Radiography and Anatomy of orbit

Radiography and Anatomy of orbit

1. Dr.Pankaj Kaira JR-I Radiodiagnosis SRMSIMS Bareilly Radiography of Orbit

2. Or b i t al an a t o m y R oof F l o o r Med i al w all L a t e r al w all Su p er i o r orb i t al f i s s u r e I n f er i o r orb i t al f i s s u r e O p t ic c an a l

3. Or b i t al r oof Frontal bone with frontal sinus Anteriorly thin Fossa for lacrimal gland

4. Or b i t al f l oor Orbital plate of maxilla Orbital process of palatine bone Orbital surface of zygomatic bone

5. Me d ial or b i t al w a l l Lacrimal groove Lacrimal bone Ethmoid bone Sphenoid bone Frontal process of maxillary bone

6. Later al Orbital wall Zygomatic bone Geater wing of Sphenoid

7. Su p er io r or b i t al f i ssu r e Location Between roof and lateral wall Surrounded by sphenoid Beneath optic canal Optic strut

8. Su p er io r or b i t al f i ssu r e Content Superior opthalmic vein CN III, IV, VI CN V1 >> Conduit between orbital apex-cavernous sinus

9. I n f er io r o r b i t al f i ssu r e Location Lies in the floor of the orbit inferior to the superior orbital fissure. Bounded superiorly by the greater wing of sphenoid ,inferiorly by the maxilla and orbital process of palatine bone and laterally bye the zygomatic bone.

10. I n f er io r o r b i t al f i ssu r e Content Maxillary branch of trigeminal nerve. Emissary veins connecting the inferior opthalmic vein to pterygoid plexus . Infraorbital vessels. Zygomatic nerve Neural branches from the pterygopalatine ganglion

11. Opt ic c anal Leads from the middle cranial fossa to the apex of the orbit. Boundaries- Medially- Body of the sphenoid Laterally- Lesser wing of the sphenoid Contents Optic nerve + ophthalmic artery (in dural shealth )

12. X-RAY VIEWS WATERS VIEW CALDWELL’S VIEW LATERAL VIEW SUBMENTOVERTEX VIEW RHESE VIEW

13. Waters View The most important view for sinus problems or injury involving the maxilla or orbits. By taking the view erect, fluid levels within the maxillary sinuses can be seen. 13

14. Waters Projection Measure: A-P at Glabella Protection: Half apron over back of chair or coat apron backwards No tube angle Film: 8” x 10” regular I.D. Down (portrait) 14

15. Waters Projection Sinus Patient is seated facing the Bucky. Get the chair as close to the Bucky as possible. May also be taken standing. Mentomeatal line should be perpendicular to film with mouth closed. 15

16. Waters Projection Sinus The nose will be 1-2 cms from Bucky with chin resting on Bucky. The mouth may be opened to see the sphenoid sinus. When this is done, the canthomeatal line should be 35 to 40 degrees to the Bucky. 16

17. Waters Projection Sinus Film Facial bones and sinuses There should be no rotation. The petrous ridges must be below the floor of the maxilla. 17

18. )   (a, frontal sinus; b, medial orbital wall; c, innominate line; d, inferior orbital rim; e, orbital floor; f, maxillary antrum ; g)superior orbital fissure; h, zygomatic -frontal suture; i , zygomatic arch

19. Caldwell Sinus Projection Patient is seated facing Bucky. Their legs should be under the Bucky. Get chair as close to the Bucky as possible. Ask patient to place their nose and forehead on center line of Bucky. Check for rotation. 19

20. Horizontal CR: exits through the Glabella or Nasion Vertical CR: mid- sagittal Center film : the x-ray beam is directed downward 15 degrees to 23 degrees to the canthomeatal line Collimation: 6” or 7” square. Breathing Instructions: Suspended Respiration 20

21. Caldwell Sinus Projection Film This view will provide a clear view of the frontal and ethmoidal sinuses . The superior orbital rims can be evaluated. To project the petrous ridges farther down, increase angle to 25 degrees 21

22. Waters Projection Sinus The most important view for sinus problems or injury involving the maxilla or orbits. By taking the view erect, fluid levels within the maxillary sinuses can be seen. 22

