This document provides an outline and introduction to imaging facial trauma. It discusses the epidemiology and types of facial fractures, the use of CT versus radiography in evaluation, normal facial anatomy, and an imaging approach. Standard radiographic views of the face are described including Waters, Caldwell's, and Towne's views. Key anatomical structures and lines of reference are identified for each view. The biomechanics of typical fracture patterns are also covered.
In this presentation we will discuss the basic of axial trauma from head to pelvis. We will discuss the important key points that aids in the diagnosis of axial trauma
In this presentation we will discuss the basic of axial trauma from head to pelvis. We will discuss the important key points that aids in the diagnosis of axial trauma
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lefort fractures are an important set of fractures to learn among midfacial fractues which requires a thorough anatomical knowlwdge for adequate management of patient as they suffer from mild to severe aesthetic deformities in addition to functional compromise which needs to be corrected with precise knowledge and care
General suggestions in ordering body CT in ED; vascular occlusion; aneurysm/pseudoaneurysm; bleeding and active contrast extravasation; extraluminal air
Practical Points in Emergency CT for Emergency PhysiciansRathachai Kaewlai
The handout describes some brief practical points on emergency CT, particularly for emergency physicians. They include imaging utilisation trends, radiation dose, contrast reaction, contrast-induced nephropathy, use of oral contrast medium and some caveats on emergency CT (esp. abdomen)
Five pearls and pitfalls in using head CT for diagnosis of traumatic brain injury. This was presented at the 51st Annual Scientific Meeting of the Royal College of Radiologists of Thailand (6 Aug 2014)
Summary and illustrations of various traumatic brain injury including primary and secondary lesions as well as limited information on indications of brain imaging in trauma
A slideshow of 'Imaging of Head Trauma: Part I' describes nature, mechanism, significance of head trauma, indications and choices of imaging in patients with head trauma, and normal anatomy of the brain with emphasis on CT.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
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Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
1. Imaging of Facial Trauma
Part 2: Introduction and Anatomy
Rathachai Kaewlai, MD
www.RadiologyInThai.com
Created: January 2007
1
quot;
2. Outline
Facial fracture epidemiology Types of facial fracture
Nasal bone fracture
Initial management Naso-orbital-ethmoid fracture
Frontal sinus fracture
Imaging: CT versus radiography Orbital fracture
Zygomatic fracture
Normal anatomy
Maxillary fracture
3D Mandibular fracture
CT (axial, coronal and sagittal planes)
Radiography Imaging approach
Biomechanics
2
3. Plain Film Radiography
Can be obtained to screen for facial injury if CT is not immediately
available
If plain film identify a fracture other than a simple nasal bone
fracture, further evaluation by CT is indicated
Multiple plain film projections are relative to ‘canthomeatal line’; an
imaginary line drawn from outer canthus to external auditory meatus
Proper positioning (of patient’s head), alignment of x-ray beam is
critical for evaluation because facial skeletal anatomy is complex
3
4. Plain Film Radiography
Remember: plain film is a 2D image of a 3D object
Overlapping structures significantly obscure anatomic detail
This problem is solved by standard views (to minimize overlap,
allow visualization of important structures, familiarity for
interpretation)
Rule of symmetry: two sides of the face are quite symmetrical
Symmetry is usual, and asymmetry is suspect
Multiplicity: fractures of facial bones are frequently multiple.
Do not stop looking for others when see one
4
5. Plain Film Radiography
Facial series Mandible
Water’s view (PA view with Oblique view, Towne’s view
cephalad angulation)
Caldwell view (PA view) Orthopanthogram
Towne’s view
Lateral view
Base view
Additional view
Lateral view of the nasal bone
(nasal technique)
Note: The lecture series are focused on CT scan
5
6. Water’s View
The most comprehensive single
projection display
Excellent view of
- Maxilla
- Maxillary sinuses
- Zygoma
- Zygomatic arches
- Rims of orbits, esp. floor
- Nasal bones
6
7. Water’s View
Key structures
1 = Frontal sinus
2 = Maxillary sinus
3 = Frontal process of
Zygoma
4 = Body of Zygoma (malar
eminence)
5 = Temporal process of
Zygoma
Dotted line = zygomatico-
frontal suture
Dolan’s lines of reference
Line A, B, C
Rule:
smooth, non-disrupted, same
contour on both sides
7
8. Line A
- Begins at inner surface of
zygomatico-frontal suture,
follows orbital surface of
zygoma, maxilla, frontal
process of maxilla and arch
of nasal bone
- If drawn to both sides, the
line is similar to lazy ‘W’ or
half frame of reading glasses
Line B
- egins at lateral and inferior
B
margin of maxilla and
extends along lateral wall of
maxillary sinus and inferior
surface of zygomatic arch
- Ends at glenoid fossa
8
9. Line C
- Begins at lateral and inferior
margins of maxilla, extends
along lateral wall of
maxillary sinus and inferior
surface of zygomatic arch
- Ends at glenoid fossa
“Friendly Line”
- Medial half of Line C is the
anterolateral wall of the
maxillary sinus.
