感染及外伤之放射线影像检查课件

外傷及感染之放射線影像檢查

RadiographicInterpretationof

TraumaandInfection外傷及感染之放射線影像檢查

RadiographicIn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內容綱要顎顏面外傷之影像檢查影像檢查在顎顏面外傷的應用PlaysacriticalroleIdentifythelocationandorientationoffracturesIndicatethedegreeofseparationordisplacement影像檢查在顎顏面外傷的應用Playsacritical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-IRoutinevi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-II5.Periapi顎顏面外傷常用

放射線影像檢查技術-III9.Tomography10.Towne’sview11.PAviewofmandible12.Obliqueviewofmandible顎顏面外傷常用

放射線影像檢查技術-III9.Tomo1.PAviewSkullJaws1.PAviewSkull2.LateralviewSkullJawsNeck2.LateralviewSkull3.PanexMandible,maxilla,dentition,70%ofmid-facefracture3.PanexMandible,maxilla,de4.Water’view

(Occipito-mental)MaxillaryfractureOrbitalfractureFrontalbone/sinus4.Water’view

(Occipito-menta5.PeriapicalviewToothandalveolarinjury5.PeriapicalviewToothanda6.Occlusalview

-MandibleFractureline,directionAxialsection6.Occlusalview

-Mandibl6.Occlusalview

-Maxilla6.Occlusalview

-Maxilla7.Submentalvertex

viewZygomaticarchfractureCoronoidfracture7.Submentalvertex

viewZ8.Lateralnasalview8.Lateralnasalview9.Tomography185180Blow–outfractureTMJfracture9.Tomography185180Blow–outf17517017517016516016516010.ModifiedTown’sviewCondylarfractureMandibularanglefracture10.ModifiedTown’sviewCondyl11.PAsymphysisview11.PAsymphysisview12.ObliquelateralviewWasreplacedbyPanoexUsedwhenpatientcannotsitorstand12.ObliquelateralviewWasreCTscanCTscanReconstructive3-DCTscanReconstructive3-DCTscan顎顏面外傷之影像檢查判讀GeneralinterpretationoffracturelineCondyleandothermandibularfractureMiddlefacialfractureCavity:sinus,orbitalDento-alveolarfracture顎顏面外傷之影像檢查判讀GeneralinterpretaGeneralinterpretationof

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

Generalinterpretationof

fraMandibularfractureMandibularfractureAngleand

symphysisfractureMalocclusionStepAngleand

symphysisfractureMCondyleandsymphysisfractureOverlap,discontinuityanddisplacementAsymmetryComminutedCondyleandsymphysisfractureCoronoidandramusfractureGap,DiscontinuityStep,DisplacementCoronoidandramusfractureGapCondyleDeviationDisplacementDislocationDislocationDeviationUndisplacedDisplacementCondyleDeviationDislocationDcondylefractureDisplacementcondylefractureDisplacementBilateralcondylefractureDislocationBilateralcondylefractureDislBonegapBonegapSplitfractureCoronoidfractureSplitfractureCoronoidfractuChinhorizontal

fractureChinhorizontal

fractureMid-facialtraumaCavity:sinus,herniaoforbitalsofttissueTomographyoforbitalfractureCTAir-emphysemaMiddlefracture(LeFortI,II,III)ZMCfractureBasilarskullfracture:air-fluidlevelinsphenoidsinusMid-facialtraumaCavity:sinuLefortIfractureLefortIfractureAir-fluidlevelAir-fluidlevel感染及外伤之放射线影像检查课件LeFortII

fractureLeFortII

fractureLeFortIIIfractureLeFortIIIfractureBlow-outfracture

Blow-outfracture感染及外伤之放射线影像检查课件Zygomaticarchfracture

Zygomaticarchfracture

Zygomatico-maxillarycomplex

(ZMC)fractureZygomatico-maxillarycomplex

Classificationofdentoalveolarinjuries1.Crowncrazeorcrack2.Crownfracture

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

1)Pulpinvolvement2)NopulpinvolvementA.ToothstructuresB.SupportingstructuresClassificationofdentoalveolaClassificationofdentoalveolarinjuries4.Rootfracture

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

*loosening,nodisplacement,

*ImageportionofPDLwideningB.SupportingStructure1.SensClassificationofdentoalveolarinjuries3.Toothdisplacement1)Intrusion2)Extrusion3)Labialdisplacement4)Lingualdisplacement5)Lateraldisplacement4.Avulsion5.AlveolarprocessfractureClassificationofdentoalveola感染的影像檢查技術PlainfilmradiographyCTscan

