The skull consists of 22 bones: 14 facial bones Caldwell's Method
etc. Registered Radiologic Technologist, Medical Student The skull consists of 22 bones: 14 facial bones Caldwell's Method etc. Citation, DOI & article dataCitation: Knipe, H. Facial bones (Waters view). Reference article, Radiopaedia.org. (accessed on 10 Oct 2022) https://doi.org/10.53347/rID-43200 The occipitomental (OM) or Waters view is an angled PA radiograph of the skull, with the patient gazing slightly upwards. On this page:It can be used to assess for facial fractures, as well as for acute sinusitis. In general, radiographs of the skull and facial bones are rapidly becoming obsolete, being replaced by much more sensitive CT scans.
History and etymologyThis view was first described by Charles A. Waters and C. W. Waldron, American radiologists in 1915 3. ReferencesRelated articles: Imaging in practicePromoted articles (advertising)Which of the following bones is not a facial bone? Middle nasal conchae Vomer Lacrimal bone Mandible What is the largest immovable bone of the face? List the four processes of the maxilla: Frontal Zygomatic Alveolar Palatine Which of the four processes of the maxilla is considered most superior? Which soft tissue landmark is found at the base of the anterior nasal spine? Which facial bones form the posterior aspect of the hard palate? Horizontal portion of the palatine bones Which two cranial bones articulate with the maxilla? Which facial bones are sometimes called the "cheek bones"? Zygomatic bones or molar bones Which of the following bones does not articulate with the zygomatic bone? Temporal Maxilla Frontal Sphenoid Which facial bone is associated with the tear ducts? The purpose of the _____, or _____, is to divide the nasal cavity into compartments and circulate air coming into the nasal cavities. T/F. The majority of the nose is formed by the right and left nasal bones. False- most of the nose is made up of cartilage A deviated nasal septum is most likely to occur at the junction between _____ and ______. Vertical portion of the mandible: The point of union between both halves of the mandible: Bony process located anterior to mandibular notch: Horizontal portion of mandible: Posterior process of upper ramus: Identify the thremina found within the orbits: Optic foramen Superior orbital fissue Inferior orbital fissue From anterior to posterior, the cone shaped orbits project upward at an angle of ____ degrees and toward the midsagittal plane at an angle of ______ degrees. Which facial bone opening has the maxillary branch of the fifth cranial nerve passing through it? Which of the facial bone openings is formed by a cleft between the greater and lesser wings of the spehnoid bone? What is another term for the second cranial nerve? What is the older term for the maxillary sinus? An infection of the teeth may travel upward and involve the ____ sinus. Specifically, where are the frontal sinuses located? Between the inner and outer tables of the skull, posterior to the glabella The frontal sinuses rarely become aerated before the age of _____. Which specific aspect of the ethmoid bone contains the ethmoid sinus? Lateral masses or labyrinths The drainage pathway for the paranasal sinuses is called the: Which sinus will be projected through the open mouth with a PA axial transoral projection? What is the name of the passageway between the maxillary sinuses and the middle nasal meatus? T/F. Most CT studies of the sinuses do not require the use of contrast media. Which position is most often used when performing a CT study of the sinuses? T/F. Facial bone studies should always be performed recumbent whenever possible. False- may also be performed erect T/F. The common basic PA axial projection for facial bones requires a 15 degree caudad angle of the CR, which projects the dense petrous ridges into the lower one third of the orbits. T/F. An increase in mAs of 25 to 30% is often required for the geriatric pt with advanced osteorporosis. False- decrease of 25 to 30% T/F. CT is useful for facial bone studies because it allows for visualization of bony structures as well as related soft tissues of the facial bones. T/F. Nuc med is not helpfung occult facial bone fractures. T/F. MRI is an excellent imaging modality for the detection of small metal foreign bodies in the eye. False- Strong magnets in the MRI prohibits this What is the name of the fracture that results from a direct blow to the orbit leading to a disruption of the inferior orbital margin? A "free floating" zygomatic bone is the frequent result of a ____ fracture. What is the major disadvantage of performing a straight PA projection for facial bones, with no CR angulation or neck extesion, as compared with other PA facial bone projections? Dense petrous pyramids superimpose the orbits, obscuring facial bone structures Where is the CR centered for a lateral position for facial bones? What is the proper method name for the paracanthial projection of the facial bones? Which facial bone structures are best seen with a parietacanthial projection? Orbits including infraorbital rims, bony nasal septum, maxillae, zygomatic bones, and arches What CR angle must be used to project the petrous ridges just below the orbital floor with the PA axial (caldwell) projection? Which structures specifically are visualized better on the modified parietoacanthial (waters) projection as compared with the basic Waters projection? Orbital rims and orbital floors Give two reasons why