Plain films of the orbit - Lieberman's eRadiology Learning Sites ...
Plain films of the orbit - Lieberman's eRadiology Learning Sites ...
Plain films of the orbit - Lieberman's eRadiology Learning Sites ...
You also want an ePaper? Increase the reach of your titles
YUMPU automatically turns print PDFs into web optimized ePapers that Google loves.
Gregory M. Sulkowski, HMS IV<br />
Gillian Lieberman, MD<br />
<strong>Plain</strong> <strong>films</strong> <strong>of</strong> <strong>the</strong> <strong>orbit</strong><br />
January 26, 2004<br />
Gregory M. Sulkowski, Harvard Medical School<br />
Year IV<br />
Gillian Lieberman, MD
Gregory M. Sulkowski, HMS IV<br />
Gillian Lieberman, MD<br />
Why learn about <strong>orbit</strong>al <strong>films</strong>?<br />
• After all, <strong>the</strong>y are no longer commonly used<br />
• Most <strong>of</strong>ten indicated to assess for ocular<br />
metal fragments in a noncommunicative<br />
patient who requires MRI<br />
• Never<strong>the</strong>less, studying <strong>the</strong>se <strong>films</strong> provides<br />
a useful review <strong>of</strong> anatomy and is a good<br />
exercise in deducing complex 3 dimensional<br />
structure which has been collapsed to 2D<br />
2
Gregory M. Sulkowski, HMS IV<br />
Gillian Lieberman, MD<br />
The <strong>orbit</strong> is hard to visualize!<br />
• Very complex<br />
arrangement <strong>of</strong><br />
curving bones<br />
www.uth.tmc.edu/.../test/er_primer/ face/images/fct16.html<br />
3
Gregory M. Sulkowski, HMS IV<br />
Gillian Lieberman, MD<br />
The <strong>orbit</strong> is hard to visualize!<br />
• Petrous portion <strong>of</strong><br />
temporal bone lies<br />
posteriorly<br />
www.meddean.luc.edu/.../neurovasc/ navigation/icpetr.htm<br />
4
Gregory M. Sulkowski, HMS IV<br />
Gillian Lieberman, MD<br />
The <strong>orbit</strong> is hard to visualize!<br />
• eyeballs lie in front <strong>of</strong><br />
an intricately textured<br />
sphere <strong>of</strong> bone<br />
courses.washington.edu/.../ amniote_skull_photos2.htm<br />
5
Gregory M. Sulkowski, HMS IV<br />
Gillian Lieberman, MD<br />
Sinuses and cavities help ...<br />
• Can use <strong>the</strong>se spaces to reveal <strong>the</strong> <strong>orbit</strong>s on X-ray<br />
ucsu.colorado.edu/~schutzh/ Anatomy.html<br />
6
Gregory M. Sulkowski, HMS IV<br />
Gillian Lieberman, MD<br />
5 views in <strong>the</strong> “Orbital Series”<br />
• Lateral<br />
• Caldwell<br />
• Waters<br />
• Submentovertex (aka Base)<br />
• Rhese (aka Oblique or Foramen)<br />
7
Gregory M. Sulkowski, HMS IV<br />
Gillian Lieberman, MD<br />
Lateral view<br />
Courtesy <strong>of</strong> Dr. Michael G. Morley<br />
• Side view <strong>of</strong> <strong>orbit</strong>s<br />
and sinuses<br />
8
Gregory M. Sulkowski, HMS IV<br />
Gillian Lieberman, MD<br />
Lateral view<br />
• Sphenoid sinus<br />
• Sella turcica<br />
• Cribriform plate<br />
http://www.amershamhealth.com/medcyclopaedia/medical/volume%20ii/skull%20base.asp#Fig.12<br />
9
Gregory M. Sulkowski, HMS IV<br />
Gillian Lieberman, MD<br />
• Projects petrous<br />
portions <strong>of</strong> temporal<br />
bones just beneath <strong>the</strong><br />
<strong>orbit</strong>s<br />
Caldwell view<br />
Courtesy <strong>of</strong> Dr. Michael G. Morley<br />
10
Gregory M. Sulkowski, HMS IV<br />
Gillian Lieberman, MD<br />
Caldwell view<br />
Courtesy <strong>of</strong> Dr. Michael G. Morley<br />
• Shows <strong>orbit</strong>s, ethmoid<br />
sinuses, frontal sinuses<br />
• Can demonstrate<br />
medial (ethmoid)<br />
blowout fractures<br />
11
Gregory M. Sulkowski, HMS IV<br />
