Unit 5 (Facial Bones)
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list the facial bones and their numbers:
 nasal bones (2)
 lacrimal bones (2)
 maxillae bones (2)
 zygomatic/malar bones (2)
 palatine bones (2)
 inferior nasal conchae (2)
 vomer (1)
 mandible (1)
 = 14 total

which bone is sometimes referred to as the "anchor bone" of the face?
the maxillae

ridges of bone that the roots of the teeth fit into:
alveolar processes

what is the largest immovable bone of the face?
maxillae

what is the largest and densest bone of the face?
mandible

where are the maxillary sinuses located?
the body of the maxillae

name the bone and label it:
 maxillae bones
 A. infraorbital foramen
 B. body of maxillae
 C. alveolar process
 D. frontal process
 E. zygomatic bone
 F. zygomatic process
 G. anterior nasal spine

what bones make up the hard palate?
 anterior 3/4 is formed by the maxillae
 posterior 1/4 is formed by the palatine bones (horizontal plates)

how are the palatine bones shaped?
 an "L" shape
 the horizontal portion help to form the hard palate
 the vertical portion extends up the nasal cavity
 the tip of the vertical portion can be seen within the orbit

what two bones make up the zygotic arch?
 the zygoma
 the zygomatic process of the temporal bone

a dislocation of the zygoma from all three articulations (with frontal bone, temporal bone, and maxilla):
 tripod fracture
 also called a freefloating malar

closeup of the nasal cavity...name the blue and the purple structures:
 blue: superior and middle nasal conchae (ethmoid bone)
 purple: inferior nasal concha

the bone that forms the inferior section of the nasal septum:
vomer

name the bone and label:
 mandible
 A. condylar process
 B. alveolar portion
 C. symphysis
 D. coronoid process
 E. mental foramen
 F. mental point
 G. mental protuberance
 H. body of mandible
 I. ramus
 J. mental foramen
 K. mental protuberance
 L. body of mandible
 M. angle of mandible/gonion
 N. ramus
 O. condylar process
 P. neck
 Q. mandibular notch
 R. coronoid process

 A. hyoid bone
 B. body
 C. lesser cornu
 D. greater cornu

describe the basic shape and aspects of the orbit:
 conical in shape
 the entire outer rim is the base
 the innermost/most posterior area is the apex
 the superior part of the base is the SOM
 the inferior part of the base is the IOM

 A. optic canal
 B. ethmoid bone
 C. lacrimal bone
 D. maxilla
 E. frontal bone
 F. sphenoid bone
 G. zygomatic bone
 H. palatine bone

at what age does the symphysis of the mandible unite?
one year old

give the two angles the orbits make within the skull?
 angled 37 degrees toward MSP
 angled 30 degrees upward from the OML

what projection is commonly used to best view the orbits?
 the Rhese Method
 (a parietoorbital oblique projection)

for the rhese method of the orbit, what side is best demonstrated?
the down side

for the reverse rhese method of the orbit, what side is best demonstrated?
the up side

give the projection criteria for the parietoorbital oblique projection (Rhese Method):
 CR is perpendicular
 pt prone
 center 1" superior and posterior to the TEA
 AML perpendicular
 MSP is 53 degrees

in the rhese method, how is the optic foramen demonstrated?
in the lower lateral quadrant of the orbit

give the projection criteria for the orbitoparietal oblique projection (Reverse Rhese Method):
 CR is perpendicular
 pt supine
 center over the up side orbit
 AML perpendicular
 MSP is 53 degrees

give the projection criteria for the lateral facial bones projection:
 CR is perpendicular
 pt lateral
 center 1/2way between outer canthus and EAM
 IOML and MSP is parallel
 IPL is perpendicular

give the projection criteria for the parietoacanthial projection (Waters Method):
 CR is perpendicular
 PA projection
 center at acanthion
 MML and MSP are perpendicular
 OML is 37 degrees

