imaging in orl
TRANSCRIPT
Imaging in ORL
1. PNS
2. Mastoid
3. Soft tissue neck
4. Sialogram
What should comment?
1. Patient’s data
2. Type ( plain or contrast)
3. Site
4. View
5. Exposure ( bone or soft tissue setting)
6. Findings
7. Remarks ( not diagnosis)
1. PNS - What findings?
• Fracture? (MVA, gun-shot, trauma)
• Infection (mucosal thickening, air-fluid level, haziness)
• Tumor (bone erosion, extension)
PNS - views
1. Occipital mental view (best for maxillary sinus because the petrosal bone don’t block it. It is also for frontal sinus & zygomatic arch)
2. Occipital frontal view (frontal sinus)3. Submento vertical/Axial (ethmoidal &
sphenoidal sinus)4. Lateral (AP depth of frontal sinus)5. Oblique (ethmoidal sinus – 3 groups)
PNS – lateral
PNS – occipital mental
•Air-fluid level???
PNS – occipital mental
•Both side maxillary sinus mucosal thickening?
PNS – occipital mental
PNS – occipital mental
•Normal
PNS – occipital mental
•Both side maxillary sinus mucosal thickening?
PNS – occipital mental
PNS – occipital mental
•right side maxillary sinus mucosal thickening?
PNS – occipital mental
PNS – occipital mental
PNS – occipital frontal
PNS – occipital frontal
PNS – submento vertical (axial)
PNS – submento vertical (axial)
2. Mastoid
• Fracture? (MVA, gun-shot, trauma)
• Infection (mucosal thickening, air-fluid level, haziness)
• Tumor (bone erosion, extension)
• Type of mastoid (acellular, cellular, diploic)
• Look for acoustic neuroma (by submento vertical view – )
Mastoid - view
1. Occipital frontal/transorbital (internal auditory meatus widening? – look for acoustic neuroma)
2. Submento vertical (look for acoustic neuroma)3. Lateral oblique (mastoid antrum –
cholesteatoma, air cell – if big can be previous infection)
4. AP oblique view (cochlear & tympanic cavity)5. Owen’s view ( ossicles – incus & malleus)
*cholesteatoma common in acellular mastoid
Example: lateral obliqueAntrum
Maxilla
External auditory meatus
Air cell
Mandible
Example : owen’s view
Mastoid lateral oblique
Mastoid lateral oblique
Mastoid lateral oblique
Mastoid lateral oblique
Mastoid lateral oblique
Mastoid lateral oblique
Mastoid lateral oblique
Mastoid lateral oblique
Mastoid lateral oblique
Mastoid lateral oblique
Mastoid Occipital frontal - Transorbital
Mastoid Transorbital view
3. Soft tissue neck
• 2 type– Adenoid (mandible must be perpendicular)– Prevertebral tissue (not thicken more the ½ of
vertebra body. C6 & C7 normally thicken)
Example: soft tissue adenoid true lateral view
Palate
Imaginary line
I
Roof of nasopharynx
IV
III
II
Sialogram –contrast type
• Lateral view• Inject contrast through submandibular vein• Look for any calculus• Alveoli appearance?• If tumour, the submandibular vein show straight
appearance
*cannot diagnose tumour because the contrast only go into the duct while the tumour can arise from peripheral tissue. The only sign will see is the duct been pushed to one side
Others
