dr mohammad younas assistant professor pshawar dental college KPK(NWFP) PAKISTAN

1. DR MUHAMMAD YOUNAS KHAN
PGR
ORAL & MAXILLOFACIAL SURGERY
KCD
MAXILLOFACIAL RADIOGRAPHY
(Radiological Interpretation)

2. Objectives
 To identify the presence are absence of disease
 To provide information on the nature and extent of disease
 To enable the formation of a differential diagnosis

3. Requirements for Interpretation
 Optimum viewing condition
 Understanding the nature and limitation of radiographic image
 Detailed knowledge of normal anatomy & pathological condition
 Systematic approach

4. Indications
 Fracture of the maxillofacial skeleton
 Fracture of the skull
 Investigation of the antra
 Disease affecting the skull base and vault
 TMJ disorder

5. Main Maxillofacial/Skull Projections
 Standard occipitomental (0o OM)
 30o occipitomenatal (37o, 45o, 14o)
 PA Skull
 Postero-anterior of the jaws
 Reverse towne’s
 Rotated PA
 True lateral skull
 Submento vertex SMV
 Transcranial
 Transpharyangeal

6. Indications (0o OM)
 Investigation of the maxillary antra
 Detecting the middle third facial fracture (Le Fort fracture + Zmc
+ Noe + Orbital blowout fracture)
 Coronoid process fractures
 Investigation of frontal, ethmoidal and sphenoidal sinuses

7. Middle Third Fracture of the Face
Interpretation by (0o OM)
 SYSTEMATIC APPROACH
a. McGrigor & Campbell (1950)
b. Trapnell line
c. Dolen line

8. Campbell’s Lines
 Line 1: Rt ZF Suture Rt Supra-orbital ridge frontal sinus
Lt supra-orbital ridge Lt ZFS
 Line 2: Rt zygomatic arch Rt body of zygoma Rt infra
orbital margin nasal complex Lt infra orbital margins
Lt body of zygoma Lt Z arch
 Line 3: Rt condylar neck Rt cronoid precces lateral wall
of Rt antrum base of nasal complex lateral wall of Lt
antrum Lt CP Lt CN

9. Campbell’s Line
 Line 4: Rt angle of Mandible Line
of occlusal plane Lt angle of
mandible
Trapnell Line
 Lower border of the mandible

12.  Standard Waters view.
 1 = Superior orbital rim;
 2 = frontal sinus;
 3 = zygomaticofrontal suture
line;
 4 = medial wall of the orbit;
 5 = ethmoid sinus;
 6 = zygomatic body;
 7 = inferior orbital rim;
 8 = floor of the orbit;
 9 = medial and lateral walls of
the maxillary sinus; and 10 =
nasal septum.

13. Dolen’s Curve
Curve 1
 Lateral wall of the antrum – inferior surface of the body of
zygoma – zygomatic arch (maxillary line)
Curve 2
 Superior margin of zygomatic arch – lateral aspect of the body of
zygoma – orbital margin (zygomatic line)

14. Dolen’s Curve
Curve 3
 Iner aspect of the orbital rim (orbital line)
Curve 4
 Outer curvature of the nasal complex (nasal line)

15. Interpretations
 Step 1
Compare both side of Campbell’s line
 Step 2
Compare both side of Dolen’s curve
 Step 3
Examination of antrum

16. 1. LINE 1 LOOK FOR:
 Fractures
 Widening of the zygomatic-frontal suture
 Fluid level (haemorrhage) in a frontal sinus
2. LINE 2 LOOK FOR:
 Fractures of the zygomatic arch
 A fracture through the inferior rim of the orbit
 A soft tissue shadow in the roof of the maxillary antrum
3. LINE 3 LOOK FOR:
 Fractures of the zygoma and of the lateral aspect of the
maxillary antrum
 A fluid level in the maxillary antrum.

17. Look for
(In step 1 and step 2)
 Alteration or asymmetry in bony outline/shape
 Step deformities
 Widening of suture lines
 Presence of radiolucent fracture lines
 Fracture line directions
 Degree of separation
 Radiopaque lines

18. Particulare
 Zygomatico-frontal sutures
 Fronto-nsal sutures
 Zygomatico-temporal sutures
 Inferior margins of orbits
 Lateral margins of antrum
 Nasal septum and complex

19. Radiographic Signs of Bone Fracture
Direct
1. Separation sign
2. Overlap sign
3. Suture diastasis
4. Bony steps
5. Periodontal ligament widening
6. Abnormal linear density
7. Disappearing fragment sign
8. Abnormal angulation / curve
9. Displaced bone

20. Indirect
1. Tear drop sign (hanging drop)
2. Sinus opacification
3. Air in soft tissues
4. Occlusal plane changes
5. Dental injuries

22. 30o Occipitomental
(water view)
INDICATIONS:
 detecting the middle third facial fracture
Le Fort I
Le Fort II
Le Fort III
 Coronoid process fractures

23. Orthopentomogram
(DPT/OPG)
 All the teeth and their supporting structures
 Reasonably simple
 Radiation dose is low

24. Indications
 Assessment of dentitions (primary, mixed, and permanent)
 Orthodontic assessment
 Assessment for bony lesion
 Assessment of periodontal bone
 Third molar status
 Mandible fractures
 Antral disease (floor, posterior, medial walls)
 Disease of the TMJ
 Vertical alveolar bone height

25. Interpretation of the OPG
 The entire radiograph
 Specific lesion

26. General view of the entire film
 Note the chronological and developmental age of patient
 To trace the out line of normal and antomical shadows

27. Real or Actual Shadows
 Hard tissue shadows
1. Teeth
2. Mandible
3. Maxilla
4. Zygomatic arches
5. Styloid processes
6. Nasal septum and conchae
7. Base of skull

28.  AIR SHADOWS
1. Mouth/oral opening
2. Oropharynx

29.  SOFT TISSUE SHADOWS
1. Ear lobes
2. Nasal cartilages
3. Soft palate
4. Dorsum of tongue
5. Lips and cheeks

30. General View
 TEETH
1. Number of teeth
2. Stage of development
3. Condition of crown
4. Position of teeth
5. Condition of root
6. Apical tissue

31. Mandible
 Both TMJ/coronoid process
 Body ramus of mandible
 Shape
 Outline
 Thickness of the lower border
 Trabeculae pattern
 Radiolucent/radiopeque areas

32.  Panoramic view.
 1 = Condylar process;
 2 = coronoid process
 3 = ramus
 4= angle of the mandible
 5 = body of the mandible
 6 = symphysis

34. Others Structures
 Antrum (floor anterior, posterior wall, radio density)
 Nasal cavity
 Styloid processes

35. Specific Lesion
 Site
 Size
 Shape
 Outline
 Relative radio-density
 Internal structure
 Effect on adjacent surrounding structures

36. Ghost Shadows
 Survical vertebrae
 Body angle, ramus of contralateral side
 Palate

37.  ANY QUESTION

38.  Any one want to add
some suggestions
 please

39. THANKS