projections of the facial bones are performed PA rather than AP when possible: Reduces OID of facial bones Reduces terior facial bones and neck structures such as thyroid glands What are two positioning differences between the lateral projection of the cranium and the lateral projecction for facial bones? IR is placed lengthwise for facial bones but crosswise for cranium CR is centered to the zygoma for facial bones and 2" above the EAM for the cranium The parietoacanthial (waters) projection for the facial bones will have the ______ line perpendicular to the IR, which places the OML at a _____ degree angle to the tabletop and IR. Where does the CR exit for a parietoacanthial (waters) projection of the facial bones? Where does the CR exit for a 15 degree PA axial (caldwell) projection for facial bones? The modified parietoacanthial (modified waters) projection requires that the ____ line is perpendicular to the IR, which places the OML at a ____ degree angle to the tabletop and IR. T/F. Lateral projections for nasal bones generally are taken bilaterally for comparison. T/F. The tangential projection for a unilateral zygomatic arch requires that the skull be rotated and tilted 15 degrees away from the affected side. False- towards the affected side T/F. Both oblique inferosuperior (tangential) projections for the zygomatic arch are generally taken for comparison. T/F. The gonadal and/or thyroid dose for all facial bone projections is NDC (no iscernible contribution). False- Thyroid gland dose is significant For a PA Waters projection, the petrous ridges should be projected directly below the ______ and projected into the lower half of the maxillary sinuses or below the ________ for a modified waters projection. Maxillary sinuses; inferior orbital rims For the superoinferior projection of the nasal bones, the IR is placed perpendicular to the _______ line. Glabelloalveolar line (GAL) Which specific facial bone structures (other than the mandible) are best demonstrated with the submentovertex (SMV) projection if the correct exposure factors are used? Where is the CR centered for an AP axial projection for the zygomatic arches? 1" superior to glabella to pass through midarches List the proper method name and the common descriptive name for the parieto-orbital oblique projection for the optic foramen: Rhese method 3 point landing The three aspects of the face that should be in contact with the head unit or tabletop when beginning positioning for the parieto-orbital oblique projection are the: ____, _____, _____. The final angle between the midsagittal plane and the IR should be _____ degrees, with the _________ line perpendicular to the IR. This places the optic foramen in the _____ quadrant of the orbit. Cheek, nose, and chin 53 Acanthiomeatal Lower outer Which projection of the facial bones best demonstrates the floor of the orbits (blow- out fractures)? Modified waters projection Which projection of the facial bones best demonstrates the optic foramen? Parieto-orbital oblique projection (Rhese method) Which projection of the facial bones best demonstrates the view of a single zygomatic arch? Oblique inferosuperior projection Which projection of the facial bones best demonstrates a profile image of nasal bones and nasal septum? Which projection of the facial bones best demonstrates bilateral zygomatic arches? Submentovertex projection (SMV) Which projection of the facial bones best demonstrates the inferior orbital rim, maxillae, nasal septum, nasal spine, zygomatic bone and arches? Parietoacanthial projection (waters) Which projection for the mandible results in a thyroid dose that is four or five times greater than the thyroid dose for any other projection described in this chapter? Which projection of the mandible will project the opposite half of the mandible away from the side of interest? What must be done to prevent the ramus of the mandible from being superimposed over the cervical spine with an axiolateral oblique projection of the mandible? What specific positioning error has been committed if both sides of the mandible are superimposed with an axiolateral oblique projection? Insufficient cephalad CR angle or head tilt Where should the CR exit for a PA axial projection of the mandible? Acanthion (At lips for PA projection) Which skull positioning line is placed perpendicular to the IR for a PA or PA axial projection of the mandible? T/F. For a true frontal view of the mandibular bone (if this is the area of interest), the AML should be perpendicular to the IR. T/F. The CR should be angled 20 to 25 degrees caudad for the PA axial projection of the mandible. Which aspect of the mandible is best visualized with an AP axial projection? What CR angle is required for the AP axial projection of the mandible if the OML is placed perpendicular to the IR? If the IOML is perpendicular to the IR for the AP axial projection, what CR angle is needed? Where is the CR centered for an AP axial projection of the mandible? Which projection of the mandible will demonstrate the entire mandible, including the coronoid and condyloid processes? Which imaging system provides a single, frontal perspective of the entire mandible? What device provides inherent collimation during a Panorex procedure? Narrow, vertical slit diaphragm What type of IR must be used with Panorex? Curved, non grid cassette T/F. The modified Law method provides a bilateral and functional study of the TMJ. T/F. The mandibular condyles move anteriorly as the mouth