Head and Neck

Departments of Radiology: Vancouver General Hospital, B.C. Cancer Agency

Dr. Savvas Nicolaou Director of ER/Trauma Radiology savvas.nicolaou@vch.ca

Dr. Montgomery Martin g y Medical director, Diagnostic Imaging B.C. Cancer Agency mmartin@bccancer.bc.ca ti @b b

Review of Anatomy

Skull Bones

Frontal Bone

Nasal B N l Bone

Orbits Zygomatic Bone

Mandible Maxilla

Orbit Bones
Roof: F t l bone Frontal b Sphenoid bone (small portion) Medial W ll M di l Wall: Maxilla Lacrimal bone Ethmoid bone Sphenoid bone Lateral Wall: Zygomatic bone Greater wing of sphenoid bone Floor: Maxilla Zygomatic bone Palatine bones

Bones & Sutures

Coronal Suture Frontal Bone Parietal Bone Temporal Bone Lambdoid Suture Occipital Bone

Sphenoid Bone (Greater Wing)

Orbit

Zygomatic Bone Mandible Maxilla

Sutures 2 planes, one Greek letter

Sagittal Suture

Coronal Suture

Lambdoid Suture

Bones & Sutures posterior view

Parietal Bone Sagittal Suture

Occipital Bone

Mandible

Bones & Sutures

Parietal Bone Sagittal Suture

Lambdoid Suture

Mandible

Bones & Sutures

Parietal Bone Sagittal Suture

Lambdoid Suture

Mandible

Bones & Sutures

Calvarium (outer table) Calvarium (inner table)

Frontal Bone

Parietal Bone

Occipital Bone

Bones & Sutures

Calvarium (outer table) Calvarium (inner table)

Coronal C l Suture

Sagittal Suture

Lambdoid Suture

Skull Bones

1. Frontal Bone 2 2. Parietal Bone 1 3. Temporal Bone 4. Occipital Bone 4 3 5 7 6 5. Sphenoid Bone 6. Zygomatic Bone 7. Maxilla 8. Mandible

Radiographs

Radiograph Views of the Skull

AP View Lateral View

Skull A-P: Bones

Sphenoid Bone (Lesser Wing) Orbits Mandible (Head) Maxilla

Skull A-P: Sutures

Sagittal Suture

Lambdoid Suture Coronal Suture

Skull A-P: Sinuses

Frontal Sinuses

Maxillary Sinuses

Ethmoid Sinuses

Skull A-P: Sinuses

Ethmoid Sinuses

Ethmoid Sinuses Catamaran

Ethmoid Sinuses Catamaran

Ethmoid Sinuses Catamaran

Ethmoid Sinuses Catamaran

Ethmoid Sinuses Catamaran

Christa Galli

Skull, A-P

Sagittal Suture Coronal C l Suture Lambdoid Suture Sphenoid Bone (Lesser Wing) Mandible (Head) Ethmoid Sinus

Frontal Sinuses Orbits Maxillary Sinuses Maxilla

Skull Lateral: Bones

Frontal Bone

Parietal Bone

Temporal Bone

Orbit

Occipital Bone

Maxilla

Sphenoid Bone

Mandible

Sella Turcica

Skull Lateral: Sutures

Coronal Suture

Lambdoid Suture

Ethmoid & Sphenoid Sinuses

Ethmoid & Sphenoid Sinuses

Ethmoid sinus

Sphenoid sinus p

Skull, Lateral: Sinuses

Frontal Sinus Ethmoid Sinus

Maxillary Sinus

Sphenoid Sinus

Skull, Lateral
Coronal Suture Frontal Bone

Parietal Bone Lambdoid Suture

Frontal Sinus Ethmoid Sinus Orbit Sphenoid Sinus Maxillary Sinus Maxilla Mandible

Temporal Bone

Occipital Bone

Sphenoid Bone (Greater Wings)

Sella Turcica

Skull Radiograph Lateral View

1

Components of the l i th calvarium:

1. 1 Inner / Internal table 2. Outer / External table

Skull Radiograph - Lateral View

Can you identify this structure?

What sits within it?

Skull Radiograph - Lateral View

Can you identify this structure?

Sella turcica

What sits within it?

Pituitary gland

CT Images

CT Reconstruction Skull Bones

1 6 2 7

3 4

8 1. Frontal bone 2. Nasal bone 3. 3 Orbital floor (maxilla, zygomatic bone (maxilla bone, palatine bones) 4. Zygomatic bone

5 5. 6. 7. 7 8.

8 Maxilla Parietal bone Temporal bone (petrous part) Mandible

Sutures CT Reconstruction and Radiograph (AP View)

1 2 1 2

1. Sagittal Suture g 2. Coronal suture

Sutures CT Reconstruction and Radiograph (Lateral View)

1 2

1. Lambdoid suture 2. Coronal suture

CT 3D Reconstruction

1. 1 Superior Orbital Fissure

Skull Axial CT

1. Superior Orbital Fissure

Skull base

Skull base

1. Foramen Ovale 2. Foramen Spinosum 3. Carotid Canal 4. Jugular f 4 J l foramen

1 2

3 4

3 3. Carotid 3 C tid canal l

Skull Axial CT

2. Carotid Canal

Skull Axial CT

Foramen Ovale

Foramen Spinosum

Carotid Canal (1st Part)

Skull Axial CT

Foramen Ovale

Foramen Spinosum

Carotid Canal (1st Part)

Skull Axial CT: Foramina Contents

Foramen Spinosum S i Middle Meningeal y Artery

Carotid Canal (1st Part) Internal Carotid Artery

Clinical Correlation: Epidural Hematoma

May result f from disruption of f the middle meningeal artery D Dura i peeled f is l d from the i h inner table of the calvarium due to filling of blood into potential space Typical convex or lens shaped lens-shaped appearance

Skull Coronal CT: Sinuses

1 3 2 2

Sinuses 1. Frontal sinus 2. Maxillary sinus 3. Ethmoid air cells

Skull Coronal CT: Sinuses

1 1 3 3 2 2 2

Sinuses 1. Frontal sinus 2. Maxillary sinus 3. Ethmoid air cells