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CT OF THE HEAD PATHOLOGIES AND PROTOCOLS

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PATHOLOGIES

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SINUSITIS Sinusitis is the name given when the lining of one or more of these sinuses is red, swollen, and tender, the opening is blocked, and the sinus is at least partially filled with fluid (mucus and/or pus). www.indiandentalacademy.com


SINUS POLYP

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ORBITAL FRACTURE Demonstrates a superior orbital fracture on the left with fragments of bone extending toward the frontal lobe. There was no evidence of an optic canal fracture. www.indiandentalacademy.com


ORBITAL ROOF FRACTURE

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TRIPOD FRACTURE

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The tripod fracture, also called the zygomaticomaxillary complex, is composed of a set of fractures including the lateral orbital wall, inferior orbital floor, and the zygomatic arch.

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Blowout fracture

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MANDIBULAR FRACTURE

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SKULL FRACTURES • OPEN • CLOSED

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Although the skull is tough, resilient, and provides excellent protection for the brain, a severe impact or blow can result in fracture of the skull and may be accompanied by injury to the brain. Some of the different types of skull fracture include: Simple: a break in the bone without damage to the skinLinear or hairline: a break in a cranial bone resembling a thin line, without splintering, depression, or distortion of boneDepressed: a break in a cranial bone (or "crushed" portion of skull) with depression of the bone in toward the brainCompound: a break in or loss of skin and splintering of the bone. Along with the fracture, brain injury, such as subdural hematoma (bleeding) may occur. www.indiandentalacademy.com


OPEN FRACTURECOMPOUND

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CLOSED FRACTURE

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HEMORRHAGE • • • •

INTRACEREBRAL SUBDURAL EPIDURAL SUBARACHNOID

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INTRACEREBRAL

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SUBDURAL

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SDH • form of traumatic brain injury in which blood gathers between the dura (the outer protective covering of the brain) and the arachnoid (the middle layer of the meninges).

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EPIDURAL

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EDH • buildup of blood occurring between the dura mater (the brain's tough outer membrane) and the skull.

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SUBARACHNOID

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SAH • is bleeding into the subarachnoid space surrounding the brain, the area between the arachnoid membrane and the pia mater.

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Rupture of an intracranial aneurysm is the most common cause of nontraumatic subarachnoid hemorrhage. 90-95% of all intracranial aneurysms are located in the carotid system. The anterior communicating artery is the most common site (30%), followed by the posterior communicating artery (25%) and the middle cerebral artery (20%).

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CEREBRAL INFARCT

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BRAIN CYST

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HYDROCEPHALUS

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ARTERIO-VENOUS MALFORMATION

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What is a brain AVM? Normally, arteries carry blood containing oxygen from the heart to the brain, and veins carry blood with less oxygen away from the brain and back to the heart. When an arteriovenous malformation (AVM) occurs, a tangle of blood vessels in the brain or on its surface bypasses normal brain tissue and directly diverts blood from the arteries to the veins www.indiandentalacademy.com


BRAIN METS

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CVA

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This is a CAT scan of a patient with a bleeding stroke caused by CAA. The two bright areas represent recent areas of bleeding into the brain. Both areas are in the outer part of the brain that is characteristic for CAAwww.indiandentalacademy.com related strokes.


BRAIN INFECTIONS • MENINGITIS • ENCEPHALITIS • ABSCESS

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MENINGITIS

Subdural empyema and diffuse cerebral edema in a patient with bacterial meningitis (same patient as in Image 18). Obtained 1 week after Image 18, this contrast-enhanced CT scan shows www.indiandentalacademy.com diffuse cerebral edema and lacunar infarcts in the thalamus.


ENCEPHALITIS

Encephalitis Encephalitis is an inflammation (irritation and swelling with presence of www.indiandentalacademy.com extra immune cells) of the brain, usually caused by infections.


BRAIN ABSCESS

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BRAIN TUMORS • • • • • •

ASTROCYTOMAS GLIOMAS PINEAL REGION TUMORS LIPOMA ACOUSTIC NEUROMA MENINGIOMA www.indiandentalacademy.com


•astrocytomas Astrocytomas are glial cell tumors that are derived from connective tissue cells called astrocytes. These cells can be found anywhere in the brain or spinal cord. Astrocytomas are the most common type of childhood brain tumor.

