body of zygoma – orbital margin (zygomatic line)

Dolen’s Curve

Curve 3

Iner aspect of the orbital rim (orbital line)

Curve 4

Outer curvature of the nasal complex (nasal line)

Interpretations

Step 1

Compare both side of Campbell’s line

Step 2

Compare both side of Dolen’s curve

Step 3

Examination of antrum

1. LINE 1 LOOK FOR: Fractures Widening of the zygomatic-frontal suture Fluid level (haemorrhage) in a frontal sinus2. LINE 2 LOOK FOR: Fractures of the zygomatic arch A fracture through the inferior rim of the orbit A soft tissue shadow in the roof of the maxillary antrum3. LINE 3 LOOK FOR: Fractures of the zygoma and of the lateral aspect of the

maxillary antrum A fluid level in the maxillary antrum.

Look for(In step 1 and step 2)

Alteration or asymmetry in bony outline/shapeStep deformitiesWidening of suture linesPresence of radiolucent fracture linesFracture line directionsDegree of separationRadiopaque lines

Particulare

Zygomatico-frontal sutures

Fronto-nsal sutures

Zygomatico-temporal sutures

Inferior margins of orbits

Lateral margins of antrum

Nasal septum and complex

Radiographic Signs of Bone Fracture

Direct1. Separation sign2. Overlap sign3. Suture diastasis4. Bony steps5. Periodontal ligament widening6. Abnormal linear density7. Disappearing fragment sign8. Abnormal angulation / curve9. Displaced bone

Indirect

1. Tear drop sign (hanging drop)

2. Sinus opacification

3. Air in soft tissues

4. Occlusal plane changes

5. Dental injuries

30o Occipitomental(water view)

INDICATIONS:

detecting the middle third facial fractureLe Fort ILe Fort IILe Fort III

Coronoid process fractures

Orthopentomogram(DPT/OPG)

All the teeth and their supporting structures

Reasonably simple

Radiation dose is low

Indications

Assessment of dentitions (primary, mixed, and permanent)Orthodontic assessmentAssessment for bony lesionAssessment of periodontal boneThird molar statusMandible fracturesAntral disease (floor, posterior, medial walls)Disease of the TMJVertical alveolar bone height

Interpretation of the OPG

The entire radiograph

Specific lesion

General view of the entire film

Note the chronological and developmental age of patient

To trace the out line of normal and antomical shadows

Real or Actual Shadows

Hard tissue shadows

1. Teeth

2. Mandible

3. Maxilla

4. Zygomatic arches

5. Styloid processes

6. Nasal septum and conchae

7. Base of skull

AIR SHADOWS

1. Mouth/oral opening

2. Oropharynx

SOFT TISSUE SHADOWS

1. Ear lobes

2. Nasal cartilages

3. Soft palate

4. Dorsum of tongue

5. Lips and cheeks

General View

TEETH

1. Number of teeth

2. Stage of development

3. Condition of crown

4. Position of teeth

5. Condition of root

6. Apical tissue

Mandible

Both TMJ/coronoid process

Body ramus of mandible

Shape

Outline

Thickness of the lower border

Trabeculae pattern

Radiolucent/radiopeque areas

Panoramic view.

1 = Condylar process;2 = coronoid process3 = ramus4= angle of the mandible5 = body of the mandible6 = symphysis

Others Structures

Antrum (floor anterior, posterior wall, radio density)

Nasal cavity

Styloid processes

Specific Lesion

Site

Size

Shape

Outline

Relative radio-density

Internal structure

Effect on adjacent surrounding structures

Ghost Shadows

Survical vertebrae

Body angle, ramus of contralateral side

Palate

ANY QUESTION

Any one want to add some suggestions

please

THANKS