HEENT pt. 2 Flashcards
Radiopaque
describes density
prevents X-rays from passing through freely
Higher atomic numbers
white shadow
radiolucent
density
X-rays pass freely
small atomic numbers
dark shadow
mandibular series
PA view
lateral
towns
bilateral oblique
Panorex
one plane
PA view (posterior anterior)
entire mandible
symphysis is obscured by spine
condyles are superimposed against mastoid or occ. bones
BEAM SHOOTS POSTERIOR TO ANTERIOR
away from the film
less white
toward the film
more white
Towns view
bone overlap is common
used to evaluate condyles
Oblique views
mandibular groove best seen
waters view
occipitomental view
basal view
submentovertex view
considerations: 1st, 2nd, 3rd
1st: evaluate the adequacy if the films
2nd: trace all cortical margins and evaluate for discrepancy
3rd: if one fracture is present, look for more!
“ring bone rule”
if the condyles are injured or broken then what else could be?
symphysis
if the angle of the mandible is broken or injured then what else could be broken ?
contralateral body or condyle
Facial series
caldwell view - chin down
waters view - chin up
submental vertex (basal) - through sub mental area
lateral view - lateral
lines of dolan
if they are misaligned then it indicate a fracture
1 = base of orbit
2 = lateral part of orbit
3 = superior part of maxillary
what is the best view for imaging the nasal bones?
lateral
Direct signs of facial fracture
nonanatomic linear lucency’s
cortical defect
bone fragments overlapping - more white
asymmetry of face
Indirect signs of facial fracture
soft tissue swelling
periorbital or intracranial air
fluid in a sinus - fracture of orbit bone
whats the most common fracture of the face?
nasal bone
Computed Tomography
uses a computer to reconstruct cross-sectional imaging
CT - IV contrast
enhances the density differences between lesions and surrounding parenchyma (tumor in the lung use contrast and abscess in throat)
Vascular anatomy
CT - Oral/Rectal contrast
given to opacify bowel
LOOKING FOR A PIECE OF SHITTT!
stones will light up on their own w/o contrast so using contrast could hide them
Ct is good for what parts of the afce?
sinuses and soft tissue
Xray sinus
waters view
Indications for CT of sinuses
persistent sinusitis
recurrent sinusitis
intraorbital or intracranial spread of infection
Indications for CT of facial bones and mandible
complex facial fractures
trauma
benign films
why is a CT the gold standard over an Xray for the face?
Xray miss a lot of facial fractures because of overlapping
Le Fort I
floating palate
Le Fort II
pyramidal
Le Fort III
craniofacial dysfunction
CT orbit is best seen when using?
CT (coronal view)
WithOUT contrast
Retropharyngeal abscess location?
anterior to C3, >3mm (increased in crying children)
Epiglottitis best seen with what view?
soft tissue lateral
(88-100% sensitive)
(96% specific)
what is it called when the epiglottis looks swollen and enlarged?
thumb print sign
aryepiglottic folds are thickened and Vallecula is thickened
Croup virus?
RSV
Croup will show what on the Xray?
distended hypo pharynx and laryngeal vesicle
HAZINESS OR NARROWING OF SUBGLOTTIC SPACE
NARROWING TRACHEA = STEEPLE SIGN
(93& sensitive)
(92% specific)
Narrowing of the airway (subglottic larynx)
Steeple Sign
Indications for CT of soft tissue neck
W/ contrast: mass, swelling, adenopathy
W/O contrast: no helpful
W/ & W/O contrast: salivary stones / ducts
what is the pre test for CT
creatinine if contrast is to be used cause the kidney does not like the contrast dye and can cause renal failure
Peritonsilar abscess (seen with CT of the neck)
W/ contrast - pus that lies between the tonsillar capsule and superior pharyngeal constrictor muscle
(75% specific)
(100% sensitive)
rim enhancing fluid collection within an enlarged and inflamed tonsil
what is the gold standard for visualizing a retropharyngeal abscess?
CT, W/ contrast
(90% sensitive)
fat planes obliterated
enhanced by ring