give the projection criteria for the modified parietoacanthial projection (Modified/Shallow Waters Method):
 CR is perpendicular
 PA projection
 center at acanthion
 LML and MSP are perpendicular
 OML is 55 degrees

give the projection criteria for the acanthioparietal projection (Reverse Waters Method):
 CR is perpendicular
 AP projection
 center at acanthion
 MML and MSP are perpendicular
 OML is 37 degrees
 **for trauma, angle tube to get central ray parallel to MML

give the projection criteria for the lateral nasal bones projection:
 CR is perpendicular
 pt is lateral
 center 1/2" below nasion
 IOML and MSP are parallel
 IPL is perpendicular

give the projection criteria for the submentovertical (SMV) or basal projection for zygomatic arches:
 CR is perpendicular
 center 1" posterior to outer canthus of eye
 IOML parallel
 MSP perpendicular

give the projection criteria for the tangential projection of the zygomatic arches:
 CR is perpendicular
 center to zygomatic arch
 MSP is 15 degrees toward affected side
 Forehead moved 15 degrees away from affected side

give the projection criteria for the AP axial projection of the zygomatic arches (Modified Townes Method):
 CR is 30 degrees caudal
 center to glabella (one inch above nasion)
 OML and MSP are perpendicular
 **if pt can't duck chin, use IOML and 37 degree caudal

give the projection criteria for the PA projection of the mandibular rami:
 CR is perpendicular
 center to acanthion
 OML and MSP are perpendicular
 ** mark down side

give the projection criteria for the PA axial projections of the mandibular rami:
 CR is 2025 degrees cephalic
 center to have light exit acanthion
 OML and MSP are perpendicular
 ** mark down side

give the projection criteria for the PA projection of the body of the mandible:
 CR is perpendicular
 center at the lips
 AML and MSP are perpendicular
 ** mark down side

give the projection criteria for the PA axial projection of the body of the mandible:
 CR is 30 degrees cephalic
 center at the TMJs (basically at the EAM)
 AML and MSP are perpendicular
 ** mark down side

give the projection criteria for the axiolateral projection for the ramus of the mandible:
 CR is 2025 degrees cephalic
 center at the ramus of the mandible
 place head lateral and extend the chin
 ** mark down side

give the projection criteria for the axiolateral oblique projection of the body of the mandible:
 CR is 2025 degrees cephalic
 center slightly posterior to gonion
 rotate face 30 degrees inward (toward film)
 body of mandible parallel to film
 **general survey: rotate face 15 degrees inward (toward film)
 ** mark down side

give the projection criteria for the axiolateral oblique projection of the mandibular symphysis:
 CR is 2025 degrees cephalic
 center at the symphysis
 rotate face 45 degrees inward (toward film)
 ** mark down side

give the projection criteria for the submentovertical (SMV) projection of the mandible:
 CR is perpendicular
 center at the gonion/angle of mandible
 IOML is parallel
 MSP is perpendicular

give the projection criteria for the AP axial projection for the temporomandibular joint (TMJ):
 CR is 35 degrees caudal
 center 3" above nasion
 OML and MSP are perpendicular
 ** closed mouth, cheeks puffed out
 ** open mouth, jaw dropped

give the projection criteria for the axiolateral projection for the TMJ (Schuller Method):
 CR is 2530 degrees caudal
 center 1/2" anterior and 2" superior to upside EAM
 IOML and MSP are parallel
 IPL perpendicular
 ** open mouth and closed mouth, both right and left
 ** mark down side and whether open or closed

give the projection criteria for the axiolateral oblique projection of the TMJ (Modified Law Method):
 CR is 15 degrees caudal
 center 1 1/2" to 2" superior to EAM
 AML is parallel
 MSP is 15 degrees inward (toward IR)
 ** 4 views, open and closed: both right and left

give the projection criteria for the parietoacanthial projection of the sinuses (Waters Method):
same as waters for facial bones!!

