Skull XRay

Aka: Skull XRay

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II. Indications (rarely used; replaced by CT Head)

  1. Penetrating Head Injury
  2. CT Head indicated for Skull Fracture evaluation but not available

III. Views

  1. See Sinus XRay
  2. General
    1. Sinuses normally appear black on XRay (air density)
    2. Opacification or fluid will appear white (fluid density)
  3. Maxillary Sinus: Waters' View (Occipitomental XRay)
    1. Maxillary Sinus visualization
      1. Water's view alone is usually sufficient for sinus imaging
    2. May identify Fractures (orbital rim, orbital floor, nasal septum and nasal bones)
  4. Frontal Sinus: Caldwell-Luc
    1. Frontal View (PA) with the patient's face against the film
    2. Best visualizes Frontal Sinus (other sinuses overlap one another on this view)
    3. Visualizes Fractures of the orbital rim and the medial orbital wall
    4. Visualizes sagital Suture
    5. Visualizes Zygomatic Bones, nasal bones, nasal septum and Mandible
  5. Lateral XRay
    1. Visualizes ethmoid and Sphenoid Sinuses with the patient seen in profile
    2. Visualizes coronal Suture and lambdoid Suture
    3. Visualizes Mandible and nasal bone

IV. Findings

  1. Linear or depressed Skull Fracture
    1. Contrast with normal skull sinus lines which have more sinusoidal curves
  2. Orbital Blow Out Fracture
    1. Increased intraorbital pressure (e.g. direct blow) results in Fracture
      1. Orbital floor Fracture (most common)
      2. Medial Orbital Fracture
    2. Best seen on Waters View and Caldwell-Luc View
      1. Bony fragments in the Maxillary Sinus
      2. Sinus air fluid levels (Maxillary Sinus, Ethmoid Sinus)
  3. Zygomatic Arch Fracture
    1. Simple zygomatic Fracture
      1. Results from direct blow to the zygomatic arch
      2. Best seen on Waters View and Caldwell-Luc View
    2. Tripod zygomatic Fracture
      1. Complicated three part Fracture resulting in a free-floating zygomatic arch
      2. Involves zygomatic arch and two Sutures (frontozygomatic, maxillozygomatic)
  4. Nasal Fracture
    1. Nasal Bone Fracture
    2. Fracture of the nasal septum is often associated
  5. Le Fort Fracture
    1. Le Fort Fracture 1
      1. Horizontal Fracture between the teeth and the Palate
    2. Le Fort Fracture 2
      1. Pyramidal Fracture from the the mid-Maxillary Sinus, through the inferior orbital rim to the Nasal Bridge
    3. Le Fort Fracture 3
      1. Fracture separates the face from the rest of the skull
      2. Vertical Fracture through the Maxillary Sinus lateral aspect and horizontal through the orbits
      3. Fracture includes the medial and lateral orbital walls
  6. Mandible Fracture
    1. Fracture at the Mandible body, angle or Mandible neck

V. Findings: Other

  1. Air-fluid levels in the sinuses
  2. Pneumocephalus
  3. Foreign bodies
  4. Midline position of pineal gland (if calcified)

VI. References

  1. Ouellette and Tetreault (2015) Clinical Radiology, Medmaster, Miami, p. 55-6

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