外傷及感染之放射線影像檢查

RadiographicInterpretationof

TraumaandInfection內(nèi)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PlaysacriticalroleIdentifythelocationandorientationoffracturesIndicatethedegreeofseparationordisplacement顎顏面外傷常用

放射線影像檢查技術-IRoutineview1.Posterior-anterior(PA)viewoffacialbones2.Lateralviewoffacialbone3.Panorex4.Water’s(Occipitomental)Suspectmid-facefracture顎顏面外傷常用

放射線影像檢查技術-II5.Periapicalview6.OcclusalviewOcclusalviewofnasalboneOcclusalviewofmandible7.Submental-vertexview8.Lateralviewofnasalbone顎顏面外傷常用

放射線影像檢查技術-III9.Tomography10.Towne’sview11.PAviewofmandible12.Obliqueviewofmandible1.PAviewSkullJaws2.LateralviewSkullJawsNeck3.PanexMandible,maxilla,dentition,70%ofmid-facefracture4.Water’view

(Occipito-mental)MaxillaryfractureOrbitalfractureFrontalbone/sinus5.PeriapicalviewToothandalveolarinjury6.Occlusalview

-MandibleFractureline,directionAxialsection6.Occlusalview

-Maxilla7.Submentalvertex

viewZygomaticarchfractureCoronoidfracture8.Lateralnasalview9.Tomography185180Blow–outfractureTMJfracture17517016516010.ModifiedTown’sviewCondylarfractureMandibularanglefracture11.PAsymphysisview12.ObliquelateralviewWasreplacedbyPanoexUsedwhenpatientcannotsitorstandCTscanReconstructive3-DCTscan顎顏面外傷之影像檢查判讀GeneralinterpretationoffracturelineCondyleandothermandibularfractureMiddlefacialfractureCavity:sinus,orbitalDento-alveolarfractureGeneralinterpretationof

fracturelineDisplacement(deviation,dislocation)Step,gap,overlappingDiscontinuityAsymmetryComminutedMalocclusionCavity:(air-fluidlevel)***Degreeanddirection

MandibularfractureAngleand

symphysisfractureMalocclusionStepCondyleandsymphysisfractureOverlap,discontinuityanddisplacementAsymmetryComminutedCoronoidandramusfractureGap,DiscontinuityStep,DisplacementCondyleDeviationDisplacementDislocationDislocationDeviationUndisplacedDisplacementcondylefractureDisplacementBilateralcondylefractureDislocationBonegapSplitfractureCoronoidfractureChinhorizontal

fractureMid-facialtraumaCavity:sinus,herniaoforbitalsofttissueTomographyoforbitalfractureCTAir-emphysemaMiddlefracture(LeFortI,II,III)ZMCfractureBasilarskullfracture:air-fluidlevelinsphenoidsinusLefortIfractureAir-fluidlevelLeFortII

fractureLeFortIIIfractureBlow-outfracture

Zygomaticarchfracture

Zygomatico-maxillarycomplex

(ZMC)fractureClassificationofdentoalveolarinjuries1.Crowncrazeorcrack2.Crownfracture

1)Enamel2)Enamel-Dentin3)Enamel-Dentin-Pulp3.Crownandrootfracture

1)Pulpinvolvement2)NopulpinvolvementA.ToothstructuresB.SupportingstructuresClassificationofdentoalveolarinjuries4.Rootfracture

1)Apicalthird2)Middlethird3)CervicalthirdShifttoanotherangleB.SupportingStructure1.Sensitivity(concussion)*percussionpain*nodisplacement*nomobility*ImagewideningofPDLspace2.Subluxation

*loosening,nodisplacement,

*ImageportionofPDLwideningClassificationofdentoalveolarinjuries3.Toothdisplacement1)Intrusion2)Extrusion3)Labialdisplacement4)Lingualdisplacement5)Lateraldisplacement4.Avulsion5.Alveolarprocessfracture感染的影像檢查技術PlainfilmradiographyCTscan

MRINuclearbonescansTomographyUltrasonography齒源性感染的常用影像檢查Plainfilmradiography根尖片:對於根尖及早期病變的顯示最佳咬合片:(Axial)Garrie’sosteomyelitis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,CTScanSpaceinfectionNeck:Airway,pharynxSinusOrbitIntracranialabscessSofttissueMRINoninvasion,noradiation,highsofttissueresolution﹐highsensitivityandspecificity對骨的細部變化spaceinfection,presenceofpus,cavitationTMJabscess選擇的要領Plainfilm:一般診斷及治療反應後的追蹤CT/MRI:Extensionintosofttissue,airwayBonescan:ResponsetotreatmentImagefindingandBonechangesDifficulttovisualizebyconventionaltechniquesinearlystageUntilsubstantialmineral

..removed35-50%Afterinfection:5-14days感染部位與描述名稱Margin:wellorpoordemarcation/defined

Lesion:radiolucent/radiopaquePeriapicalchanges:PDL,trabeculae.Cavity(sinus):cloudy,air-fluidlevel…Osteomyelitis:periostealreaction﹐motheaten,rarefaction,….Sinustract(fistula)1.PeriapicalInfection(acute/chronic)WideningofPDLLaminaduradiscontinuityTrabeculaedestructionChronicPeriapicalabscessPeriapicalgranulomaFistulaRootresorption2.Osteomyelitis(骨髓炎)AcutesuppurativeosteomyelitisTrabeculae:fuzzy,diffusedestruction﹐RadiolucentareaPoordemarcationIrregularborderChronicsuppurativeosteomyelitisMotheaten*RadiolucentareawithpoordemarcationNecroticboneSequestrumRadiopaquewithperipheralrediolucentareaRarefactionNecroticBoneMotheatenSequestrumRadiopaquewithperipheralradiolucentareaPathologicfractureRarefactionExpansionSclerosingOsteomyelitisFocaltypeIncreasingdensity(dispositionofthebone)rarefactionPeriapicalareaThickeningofPDLBonescarScl