give the projection criteria for the parietoacanthial projection of the sinuses (Open Mouth Waters Method):
 CR is perpendicular
 center at acanthion
 MML and MSP are perpendicular
 **lower bottom jaw (this changes the MML)

give the projection criteria for the lateral sinus projection:
 CR is perpendicular
 center 1/2" to 1" posterior to outer canthus
 IOML and MSP are parallel
 IPL is perpendicular

give the projection criteria for the PA axial projection (Caldwell Method) for sinus:
 CR 15 degrees caudal
 center to nasion
 OML and MSP are perpendicular

give the projection criteria for the submentovertical (SMV) projection of the sinuses:
 CR is perpendicular
 center 3/4" anterior to EAM
 IOML and MSP are parallel

where is the mental point?
at the center of the mental protuberance

which is the largest, densest facial bone?
mandible

what is the only moveable bone of the skull?
mandible

where is the hyoid bone and what is its function?
 above the larynx at the base of the tongue
 helps you to speak and swallow

what is a fracture of the inferior rim of the orbit and what projection best demonstrates it?
 blowout fracture
 Modified Waters Method (or Waters if only option)

what positioning error is present if the optic foramen is not in the lower outer quadrant of the Rhese Method?
 AML is not aligned (too far up or down in orbit)
 or the head is not obliqued 53 degrees (too far left or right)

what is the disadvantage of the Reverse Rhese Method as compared to the Rhese Method?
 the orbits are magnified
 there is more exposure to the lens of the eye

what should be visualized in the Waters Method for facial bones?
 the petrous pyramids are completely below the maxillary sinuses
 the mandible makes an upside down U
 the dens is in the foramen magnum

what should be visualized in the Modified/Shallow Waters method for facial bones?
 the petrous pyramids are in the lower portion of the maxillary sinuses
 the mandible is straighter
 you cannot see the foramen magnum

why do you have pt fill cheeks with air on some views of the mandible?
to increase contrast

what should be seen in the SMV for the mandible?
 condyles should be anterior to petrous pyramids
 (if not, head is not tilted back enough)
 foramen ovale and spinosum are demonstrated

in which projection is the foramen rotundum best demonstrated?
Waters Method

in which projection are the foramen ovale and spinosum best demonstrated?
SMV

for the Modified Law projections of the TMJs, what is seen differently between an open mouth projection and a closed mouth projection?
 open mouth: condyle is at the level of the tubercle
 closed mouth: condyle is at the level of the mandibular fossa

what is another name for the maxillary sinuses?
antrum of highmore

at what age do the different sinuses develop?
 maxillary: at birth
 frontal and sphenoid: age 67
 ethmoid: at puberty
 all sinuses completely formed by age 17  20

what projection best demonstrates the sphenoid sinuses?
lateral and SMV

why is technique especially sensitive when imaging the sinuses?
 overpenetrate: you burn out pathology
 underpenetrate: you create pathology

what techniques should be used for sinuses?
 75 kVp for all
 PA projections: 2025mAs
 Waters and SMV: 2530mAs
 Laterals: 810mAs

name the projection and label:
 Rhese Method (ParietalOrbital Optic Canal)
 A. SOM
 B. lateral orbital margin
 C. optic canal
 D. IOM
 E. medial orbital margin

name the projection and label:
 lateral facial bones
 A. orbital roofs
 B. zygomatic bone
 C. sella turcica
 D. mandibular rami

name the projection and label:
 Waters Method (Parietoacanthial projection)
 A. orbit
 B. zygoma
 C. zygomatic arch
 D. maxillary sinus
 E. maxilla
 F. petrous ridge

name the projection and label:
 Modified Waters (parietoacanthial facial bones)
 A. IOM
 B. zygomatic bone
 C. nasal septum
 D. maxillary sinuses
 E. petrous ridge
 F. mandible

name the projection and label:
 lateral nasal bones
 A. nasofrontal suture
 B. nasal bone
 C. anterior nasal spine of maxillae

name the projection and label:
 SMV for zygomatic arches
 A. temporal process of zygomatic bone
 B. zygomatic arch