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A comparatively large amount of tracer accumulates in relation to the cranial tables and sutures, orbital walls, paranasal sinuses, nasal cavity, zygoma, sphenoidal ridge, and skull base including the temporomandibular and at-lantooccipital joints (Fig. 4.1). Normally, the maxilla and mandible accumulate tracer in the premolar zones presumably due to major masticatory movement. The vertex view shows uptake in the sagittal and coronal sutures and occasional variants. The modified vertex view is

Fig. 4.1A, B Anterior view of the skull and facial bones. A Anterior pinhole scintigraph shows prominent tracer uptake in the cranium and nasal mucosal and paranasal mucoperiosteal membranes, clearly delineating the paranasal sinuses (s), nasal cavity with turbinates and septum (nc), zygomas (z), and orbits (o) (arrow sphenoidal ridge). B Posteroanterior radiograph identifies the maxillary and frontal sinuses (s, thin arrows), nasal cavity with turbinates and septum (nc), orbits (o), and sphenoidal ridges (thick arrows)

Bone Scan Normal Skull Sinus UptakeAnterior Fontanelle
Fig. 4.2 Slightly tilted anterior scintigraph of the skull in a 2-year-old boy shows an open anterior fontanel at the intersection of the coronal and sagittal sutures (arrow). Note tracer uptake in the metopic suture (arrowhead)
Stenver Projection

Fig. 4.3A, B Lateral view of the frontotemporal skull. A Lateral pinhole scintigraph of the skull shows intense tracer uptake in the atlantooccipital joint (ao), temporomandibular joint (tm), sphenoid sinus (ss), and planum sphenoidale (ps). B Lateral radiograph identifies the planum sphenoidale (ps), sphenoid sinus (ss), temporomandibular joint (tm), and atlantooccipital articulation (ao), atlantoaxial joint (aa)

particularly useful for the demonstration of the fontanelles in children (Fig. 4.2). The close-up lateral pinhole scintigraph of the temporal region reveals prominent tracer uptake in the sphenoparietal ridge, planum sphenoidale, and sphenoid sinus, and also the temporomandi-bular, atlantooccipital and atlantoaxial joints (Fig. 4.3). In children, the sphenooccipital syn-chondrosis occasionally accumulates tracer intensely.

The special views adopted from radiography are utilized for the demonstration of small structures of the skull, especially the face, in which diverse parts are superimposed upon each other in ordinary anterior or lateral scans. The Waters' view is useful for separate visualization of the individual paranasal sinuses including the maxillary and frontal sinuses and the nasal cavity with the nasal bone above, the septum in the midline, and the turbinates in

Fig. 4.3A, B Lateral view of the frontotemporal skull. A Lateral pinhole scintigraph of the skull shows intense tracer uptake in the atlantooccipital joint (ao), temporomandibular joint (tm), sphenoid sinus (ss), and planum sphenoidale (ps). B Lateral radiograph identifies the planum sphenoidale (ps), sphenoid sinus (ss), temporomandibular joint (tm), and atlantooccipital articulation (ao), atlantoaxial joint (aa)

between (Fig. 4.4). The zygomatic arches and occasionally the crista galli can be imaged in this view. It is to be noted that more intense uptake normally occurs in and around the nasal cavity, contrasting with the relatively low uptake in the orbit, zygoma, and paranasal sinuses. Prominent uptake in the premolar regions of the maxilla is well portrayed in this view. The Towne's view can be utilized to visualize the lambdoidal suture and the posterior sector of the sagittal suture that conjoin to form the lambda in the occiput (Fig. 4.5). The straight

Posteroanterior Radiograph Crista Galli

Fig. 4.4A, B Tilted anterior (Waters') view of the facial bones. A Pinhole scintigraph reveals the maxillary sinuses (ms), nasal cavity (nc) with turbinates (t), ethmoid sinuses (es), frontal sinus (fs), and orbits (o). Physiologically increased tracer uptake is noted in the premolar region of the maxilla due to mastication (arrow). Similar tracer uptake may also occur in the mandibular premolar region. B Tilted posteroanterior radiograph identifies the maxillary sinuses (ms), nasal cavity (nc) with turbinates (t), ethmoid sinus (es), frontal sinus fs), and orbits (o) (arrow premolar region of the maxilla)

Fig. 4.4A, B Tilted anterior (Waters') view of the facial bones. A Pinhole scintigraph reveals the maxillary sinuses (ms), nasal cavity (nc) with turbinates (t), ethmoid sinuses (es), frontal sinus (fs), and orbits (o). Physiologically increased tracer uptake is noted in the premolar region of the maxilla due to mastication (arrow). Similar tracer uptake may also occur in the mandibular premolar region. B Tilted posteroanterior radiograph identifies the maxillary sinuses (ms), nasal cavity (nc) with turbinates (t), ethmoid sinus (es), frontal sinus fs), and orbits (o) (arrow premolar region of the maxilla)

Towne View Sinusitis

Fig. 4.5A, B Tilted posterior (Towne's) view of the occiput. A Tilted posterior pinhole scintigraph of the skull reveals tracer accumulation along the posterior sagittal and lambdoidal sutures (arrow Lambda). B Tilted anteroposterior radiograph identifies the posterior sagittal and lambdoidal sutures (arrowheads)

Fig. 4.5A, B Tilted posterior (Towne's) view of the occiput. A Tilted posterior pinhole scintigraph of the skull reveals tracer accumulation along the posterior sagittal and lambdoidal sutures (arrow Lambda). B Tilted anteroposterior radiograph identifies the posterior sagittal and lambdoidal sutures (arrowheads)

posterior view of the skull visualizes the torcu-lar Herophili, lateral sinus, and often occipito-parietomastoid sutural junction (Fig. 4.6). Another special projection is the Stenvers or tilted tangential view of the mastoid, in which the temporomandibular joint, the osseous labyrinth of the inner ear, and the occipitoparie-tomastoid sutural junction can be regularly imaged due to their characteristic uptake. The aerated mastoid bone and relatively thin petrous ridge do not accumulate tracer visibly unless diseased (Fig. 4.7). A number of modified views are available and still others may be improvised for the study of the selected parts of the skull and facial bones as the clinical situation demands.

Fig. 4.6 Straight posterior view of the occiput. Posterior pinhole scintigraph of the skull delineates the torcular Herophili (tH), lateral sinus (arrows), and occipitopari-etomastoid sutural junction (opm). The lambdoidal suture is also visualized

Fig. 4.6 Straight posterior view of the occiput. Posterior pinhole scintigraph of the skull delineates the torcular Herophili (tH), lateral sinus (arrows), and occipitopari-etomastoid sutural junction (opm). The lambdoidal suture is also visualized

Stenvers Radiography

surround the mastoid bone, which is relatively photope-nic because of aeration. B Tangential radiograph identifies the temporomandibular joint (tmj), osseous labyrinth (ol), and the occipitoparietomastoid sutural junction (opm). The air cells in the mastoid are lucent

Fig. 4.7A, B Tangential (Stenvers) view of the mastoid. A Tangential pinhole scintigraph of the left mastoid demonstrates increased tracer uptake in the temporomandibular joint (tmj), osseous labyrinth (ol), and the occipi-toparietomastoid sutural junction (opm). These landmarks surround the mastoid bone, which is relatively photope-nic because of aeration. B Tangential radiograph identifies the temporomandibular joint (tmj), osseous labyrinth (ol), and the occipitoparietomastoid sutural junction (opm). The air cells in the mastoid are lucent

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  • sago
    What is tm joints and maxillary sinuses?
    8 years ago

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