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48 - Facial x-ray

from Section 11 - Surgical radiology

Published online by Cambridge University Press:  05 July 2015

Hardi Madani
Affiliation:
Clinical Radiology, Royal Free Hospital, London Deanery, London, UK
John Curtis
Affiliation:
University Hospital Aintree
Helen Marmery
Affiliation:
Royal Free Hampstead NHS Trust, London, UK
Petrut Gogalniceanu
Affiliation:
Specialist Registrar, General and Vascular Surgery, London Deanery
James Pegrum
Affiliation:
Orthopaedic Registrar, Oxford Deanery
William Lynn
Affiliation:
Specialist Registrar, General Surgery, North East Thames
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Summary

Introduction

‘This is an OM/OPG/PA view x-ray of the face/mandible.’

Views

  1. • Occipitomental (OM) view at 0°: frontal sinuses, orbits, maxillary antra, nasal bones and ethmoid air cells

  2. • Occipitomental (OM) view at 30°: additional features – zygoma, mandible, infraorbital foramina, odontoid peg

  3. • Orthopantomogram (OPG): mandible, maxilla, teeth, TMJ and inferior alveolar canal

  4. • PA mandible: mandibular fractures

Anatomy

Bones

  1. • Frontal bones and sinuses

  2. • Orbits and orbital floor

  3. • Maxilla: medial and lateral walls of maxillary antra

  4. • Zygomatic arch

  5. • Mandible: symphysis, body, angle, ramus, condyle and coronoid process

  6. • Teeth

  7. • Temporomandibular joint (TMJ)

Circles: broken circle indicates a possible fracture

  1. • Frontal sinuses

  2. • Orbits

  3. • Maxillary sinuses

  4. • Nasal and ethmoid spaces

Lines: broken line indicates a possible fracture

  1. • Lines of Dolan (OM30)

  2. • McGrigor's lines

  3. • Elephant trunks of Rogers (zygomatic arch fractures): formed from lines of Dolan

Pathology

Fractures

  1. • Maxillary fractures: alveolar process; lateral and medial walls of maxillary antra.

  2. • Zygomatic arch fracture: look at ‘elephant trunks’.

  3. • Tripod fractures: zygoma detachment (complex zygomaticomaxillary fracture). Suture lines involved are: 1. zygomaticofrontal suture; 2. orbital floor; 3. infraorbital rim; 4. lateral wall of maxillary sinus.

  4. • Inferior orbital margin fracture.

  5. • Orbital floor ‘blow-out’ fracture.

  6. • ‘black eyebrow’ sign: surgical emphysema in the upper orbital rim area

  7. • ‘teardrop sign’: herniation of orbital soft tissues in the maxillary antrum

  8. • fluid level in antrum of maxilla

  9. • Mandibular fractures.

Tumours

  1. • Bone: lytic lesions and cysts

  2. • Soft tissues: contour changes

Infections

  1. • Sinusitis (OPG and OM): opacity of maxillary and frontal sinuses

  2. • Osteomyelitis (OPG and OM): opacity of mandible and maxilla

Dislocations

  1. • TMJ (OPG).

Teeth

  1. • Fractures and caries.

To complete the examination…

  1. • If suspecting a complex fracture or inadequate views, ask for CT face/skull to determine.

  2. • Facial trauma is associated with C-spine and head injuries, so consider CT head and C-spine imaging.

Type
Chapter
Information
Physical Examination for Surgeons
An Aid to the MRCS OSCE
, pp. 409 - 413
Publisher: Cambridge University Press
Print publication year: 2015

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