4.1_pemeriksaan radiologi pada tht

BAGIAN RADIOLOGI FAKULTAS KEDOKTERAN UNISSULA

BEKTI SAFARINI

Pemeriksaan radiologi maksilofasial

Pemeriksaan radiologi sinus

paranasalis

Pemeriksaan radiologi mastoid

Pemeriksaan radiologi nasofaring

PEMERIKSAAN RADIOLOGI PADA TRAUMA

MAKSILOFASIAL

Panoramic

X Foto Polos

CT Scan

CT SCAN

3D CT

Urutan kedua tersering

pada trauma tulang

wajah.

50% nya adalah fraktur

multiple

Pemeriksaan fisik &

radiologi diperlukan

untuk menegakkan

diagnosis

Tanda & Gejala

Nyeri

Maloklusi

Bengkak

Laserasi mukosa

Deformitas

Panoramic Post Operasi

LeFort I Transverse Maxillary

Lefort II Pyramidal

Lefort III Craniofacial Dysjunction

Zygomatic Complex

Orbital Floor

Nasal Fractures

Naso-orbital/Ethmoid

Weakest areas of midfacial complex when assaulted from a frontal direction at different levels (Rene’ Lefort, 1901)

Lefort I: above the level of teeth

Lefort II: at level of nasal bones

Lefort III: at orbital level

Plain Films

Lateral Skull

Waters View

Posteroanterior view of skull

Submental vertex

CT Scan

Axial and coronal views

3D

Lateral skull Water’s View

CT SCAN 3D CT

Stereolithography allows actual model of defect. A nice reconstruction tool to use if available

4 proyeksi dasar foto konvensial SPN

Caldwell.

Waters.

Lateral

Submentovertex/Basiler.

Proyeksi tambahan:

Open Mouth Waters.

FOTO POLOS

•Untuk evaluasi awal pada SPN

•Cukup ekonomis serta radiasi minimal.

• Kelemahan : banyak unsur yang tumpang

tindih

•Caldwell, Waters, Lateral.

Struktur yang tampak : sinus frontalis, sinus ethmoidalis anterior

Struktur yang tampak paling baik: sinus maksilaris dan fossa nasal

Sinus sphenoidalis terlihat

Struktur yang tampak: sinus sphenoid, sinus frontalis, sinus ethmoid, sinus maksilaris, sela tursica & supraorbita.

Struktur yang tampak : sinus sphenoid, sinus ethmoid & fossa nasal.

LAW’S POSITIONS ( Lateral projections )

STENVERS’ POSITION ( PA projection of petrous ridges )

TOWNE

SCHULLER

LAW’S PROJECTION

STENVERS’ POSITION

Struktur paling terlihat baik : petrous

pyramid, mastoid air cell dan tulang labirin.

Closed Mouth Open Mouth

CT SCAN

NORMAL CT MASTOID

Normal CT temporal boneNormal CT temporal bone

Figure 5e. Petrous apicitis in a 7-year-old girl with fever, right-sided facial pain, and diplopia.

Vazquez E et al. Radiographics 2003;23:359-372

©2003 by Radiological Society of North America

MASTOIDITIS

MASTOIDITIS

Citelli’s angle

•Acute – in primary

sclerosis

•Obtuse- in secondary

sclerosis ( due to CSOM)

NORMAL MASTOIDITIS

PEMBESARAN ADENOID

ABSES RETROPHARYNGEAL

BENDA ASING X ray neck AP view

•Round radio opaque

object ( ? Coin)

•In Esophagus

• Because the

esophagus is an AP

compressed tubular

structure

•A coin would

occupy this

position

•Can be confirmed

by lateral view

X ray neck Lateral view

ACHALASIA CARDIA • Regular dilation of esophagus. • Air fluid level • Abrupt strcture formation. • “Rat tail appearance / Bird beak appearance “

ACHALASIA

MALIGNANCY • “ shouldering effect “ margin of malignant ulcer. • Proksimal dilatation • “Apple core appearance “

MALIGNANCY Contrast Xray – Barium Swallow

•Irregularity of mucosa

•Shouldering effect

•Persistent

•Middle third of esophagus

Diagnosis:

? Malignancy of

Middle thrid of esophagus

Merupakan 70 % dari keganasan primer di Nasofaring.

Paling sering terjadi di Asia, terutama China.

Ada 3 Tipe :

Type I : keratinizing squamous cell carcinoma

Type II : non-keratinizing squamous cell carcinoma

Type III : undifferentiated carcinoma

CA NASOFARING

CT NASOFARING

MRI

(a) Axial T1 weighted image shows a bulging right nasopharyngeal mass with extension to the skull base, partially encasing the right internal carotid artery. The right parapharyngeal fat is obliterated. (b) Axial T2 weighted image shows mild hyperintensity of the right nasopharyngeal mass. The signal intensity of the mass is similar to that of the nasopharyngeal mucosa, and the margin between the normal mucosa and the mass could not be delineated. Note the presence of right mastoiditis change. (c) Axial and (d) coronal contrast-enhanced T1 weighted images with fat saturation shows vivid enhancement of the nasopharyngeal mass. There is skull-base and cavernous sinus invasion with encasement of the right internal carotid artery, which is not narrowed (white arrows). Bilateral neck lymphadenopathy (black arrows) is prominent.

TNM staging Primary tumour (T)

Tx : primary tumour cannot be assessed

T0 : no evidence of primary tumour

Tis : carcinoma in situ

T1 : tumour is confined to the nasopharynx

T2 : tumour extends to soft tissues of the oropharynx and/or nasal fossa

T2a : without extension to the parapharyngeal region

T2b : with extension to the parapharyngeal region

T3 : invasion of adjacent bony structures and/or paranasal sinuses

T4 : invasion of any one or more of the following

intracranial content

cranial nerves

infratemporal fossa / masticator space

hypopharynx

orbit

Nodal status (N) Nx : nodes cannot be assessed N0 : no evidence of nodal involvement N1 : unilateral nodal involvement < 6cm maximal diameter above

supracalvicular fossa N2 : bilateral nodal involvement < 6cm maximal diameter above

supracalvicular fossa N3 N3a : > 6 cm maximal diameter (unilateral or bilateral) N3b : involvement of the supracalvicular fossa

Metastases (M) Mx : presence of metastases cannot be assessed M0 : no evidence of metastases M1 : distant metastases present

Meschan I,1963. Detail consideration of certain area of the skull

in an atlas of normal radiographic anatomi. Second edition.WB.Saunders Company. Philadelphia : 282-318.

Vasquez, etc. 2003.Acute mastoiditis in children. RadioGraphics; 23:359 –372.

Weissleder R, Wittenberg J, Harisinghani MG, Chen JW. 2007. Head and neck imaging. In: Primer of Diagnostic imaging. Fourth Edition.Mosby Elsevier, Philadelphia :607-660.

DAFTAR PUSTAKA