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Skull Radiography

NTK: Main indications for each skull view and be able to id the different skull views
Types:
Lateral Skull Projection
PA Skull Projection
ater!s Projection
"aldwell Projection
Sub#entoverte$ Projection
%everse Towne Projection
&asic 'dea:
So#eti#es when you are usin( intraoral radio(raphs and panos there will be thin(s you can!t see the full
e$tent of on those fil#s) *ne of the #ain rules we follow is that if you see so#eti#e suspicious and the
border of it is off the fil# you need to follow it up with another fil# so you can see the entire e$tent of
the abnor#ality)
't is also used for (rowth and develop#ent+ ortho+ trau#a+ lookin( at paranasal sinuses+ etc)
Most of the ti#e if you are takin( a skull radio(raph you will be usin( a cephalo#etric attach#ent on a
pano #achine) There are other types you can buy but #ost dentists use this) 't is an e$tra attach#ent you
can choose to use or not)
Two %eference Lines ,sed in Positionin( for Skull %adio(raphs:
Franfort Horizontal Plane: lower border of the orbit to the upper border of the e$ternal auditory canal
Tragocanthal Line: "anthu# of the eye -outer border of the eye. to the tra(us of the ear
Lateral Skull Projection:
Most co##only used in dentistry+ used routinely in ortho) The #id/sa(ittal plane -strai(ht down the
#idline of the face. is parallel to the fil#) The 0rankfort hori1ontal plane is what is usually used with this
and is parallel to the floor) The patient closes their teeth in nor#al occlusion and the $/ray bea# is
perpendicular to the fil#)
Main Indications:
2rowth and 3evelop#ent4*rthodontics
Paranasal Sinuses
hat 5ou ill See:
5ou can see all of the paranasal sinuses in an anterior to posterior di#ension -#a$illary+ frontal+ eth#oid+
and the sphenoid sinus bellow the sella turcica. 6 there is (reat variation in the si1e of these
The airway
The sella turcica -can see fairly well.
7ard palate
Part of the cervical spine
*ne thin( to re#e#ber: since it is a 8/3 representation of a 9/3 object you can!t really tell the left side of
the jaw fro# the ri(ht side+ they will be superi#posed)
Lateral "ephalo#etric Projection:
Sa#e as a lateral skull radio(raph e$cept that with a lateral ceph you will see the soft tissue outline of the
patient -tissue profile.) 5ou do that by filterin( out so#e of the $/ray bea# in that area so you can see the
soft tissue outline4profile)
*n a teena(er or a child you will see a pattern on the skull) This is fro# nor#al (rowth and nor#al
re#odelin( of the inner cortical table of the skull)
5ou will not see this on an adult+ if you do see it on an adult that is cause for concern) This could be
caused by a pituitary (land tu#or which would also cause the sella turcica to be enlar(ed) This re:uires
follow up in an adult)
Airway should be patent -open.) And the sinuses should be radiolucent+ that #eans they are clear)
A narrowed pharyn$ with a conve$ity in the posterior pharyn(eal wall can be caused by enlar(ed
adenoids) To see this in a child is not unusual) 'f the adenoids beco#e too enlar(ed they can obstruct the
;ustachian tube which opens up into the nasopharyn$+ which #ay be caused by recurrent ear infections)
Posterior/Anterior -PA. Skull Projection:
The $/ray bea# is directed fro# the posterior so it hits the posterior part of the skull first and the anterior
part last) The bea# is perpendicular to the fil#) The patient!s forehead and nose typically touch the fil#
cassette) The tra(o/canthal line should be parallel to the floor)
Petrous Part of the Te#poral &one: lar(e part+ bilateral+ can be used as a reference point to show if the
techni:ue used is correct or incorrect)
The petrous part should be ri(ht in the #iddle of the orbit in a typical PA projection -should overlap the
lower border of the orbit+ should overlap the lower <49 of the orbit.) 5ou should also see the internal
auditory canal)
Posterior-Anterior (PA) Cephalometric Projection:
,sed #ostly in practice today) The difference here is that the 0rankfort hori1ontal plane is parallel to the
floor+ instead of the tra(o/canthal line) The fil# and $/ray bea# are in the sa#e locations and the $/ray
bea# is still perpendicular to the fil#)
Main Indications:
2rowth and 3evelop#ent4*rtho
0acial Assy#etry: to evaluate #edio/lateral asy##etry -to co#pare the left side of the face to the ri(ht
side of the face.
hat 5ou ill See:
Petrous Part of the Te#poral &one
See so#e of the Paranasal Sinuses well: ;th#oid+ Ma$illary+ and 0rontal -not sphenoid.