MRINuclearbonescansTomographyUltrasonography感染的影像檢查技術Plainfilmradiograph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,齒源性感染的常用影像檢查PlainfilmradiogrCTScanSpaceinfectionNeck:Airway,pharynxSinusOrbitIntracranialabscessSofttissueCTScanSpaceinfectionMRINoninvasion,noradiation,highsofttissueresolution﹐highsensitivityandspecificity對骨的細部變化spaceinfection,presenceofpus,cavitationTMJabscessMRINoninvasion,noradiation,選擇的要領Plainfilm:一般診斷及治療反應後的追蹤CT/MRI:Extensionintosofttissue,airwayBonescan:Responsetotreatment選擇的要領Plainfilm:一般診斷及治療反應後的追ImagefindingandBonechangesDifficulttovisualizebyconventionaltechniquesinearlystageUntilsubstantialmineral

..removed35-50%Afterinfection:5-14daysImagefindingandBonechanges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)感染部位與描述名稱Margin:wellorpoor1.PeriapicalInfection(acute/chronic)WideningofPDLLaminaduradiscontinuityTrabeculaedestructionChronicPeriapicalabscessPeriapicalgranulomaFistulaRootresorption1.PeriapicalInfection(acute2.Osteomyelitis(骨髓炎)AcutesuppurativeosteomyelitisTrabeculae:fuzzy,diffusedestruction﹐RadiolucentareaPoordemarcationIrregularborder2.Osteomyelitis(骨髓炎)AcutesChronicsuppurativeosteomyelitisMotheaten*RadiolucentareawithpoordemarcationNecroticboneSequestrumRadiopaquewithperipheralrediolucentareaRarefactionNecroticBoneChronicsuppurativeosteomyeliMotheatenMotheaten感染及外伤之放射线影像检查课件SequestrumRadiopaquewithperipheralradiolucentareaSequestrumRadiopaquewith感染及外伤之放射线影像检查课件PathologicfracturePathologicfractureRarefactionExpansionRarefactionExpansionSclerosingOsteomyelitisFocaltypeIncreasingdensity(dispositionofthebone)rarefactionPeriapicalareaThickeningofPDLBonescarSclerosingOsteomyelitisFocalSclerosingOsteomyelitisDiffusetypeBorderbetweennormalandsclerosis..poordefinedCottonwoolappearance。SclerosingOsteomyelitisDiffu感染及外伤之放射线影像检查课件Garre’sproliferativeperiostitis(Osteomyelitis)Subperiostealreaction:onionskinning﹐DuplicationofthecorticallayerofboneGarre’sproliferativeperiostiORN(Osteo-RadioNecrosis)NoremodelingORN(Osteo-RadioNecrosis)No90.1.1890.3.1290.1.1890.3.12BonenecrosisduetoArsenic

Toothgerm,nervedamage…BonenecrosisduetoArsenic

軟組織感染InfectionsinvolvingsofttissuesarenotreadilyDemonstratedbymanyimagingtechniquesGasproducingorganism軟組織感染InfectionsinvolvingsoftInfratemporalspaceSubmassetericspaceInfratemporalspaceSubmasseterAirwayAirway感染及外伤之放射线影像检查课件MRIofTMJspaceabscessMRIofTMJspaceabscessSinusitisCloudyAir-FluidlevelSinusitisCloudy

下課下課外傷及感染之放射線影像檢查

RadiographicInterpretationof

TraumaandInfection外傷及感染之放射線影像檢查

RadiographicIn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內容綱要顎顏面外傷之影像檢查影像檢查在顎顏面外傷的應用PlaysacriticalroleIdentifythelocationandorientationoffracturesIndicatethedegreeofseparationordisplacement影像檢查在顎顏面外傷的應用Playsacritical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-IRoutinevi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-II5.Periapi顎顏面外傷常用

放射線影像檢查技術-III9.Tomography10.Towne’sview11.PAviewofmandible12.Obliqueviewofmandible顎顏面外傷常用

放射線影像檢查技術-III9.Tomo1.PAviewSkullJaws1.PAviewSkull2.LateralviewSkullJawsNeck2.LateralviewSkull3.PanexMandible,maxilla,dentition,70%ofmid-facefracture3.PanexMandible,maxilla,de4.Water’view

(Occipito-mental)MaxillaryfractureOrbitalfractureFrontalbone/sinus4.Water’view

(Occipito-menta5.PeriapicalviewToothandalveolarinjury5.PeriapicalviewToothanda6.Occlusalview