is opened. Which projection of the TMJ requires that the skull be kept in a true lateral position? The axiolateral (schuller method) projection for the TMJ requires a CR angle of ______ degrees _______ (caudad or cephalad). The axiolateral oblique projection of the TMJ is commonly referred to as the _______ method, which requires a _____ degree head rotation from lateral and _______ degree caudad CR angle. If the area of interest is the temporomandibular fossae, angle the CR ______ to the OML for the AP axial (modified Towne) projection to reduce superimposition of the TM fossae and mastoid portions of the temporal bone. Alining the _____ plane perpendicular to the IR will prevent rotation of either a PA or AP axial mandible. What kV range should be used for sinus radiography? To demonstrate any possible air or fluid levels within the sinuses, it is important to: Perform positions erect when possible Use horizontal x-ray beams T/F. Ultrasound exams of the maxillary sinuses to rule out sinusitis are possible. T/F. Magnetic resonance imaging is preferred modality to study soft tissue changes and masses within the sinuses. T/F. Secondary osteomyelitis is often due to tumor invasion. List the four most commonly performed basic or routine projections for paranasal sinuses: Lateral PA caldwell Parietoacanthial (waters) SMV Which single projection for a paranasal sinus routine provides an image of all four sinus groups? If the pt cannot stand for the lateral projection of the paranasal sinuses, it should be taken with: Which paranasal sinuses are best deomstrated with a PA (caldwell) projection? Frontal and anterior ethmoid To avoid angling the CR for the erect PA axial Caldwell sinus projection, the head should be adjusted so that the OML is ______ degrees from horizontal. Which positioning line is placed perpendicular to the IR for a parietoacanthial projection? Where are the petrous ridges located on a well positioned parietoacanthial projection? Just below the maxillary sinus Which paranasal sinuses are demonstrated with an SMV projection of the paranasal sinuses? Sphenoid, ethmoid, and maxillary sinuses Where should the CR exit for both the PA parietoacanthial (waters) and the PA transoral (open mouth Waters) projection? What is the one major difference in positioning between the parietoacanthial and PA axial transoral projections? The mouth (oral cavity) is open with the PA transoral projection Which sinuses are projected through the oral cavity with the PA axial transoral projection? Which projection best demonstrates the sphenoid sinus in oral cavity? Which projection best demonstrates the inferosuperior view of sphenoid and ethmoid sinus? Which projection best demonstrates all four paranasal sinuses?
Which projection best demonstrates the maxillary sinus best? Parietoacanthial (waters) projection Which projection best demonstrates the frontal and ethmoid sinuses? A radiograph of a lateral projection of the facial bones reveals that the mandibular rami are not superimposed. What positioning error led to this radiographic outcome? A radiograph of a parietoacanthial (waters) projection reveals that the petrous ridges are projected within the maxillary sinuses. Is this an acceptable image? If not, what must be done to improve the image during the repeat exposure? No, the petrous ridges should be projected just below the maxillary sinuses. The pts head needs to be extended more A radiograph of a parietoacanthial (waters) projection reveals that the distance between the lateral margins of the orbits and the lateral aspect of the skull is not equal. What type of positioning error led to this radiographic outcome? A radiograph of a 30 degree PA axial projection of the facial bones reveals that the petrous ridges are projected at the level of the inferior orbital margins. Is this an acceptable image for this projection? If not, what must be done to improve the quality of the image during the repeat exposure? Yes, this image meets the evaluation criteria for a 30 degree PA axial projection A radiograph of a superoinferior projection of the nasal bones reveals that the glabella is superimposed over the nasal bones. What positioning error led to this radiographic outcome, and how can it be corrected during the repeat exposure? Excessive flexion of the head and neck or incorrect CR angle will projection the glabella into the nasal bones. The CR must be parallel to the GAL A lateral radiograph of the facial bones demonstrates that the bodies of the mandible are not superimposed; one is about 1 cm superior to the other. How would this be corrected on a repeat exposure? The head was tilted. Ensure that the MSP is parallel to the IR A radiograph of a parieto-orbital oblique (Rhese) projection reveals that the optic foramen is located in the upper outer quadrant of the orbit. Is this an acceptable image for this projection? If not, what must be dones to correct this problem during the repeat exposure? No, increase extension of the head and neck. The AML should be placed perpendicular to the IR to ensure that the optic foramen is open and is projected into the lower outer quadrant of the orbit (head rotation is corrected) A radiograph of an axiolateral oblique projection of the mandible reveals that the bod y of the mandible is severely foreshortened. The body of the mandible is the area of interest. What positioning error led to this radiograhic outcome? Insicient rotation of the head toward the IR. The head should be rotated 30 