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•Brain stem gliomas are tumors found in the brain stem. Most brain stem tumors cannot be surgically removed because of the remote location and delicate and complex function this area controls. Brain stem gliomas occur almost exclusively in children; the group most often affected is the school-age child. The child usually does not have increased intracranial pressure, but may have problems with double vision, movement of the face or one side of the body, or difficulty with walking and coordination

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•optic nerve gliomas Optic nerve gliomas are found in or around the nerves that send messages from the eyes to the brain. They are frequently found in persons who have neurofibromatosis, a condition a child is born with that makes him/her more likely to develop tumors in the brain. Persons usually experience loss of vision, as well as hormone problems, since these tumors are usually located at the base of the brain where hormonal control is located. These are typically difficult to treat due to the surrounding sensitive brain structures. www.indiandentalacademy.com


•medulloblastomas Medulloblastomas are one type of PNET that are found near the midline of the cerebellum. This tumor is rapidly growing and often blocks drainage of the CSF (cerebral spinal fluid, which bathes the brain and spinal cord), causing symptoms associated with increased ICP. Medulloblastoma cells can spread (metastasize) to other areas of the central nervous system, especially around the spinal cord. A combination of surgery, radiation, and chemotherapy is usually needed to control these tumors www.indiandentalacademy.com


•pineal region tumors Many different tumors can arise near the pineal gland, a gland which helps control sleep and wake cycles. Gliomas are common in this region, as are pineal blastomas (PNET). In addition, germ cell tumors, another form of malignant tumor, can be found in this area. Tumors in this region are more common in children than adults, and make up 3 to 8 percent of pediatric brain tumors. Benign pineal gland cysts are also seen in this location, which makes the diagnosis difficult between what is malignant and what is benign. Biopsy or removal of the tumor is frequently necessary to tell the different types of tumors apart. Persons with tumors in this region frequently experience headaches or symptoms of increased intracranial pressure. Treatment depends on the tumor type and size. www.indiandentalacademy.com


GLIOMA

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ACOUSTIC NEUROMA

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ACOUSTIC NEUROMA

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PITUITARY GLAND TUMOR

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CT PROTOCOLS • • • • • • • • • •

HEAD HEAD VASCULAR CTA CTV PITUITARY & SELLA TURCICA INTERNAL AUDITORY CANAL ORBITS PARANASAL SINUSES TMJ FACIAL BONES DENTAL STEREOTACTIC www.indiandentalacademy.com


OML CML

IOML

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HEAD/BRAIN (ADULT) SCOUT: LATERAL FOV -240 LANDMARK: OML – 15 DEG ABOVE OML SLICE PLANE: AXIAL I.V. CONTRAST: 100-140 ML 1-1.5 ML/SEC, TUMOR, METS - 5 MIN DELAY

SLICE THICKNESS: 5 x 5 mm START LOCATION: FORAMEN MAGNUM END LOCATION: VERTEX FILMING: BONE & SOFT TISSUE

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DFOV 25


15 DEG AND 20 DEG ABOVE OML

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CT HEAD – LOSS OF BALANCE SCOUT: LATERAL FOV -240 LANDMARK: OML – 15 DEG ABOVE OML SLICE PLANE: AXIAL I.V. CONTRAST: 100-140 ML 1-1.5 ML/SEC, TUMOR, METS - 5 MIN DELAY

SLICE THICKNESS: 2 x 2 mm POSTERIOR FOSSA 5 x 5 mm THE REST START LOCATION: FORAMEN MAGNUM END LOCATION: VERTEX FILMING: BONE & SOFT TISSUE www.indiandentalacademy.com

DFOV 25


CT HEAD – SEIZURES -20 DEG TO OML

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BRAIN ANGIO CTA SCOUT: LATERAL LANDMARK: OML SLICE PLANE: AXIAL I.V. CONTRAST: 100-140 ML- 3-5 ml /sec -

15 - 20 SEC DELAY CTA 30 SEC DELAY CTV BREATH HOLD: NONE SLICE THICKNESS: 1-2 MM START LOCATION: BELOW SELLAR FLOOR END LOCATION: 4-5 CM ABOVE SELLA RECON: 50% OVERLAP FILMING: 3 D RECON www.indiandentalacademy.com

