Dr.Pankaj Kaira

JR-I Radiodiagnosis

SRMSIMS Bareilly

Orbital anatomy

• Roof

• Floor

• Medial wall

• Lateral wall

• Superior orbitalfissure

• Inferior orbitalfissure

• Optic canal

• Frontal bonewith frontalsinus

• Anteriorly thin

• Fossa forlacrimal gland

• Orbital plate ofmaxilla

• Orbital process

of palatine bone

• Orbital surface ofzygomatic bone

• Lacrimal groove• Lacrimal bone• Ethmoid bone• Sphenoid bone

• Frontal process

of maxillary

bone

• Zygomaticbone

• Geater wing of Sphenoid

Location

•Between roofand lateral wall

•Surrounded bysphenoid

•Beneath opticcanal

•Optic strut

Content•Superioropthalmic vein•CN III, IV, VI•CN V1

>> Conduitbetween orbitalapex-cavernoussinus

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.

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

Optic canal

• 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 + ophthalmicartery

(in dural shealth)

WATERS VIEW

CALDWELL’S VIEW

LATERAL VIEW

SUBMENTOVERTEX VIEW

RHESE 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

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

Patient is seated facingthe 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

The nose will be 1-2 cmsfrom 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

Facial bones and sinuses

There should be no rotation.

The petrous ridges must be below the floor of the maxilla.

17

(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

Patient is seated facingBucky. 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

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

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This view will provide a clear view of the frontal and ethmoidal sinuses.

The superior orbital rims can be evaluated.

To project the petrousridges farther down, increase angle to 25 degrees

21

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

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

Patient is seated facingthe 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

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

Facial bones and sinuses

There should be no rotation.

The petrous ridges must be below the floor of the maxilla.

26

(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)

Patient seated or standing facing the Bucky. Rotate the body into an oblique position.

Turn skull so the affectedside is next to the Bucky.

The interpupillary line must be perpendicular to film and tube.

Mid sagittal plane parallel to the film.

28

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

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

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

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

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

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

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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

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

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

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

THANK YOU