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Skull Exam Flashcards

1
Q

List 3 skull types & Angles

A

Dolichocephalic - 40*
Mesocephalic - 47*
Brachycelphalic - 54*

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2
Q

Cephalic Index =
& answers

A

width/length x 100
Dolichocephalic <75
Mesocephalic 75-80
Brachycephalic >80

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3
Q

What is the landmark for petrous ridges

A

TEA

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4
Q

Difference for OML GML and IOML

A

8* GML
OML
7* IOML

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5
Q

What is seen in a lateral projection of the skull

A
  • orbital plates superimposed
  • TMJ in same vertical plane
  • EAMs in same vertical plane
  • sella turcica in profile
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6
Q

Lateral Skull Tilt on patient & Image

A
  • IPL not perp to IR
  • Orbital plates not superimposed
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7
Q

Lateral Skull Rotation faults on patient and image

A
  • MSP is not parallel to bucky
  • TMJ will not be SI’d posteriorly & EAMs not in same vertical plane
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8
Q

What is seen in PA Ruggles of the skull

A
  • Petrous ridges fill orbits
  • Best demonstrates IACs
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9
Q

Ruggles Skull TIlt Positioning Faults on patient and image

A

IPL not perpendicular to IR
- supraorbital margins not flat

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10
Q

Ruggles Skull Rotation Positioning Faults on patient and image

A

MSP not parallel to IR
- lateral borders of skull and orbits

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11
Q

Ruggles Skull Extension positioning faults on patient and image

A
  • OML not perpendicular to IR
  • Petrous ridges dont fill the orbits
    (higher = too much tuck)
    (lower = not enough tuck)
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12
Q

What is best seen on PA Axial Caldwell of the skull

A

Petrous ridges in lower 1/3 of orbits
Supraorbital fissures

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13
Q

Caldwell Skull Tilt Positioning faults on patient and image

A
  • IPL not perp
  • supraorbital margins tilted
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14
Q

Caldwell Skull Rotation Positioning faults on patient and image

A
  • MSP not perpendicular
  • lateral skull and orbital margins
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15
Q

Caldwell Skull Extension Positioning faults on patient and image

A
  • OML not perpendicular to IR
  • Petrous ridges not 1/3 in orbits
    (too high= chin too tucked or not enough angle)
    (too low= not enough chin tuck or too much angle)
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16
Q

What is best seen on AP Axial Towne of the skull

A
  • dorsum sellae and posterior clinoid process in the foramen magnum
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17
Q

Towne Skull Tilt Positioning faults on patient and image

A
  • IPL not perp to IR
  • petrous ridges are symmetrical
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18
Q

Townes Skull Rotation Positioning faults on patient and image

A
  • MSP not parallel to IR
  • the petrous ridges are not symmetrical
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19
Q

Townes Skull Extension Positioning faults on patient and image

A
  • OML not perpendicular to IR
  • Dorsum sellae not seen in foramen magnum
    (too much angle or too much stuck you miss it and see C1 post arch)
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20
Q

What is best demonstrated in SMV/Basal/Schuller of the Skull

A
  • Odontoid process seen in the foramen magnum
  • mandibular condyles anterior to petrous ridges
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21
Q

SMV Skull Tilt Positioning faults on patient and image

A
  • IPL perp to IR
  • equal distance between mandibular condyles and edges of skull
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22
Q

SMV Skull Rotation Positioning faults on patient and image

A
  • MSP perp to IR
  • mandibular condyles at equal height
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23
Q

SMV Skull Extension Positioning faults on patient and image

A
  • GAL line perp to IR & IOML parallel to IR
  • Frontal bone SI’d with mental protuberance
    (too much extenstion = mandible too high)
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24
Q

