Facial Bone

Anatomy &
Positioning
RTEC 233

Anterior Aspect of Facial

Bones

2 Maxillae

2 Zygomatic bones

2 Lacrimal bones

2 Nasal bones

2 Inferior nasal conchae

2 Palatine bones (not

visualized

1 vomer

1 mandible

Palatine Bones

L-shaped bones

Horizontal portion forms

posterior hard palate

Vertical portion extends

between 1maxillae and 1
pterygoid plate of
sphenoid bone
Articulates with 2 cranial
bones and 4 facial bones

Zygomatic Bones

Forms cheeks
Forms lower outer
margin of orbits
Articulates with 3
cranial bones

Frontal
Sphenoid
Temporal

Articulates with
maxillae

Inferior Nasal Cochae

The only pair of

conchae that are
separate facial bones

Articulates with 1
cranial bone and 3
facial bones

Covered with mucous

membranes to warm,
moisten and cleanse
inhaled air

Lacrimal Bones

About the size &

shape of a fingernail

Lacrimal foramen for

tear duct

Lie anteriorly on the

medial side of orbit

Can be seen on PA and

lateral projections

Articulates with 2
cranial bones and 2
facial bones

Nasal Bones

Fused and form

bridge of nose

Vary in size
considerably

The point of junction

with the frontal bone
is the nasion

Articulates with 2
cranial and 2 facial
bones

Vomer

Forms inferosuperior
part of nasal septum

Deviated nasal septum

Depressions for blood

vessels

Articulates with 2
cranial bones & 4
facial bones

Mandible

Only movable bone

in the skull

Densest & largest

facial bone

2 bones at birth

Contains mental
foramina

Pathologic Indications for

Facial Radiography

Fractures

Blowout
Tripod
LeFort
Coutrecoup

Foreign Body

Osteomyelitis

Neoplasms

Secondary
Osteomyelitis

TMJ Syndrome

Tri-pod Fracture

Blow out fracture

LeFort Fractures

FIG 3 - LeFort lines used for classifying fractures of the middle third of the face.

Hodgkinson, D W et al. BMJ 1994;308:46-50

Copyright 1994 BMJ Publishing Group Ltd.

Positioning: Lateral
Facial bones

Semiprone or seated

MSP parallel

IPL perpendicular

Suspend respiration

CR is perp and enters

lateral zygomatic
bone way between
outer canthus and
EAM.

Lateral Facial
Radiograph

All facial bones in with

zygomatic bone in
center

Almost SI mandibular
rami

SI orbital roofs (no tilt)

No rotation of sella
turcica

Anatomy Identity

Radiograph Anatomy

E) Anterior nasal spine

F) Alveolar process of
maxilla
G) Alveolar process of
mandible
H) Mentum
J) Body of mandible
K) Angle of mandib le
L) Ramus of mandible
M) Coronoid process
O) Neck of mandibular
condyle

P) Condyle or neck of
mandible
Q) EAM
R) Temporalmandibular
fossa of temporal bone
S) Greater wings of
sphenoid
T) Lesser wings of
sphenoid
U) Ethmoid sinuses
between orbits
V) Body of maxilla
containing maxillary
sinuses

Anatomy Identity

Lateral Skull Anatomy

A) zygomatic arch
B) RT zygomatic
bone
C) RT nasal bone
D) Frontal process of
maxilla
E) Anterior nasal
spine
F) Alveolar process
of maxilla
G) Alveolar process
of mandible
H) Mentum
I) Mental foramen

J) Body of mandible
K) Angle (gonion)
L) Ramus of
mandible
M) Coronoid process
N) Mandibular notch
O) Neck of
mandibular condyle
P) Condyle or head
of mandible
Q) EAM

Positioning: Waters

Prone or seated upright

Chin on bucky -OML 37

angle with plane of
cassette

MML & MSP perp

Nose 3/4 inch from IR

Suspend respiration

CR perpendicular to
exit acanthion

Waters Radiograph

Distance from
lateral border of
skull and orbit
equal on each side

Petrous ridges
projected
immediately below
maxillary sinuses

Trauma

Reverse Waters

Supine

Extend neck so OML

is 37 degree with
plane of IR

MML and MSP perp

Suspend respiration

CR perpendicular and
enters acanthion

Reverse Waters
Radiograph

Distance from
lateral border of
skull and orbit
equal on each side

Petrous ridges
projected
immediately below
maxillary sinuses

Modified Waters

OML 55 degree
angle from plane of
IR

MSP perp

CR perpendicular
and exits acanthion

Modified Waters
Radiograph

Petrous ridges
projected
immediately below
the inferior border
of the orbits

Equal distance
from lateral orbit
to lateral skull on
both sides

PA Axial - Caldwell

Prone or seated
upright

Forehead & nose

against grid device

OML perpendicular

CR 15 caudal to exit
nasion

Suspend respiration

PA Axial- Caldwell
Radiograph

Equal distance from

lat skull to lat orbit

Symmetric petrous
ridges in lower 1/3
orbit

Penetration of frontal
bone without
excessive density at
lateral borders of
skull.

Lateral Nasal Bones

Semiprone

MSP & IOML parallel

IPL perpendicular

CR perpendicular to
the bridge of nose at
a point 1 distal to
the nasion

Lateral Nasal bones

Radiograph

No rotation of nasal
bone and soft tissue

Anterior nasal
spine and
frontonasal suture
evident

Close collimation