imaging in orl

Imaging in ORL

1. PNS

2. Mastoid

3. Soft tissue neck

4. Sialogram

What should comment?

1. Patient’s data

2. Type ( plain or contrast)

3. Site

4. View

5. Exposure ( bone or soft tissue setting)

6. Findings

7. Remarks ( not diagnosis)

1. PNS - What findings?

• Fracture? (MVA, gun-shot, trauma)

• Infection (mucosal thickening, air-fluid level, haziness)

• Tumor (bone erosion, extension)

PNS - views

1. Occipital mental view (best for maxillary sinus because the petrosal bone don’t block it. It is also for frontal sinus & zygomatic arch)

2. Occipital frontal view (frontal sinus)3. Submento vertical/Axial (ethmoidal &

sphenoidal sinus)4. Lateral (AP depth of frontal sinus)5. Oblique (ethmoidal sinus – 3 groups)

PNS – lateral

PNS – occipital mental

•Air-fluid level???

PNS – occipital mental

•Both side maxillary sinus mucosal thickening?

PNS – occipital mental

PNS – occipital mental

•Normal

PNS – occipital mental

•Both side maxillary sinus mucosal thickening?

PNS – occipital mental

PNS – occipital mental

•right side maxillary sinus mucosal thickening?

PNS – occipital mental

PNS – occipital mental

PNS – occipital frontal

PNS – occipital frontal

PNS – submento vertical (axial)

PNS – submento vertical (axial)

2. Mastoid

• Fracture? (MVA, gun-shot, trauma)

• Infection (mucosal thickening, air-fluid level, haziness)

• Tumor (bone erosion, extension)

• Type of mastoid (acellular, cellular, diploic)

• Look for acoustic neuroma (by submento vertical view – )

Mastoid - view

1. Occipital frontal/transorbital (internal auditory meatus widening? – look for acoustic neuroma)

2. Submento vertical (look for acoustic neuroma)3. Lateral oblique (mastoid antrum –

cholesteatoma, air cell – if big can be previous infection)

4. AP oblique view (cochlear & tympanic cavity)5. Owen’s view ( ossicles – incus & malleus)

*cholesteatoma common in acellular mastoid

Example: lateral obliqueAntrum

Maxilla

External auditory meatus

Air cell

Mandible

Example : owen’s view

Mastoid lateral oblique

Mastoid lateral oblique

Mastoid lateral oblique

Mastoid lateral oblique

Mastoid lateral oblique

Mastoid lateral oblique

Mastoid lateral oblique

Mastoid lateral oblique

Mastoid lateral oblique

Mastoid lateral oblique

Mastoid Occipital frontal - Transorbital

Mastoid Transorbital view

3. Soft tissue neck

• 2 type– Adenoid (mandible must be perpendicular)– Prevertebral tissue (not thicken more the ½ of

vertebra body. C6 & C7 normally thicken)

Example: soft tissue adenoid true lateral view

Palate

Imaginary line

I

Roof of nasopharynx

IV

III

II

Sialogram –contrast type

• Lateral view• Inject contrast through submandibular vein• Look for any calculus• Alveoli appearance?• If tumour, the submandibular vein show straight

appearance

*cannot diagnose tumour because the contrast only go into the duct while the tumour can arise from peripheral tissue. The only sign will see is the duct been pushed to one side

Others