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BAGIAN RADIOLOGI FAKULTAS KEDOKTERAN UNISSULA
BEKTI SAFARINI
Pemeriksaan radiologi maksilofasial
Pemeriksaan radiologi sinus
paranasalis
Pemeriksaan radiologi mastoid
Pemeriksaan radiologi nasofaring
PEMERIKSAAN RADIOLOGI PADA TRAUMA
MAKSILOFASIAL
Panoramic
X Foto Polos
CT Scan
CT SCAN
3D CT
Urutan kedua tersering
pada trauma tulang
wajah.
50% nya adalah fraktur
multiple
Pemeriksaan fisik &
radiologi diperlukan
untuk menegakkan
diagnosis
Tanda & Gejala
Nyeri
Maloklusi
Bengkak
Laserasi mukosa
Deformitas
Panoramic Post Operasi
LeFort I Transverse Maxillary
Lefort II Pyramidal
Lefort III Craniofacial Dysjunction
Zygomatic Complex
Orbital Floor
Nasal Fractures
Naso-orbital/Ethmoid
Weakest areas of midfacial complex when assaulted from a frontal direction at different levels (Rene’ Lefort, 1901)
Lefort I: above the level of teeth
Lefort II: at level of nasal bones
Lefort III: at orbital level
Plain Films
Lateral Skull
Waters View
Posteroanterior view of skull
Submental vertex
CT Scan
Axial and coronal views
3D
Lateral skull Water’s View
CT SCAN 3D CT
Stereolithography allows actual model of defect. A nice reconstruction tool to use if available
4 proyeksi dasar foto konvensial SPN
Caldwell.
Waters.
Lateral
Submentovertex/Basiler.
Proyeksi tambahan:
Open Mouth Waters.
FOTO POLOS
•Untuk evaluasi awal pada SPN
•Cukup ekonomis serta radiasi minimal.
• Kelemahan : banyak unsur yang tumpang
tindih
•Caldwell, Waters, Lateral.
Struktur yang tampak : sinus frontalis, sinus ethmoidalis anterior
Struktur yang tampak paling baik: sinus maksilaris dan fossa nasal
Sinus sphenoidalis terlihat
Struktur yang tampak: sinus sphenoid, sinus frontalis, sinus ethmoid, sinus maksilaris, sela tursica & supraorbita.
Struktur yang tampak : sinus sphenoid, sinus ethmoid & fossa nasal.
LAW’S POSITIONS ( Lateral projections )
STENVERS’ POSITION ( PA projection of petrous ridges )
TOWNE
SCHULLER
LAW’S PROJECTION
STENVERS’ POSITION
Struktur paling terlihat baik : petrous
pyramid, mastoid air cell dan tulang labirin.
Closed Mouth Open Mouth
CT SCAN
NORMAL CT MASTOID
Normal CT temporal boneNormal CT temporal bone
Figure 5e. Petrous apicitis in a 7-year-old girl with fever, right-sided facial pain, and diplopia.
Vazquez E et al. Radiographics 2003;23:359-372
©2003 by Radiological Society of North America
MASTOIDITIS
MASTOIDITIS
Citelli’s angle
•Acute – in primary
sclerosis
•Obtuse- in secondary
sclerosis ( due to CSOM)
NORMAL MASTOIDITIS
PEMBESARAN ADENOID
ABSES RETROPHARYNGEAL
BENDA ASING X ray neck AP view
•Round radio opaque
object ( ? Coin)
•In Esophagus
• Because the
esophagus is an AP
compressed tubular
structure
•A coin would
occupy this
position
•Can be confirmed
by lateral view
X ray neck Lateral view
ACHALASIA CARDIA • Regular dilation of esophagus. • Air fluid level • Abrupt strcture formation. • “Rat tail appearance / Bird beak appearance “
ACHALASIA
MALIGNANCY • “ shouldering effect “ margin of malignant ulcer. • Proksimal dilatation • “Apple core appearance “
MALIGNANCY Contrast Xray – Barium Swallow
•Irregularity of mucosa
•Shouldering effect
•Persistent
•Middle third of esophagus
Diagnosis:
? Malignancy of
Middle thrid of esophagus
Merupakan 70 % dari keganasan primer di Nasofaring.
Paling sering terjadi di Asia, terutama China.
Ada 3 Tipe :
Type I : keratinizing squamous cell carcinoma
Type II : non-keratinizing squamous cell carcinoma
Type III : undifferentiated carcinoma
CA NASOFARING
CT NASOFARING
MRI
(a) Axial T1 weighted image shows a bulging right nasopharyngeal mass with extension to the skull base, partially encasing the right internal carotid artery. The right parapharyngeal fat is obliterated. (b) Axial T2 weighted image shows mild hyperintensity of the right nasopharyngeal mass. The signal intensity of the mass is similar to that of the nasopharyngeal mucosa, and the margin between the normal mucosa and the mass could not be delineated. Note the presence of right mastoiditis change. (c) Axial and (d) coronal contrast-enhanced T1 weighted images with fat saturation shows vivid enhancement of the nasopharyngeal mass. There is skull-base and cavernous sinus invasion with encasement of the right internal carotid artery, which is not narrowed (white arrows). Bilateral neck lymphadenopathy (black arrows) is prominent.
TNM staging Primary tumour (T)
Tx : primary tumour cannot be assessed
T0 : no evidence of primary tumour
Tis : carcinoma in situ
T1 : tumour is confined to the nasopharynx
T2 : tumour extends to soft tissues of the oropharynx and/or nasal fossa
T2a : without extension to the parapharyngeal region
T2b : with extension to the parapharyngeal region
T3 : invasion of adjacent bony structures and/or paranasal sinuses
T4 : invasion of any one or more of the following
intracranial content
cranial nerves
infratemporal fossa / masticator space
hypopharynx
orbit
Nodal status (N) Nx : nodes cannot be assessed N0 : no evidence of nodal involvement N1 : unilateral nodal involvement < 6cm maximal diameter above
supracalvicular fossa N2 : bilateral nodal involvement < 6cm maximal diameter above
supracalvicular fossa N3 N3a : > 6 cm maximal diameter (unilateral or bilateral) N3b : involvement of the supracalvicular fossa
Metastases (M) Mx : presence of metastases cannot be assessed M0 : no evidence of metastases M1 : distant metastases present
Meschan I,1963. Detail consideration of certain area of the skull
in an atlas of normal radiographic anatomi. Second edition.WB.Saunders Company. Philadelphia : 282-318.
Vasquez, etc. 2003.Acute mastoiditis in children. RadioGraphics; 23:359 –372.
Weissleder R, Wittenberg J, Harisinghani MG, Chen JW. 2007. Head and neck imaging. In: Primer of Diagnostic imaging. Fourth Edition.Mosby Elsevier, Philadelphia :607-660.
DAFTAR PUSTAKA