Nasal "avity
Waters Projection:
The patient!s chin should be touchin( the fil# cassette and the tra(o/canthal line should be at an an(le of
9= de(rees to the hori1ontal plane)
hat 5ou ill See:
Nasal "avity
Nasal Septu#
Ma$illary Sinus -May also see 0rontal and ;th#oid Sinuses.
Petrous Part of the Te#poral &one
0loor of the *rbit
Main Indications:
Ma$illary Sinuses
't taken properly the petrous part of the te#poral bone should be below the lower border of the
#a$illary sinus+ so you should be able to see all of it)
Appears to be trian(ular
0loor of the *rbit
The floor of the orbit is lower than the palpable lower border of the orbit) So if an(led upward
the upper line will be the palpable ri# of the lower orbit and the lower line will be the true floor
of the orbit)
5ou would be able to see a &low/*ut 0racture on this fil#+ with that the floor of the orbit will
appear discontinuous and the #a$illary sinus will appear cloudy because it is full of blood and
fluid)
The floor of the orbit is the superior border of the #a$illary sinus
Caldell Projection:
7ere you use the tra(o/canthal line and it should be parallel to the floor) This is a posterior/anterior
projection #eanin( the $/ray bea# co#es fro# behind the patient!s head and the fil# is in front of the
patient) The $/ray bea# is directed downward at an an(le of appro$i#ately 89 de(rees)
'f you do this correctly the petrous part of the te#poral bone should be in the #iddle of the #a$illary
sinuses) Therefore this is not your best view for the #a$illary sinuses)
Main Indications:
0rontal Sinus
;th#oid Sinuses -look narrow in this view and are just #edial to the orbit.
The &orders of the *rbits
Su!mento"erte# Projection:
The radiation (oes first throu(h the sub#ental area under the #andible and ends at the verte$) The books
vary on positionin(+ so#e say to use each line) ;ither way this is a difficult fil# for the patient because
they have to tip their head way back so the line is parallel to the fil#) 't is particularly hard for those with
arthritis or who have had trau#a to the neck) The $/ray bea# is perpendicular to the fil#)
AKA &asalar >iew 6 because it shows the base of the skull
Main Indications:
Sphenoid Sinus
Mandibular "ondyles
?y(o#atic Arches
'f you take this fil# to see the bony structures of the skull the 1y(o#atic arch is typically burned out)
't is used to deter#ine the an(ulation of the #andibular condyles so you can take slices throu(h the
condyle -TM@. that are perpendicular to the lon( a$is of the condyle) 't is kind of like a preli#inary view)
'f you use one of these fil#s you will need to chan(e the settin(s -e$posure factors.: k>p+ etc) 'f the fil#
is undere$posed you can see a fracture of the 1y(o#atic arch) So you intentionally undere$pose the fil#
in order to see a 1y(o#atic arch fracture -and overe$pose the area where the 1y(o#atic arch is.)
Tripod 0racture: "ould use a Sub#entoverte$ Projection or "aldwell Projection -can use both.
Re"erse $one Projection:
The patient!s forehead touches the fil# cassette and their head is tipped downward) The tra(o/canthal
line is appro$i#ately 9A de(rees to the hori1ontal plane) 'f you take a Town view the patient!s head
would be reversed and would be facin( the $/ray head) The %everse Towne is better because this way the
object/to/fil# distance is short and decreases the unsharpness)
AKA *ccitput >iew
Main Indications:
*cciput B Posterior "ranial 0ossa or the Area of the *ccipital &one
"ondylar Neck and "ondylar 7ead 6 for fractures
5ou "an Also See:
Posterio/lateral &order of the Ma$illary Sinus
0ora#en Ma(nu#
Petrous Part of the Te#poral &one
2ood view for subcondylar fractures+ can be taken with the patient!s #outh open or closed)