What to repeat for in Ruggles/Caldwell/Towne

A

Rotation and extension

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25
What to repeat for in an SMV Skull
extension and tilt
26
What to repeat for in a lateral
rotation and tilt
27
What is best viewed in lateral projection of facial bones
- air fluid levels (erect) - sella turcica - superimposed mandibular rami & orbital plates & zygomatic processes of the maxilla
28
Lateral Facial Bones Tilt Positioning faults on patient and image
- IPL perp to IR - Superimposed orbital plates & sup borders of zygomatic processes of the maxilla
29
Lateral Facial Bones Rotation Positioning faults on patient and image
- MSP parallel to IR - Superimposed mandibular rami
30
Lateral Facial Bones Extension Positioning faults on patient and image
- IOML perpendicular to IR - gonions off the spine
31
What to repeat for in lateral facial bones
rotation and tilt
32
What is best viewed in parietoacanthial (waters) projection of the facial bones
- petrous ridges below maxillary sinuses & zygomatic arches - Maxillary sinuses **
33
Waters Facial Bones Tilt Positioning faults on patient and image
- IPL perp to IR - supraorbital margins
34
Waters Facial Bones Rotation Positioning faults on patient and image
- MSP not perp to IR - lateral orbital margins or zygomatic arches to lateral border of the skull
35
Waters Facial Bones Extension Positioning faults on patient and image
- MML not perp and OML not 37* from IR - petrous ridges below maxillary sinuses ( ridges are seen in/above maxillary sinuses or chin covering the dens = not enough extension) (ridges at the level of the gonions = too much extension)
36
What to repeat for in Waters Facial bones
rotation and extension
37
When would acanthioparietal facial bones be used
- trauma/recumbent supine
38
What is best viewed in PA Axial Caldwell of facial bones
- frontal sinuses - petrous ridges in 1/3 of orbits
39
Caldwell Facial Bones Tilt Positioning faults on patient and image
- IPL not parallel to IR - supraorbital margins are flat
40
Caldwell Facial Bones Rotation Positioning faults on patient and image
- MSP not perp to IR - lateral margins of orbits and skull
41
Caldwell Facial Bones Extension Positioning faults on patient and image
- OML not perp to IR - petrous ridges not in lower 1/3 of orbits (higher = too much chin tuck or not enough angle) (lower = not enough chin tuck or too much angle)
42
Why do we do orbit imaging
- foreign body (pre MRI) - pathology - fracture
43
Patient Prep for Orbits For Foreign Body
Clean IR Grid and bucky get patient history regarding foreign body in the eye have patient focus on one spot and keep eyes open during exposure
44
Routine Orbit Views
Lateral Modified Caldwell or Modified Waters
45
What is best viewed in lateral orbits projection
- fractures - frontal sinuses - orbits
46
Lateral Orbits Tilt Positioning Faults on patient and image
- IPL not perp to IR - oribital plates not superimposed
47
Lateral Orbits Rotation Positioning Faults on patient and image
- MSP not parallel to IR - Posterior border of zygomatic processes of the maxilla
48
Lateral Orbits Extension Positioning Faults on patient and image
- IOML not parallel to the IR - non factor
49
What to repeat for on lateral orbits image
- rotation and tilt
50
What is best demonstrated in Modified Caldwell for orbits
petrous ridges seen below inferior margin of the orbits maxillary sinuses superior orbital fissure
51
Modified Caldwell Orbits Tilt Positioning Faults on patient and image
- IPL not parallel to IR - supraorbital margins
52
Modified Caldwell Orbits Rotation Positioning Faults on patient and image
- MSP not perp to IR - lateral border of orbits to lateral border of skull
53
Modified Caldwell Orbits Extension Positioning Faults on patient and image
- OML not perp to IR - petrous ridges not below orbits (higher = too much tuck or not enough angle)
54
What to repeat for on modified caldwell for orbits
- Extension and rotation
55
What is best demonstrated on shallow waters for orbits
- orbital floors not distorted - good for blowout fractures - petrous ridges in lower 1/3 of maxillary sinuses
56
Shallow Waters Orbits Tilt Positioning Faults on patient and image
- IPL not parallel to IR - supraorbital margins not flat
57
Shallow Waters Orbits rotation Positioning Faults on patient and image
- MSP not perp to IR - lateral border of orbits and skull
58
Shallow Waters Orbits Extension Positioning Faults on patient and image
- LML not perp/OML not 55* from bucky - petrous ridges not in 1/3 of maxillary sinuses (higher = not enough extension)
59
Why do we always do sinuses with no angle and erect
- air fluid levels (positioning faults are never about angles on the tube)
60
What is best demonstrated in lateral sinus image
- can see all 4 sinuses but best for maxillary - sphenoid are post to maxillary - sphenoid are primary importance
61
Lateral SInuses Tilt Positioning Faults on patient and image
- IPL not perp to IR - orbital plates not superimposed
62
Lateral Sinuses Rotation Positioning Faults on patient and image
- MSP not parallel to IR - no rotation of sella turcica and SI'd mandibular rami - SI'd zygomatic processes of the maxilla
63
Lateral Sinuses Extension Positioning Faults on patient and image
- IOML not perp to IR
64
What to repeat for on Lateral Orbits
- rotation and tilt
65
What is best demonstrated in Caldwell Sinsuses Projection
- frontal sinuses - ant ethmoid sinuses
66
Caldwell Sinuses Tilt Positioning Faults on patient and image
- IPL not parallel to IR - supraorbital margins
67
Caldwell Sinuses Rotation Positioning Faults on patient and image
- MSP not perp to IR - lateral borders of orbits and skull
68
Caldwell Sinuses Extension Positioning Faults on patient and image
- line from TEA to 1/3 of orbits - petrous ridges in 1/3 of orbits & ethmoid air cells above petrous ridges
