X-RAY POSITIONING OF FACIAL BONES (2020 UPDATED)

Summary

This educational video script focuses on the radiographic positioning of the facial bones, emphasizing the intricacies involved in capturing clear images of these delicate structures. It covers the importance of understanding the anatomy, the advantages of CT scans for detecting fractures, and the use of plane radiography for identifying fluid levels in sinuses. The script details various projections, including the Waters and submental vertical (SMV) projections, and discusses the challenges and techniques for achieving accurate positioning to visualize structures like the eyes, orbits, and nasal bones.

Takeaways

• 📚 The video is the third in a series of four, focusing on the positioning of the cranial vault and facial bones, with prerequisites to watch videos on the cranial vault and paranasal sinuses.
• 🦴 The facial bones are delicate and thin, making them difficult to visualize, especially when fractured, which is why CT scans are excellent for investigating facial bone injuries.
• 🔬 Despite CT's advantages, plain radiography can still be valuable for detecting fractures, particularly fluid levels within the maxillary sinuses.
• 📐 For imaging the facial bones, a 24x30-inch receptor is used with the central row in the middle and a portrait orientation for all cases.
• 🔄 The standard views of the facial bones are variable and may change based on the radiologist's and maxillofacial surgeon's needs.
• 👁️ The Waters projection is essential for examining the paranasal sinuses and can be adapted for different angles, with the patient's position remaining consistent across multiple images.
• 📏 The positioning for a Waters projection involves a specific angle of the orbit (37 degrees from the vertical axis or 53 degrees from the horizontal) and requires patient cooperation to maintain an uncomfortable position.
• 👁️‍🗨️ The Waters projection is also useful for eye examinations, especially when looking for foreign bodies, and requires the patient to maintain different gazes for multiple projections.
• 🌡️ The lateral facial bones projection involves a true lateral position of the patient's head, with the central ray 2.5 cm posterior to the outer canthus of the eye.
• 🤔 The Submental Vertical (SMV) projection is challenging and requires significant patient compliance, with the central ray passing through the orbital meatus at a 90-degree angle.
• 🛑 The Towne's projection can serve as an alternative to the SMV for examining the zygomatic arch, especially when the SMV is not feasible for the patient.

Q & A

What is the main focus of the third video in the series?

The third video focuses on the positioning of the facial bones, particularly the techniques and considerations for radiographic imaging of these structures.

Why are the facial bones considered fine structures in the context of radiography?

The facial bones are considered fine structures because they are very thin and can be difficult to visualize, especially when they fracture, as the fracture lines are also very fine.

What imaging modality is recommended for investigating facial bone injuries due to their fine structure and superimposition?

CT (Computed Tomography) is recommended due to its ability to clearly show the fine structures and details of facial bones, despite their superimposition.

Why is plane radiography still advantageous for detecting fractures in facial bones despite the benefits of CT scans?

Plane radiography can show signs of fractures, such as fluid levels within and around the maxillary sinuses, and it can have a significantly lower dose than a CT scan.

What is the standard size of the image receptor used for imaging the facial bones in the video?

A 24 by 30 inch receptor is used for imaging the facial bones, ensuring the entirety of the facial bones is covered.

What orientation is used for all cases of facial bone imaging in the video?

A portrait orientation is used in all cases for imaging the facial bones.

What is the significance of the Waters projection in facial bone radiography?

The Waters projection is significant because it allows for the visualization of the maxillary sinuses and the detection of fluid levels, which can indicate fractures or other issues.

How does the positioning for a Waters projection differ from a standard chin and nose touch to the image receptor position?

For a Waters projection, the patient's neck is extended further than in the standard position to achieve the required 53-degree angle for the Waters projection.

What is the purpose of taking multiple Waters projections with the patient in the same position?

Taking multiple Waters projections in the same position allows for consistent imaging to detect changes or issues that may not be apparent in a single image.

What are the key criteria for a well-positioned Waters projection with zero angulation?

The key criteria include the infraorbital margin being horizontal and thin, visualization of the entire facial structure from the top of the orbits to the bottom of the ethmoid and sphenoid sinuses, and no excessive tilt or rotation of the head.

What is the purpose of the submental vertical (SMV) projection in skull radiography?

The SMV projection is used to create an image at 90 degrees to the PA and lateral projections, passing from the inferior part of the patient's cranium to the top, providing a different perspective for identifying fractures or other issues.

What challenges does the submental vertical projection present for both the patient and the radiographer?

The SMV projection requires a high degree of patient compliance due to the need for significant hyperextension of the neck, which can be uncomfortable. For the radiographer, it requires precise positioning and tube angulation to achieve the correct projection.

How can the lateral facial bones projection be improved for better visualization?

The lateral facial bones projection can be improved by ensuring the patient is in a true lateral position with no tilt, and by adjusting the central ray to be 2.5 cm or 1 inch posterior to the outer canthus of the eye.

What is the importance of patient instructions and compliance in Waters projection for eyes or orbits?

Patient instructions and compliance are critical in Waters projection for eyes or orbits because the patient is required to maintain a fixed gaze in different directions for multiple projections, which helps in identifying the position of a foreign body or other issues within the eye.

Why is the lateral projection the most useful for visualizing the nasal bones?

The lateral projection is the most useful for visualizing the nasal bones because it provides a true lateral view of the skull, allowing for clear detail of the fine structures of the nasal bone without superimposition from other structures.