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 ...
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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 />
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