M-1

RADIOLOGY Head and Neck

OBJECTIVES

• Skull, Sinus and Orbit anatomy

• Vascular anatomy

• Neck anatomy

• Clinical cases

SKULL ANATOMY

SINUSES PA view

1. Nasal Septum

2. Frontal Sinus

3. Maxillary Sinus

4. Ethmoid Sinus

5. Inferior Turbinate

6. Superior orbital fissure

2

1

4

3

5

6

1- Superior orbital fissure

2- Inferior orbital foramen

3- Mental foramen

1

2

3

1

2

3

Fissures and foramen havenerves that show on labpracticals.

OPTIC CANAL

SINUSES1. Frontal sinus

2. Zygomatic-Frontal Suture

3. Maxillary Sinus

4. Inferior orbital margin

1

3

4

2

AP WATERS VIEW

This view is angled to project the maxillary sinuses free of the petrous ridge.

Note the opacified right maxillary sinus with fluid layering dependently indicating sinusitis

• Superior

• Inferior

• Medial

• Lateral

WHAT RECTUS MUSCLE CAN BE INJURED

BY EYE TRAUMA?

ORBITAL FLOOR FRACTURE

Arrow points to bone fragment displaced into orbit. The inferior

rectus muscle can become entrapped in fracture

CORONAL SCANCT FACIAL

CT scans redemonstrate fracture and edema at site.

1. Frontal Sinus

2. Maxillary Sinus

3. Ethmoid Sinus

4. Sphenoid Sinus

1

2

3

4

LATERAL SINUS & SKULL

Middle meningeal artery

FRACTUREEPIDURAL

HEMATOMA

Cause: Laceration of the meningeal artery adjacent to

inner table.

Normal skull

Sella

CT SKULL BASE

CAROTID CANAL

JUGULAR FORAMEN

CT SKULL BASE

MANDIBULAR

CONDYLE

MASTOID AIR CELLS

PINNA

SKULL BASE FRACTURE

“RACCOON EYES” Periorbital ecchymosis is a sign of a basal skull fracture. Blood tracks along the periosteum and can collect in soft tissues of the orbital lid.

CT SKULL BASE

ZYGOMATIC ARCH

EXTERNAL

AUDITORY CANAL

CT SKULL BASE

FORAMEN OVALE

FORAMEN

SPINOSUM

PETROUS CAROTID CANAL

CLIVUS

CT SKULL BASE

IACINTERNAL AUDITORY CANAL

CAROTID CANAL

OSSICLES

Acoustic neuroma is a slow growing tumor that develops on the 8th cranial nerve. Symptoms include unilateral loss of hearing, Tinnitus-ringing in ears. dizziness and vertigo.

SINUS AND ORBIT ANATOMY

SINUSES

PA view

1. Frontal Sinus

2. Maxillary Sinus

3. Ethmoid Sinus

1

3

2

SINUSES

1. Frontal sinus

2. Zygomatic-Frontal Suture

3. Maxillary sinus

4. Inferior orbital margin

1

3

4

2

AP WATERS VIEW

This view is angled to project the maxillary sinuses free of the petrous ridge.

1. Frontal Sinus

2. Maxillary Sinus

3. Ethmoid Sinus

4. Sphenoid Sinus

5. Sella Turcica

1

2

3

4

5

LATERAL SINUS & SKULL

1

1. Frontal Sinus

CT- SINUSAXIAL VIEW

Scans start superiorly and are shown going inferiorly

CT SINUSAXIAL SCAN

normal

Note the destroyed posterior wall of the left frontal sinus due to bacterial invasion.

1. Ethmoid sinus

2. Sphenoid sinus

3. Carotid canal

1

2

3

CT- SINUSAXIAL VIEW

1. Maxillary sinus

2. Med. & Lat. Pterygoid plate

3. Nasopharynx

4. Nasal septum

5. Inferior turbinate

1

23

4

5

CT- SINUSAXIAL VIEW

1. Fronto-nasal suture

2. Frontal sinus

3. Nasal bones

1

2

3

CT- SINUSCoronal sections extending from

anterior to posterior

1. Ethmoid sinus

2. Maxillary sinus

3. Middle turbinate

1

3

CT- SINUSCORONAL VIEW

CT- SINUSCORONAL VIEW

Maxillary sinus

1. Sphenoid sinus

2. Hard palette

3. Anterior clinoid

1

CT- SINUSCORONAL VIEW

2

3

1. Retro orbital fat

2. Medial rectus

3. Lens

4. Lateral rectus

5. Optic nerve5

1 32 4

CT ORBITAXIAL SCAN

CORONAL SCAN

AXIAL SCAN

MR SCAN

Chiasm

Opticnerves

In Biblical liturature who showed

a knowledge of cranial nerve

anatomy?