-MandibleFractureline,directionAxialsection6.Occlusalview

-Mandibl6.Occlusalview

-Maxilla6.Occlusalview

-Maxilla7.Submentalvertex

viewZygomaticarchfractureCoronoidfracture7.Submentalvertex

viewZ8.Lateralnasalview8.Lateralnasalview9.Tomography185180Blow–outfractureTMJfracture9.Tomography185180Blow–outf17517017517016516016516010.ModifiedTown’sviewCondylarfractureMandibularanglefracture10.ModifiedTown’sviewCondyl11.PAsymphysisview11.PAsymphysisview12.ObliquelateralviewWasreplacedbyPanoexUsedwhenpatientcannotsitorstand12.ObliquelateralviewWasreCTscanCTscanReconstructive3-DCTscanReconstructive3-DCTscan顎顏面外傷之影像檢查判讀GeneralinterpretationoffracturelineCondyleandothermandibularfractureMiddlefacialfractureCavity:sinus,orbitalDento-alveolarfracture顎顏面外傷之影像檢查判讀GeneralinterpretaGeneralinterpretationof

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

Generalinterpretationof

fraMandibularfractureMandibularfractureAngleand

symphysisfractureMalocclusionStepAngleand

symphysisfractureMCondyleandsymphysisfractureOverlap,discontinuityanddisplacementAsymmetryComminutedCondyleandsymphysisfractureCoronoidandramusfractureGap,DiscontinuityStep,DisplacementCoronoidandramusfractureGapCondyleDeviationDisplacementDislocationDislocationDeviationUndisplacedDisplacementCondyleDeviationDislocationDcondylefractureDisplacementcondylefractureDisplacementBilateralcondylefractureDislocationBilateralcondylefractureDislBonegapBonegapSplitfractureCoronoidfractureSplitfractureCoronoidfractuChinhorizontal

fractureChinhorizontal

fractureMid-facialtraumaCavity:sinus,herniaoforbitalsofttissueTomographyoforbitalfractureCTAir-emphysemaMiddlefracture(LeFortI,II,III)ZMCfractureBasilarskullfracture:air-fluidlevelinsphenoidsinusMid-facialtraumaCavity:sinuLefortIfractureLefortIfractureAir-fluidlevelAir-fluidlevel感染及外伤之放射线影像检查课件LeFortII

fractureLeFortII

fractureLeFortIIIfractureLeFortIIIfractureBlow-outfracture

Blow-outfracture感染及外伤之放射线影像检查课件Zygomaticarchfracture

Zygomaticarchfracture

Zygomatico-maxillarycomplex

(ZMC)fractureZygomatico-maxillarycomplex

Classificationofdentoalveolarinjuries1.Crowncrazeorcrack2.Crownfracture

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

1)Pulpinvolvement2)NopulpinvolvementA.ToothstructuresB.SupportingstructuresClassificationofdentoalveolaClassificationofdentoalveolarinjuries4.Rootfracture

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

*loosening,nodisplacement,

*ImageportionofPDLwideningB.SupportingStructure1.SensClassificationofdentoalveolarinjuries3.Toothdisplacement1)Intrusion2)Extrusion3)Labialdisplacement4)Lingualdisplacement5)Lateraldisplacement4.Avulsion5.AlveolarprocessfractureClassificationofdentoalveola感染的影像檢查技術PlainfilmradiographyCTscan

MRINuclearbonescansTomographyUltrasonography感染的影像檢查技術Plainfilmradiograph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,齒源性感染的常用影像檢查PlainfilmradiogrCTScanSpaceinfectionNeck:Airway,pharynxSinusOrbitIntracranialabscessSofttissueCTScanSpaceinfectionMRINoninvasion,noradiation,highsofttissueresolution﹐highsensitivityandspecificity對骨的細部變化spaceinfection,presenceofpus,cavitationTMJabscessMRINoninvasion,noradiation,選擇的要領Plainfilm:一般診斷及治療反應後的追蹤CT/MRI:Extensionintosofttissue,airwayBonescan:Responsetotreatment選擇的要領Plainfilm:一般診斷及治療反應後的追ImagefindingandBonechangesDifficulttovisualizebyconventionaltechniquesinearlystageUntilsubstantialmineral

..removed35-50%Afterinfection:5-14daysImagefindingandBonechanges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)感染部位與描述名稱Margin:wellorpoor1.PeriapicalInfection(acute/chronic)WideningofPDLLaminaduradiscontinuityTrabeculaedestructionChronicPeriapicalabscessPeriapicalgranulomaFistulaRootresorption1.PeriapicalInfection(acute2.Osteomyelitis(骨髓炎)AcutesuppurativeosteomyelitisTrabeculae:fuzzy,diffusedestructi