Transcript 外傷及感染之放射線影像檢查 Radiographic Interpretation of Trauma and Infection

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 -I
Routine view
1. Posterior-anterior (PA) view of facial
bones
2. Lateral view of facial bone
3. Panorex
4. Water’s ( Occipitomental )
• Suspect mid-face fracture
顎顏面外傷常用
放射線影像檢查技術-II
5. Periapical view
6. Occlusal view
• Occlusal view of nasal bone
• Occlusal view of mandible
7. 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. Tomography
10. Towne’s view
11. PA view of mandible
12. Oblique view of mandible
1. PA view
 Skull
 Jaws
2. 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 injury
6. Occlusal view
- Mandible
 Fracture line , direction
 Axial section
6. Occlusal view
- Maxilla
7. Submental vertex
view
 Zygomatic arch fracture
 Coronoid fracture
8. Lateral nasal view
9. Tomography
185
Blow –out fracture
TMJ fracture
180
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10. Modified Town’s view
 Condylar fracture
 Mandibular angle fracture
11.PA symphysis view
12. Oblique lateral view
 Was replaced by Panoex
 Used 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
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General interpretation of fracture line
Condyle and other mandibular fracture
Middle facial fracture
Cavity: sinus, orbital
Dento-alveolar fracture
General 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 fracture
Malocclusion
Step
Condyle and symphysis fracture
Asymmetry
Comminuted
Overlap , discontinuity and
displacement
Coronoid and ramus fracture
 Gap, Discontinuity
 Step , Displacement
Condyle
 Deviation
 Displacement
 Dislocation
Displacement
Undisplaced
Deviation
Dislocation
condyle fracture
Displacement
Bilateral condyle fracture
Dislocation
Bone gap
Split fracture
Coronoid fracture
Chin horizontal
fracture
Mid-facial trauma
 Cavity: sinus, hernia of orbital soft tissue
• Tomography of orbital fracture
• CT
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Air-emphysema
Middle 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 II
fracture
Le Fort III fracture
Blow-out fracture
Zygomatic arch fracture
Zygomatico-maxillary complex
( ZMC) fracture
Classification of dentoalveolar
injuries
A. Tooth structures
B. Supporting structures
1. Crown craze or crack
2. Crown fracture
1) Enamel
2) Enamel-Dentin
3) Enamel-Dentin- Pulp
3. Crown and root fracture
1) Pulp involvement
2) No pulp involvement
Classification of dentoalveolar
injuries
4. Root fracture
1) Apical third
2) Middle third
3) Cervical third
Shift to another angle
B. Supporting Structure
1. Sensitivity ( concussion )
* percussion pain
* no displacement
* no mobility
* Image  widening of PDL space
2. Subluxation
* 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 displacement
4. Avulsion
5. Alveolar process fracture
感染的影像檢查技術
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Plain film radiography
CT scan
MRI
Nuclear bone scans
Tomography
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) Garrie’s 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
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Space infection
Neck: Air way, pharynx
Sinus
Orbit
Intracranial abscess
Soft tissue
MRI
 Noninvasion, no radiation, high soft tissue
resolution﹐high sensitivity 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 treatment
Image finding and Bone changes
 Difficult to visualize by conventional
techniques in early stage
 Until 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 level…
 Osteomyelitis: periosteal reaction﹐moth
eaten , rarefaction, ….
 Sinus tract ( fistula )
1. Periapical Infection
( acute / chronic )
 Widening of PDL
 Lamina dura discontinuity
 Trabeculae destruction
 Chronic
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Periapical abscess
Periapical granuloma
Fistula
Root resorption
2. Osteomyelitis (骨髓炎 )
Acute suppurative osteomyelitis
 Trabeculae: fuzzy, diffuse destruction﹐
 Radiolucent area
• Poor demarcation
• Irregular border
Chronic suppurative osteomyelitis
 Moth eaten*
 Radiolucent area
with poor demarcation
 Necrotic bone
 Sequestrum
• Radiopaque with
peripheral
rediolucent area
 Rarefaction
Necrotic Bone
Moth eaten
Radiopaque with
peripheral radiolucent area
Sequestrum
Pathologic fracture
Expansion
Rarefaction
Sclerosing Osteomyelitis
Focal type
 Increasing density ( disposition of the
bone ) rarefaction
 Periapical area
 Thickening of PDL
 Bone scar
Sclerosing Osteomyelitis
Diffuse type
 Border between normal and sclerosis ..
poor defined
 Cotton wool appearance。
Garre’s proliferative periostitis
(Osteomyelitis)
 Subperiosteal reaction: onion skinning﹐
 Duplication 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 techniques
 Gas producing organism
Infratemporal space
Submasseteric space
Air way
MRI of TMJ space abscess
Sinusitis
Cloudy
Air-Fluid level
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