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 role Identify the location and orientation of fractures Indicate the degree of separation or displacement 顎顏面外傷常用放射線影像檢查技術-IRoutine view1.Posterior-anterior
2、(PA)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-II5.Periapical view6.Occlusal view Occlusal view of nasal bone Occlusal 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.Tomograph
3、y10.Townes view11.PA view of mandible12.Oblique view of mandible1.PA view Skull Jaws2.Lateral view Skull Jaws Neck 3.Panex Mandible,maxilla,dentition,70%of mid-face fracture 4.Water view(Occipito-mental)Maxillary fracture Orbital fracture Frontal bone/sinus 5.Periapical view Tooth and alveolar injur
4、y6.Occlusal view -Mandible Fracture line,direction Axial section 6.Occlusal view -Maxilla 7.Submental vertex view Zygomatic arch fracture Coronoid fracture 8.Lateral nasal view9.Tomography185180Blow out fractureTMJ fracture17517016516010.Modified Towns view Condylar fracture Mandibular angle fractur
5、e 11.PA symphysis view12.Oblique lateral view Was replaced by Panoex Used when patient can not sit or stand CT scanReconstructive 3-D CT scan顎顏面外傷之影像檢查判讀 General interpretation of fracture line Condyle and other mandibular fracture Middle facial fracture Cavity:sinus,orbital Dento-alveolar fractureG
6、eneral interpretation of fracture line Displacement(deviation,dislocation)Step,gap,overlapping Discontinuity Asymmetry Comminuted Malocclusion Cavity:(air-fluid level)*Degree and direction Mandibular fracture Angle and symphysis fractureMalocclusionStepCondyle and symphysis fractureOverlap,discontin
7、uity and displacement Asymmetry Comminuted Coronoid and ramus fracture Gap,Discontinuity Step,Displacement Condyle Deviation Displacement Dislocation DislocationDeviationUndisplacedDisplacementcondyle fractureDisplacement Bilateral condyle fractureDislocationBone gap Split fracture Coronoid fracture
8、Chin horizontal fracture Mid-facial trauma Cavity:sinus,hernia of orbital soft tissue Tomography of orbital fracture CT Air-emphysema Middle fracture(Le Fort I,II,III)ZMC fracture Basilar skull fracture:air-fluid level in sphenoid sinus Le fort I fractureAir-fluid levelLe Fort IIfractureLe Fort III
9、fracture Blow-out fracture Zygomatic arch fracture Zygomatico-maxillary complex(ZMC)fractureClassification of dentoalveolar injuries1.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 involvementA.Tooth structures
10、B.Supporting structuresClassification of dentoalveolar injuries 4.Root fracture 1)Apical third 2)Middle third 3)Cervical thirdShift to another angleB.Supporting Structure1.Sensitivity (concussion)*percussion pain *no displacement*no mobility*Image widening of PDL space 2.Subluxation *loosening,no di
11、splacement,*Image portion of PDL widening Classification of dentoalveolar injuries3.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 radiography CT scan MRI Nuclear bone scans Tomog
12、raphy 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 infection Neck:Air way,pharynx Sinus Orbit Intracranial abscess Soft tissue MRI Noninvasion,no radiation,high soft tissue resolutionhigh sen
13、sitivity and specificity 對骨的細部變化 space infection,presence of pus,cavitation TMJ 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 treatmentImage finding and Bone changes Difficult to visualize by conventional techniques in early stage Until substa
14、ntial 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 level Osteomyelitis:periosteal reactionmoth eaten,rarefaction,.Sinus tract(fistula)1.Periapical Infect
15、ion(acute/chronic)Widening of PDL Lamina dura discontinuity Trabeculae destruction Chronic Periapical abscess Periapical granuloma Fistula Root resorption2.Osteomyelitis(骨髓炎)Acute suppurative osteomyelitis Trabeculae:fuzzy,diffuse destruction Radiolucent area Poor demarcation Irregular borderChronic
16、 suppurative osteomyelitis Moth eaten*Radiolucent area with poor demarcation Necrotic bone Sequestrum Radiopaque with peripheral rediolucent area Rarefaction Necrotic BoneMoth eaten Sequestrum Radiopaque with peripheral radiolucent areaPathologic fractureRarefactionExpansionSclerosing OsteomyelitisF
17、ocal type Increasing density(disposition of the bone)rarefaction Periapical area Thickening of PDL Bone scarSclerosing Osteomyelitis Diffuse type Border between normal and sclerosis.poor defined Cotton wool appearance。Garres proliferative periostitis(Osteomyelitis)Subperiosteal reaction:onion skinni
18、ng Duplication of the cortical layer of boneORN(Osteo-Radio Necrosis)No remodeling90.1.1890.3.12Bone necrosis due to Arsenic Tooth germ,nerve damage軟組織感染 Infections involving soft tissues are not readily Demonstrated by many imaging techniques Gas producing organism Infratemporal spaceSubmasseteric spaceAir wayMRI of TMJ space abscessSinusitis CloudyAir-Fluid level 下 課