• Moses

• Noah

• David

• Goliath

Normal

Sella Mass

Compare the normal with the enlarged pituitary adenoma. The mass impinges on the optic chiasm to create the visual disturbance.

NECK ANATOMY

LATERAL NECK

1. Hard palate

2. Soft palate

3. Nasopharynx

4. Oropharynx

5. Epiglottis

12

3

4

5

1

2

3

4

AIRWAY1. Calcified tracheal

cartilage rings

2. Hyoid bone

3. Epiglottis

4. Thyroid cartilage

5. Cricoid cartilage

5

LATERAL VIEW OF NECK

1

2

3

4

AIRWAY

1. Calcified tracheal cartilage rings

2. Hyoid bone

3. Epiglottis

4. Thyroid cartilage

5. Cricoid cartilage

5

LATERAL VIEW OF NECK

Where do you insert the tube at an emergency tracheostomy?

Cricothyroid membrane

LATERAL VIEW OF NECK

SCAN LEVELMAXILLARY SINUSES

ZYGOMA

ZYGOMA

SPHENOIDSINUS

LT

Sections from the skull base extending inferiorly through the

neck.

MASTOIDS

NASOPHARYNX

MAXILLA LT

EXTERNALAUDITORYMEATUS

MANDIBULAR CONDYLE

SCAN LEVEL

SCAN LEVEL

MANDIBLE

PAROTIDGLAND

MASSETER MUSCLE

MASSETER MUSCLE

PTERYGOIDMUSCLES

LT

SCAN LEVEL

SUBCUTANEOUS FAT

SUBMANDIBULARGLAND

EPIGLOTTIS

STERNOCLEIDOMASTOIDMUSCLE

LT

SCAN LEVELHYOID BONE

JUGULARVEIN

JUGULARVEIN

COMMON CAROTID ARTERIES

LT

VALLECULA

PYRIFORM SINUS

SCAN LEVELTHYROID CARTILAGE

VOCAL CORD

STERNOCLEIDOMASTOID

MUSCLE

LT

SCAN LEVELTHYROID CARTILAGE

CRICOID CARTILAGE

JUGULARVEIN

COMMON CAROTIDARTERY

LT

SCAN LEVEL

CLAVICLECLAVICLE

THYROID GLAND

FAT FAT

LT

TRACHEA ESOPHAGUS

SWALLOWING STUDY

1 2

3 4

Note hyoid bone moves anteriorly and superiorly with swallowing.

THYROID SCAN

Nuclear Medicine

THYROID SCAN

SAGITTAL

SAGITTAL SCANS

LEFT LOBE RIGHT LOBE

NUCLEAR MEDICINE

Normal Hypo-functional

THYROID SCAN

PATIENT PRESENTS WITH WHEEZING AND NECK MASS IN MIDLINE AT

STERNAL NOTCH

THYROIDSCAN

Nuclear Medicine

Chest x-ray showing superior Mediastinal mass with displacement of the trachea to the right. Nuclear Medicine I123 thyroid scan shows lobular mass extending inferiorly from the thyroid indicating a thyroid goiter accounting for displacement on chest x-ray.

CORONAL CT SCANS SHOWS THYROID LESION.

5

2

3

6

4

ARTERIOGRAM

1. Internal carotid artery

2. Intracranial carotid

3. Maxillary artery

4. Occipital artery

5. External carotid artery

6. Common carotid artery

7. Facial artery

17

WHAT VESSEL HAS TO BE LIGATED OR EMBOLIZED TO CONTROL EPISTAXIS IF PACKING NOSE FAILS?

• Maxillary

• Facial

• Lingual

• Superficial temporal

Here injection into the external carotid shows extravasation of blood from a branch of the maxillary artery compared with the normal.

Maxillary artery

normal

EMBOLIZATION

Radiologist has directed a coil through the catheter to occlude vessels that were bleeding.

ASYMPTOMATIC BRUIT ON

PHYSICAL EXAM

Abnormal

Normal

Normal

Ultrasound and arteriogram show high grade narrowing of internal carotid artery due to atherosclerosis.

HOARSENESS

NORMAL

ASPIRATION

A small amount of barium has spilled anteriorly with aspiration into the airway.

Hiatal hernia and reflux.

Here two patients with masses in their chest have involvement of the recurrent laryngeal nerve causing hoarseness due to vocal cord paralysis .

LARGE THORACIC ANEURYSM

LUNG MALIGNANCY

Amoebic meningitis can be contracted in southern states from swimming in warm lake water in summer by what

route?

• Ear infection

• Aspiration into airway

• Mosquito bite

• Ethmoid transmission