Identifying the bones and their parts forming the skeleton of the head & neck and the paranasal air sinuses in radiographs

1. Radiological anatomy of
the Head and Neck
All the information, including the images and pics
collected from different sources is strictly for teaching
purposes only.
G R N 1

2. Now , With the availability of CT and MRI there has been a dramatic decline in
the use of plain films and the indications for skull radiographs have been
redefined.

3. Main anatomical planes used in Skull radiography
• The median sagittal plane is a vertical plane perpendicular to the
ground that separates the skull into equal right and left halves when
viewed from the front of the patient.
• The coronal plane (auricular plane) is a vertical plane that divides the
skull into anterior and posterior parts along the auricular line.
• The transverse plane (anthropological plane) is a horizontal plane that
splits the skull into upper and lower halves.

4. Auricular vertical line- Passes through vertex & centre point of EAM
Major base lines used in Skull radiography

5. The infraorbitomeatal line (IOML) or
Anthropological base line-runs from
the inferior orbital margin to the
upper border of the external auditory
meatus.

6. 1.PA view of skull or Occipito-frontal(OF)
projection
• Central ray is parallel to the sagittal
plane and enters the skull through
occipital bone and exits through the
frontal bone... centering at nasion
• Therefore, it is called Occipito-Frontal
(OF) projection or PA view based on
the direction of the central ray.

9. 2.AP view of the Skull or Fronto-
occipital(FO) projection
• Here also ,Central ray is parallel to
the sagittal plane, but it enters the
skull through the frontal bone and
exits through the occipital
bone(Centring at external occipital
protuberance).
• Same anatomy is demonstrated as
in PA view or OF projection...but
orbits & frontal bones are more
magnified .

10. Water's view is an angled PA
radiograph of the skull. The chin is
raised until the mento-meatal line
(MML) is perpendicular to the
receptor plate (OML will be 37° from
receptor plate). The beam(CR) is
exiting at the acanthion .
Water's view is used to assess
the sinuses (acute/chronic
sinusitis) and to look for facial
fractures.
The occipitomental (OM) or Water’s view

11. Water’s view

12. Water’s View:
Showing normal
sinuses without any
opacification

13. Water’s View: showing
orbital blowout
fracture with teardrop
sign

15. 3.Beam angulation
• OF and FO projections sometimes, it
may require central ray to
pass at some angle to the orbito-
meatal line along the sagittal plane.
• In these cases, the degree of
angulation is mentioned after the
name of the projection.
• Caudo-cranial angulation involves
the beam pointing up the body
towards the head (written in short
form as↑).
• Cranio-caudal angulation involves
the beam pointing down body
towards feet (written in short
form as ↓).
• Example - fronto-occipital 30-degree
cranio-caudal projection (FO30° ↓).

16. Fronto-occipital(AP) view with30 cranio-caudal angulation/ projection
to orbito-meatal line -Towne's view
It allows better evaluation of the posterior fossa
region than a standard nonangled AP skull view. The
lambdoid suture is better evaluated and gives better
sensitivity for detecting skull fractures than an AP
and lateral view alone. It throws the anterior part of
the skull away from the occipital region.

18. Right-sided ventricular shunt
catheter.

19. Lateral projection
• Central ray passes at right-
angles to the median sagittal
plane along coronal plane.
• Named according to the side of
the head nearer to the image
receptor.
• For example, if the beam
enters the head on the left
side, and exits the head on the
right side, where the image
receptor is located then, it is a
right lateral projection.

21. Fifty-five-degree left anterior oblique with 35 degree
caudal angulation / optic foramina view
• The head has been rotated, such
that the right side of the face is
in contact with the cassette and the
median sagittal plane makes an
angle of 55 degrees to the Bucky.
the central ray has a 35-degree
caudal angulation.

22. XRAY VIEW OF OPTIC FORAMINA
55̊ left anterior oblique with
35-degree caudal angulation /
optic foramina view

23. The submento-vertex view is an angled inferosuperior radiograph of
the base of the skull to see basal skull structures , including
the foramen ovale, foramen spinosum and sphenoid sinuses.

24. PANTOMOGRAPHY
• A Pantomograph is a panoramic
Radiograph Machine.
• It permits visualization of entire
maxillary and mandibular
dentition, alveolar arches and
contiguous structures

25. Open Mouth Odontoid Radiograph

26. Lateral view of neck
This projection helps to visualize
pathology involving the entire
cervical spine orthogonal to
the AP view .
It also helps to demonstrate any
adjacent soft tissue
structure, osteoarthritis and
spondylosis.

28. Note the Clay-shoveler
fracture (# of the spinous
process) –
# of the spinous processes of
the cervicothoracic junction.
Usually isolated but are
uncommonly multiple.

29. Cervical fracture
dislocation C5-C6

30. Hangman fracture, also known as
traumatic spondylolisthesis of the
axis, is a fracture which involves the
pars interarticularis of C2 on both
sides and is a result of
hyperextension and distraction.
• bilateral lamina and pedicle
fracture at C2
• usually associated
with anterolisthesis of C2 on C3

31. This projection helps to visualize
pathology relating to C3-C7 in the
anatomical position, demonstrating
any compression fractures, clay-
shoveler fractures and herniated
nucleus pulposus (HNP)
The central ray is midline, centered
at the level of C4 to enter
immediately below the hyoid bone
The anteroposterior (AP)
cervical spine projection

33. Jefferson fracture -burst
fracture of the atlas. It was
described as a four-part
fracture with double fractures
through the anterior and
posterior arches.