23. Waters Projection Measure: A-P at Glabella Protection: Half apron over back of chair or coat apron backwards No tube angle Film: 8” x 10” regular I.D. Down (portrait) 23

24. Waters Projection Sinus Patient is seated facing the Bucky. Get the chair as close to the Bucky as possible. May also be taken standing. Mentomeatal line should be perpendicular to film with mouth closed. 24

25. Waters Projection Sinus The nose will be 1-2 cms from Bucky with chin resting on Bucky. The mouth may be opened to see the sphenoid sinus. When this is done, the canthomeatal line should be 35 to 40 degrees to the Bucky. 25

26. Waters Projection Sinus Film Facial bones and sinuses There should be no rotation. The petrous ridges must be below the floor of the maxilla. 26

27. (a, frontal sinus; b, innominate line; c, inferior orbital rim; d, posterior orbital floor; e, superior orbital fissure; f, greater wing of sphenoid;g , ethmoid sinus; h, medial orbital wall; i , petrous ridge; j, zygomatic -frontal suture; k, foramen rotundum ) 

28. Skull Lateral Patient seated or standing facing the Bucky. Rotate the body into an oblique position. Turn skull so the affected side is next to the Bucky . The interpupillary line must be perpendicular to film and tube . Mid sagittal plane parallel to the film. 28

29. Horizontal CR: 3/4”superior to EAM Vertical CR: 3/4” anterior to EAM or mid skull Center film to horizontal CR. Collimation: slightly less than film size Breathing Instructions : Suspended respiration Make exposure and let patient relax. 29

30. Skull Lateral Film Entire skull must be on the film. There should be no rotation of the skull, orbits and mandible ramus superimposed. The facial bones and sinuses will be dark (over exposed). Usually both lateral views are taken. 30

31. Radiograph of a lateral projection. (a, orbital roof; b, frontal sinus; c, ethmoid sinus; d, anterior clinoid process; e, sella turcica ; f, planum sphenoidale )

32. Base Posterior Skull ( Submentovertical view) Measure: A-P at Glabella Protection: Half apron SID: 40” Bucky Tube Angle: None, but if patient cannot extend head back far enough to get inferior orbital -meatal line perpendicular to horizontal CR , tube angle may be needed. 32

33. Base Posterior Skull Film Size: 10” x 12” regular I.D. down (Portrait ) Patient is seated in a reclining chair. The chair is placed about 6” to 10” from Bucky . Patient is asked to extend neck back until inferior orbital meatal line is parallel to film with top of skull touching the Bucky. 33

34. Base Posterior Skull Horizontal CR: EAM Vertical CR: mid- sagittal Center film to horizontal CR The x-ray beam is directed at right angles to the infraorbitomeatal line Collimation: slightly less than film size or skin of skull Breathing Instructions: suspended respiration Make exposure 34

35. Base Posterior Skull Assist patient get out of the position. Be very careful that the patient does not hit face on x-ray tube. The ability of the patient to lay back in the chair will make the view much easier for all concerned. 35

36. The entire skull is visualized. The mandible and frontal region of skull are superimposed. With a bright light, the zygomatic arches can usually be seen. 36

37. (a, zygomatic arch; b, orbit; c, lateral orbital wall; d, posterior wall of maxillary sinus; e, pterygoid plate; f, sphenoid sinus

38. POSTEREO-ANTERIOR OBLIQUE VIEW (RHESE VIEW): The zygoma , nose, and chin should touch the cassette. The x-ray beam is directed posterior- anteriorly at 40 degrees to the midsagittal plane

39.   Radiograph of an oblique apical projection. (a, right optic canal; b, optic strut; c, superior orbital fissure; d, ethmoid sinus; e, planum sphenoidale ; f, greater wing of sphenoid) 

40. PROJECTION STRUCTURE PATHOLOGY WATERS VIEW ORBITAL FLOOR ANT 2/3 BLOW OUT# CALDWELL’S VIEW INNOMINATE LINE,ORBITAL FLOOR POST.1/3 MEDIAL, LATERAL WALL# LATERAL VIEW ORBITAL ROOF ORBITAL ROOF # SUBMENTO VERTEX LATERAL WALL OF ORBIT LATERAL WALL# RHESE VIEW OPTIC CANAL OPTIC NERVE TUMORS

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