1、外傷及感染之放射線影像檢查 Radiographic Interpretation of Trauma and Infection,內容綱要,顎顏面外傷之影像檢查技術顎顏面外傷分類判讀感染的影像檢查軟硬組織感染判讀,影像檢查在顎顏面外傷的應用,Plays a critical roleIdentify the location and orientation of fracturesIndicate the degree of separation or displacement,顎顏面外傷常用放射線影像檢查技術 -I,Routine view1. Posterior-anterior (PA
2、) view of facial bones2. Lateral view of facial bone3. Panorex4. Waters ( Occipitomental )Suspect mid-face fracture,顎顏面外傷常用放射線影像檢查技術-II,5. Periapical view6. Occlusal viewOcclusal view of nasal boneOcclusal view of mandible7. Submental-vertex view 8. Lateral view of nasal bone,顎顏面外傷常用放射線影像檢查技術-III,9.
3、 Tomography10. Townes view11. PA view of mandible12. Oblique view of mandible,1. PA view,SkullJaws,2. Lateral view,Skull JawsNeck,3. Panex,Mandible, maxilla, dentition,70 % of mid-face fracture,4. Water view(Occipito-mental ),Maxillary fracture Orbital fracture Frontal bone / sinus,5. Periapical vie
4、w,Tooth and alveolar injury,6. Occlusal view - Mandible,Fracture line , directionAxial section,6. Occlusal view - Maxilla,7. Submental vertex view,Zygomatic arch fracture Coronoid fracture,8. Lateral nasal view,9. Tomography,185,180,Blow out fractureTMJ fracture,175,170,165,160,10. Modified Towns vi
5、ew,Condylar fractureMandibular angle fracture,11.PA symphysis view,12. Oblique lateral view,Was replaced by PanoexUsed when patient can not sit or stand,CT scan,Reconstructive 3-D CT scan,顎顏面外傷之影像檢查判讀,General interpretation of fracture lineCondyle and other mandibular fractureMiddle facial fractureC
6、avity: sinus, orbitalDento-alveolar fracture,General interpretation of fracture line,Displacement ( deviation, dislocation )Step, gap, overlappingDiscontinuityAsymmetryComminutedMalocclusionCavity: (air-fluid level )* Degree and direction,Mandibular fracture,Angle and symphysis fracture,Condyle and
7、symphysis fracture,Coronoid and ramus fracture,Gap, Discontinuity Step , Displacement,Condyle,DeviationDisplacementDislocation,Dislocation,Deviation,Undisplaced,Displacement,condyle fracture,Displacement,Bilateral condyle fracture,Bone gap,Split fracture,Coronoid fracture,Chin horizontal fracture,Mi
8、d-facial trauma,Cavity: sinus, hernia of orbital soft tissueTomography of orbital fracture CTAir-emphysemaMiddle fracture ( Le Fort I, II, III )ZMC fracture Basilar skull fracture: air-fluid level in sphenoid sinus,Le fort I fracture,Air-fluid level,Le Fort IIfracture,Le Fort III fracture,Blow-out f
9、racture,Zygomatic arch fracture,Zygomatico-maxillary complex ( ZMC) fracture,Classification of dentoalveolar injuries,1. Crown craze or crack2. Crown fracture 1) Enamel 2) Enamel-Dentin 3) Enamel-Dentin- Pulp3. Crown and root fracture 1) Pulp involvement 2) No pulp involvement,A. Tooth structuresB.
10、Supporting structures,Classification of dentoalveolar injuries,4. Root fracture 1) Apical third 2) Middle third 3) Cervical thirdShift to another angle,B. Supporting Structure,1. Sensitivity ( concussion ) * percussion pain * no displacement * no mobility * Image widening of PDL space 2. Subluxation
11、 * loosening, no displacement, * Image portion of PDL widening,Classification of dentoalveolar injuries,3. Tooth displacement 1) Intrusion 2) Extrusion 3) Labial displacement 4) Lingual displacement 5) Lateral displacement4. Avulsion5. Alveolar process fracture,感染的影像檢查技術,Plain film radiographyCT sca
12、n MRINuclear bone scansTomography Ultrasonography,齒源性感染的常用影像檢查,Plain film radiography 根尖片 : 對於根尖及早期病變的顯示最佳咬合片 : (Axial) Garries osteomyelitis全口片 (panoex) 有張口困難的病人,同時對牙齒的情況做,骨頭的破壞檢查,CT Scan,Space infectionNeck: Air way, pharynx SinusOrbitIntracranial abscess Soft tissue,MRI,Noninvasion, no radiation,
13、 high soft tissue resolutionhigh sensitivity and specificity對骨的細部變化space infection, presence of pus, cavitationTMJ abscess,選擇的要領,Plain film : 一般診斷及治療反應後的追蹤CT / MRI : Extension into soft tissue , air way Bone scan: Response to treatment,Image finding and Bone changes,Difficult to visualize by convent
14、ional techniques in early stageUntil substantial mineral . removed 35 - 50 % After infection :5 -14 days,感染部位與描述名稱,Margin: well or poor demarcation / defined Lesion: radiolucent / radiopaque Periapical changes: PDL , trabeculae .Cavity (sinus) : cloudy, air-fluid levelOsteomyelitis: periosteal react
15、ionmoth eaten , rarefaction, . Sinus tract ( fistula ),1. Periapical Infection,( acute / chronic )Widening of PDL Lamina dura discontinuity Trabeculae destructionChronic Periapical abscessPeriapical granuloma Fistula Root resorption,2. Osteomyelitis (骨髓炎 ),Acute suppurative osteomyelitis Trabeculae:
16、 fuzzy, diffuse destructionRadiolucent areaPoor demarcationIrregular border,Chronic suppurative osteomyelitis,Moth eaten*Radiolucent area with poor demarcation Necrotic boneSequestrum Radiopaque with peripheral rediolucent areaRarefaction,Radiopaque with peripheral radiolucent area,Pathologic fractu
17、re,Rarefaction,Expansion,Sclerosing Osteomyelitis,Focal typeIncreasing density ( disposition of the bone ) rarefactionPeriapical areaThickening of PDLBone scar,Sclerosing Osteomyelitis,Diffuse typeBorder between normal and sclerosis . poor defined Cotton wool appearance。,Garres proliferative periost
18、itis (Osteomyelitis),Subperiosteal reaction: onion skinningDuplication of the cortical layer of bone,ORN ( Osteo-Radio Necrosis ),No remodeling,90.1.18,90.3.12,Bone necrosis due to Arsenic,Tooth germ, nerve damage,軟組織感染,Infections involving soft tissues are not readily Demonstrated by many imaging techniquesGas producing organism,Infratemporal space,Submasseteric space,MRI of TMJ space abscess,Sinusitis,CloudyAir-Fluid level,下 課,
