Imaging methods of the head and neck in dentistry MUDr. Anna Rábová Overview of methods •X-ray –Extraoral projection –Intraoral projection •CT •MRI •USG •Arthroscopy X-ray - extraoral •OPG •Lateral projection •Posteroanterior projection •Oblique posterior, semi-axial, caudally eccentric projection (according to Clementschitsch) •Oblique posterior, semi-axial, cranially eccentric projection (according to Waters) •Special targeted projections (eg TMJ) • X-ray - principle data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAQwAAAC8CAMAAAC672BgAAABUFBMVEX////MzMwAAADKysrd3d1QI CPZtrjLzM7TwLtqKS3R0dFmZmbS0tKRkZEDAwNzc3P6///CwsKysrLj4+O6urqKior4+PiioqKcnJyoqKj//P+AgIBcXFxPT096 enr8//11LzIqEA8yMjLw8PA9GhgfHx8pKSmMOjs7OztGRkYzFBJVIiJbJSpjJi5paWlISEgZGRl/MjkmEA9HGhgaDwATCAFiGyD 86ub3y8r5p6lIICAPDw8vLy///6NJEhZCAAJXXVWJJCpqAAyoRESiVFP/trX6op384eT1v7/98Or4tbn8z8n2wsT75OT5nKD5rL DXh4bSuK/87eTjqKqqSlboxLz43NO+dHbZr6jmhInMzsPel5LenaDilo7WrK3rgYhHRjGysXWVcHX//5gyMRx1dU7FxXhxdlve3 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Orthopantomography (OPG) § Used to examine both jaws, TMJ, maxillary sinuses and the teeth together on one image § § Convenient and inexpensive method with low radiation exposure § Panoramatic extraoral technique Disadvantages: inaccuracy (two-dimensional display -> summation of structures) § Patient is positioned with the Frankfort plane horizontal, bite peg between the anterior teeth and the chin positioned on the chin support § § The film and the tubehead (X-ray source) rotate around the patient and produce a series of individual images on a single film § position! § prepare the patient well RTGhlava1 Lateral projection Posteroanterior projection 02 ? Figure2a Oblique posterior, semi-axial, caudally eccentric projection (according to Clementschitsch) •Middle and lower facial floor •Examination of joints, shoulders and body of the lower jaw 9 Oblique posterior, semi-axial, cranially eccentric projection (according to Waters) •Upper and middle facial floor •Paranasal sinuses České vysoké učení technické v Praze 8 7 Albers-Schönbergova Targeted X-ray projections 11 Semisagit. projection (Stenvers) Semilat. projection (Schüller) X-ray - intraoral •Complementary overall finding on OPG (targeted) - only when we ask something specific •Different types (division according to the passage of the central beam): –Apical projection –Parodontal projection –Coronal projection –Occlusal projection – Figure_09-17 Bundle bone § Radiographically, the bundle bone is the lamina dura = the inner portion of the bone of the alveolus that surrounds teeth and into which the collagen fibers of the periodontal ligament are embedded Computed tomography(CT) - A non-invasive x-ray technique - More sensitive than conventional X-rays - 3 dimensional images - In the axial or coronary plane, 3D reconstruction Disadvantages: lower availability, higher radiation dose Ankylóza levého kloubu po nehodě. 3D reconstruction MRI allows visualization of soft tissue (muscles, fat, and internal organs) without the use of x-rays Magnetic resonance (MRI) Magnetic resonance (MRI) Advant.: high resolution (soft tissues) Disadvant.: availability medical conditions of the patient - KI: PACEMAKER, COCH. IMPLANT, METAL MAT. IN THE HEAD AND NECK AREA High frequency sound waves are emitted from the transducer and returned waves are received by the transducer, forming an image that is displayed on the monitor Ultrasonography – non invasive procedure Ultrasonography – non invasive procedure Adv. Compared to MRi: lower examination costs less time consuming less discomfort for the patient Disadv: lower diagnostic accuracy, not precise MRi US On Point Arthroscopy - endoscopic examination, accurate dg of joint changes, but also the implementation of adequate surgery is needed Disadvant: invasive method the need of general anesthesia possibility of damage n. auriculotemp. BMF-8061 Artroskopie_temp_kloubu08 Adhesion in ATM Types of arthroscopy: 1. upper articular cleft 2. lower articular cleft References: •Čihák, R.: Anatomie 1,2,3, Praha, Grada, 2001 •Netter, F.: Atlas of HumanAnatomy, 4th ed., Elseviesr, USA, 2006 •Naňka, Elišková: Přehled anatomie. Galén, Praha 2009 •Seidl et al.: Radiologie pro studium i praxi, Grada publishing, 2013 •Mrázková, Doskočil: Klinická anatomie pro stomatology, Alberta, Praha, 1994 •Brand, Isselhard: Anatomy of orofacial structures, 8th edition, Elsevier, USA, 2019 •Fehrenbach, Herring: Illustrated anatomy of the head and neck, 5th edition, Elsevier, USA, 2017 •Moore, Dalley: Clinically oriented anatomy, 5th edition, USA, 2006