Gillian Lieberman, MD<br />
Caldwell view<br />
Courtesy <strong>of</strong> Dr. Michael G. Morley<br />
• Orbital<br />
floor fx<br />
extending<br />
to lateral<br />
<strong>orbit</strong>al wall<br />
12
Gregory M. Sulkowski, HMS IV<br />
Gillian Lieberman, MD<br />
• Projects petrous<br />
portion <strong>of</strong> temporal<br />
bones just beneath <strong>the</strong><br />
maxillary sinuses<br />
Waters view<br />
Courtesy <strong>of</strong> Dr. Michael G. Morley<br />
13
Gregory M. Sulkowski, HMS IV<br />
Gillian Lieberman, MD<br />
Waters view<br />
Courtesy <strong>of</strong> Dr. Michael G. Morley<br />
Shows:<br />
• <strong>orbit</strong>s<br />
• maxillary<br />
sinuses<br />
• zygomatic<strong>of</strong>rontal<br />
suture<br />
14
Gregory M. Sulkowski, HMS IV<br />
Gillian Lieberman, MD<br />
Waters view<br />
Courtesy <strong>of</strong> Dr. Michael G. Morley<br />
Tripod fx:<br />
• arch <strong>of</strong> <strong>the</strong><br />
zygomatic<br />
bone<br />
• zygomatic<br />
process <strong>of</strong><br />
frontal bone<br />
• zygomatic<br />
process <strong>of</strong><br />
maxillary bone<br />
15
Gregory M. Sulkowski, HMS IV<br />
Gillian Lieberman, MD<br />
• Waters (notice<br />
clear view <strong>of</strong><br />
maxillary sinuses -<br />
shows an <strong>orbit</strong>al<br />
floor fx)<br />
• Caldwell (petrous<br />
pyramids obscure<br />
maxillary sinuses)<br />
16<br />
Courtesy <strong>of</strong> Dr. Michael G. Morley
Gregory M. Sulkowski, HMS IV<br />
Gillian Lieberman, MD<br />
Submentovertex or Base view<br />
• Zygomatic arch<br />
• Lateral wall <strong>of</strong> <strong>orbit</strong><br />
• Sphenoid sinuses<br />
Courtesy <strong>of</strong> Dr. Michael G. Morley<br />
17
Gregory M. Sulkowski, HMS IV<br />
Gillian Lieberman, MD<br />
Submentovertex or Base view<br />
Courtesy <strong>of</strong> Dr. Michael G. Morley<br />
Underpenetrated<br />
or “light”<br />
view is best<br />
for zygomatic<br />
arch fx<br />
18
Gregory M. Sulkowski, HMS IV<br />
Gillian Lieberman, MD<br />
Rhese/Oblique/Foramen view<br />
• Directs beam through<br />
optic canal<br />
Courtesy <strong>of</strong> Dr. Michael G. Morley<br />
19
Gregory M. Sulkowski, HMS IV<br />
Gillian Lieberman, MD<br />
Rhese/Oblique/Foramen view<br />
• can show unilateral<br />
foramen<br />
enlargement (e.g.,<br />
aneurysm, tumor,<br />
or rarely fx)<br />
Courtesy <strong>of</strong> Dr. Michael G. Morley<br />
20
Gregory M. Sulkowski, HMS IV<br />
Gillian Lieberman, MD<br />
Postscript: CT is much better ...<br />
• Can better localize fragments, extent <strong>of</strong> fxs<br />
www.uth.tmc.edu/.../test/er_primer/ face/images/fct16.html<br />
21
Gregory M. Sulkowski, HMS IV<br />
Gillian Lieberman, MD<br />
22<br />
http://www.littledoll.com/petite_fantasy/gallery/eyelesson/eye_paint_diagram.htm
Gregory M. Sulkowski, HMS IV<br />
Gillian Lieberman, MD<br />
References<br />
• Medcyclopaedia Pr<strong>of</strong>essional Edition online:<br />
http://www.amershamhealth.com/medcyclopaedia<br />
• Netter, FH. Atlas <strong>of</strong> human anatomy. Summit, N.J. : CIBA-<br />
GEIGY Corp., 1995.<br />
• Novelline, RA. Squire's fundamentals <strong>of</strong> radiology, 5th ed.<br />
Cambridge: Harvard University Press, 1997.<br />
23
Gregory M. Sulkowski, HMS IV<br />
Gillian Lieberman, MD<br />
Acknowledgements<br />
Thanks to:<br />
• Michael G. Morley, MD for plain <strong>films</strong> and<br />
diagrams<br />
• Larry Barbaras our Webmaster<br />
• Gillian Lieberman, MD<br />
• Pamela Lepkowski<br />
• Sunana Sohi for screening <strong>the</strong> talk<br />
24