SEMINAR ON

Various radiographic views in facial fractures

SUBMITTED BY
Rajendran Navaradnasinkam
C.R.I
The array of facial injuries was first describes
by Hippocrates in 400 B.C. The French man,
Rene Le Fort described three types of fractures
in 1901. Radiography developed during the
First World war leading to a better
understanding and treatment of facial
fractures. The advent of CT reconstruction,
along with new surgical techniques has
improved the final appearance immensely.
Le fort I fracture
Le fort II fracture ( Pyramidal/ subzygomatic)
Le fort III fracture ( suprazygomatic)
Nasal Bone fracture
Nasoethmoidal fracture
Zygomatic arch fracture
Zygomaticomaxillary arch fracture
SR
GENERAL PROJECTIONS COMMON
ANATOMICA INDICATIONS
L AREA
Facial bones, upper mid Waters projection Injuries
1 third
Zygomatic arch Jug Handle projection Injury
2
Orbits - Occipitomental projection - Injury
3 - Lateral cephalometric projection - Blow out fracture

Nasal bones - Occipitomental projection

4 - Lateral cephalometric projection
Maxilla - Oblique projection and Minor injury
5 - Occlusal & periapical projection
Mandible - Posteroanterior projection Injury
6 - Lateral jaw projection
Symphysis menti / Central - PA oblique projection Injury
7 Mandible - Occlusal projection
TMJ - Lateral oblique projection - Internal Dearrangement
8 - Transcranial view - Secondary osteoarthritis
- Transpharyngeal view - Fracture dislocation
- TMJ Tomography
Maxillary Sinus - Occipitomental view
9 - Occipitofrontal view
- Lateral projection
Lateral jaw projection is useful
to examine the posterior
region of the mandible. This
radiographic projection is
also called lateral oblique
view. This radiograph is
very useful in the diagnosis
of fracture or any pathology
in patients with restricted
mouth opening.
 
Two types of Lateral jaw
projections are :-
Body of mandible projection
Ramus of mandible projection
Body of mandible projection
is used in evaluation of
impacted teeth, fracture of
mandible.
The film is kept first against
the cheek of the required
side and is centered over the
body of the mandible. The
patients head is titled 15
degree to the side being
imaged and the chin is
elevated and extended
upwards. The central x-ray
beam is directed
perpendicular to the
horizontal plane of the
cassette with a vertical
angulation of -15 to -20
degrees.
In the ramus of mandible
projection , the film is held
flat on the cheek of the
required side and centered
over ramus of mandible.
Patients head is tilted 15
degrees towards the
required side and the chin is
elevated and extended. The
central x-ray beam should be
perpendicular to plane of
cassette at vertical
angulation of -15 to -20
degrees.
Lateral cephalometric projection
is popularly known as lateral
cephalogram. This projection
shows bones of skull and face as
well as soft tissues profile of the
face.
The cassette is kept
perpendicular to the floor. The
left side of the patients head is
positioned close to the cassette.
The mid- sagittal plane is
perpendicular to the floor and
parallel to the cassette. The teeth
should be in occlusion and the
lips should be gently closed.
The central x-ray beam is
directed through the centre of
the cassette. The target to object
distance is 60 inches.
Posteroanterior projection or
PA view demonstrates the
frontal and ethmoidal sinus,
orbits and the nasal cavity.
The long axis of the cassette
is positioned vertically. The
patient faces the cassette in
such a way that the forehead
and nose touch the surface.
Frankfort plane is parallel to
floor
Waters projection or
Paranasal sinus projection is
used in evaluation of
maxillary sinus. This
projection also demonstrates
the frontal and ethmoid
sinuses, the orbits and the
nasal cavity. This projection
is very useful in the
diagnosis of maxillary
sinusitis and Le fort II and
Le fort III fractures.
The patient faces the cassette
with the chin touching the
cassette. The tip of the nose
is positioned half to one inch
away from the cassette. The
mid sagittal plane is
perpendicular to the floor
and head is positioned in the
centre of the cassette. The
central x-ray beam is
directed from the centre of
the head.
The submentovertex
view(SMV) helps to
identify the position of the
condyle, visualize base of
the skull and evaluate
fractures of the zygomatic
arch. This projection also
demonstrates the sphenoid
and theethmoid sinuses and
lateral wall of maxillary
sinus.
Submentovertex view is of two
types :-
Zygomatic arch projection
Base of skull projection
ZYGOMATIC ARCH PROJECTION
Zygomatic arch projection is also called as the Jug-
Handle view. This radiograph is essentially similar to
base of the skull projection with the exception that the
radiation exposure and development time are less.
BASE OF THE SKULL PROJECTION
The cassette is placed perpendicular to the floor with
the long axis vertical.
The patients head and neck are extended backwards as
far as possible. The vertex or top of skull touches the
cassette. The head is centered on the cassette. X-ray
beam is directed through the centre of the head and
perpendicular to centre of the cassette
TRANSCRANIALVIEW
Transcranial view helps in
visualisation of superior
surface of the condyle and
the articular eminence. The
joint space is also visualised.
The cassette is placed flat
over the ear of the required
side in such a way that it is
centered over the TMJ. The
mid sagittal plane is
perpendicular to the floor
and parallel with the
cassette. The central x-ray
beam is directed to a point 2
inches superior to and
0.5inches behind the opening
of the ear canal ( external
auditory meatus
TRANSORBITAL VIEW

Transorbital view helps in

the visualization of the joint
with relatively less
superimposition.
  This view is also called :-
Zimmer projection or
Transmaxillary projection
This view demonstrates the
entire latero-medial
articulating surface of both
the condyle and the articular
eminence and the condylar
neck.
The head of the patient is tipped down 10 degrees in such
a way that the canthomeatal line is horizontal. The mid
sagittal plane is kept at 30 degrees to the central x-ray
beam by moving the head to the left for left side
projection and to the right for right side projection.
The cassette is positioned behind the patients head and
the central x-ray beam is directed through the Ipsilateral
orbit and through the required TMJ, exiting from the
skull behind the mastoid process. During the exposure,
the patient is asked to open the mouth as wide as
possible.
TEMPEROMANDIBULAR JOINT
TOMOGRAPHY

Temperomandibular joint
tomography helps in the
visualization of the condyle,
articular eminence and
glenoid fossa. It can be also
used to determine the joint
space and to evaluate the
extent of movement of
condyle when the mouth is
opened.
 TRANSPHARYNGEAL VIEW
Transpharyngeal view is also
called as
Infracranial view
McQueen projection
This projection demonstrates the
angular process from the mid
mandibular ramus to the
condyle.
This technique helps in the
diagnosis of fractures of the
condyle and the condyle neck
and in detecting alterations in
condyle morphology.
The cassette is held over the ear
in such a way that the TMJ of
interest is in the centre of the
cassette. The cassette is held
parallel to the mid sagittal
plane. The x-ray tube is kept on
the side of the skull opposite to
the TMJ imaged. It is angled in
such a way that the mouth wide
so that the central x-ray beam
enteres through the tube side
sigmoid notch, below the skull
base and oropharynx.