degrees (from lateral) toward the IR to prevent foreshortening of the body Situation: A pt with a possible fraccture of the nasal bones enters the ER. The physician is concerned about deviation of the bony nasal septum along with possible nasal bones fracture. What radiographic routine would be best for this situation? PA waters and right and left laterals Situation: A pt with a possible blowout fracture of the right orbit enters the ER. In addition to the basic facial bone routine, what single projection would best demonstrate this type of injury? Modified parietoacanthial (modified waters) projection Situation: A pt with a possible fracture of the left zygomatic arch enters the ER. Neither the AP axial nor the SMV projection demonstrates the left side well. The radiologist is indecisive as to whether this zygomatic arch is fractured. What other projections can the tech provide to better define this area? Perform the oblique inferosuperior (tangential) projections. These projections are most ideal to demonstrate a depressed fracture of the zygomatic arch. Situation: As part of a study of the zygomatic arches, the tech attempts to perform the SMV position. Because of the size of the pts shoulders, he is unable to flex the neck adequately to place the IOML parallel to the IR. What other options does the tech have to produce an acceptable SMV projection? Angle CR to place it perpendicular to the IOML. Angle IR to maintain a perpendicular relationship between the CR and IR. This will prevent distortion of anatomy A radiograph of a PA (caldwell) projection for sinuses reveals that the petrous ridges are projected into the lower hald of the orbits and obscuring the ethmoid sinuses. The tech used a horizontal x-ray beam for the projection. The skull was positioned to place the OML at a 15 degree angle from the horizontal plane. What positioning modification is needed to correct this problem during repeat exposure? The head and neck need to be extended more to project the petrous ridges below the ethmoid sinus A radiograph of a parietoacanthial projection reveals that the distance between the midsagittal plane and the outer orbital margin is not equal. What positioning error is present on this radiograph? A radiograph of a PA transoral projection reveals that the sphenoid sinus is superimposed over the upper teeth and the nasal cavity. How must the position be modified to avoid this problem during the repeat exposure? Increase extension of the head and neck to project the entire sphenoid sinus through the oral cavity A radiograph of a parietoacanthial projection reveals that the petrous ridges are projected just below the maxillary sinused. What positioning error (if any) is present? None, the petrous ridges should be below the floors of the maxillary sinuses on a well positioned parietoacanthial projection Situation: A pt with a clincal history of sinusitis comes to the department for a sinus study. The pt is quadraplegic and cannot be placed erect. Which single projection will demonstrate any possible air fluid levels in the sinuses? The most diganostic projection is the horizontal beam lateral projection to demonstrate any air fluid levels Situation: A pt comes to the department to rule out any possible polyp within the sphenoid sinus. What routine and/or special projection would provide the best overall assessment of the sinuses for this pt? PA transoral special projection along with the four routine projections (lateral, PA caldwell, parietoacanthial, and SMV) Situation: A pt comes to the department with a clinical history of a deviated bony nasal septum. Which facial projections will best demonstrate the degree of deviation? PA, PA axial, and parietoacanthial projections will demonstrate a possible bony nasal septal deviation The majority of the hard palate is formed by: Which of the following is not an aspect of the maxilla? Frontal process Body Zygomatic process Ramus Which facial bone contains four processes? Which facial bone forms the lower, outer aspect of the orbit? Which facial bone lies just anterior and medial to the frontal process of the maxilla? Which facial bone is unpaired in the adult body? Which facial bone is located anteriorly in the medial aspect of the orbit? Which facial bone helps to mix air drawn into the nasal cavity? Which facial bone possesses a vertical and horizontal portion? On average, how many separate cavities make up the frontal sinus? T/F. All of the paranasal sinuses are contained within cranial bones, except the maxillary sinuses. T/F. All of the paranasal sinuses except the spehnoid comminicate with the nasal cavity. T/F. In general, all the paranasal sinuses are fully developed by the age of 6 or 7. T/F. The frontal sinuses are usually larger in men than in women. Which aspect of the ethmoid bone contains the ethmoid air cells? Lateral masses or labyrinth What is the angle between the OML and the plane of the IR for the Parietoacanthial waters projection?RTE 1533 Week 4 test review. How much difference is there between the OML and IOML positioning lines?Procedures 2. Skull landmarks, planes, lines. What is the angle between the MSP and the plane of the IR from a lateral position for the ParietoChapter12 Bontegar. Where does the CR exit for a modified Parietoacanthial projection of the facial bones?Rotation review. |
What is the angle between the OML and the plane of the IR for a well positioned Parietoacanthial projection?
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