Imaging methods of the
head and neck
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
- Summation imaging, displays 3D structures as
2D photography
- disadvantage radiation , X rays (RTG)
- a range of shades
of grey depending
on the exposure
(negative)
1. 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
• description
Lateral projection
Posteroanterior projection
?
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
Oblique posterior, semi-axial, cranially
eccentric projection (according to Waters)
• Upper and middle
facial floor
• Paranasal sinuses
Albers-Schönbergova
Targeted X-ray projections
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
?
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
Arthrography
X-ray picture after filling with a contrast
agent
Disadvantages: invasive method
Computed tomography(CT)
- A non-invasive x-ray technique
- More sensitive than conventional X-rays
- In the axial or coronary plane,
3D reconstruction
Disadvantages: lower availability,
higher radiation dose
3D reconstrucion
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
Ultrasonography
Adv. Compared to MRi:
lower examination costs
less time consuming
less discomfort for the patient
Disadv: lower diagnostic accuracy
MRiUS
Arthroscopy - accurate dg of joint changes, but also the
implementation of adequate surgery is needed
Endoscopic examination
Disadvant: invasive method
the need for general anesthesia
possibility of damage n. auriculotemp.
Adhesion in ATM
Types of arthroscopy:
1. upper articular cleft
2. lower articular cleft