DFOV 18


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PITUITARY AND SELLA TURCICA SCOUT: LATERAL LANDMARK: OML SLICE PLANE: CORONAL & AXIAL I.V. CONTRAST: 100-140 ML BREATH HOLD: NONE SLICE THICKNESS: 1-1.5 mm FILMING: BONE & SOFT TISSUE www.indiandentalacademy.com

DFOV 12


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IAC SCOUT: LATERAL LANDMARK: IOML SLICE PLANE: CORONAL & AXIAL I.V. CONTRAST: 100-140 ML FOR ACOUSTIC NEUROMA OR HEARING LOSS

65 SEC DELAY BREATH HOLD: NONE SLICE THICKNESS: 1-2 MM, 1MM THROUGH CANAL, 2 MM PETROUS BONE START LOCATION: CORONAL: P. SEMI-CIRC. CANAL, AXIAL: F. MAGNUM END LOCATION: CORONAL: THROUGH PETROUS BONE AXIAL THROUGH PETROUS BONE FILMING: BONE & SOFT TISSUE

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SCANNED DFOV 20 CM

RECON: R & L SIDE DFOV 10 CM www.indiandentalacademy.com


ORBITS SCOUT: LATERAL LANDMARK: IOML

DFOV 15CM

SLICE PLANE: CORONAL & AXIAL I.V. CONTRAST: 100-140 ML MASS OR VISUAL DISTURBANCE 2 CC/SEC

65 SEC DELAY BREATH HOLD: NONE SLICE THICKNESS: 2-3 MM START LOCATION: CORONAL: SPH. SINUS, AXIAL: TOP OF MAX. SINUS END LOCATION: CORONAL: ANTERIOR GLOBE AXIAL:UPPER ORBITAL RIM FILMING: BONE & SOFT TISSUE www.indiandentalacademy.com


OPTIC NERVE PROTOCOL

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PATIENT CAN’T ASSUME PRONE POSITION

SUPINE-CORONAL

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DENTAL ARTIFACT OMISSIONMULTIANGULATION

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FACIAL BONES SCOUT: LATERAL LANDMARK: IOML SLICE PLANE: CORONAL & AXIAL I.V. CONTRAST: 100-140 ML MASS 2 cc/sec

65 SEC DELAY SLICE THICKNESS: 2-3 MM START LOCATION: CORONAL: EAM AXIAL: S. MENTI END LOCATION: CORONAL: ANTERIOR GLOBE AXIAL: SUPERIOR ORBITAL MARGIN FILMING: BONE & SOFT TISSUE www.indiandentalacademy.com

DFOV 20 CM


FACIAL BONES

INCLUDE MANDIBLE!!!!!!

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PNS SCOUT: LATERAL LANDMARK: OML

DFOV 15 CM

SLICE PLANE: CORONAL & AXIAL I.V. CONTRAST: 100-140 ML MASS 2 cc/sec

65 SEC DELAY BREATH HOLD: NONE SLICE THICKNESS: 3 - 5 MM START LOCATION: CORONAL: BEHIND SPHENOID SINUS AXIAL: BOTTOM OF MAX. SINUS END LOCATION: CORONAL: THROUGH FRONTAL SINUS AXIAL: THROUGH FRONTAL SINUS FILMING: BONE & SOFT TISSUE www.indiandentalacademy.com


TMJ SCOUT: LATERAL LANDMARK: OML SLICE PLANE: CORONAL & AXIAL I.V. CONTRAST: NONE BREATH HOLD: NONE SLICE THICKNESS: 1 - 2 MM START LOCATION: CORONAL: POSTERIOR TO JOINT AXIAL: POSTERIOR TO JOINT END LOCATION: CORONAL: THROUGH THE ENTIRE JOINT AXIAL: THROUGH THE ENTIRE JOINT FILMING: BONE & SOFT TISSUE www.indiandentalacademy.com


SCANNED DFOV 20 CM

RECON: R & L SIDE DFOV 10 CM

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DENTAL

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STEREOTACTIC

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Stereotactic system use • • • •

Biopsy of intracranial lesions Aspiration of cysts Laser microsurgery Aspiration of brain abcess

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Head pathologies and protocols/ dental implant courses by Indian dental academy