- If it is disrupted, the
possibilities of fx include
1) Isolated maxillary
antrum
2) Zygomatico-maxillary
complex (ZMC)
3) LeFort (unilateral or
bilateral)
9
10. Caldwell’s View
Excellent view of
- Entire rim of orbit, esp.
superomedial rim
- Ethmoid sinus
- Floor of orbit may be well
seen in petrous bones are
projected below the inferior
orbital rim (not in this
example)
10
11. Key structures
1 = Ethmoid sinuses
2 = Orbit
Line A, B, C, D = superior,
2 lateral, inferior and medial
walls of the orbit, respectively
Line E = midline nasal
septum and vomer
Rule:
- Ethmoid sinuses density
should be equal, darker than
orbit
- Smooth non-disrupted
orbital walls
11
12. Lateral View
Excellent view of
- Frontal sinus: anterior wall
- Maxillary sinus: anterior
and posterior wall
- Sphenoid sinus
- Pterygoid plate
- Floor of anterior cranial
fossa, hard palate
- Lateral rim of orbit
12
13. Key structures
1 = Frontal sinus
2 = Maxillary sinus
3 = Sphenoid sinus
4 = Hard palate
5 = Anterior wall of temporal
fossa
Between green arrows =
Pterygoid plate
Line A = Anterior wall of
frontal sinus
Line B = Anterior cranial
fossa
Line C = Anterior wall of
maxillary sinus
Line D = Posterior wall of
maxillary sinus
13
14. Line A
- Connects anterior surface of
frontal sinus and anterior
surface of hard palate
Line B
- Connects anterior wall of
temporal fossa and posterior
edge of hard palate
Line C
- Along planum sphenoidale
Line D
- Along hard palate
Rule:
- Line A & B parallel
- Line C & D parallel
14
16. Key structures
1 = Zygomatic arch
Line A = Posterolateral wall
of maxillary sinus
Rule:
- Smooth, non-disrupted line
16
17. Orthopanthogram or Panorex®
Key structures
R = Temporomandibular joint
13 = Mandible, condyle 14 = Mandible, ramus 17 = Mandible, body
18 = Mandible, angle 19 = Mandible, coronoid process 20 = Mandible, symphysis
17
18. 8 9
25 24
Counting the teeth on Orthopanthogram or Panorex®
American Dental Association (ADA) system preferred this system because you will speak same ‘language’ with
dentists.
Count from midline and go laterally (some individuals may not have #1, #16, #17, and #32)
Maxillary Arch ADA#1 - 8 (right), #9-16 (left)
Mandibular Arch ADA#32-25 (right), #24-17 (left)
18
19. Oblique View of Mandible
Key structures
R = Temporomandibular joint
13 = Mandible, condyle 14 = Mandible, ramus 17 = Mandible, body
18 = Mandible, angle 19 = Mandible, coronoid process 20 = Mandible, symphysis
19
20. Biomechanics
LeFort described areas of
relative strength within the
facial skeleton
Alveolar process of maxilla
(1)
Frontal process of maxilla
(2)
Body of zygoma or malar
eminence (3)
Line of fracture tends to
avoid these areas
20
21. Checklist for Facial
Radiograph/CT
Facial structures are quite symmetrical
Do not stop searching when see one abnormality
If suspect for more than simple nasal fracture, do CT
Significant (but can be subtle) fractures
Fracture involves the optic foramen which can cause permanent visual loss if
not treated promptly
Fracture of the posterior wall of frontal sinus requires neurosurgical
evaluation and may require antibiotics prophylaxis
Fracture/dislocation of the TMJ usually missed on initial survey. It can cause
significant disability if left untreated
Look for significant soft tissue injuries
Globe rupture, hemorrhage
21
23. The information provided in this presentation…
Is intended to be used as educational purposes only.
Is designed to assist emergency practitioners in providing
appropriate radiologic care for patients.
Is flexible and not intended, nor should they be used to
establish a legal standard of care.
Thanks, MGH Radiology, for cases I’ve seen and things I’ve
learned.
R.K.
23