69
What to repeat for on Caldwell Sinuses
- rotation and extension
70
What is best demonstrated in parietoacanthial sinuses (open mouth waters) projection
sphenoid sinuses projected through mouth maxillary sinuses
71
Open mouth waters Sinuses Tilt Positioning Faults on patient and image
- IPL parallel to IR - Orbital roof
72
Open mouth waters Sinuses Rotation Positioning Faults on patient and image
- MSP perp to IR - sinuses symmetric
73
Open mouth waters Sinuses Extension Positioning Faults on patient and image
- MML perp to IR and OML at 37* - petrous ridges directly inferior to maxillary sinuses
74
What to repeat for on Open Mouth Waters for Sinuses
- rotation - extension
75
What is best demonstrated on an SMV sinuses projection
shenoid and posterior ethmoid sinuses
76
SMV Sinuses Tilt positioning faults on patient and images
- IPL parallel to IR - equal distance from lateral border of condyles and skull
77
SMV Sinuses Rotation positioning faults on patient and images
- MSP perp to IR - height of mandibular condyles
78
SMV Sinuses Extension positioning faults on patient and images
- IOML parellel to IR and GAL perp to IR - frontal bone and mental protuberance superimposed
79
What to repeat for on SMV sinuses
Extension and tilt
80
Lateral Nasal Bone Prep/Stuff
- Need to do bilateral - no grid
81
What is best demonstrated in lateral nasal bone
bilateral nasal bones in center of image
82
Lateral Nasal Bone Tilt on patient
- IPL perp to IR - nasal bones SI'd
83
Lateral Nasal Bones Rotation on patient
- MSP parallel to IR - nasal bones SI'd
84
Lateral Nasal bones Extension on patient
- IOML parallel to IR
85
What is best demonstrated in Waters for nasal bones
- lateral deviation of nasal septum - maxillary sinuses
86
What to repeat for on lateral nasal bone
- rotation and tilt
87
Waters Nasal Bones Tilt on patient and image
- IPL parallel to IR - orbital roofs
88
Waters Nasal Bones Rotation on patient and image
- MSP perp to IR - lateral borders of orbits and skull
89
Waters nasal bones Extension on patient and image
- MML perp to IR/ OML 37* from IR - petrous ridges below maxillary sinuses
90
Which projection will place petrous ridges at infraorbital margins
20* caldwell
91
Which projection best displays superior orbital fissures
Caldwell/Modified Caldwell
92
What is best displayed in the SMV for zygomatic arches and why do we use short SID
- arches free from overlying structures - symmetric and no foreshortening - Must use a short SID to allow divergence of the beam to superimpose the narrower mandible with the wider skull
93
SMV Zygos tilt on patient and image
- IPL parallel to IR - equal distnace between zygomatic arches (zygo you can see best is the direction the mandible is titled)
94
SMV Zygos Rotation on patient and image
- MSP perp to IR - height of mandibular condyles
95
SMV Zygos Extension on patient and image
- IOML parallel to IR/GAL perp to IR - frontal bone and mental protuberance SI'd
96
What to repeat for on SMV Zygos
extension and tilt
97
What is best displyed on Tangential Zygo projection
Affected zygomatic arch
98
Tangential Zygos tilt on patient and image
- IPL 15* towards side being image/ you see bump on bucky - can sees whole zygomatic arch
99
Tangential Zygos rotation on image and patient
- MSP 15* from IR - whole zygomatic arch is seen off the skull and straight
100
Tangential zygos Extension on patient and image
- IOML parallel to IR/ GAL perp to IR - frontal bone and mental protuberance SI'd
101
What is best seen on AP Towne of zygomatic arches
symmetric projection of both zygomatic arches with no overlap of mandible
102
AP Towne Zygos tilt on patient and image
- IPL parallel to IR - equal distance between zygos and skull
103
AP Towne Zygos Rotation on patient and image
- MSP perp to IR - zygomatic arches are symmetrical
104
AP Townes Extension on patient and image
- OML perp to IR - arches are lateral to mandibular rami
105
What to repeat for on townes
- extension and rotation
106
What is 2 fractures in the mandible called
contrecoup
107
What is best seen in lateral mandible
mandibular rami (affected side closest to IR)
108
Lateral Mandible tilt on patient and image
- IPL perp to IR - body and gonions SI'd
109
Lateral Mandible Rotation on patient and image
- MSP parallel to IR - rami superimposed
110
Lateral Mandible Extension on patient and image
- IOML parallel to IR - gonion off the c-spine
111
What to repeat for on lateral mandible
rotation and tilt
112
Why do we do an axiolateral oblique of the mandible
to project one side of mandible off the other
113
Ramus, Body, General Survey and mental protuberance
- true lateral - 30* towards IR - 15-20* towards IR - 45* towards IR
114
angles for axiolateral oblique mandible
- 25 cephalad or tilt vertex 15* towards IR and 10* cephalad angle
115
Ramus rotation on image
- gonions in same vertical plane
116
Body/Gen Survey rotation on image
- gonions are off centered
117
What do you see in Townes of the mandible
- elongated mandible - good visualization of the condyles - to assess medial or lateral displacement
118
Why do we use less angle on a PA axial mandible than AP axial mandible
- too much angle would cause spine to be projected over mandible
119
What is best visualized in PA axial mandible
- body and ramus - condlyes - not good for symphysis menti
120
Panoramic Tomography
- tube and IR rotate around patient
121
What is best seen in panoramic tomography
- mandible - TMJ - maxillary sinuses - fractures or infectious processes
122
What is the TMJ formed by
- condyle of the mandible articulates with the mandibular fossa of the zygomatic process of the temporal bone
123
What does the axiolateral of TMJ demonstrate
Excursion of condyles

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