SKULL

SKULL PLANES, POINTS & LINE

 Midsagittal plane (MSP) 11.) TMJ Syndrome
 Interpupillary line (IPL)  Dysfunction of the temporomandibular joint
 Acanthion
 Outer canthus A.) SKULL
 Infraorbital margin
 External acoustic meatus (EAM) PA PROJECTION
 Orbitalmeatal line (OML) PP: Prone; forehead & nose against IR; MSP &
OML perpendicular to IR
 Infraorbitomeatal line (IOML)/Frankpurt
RP: Nasion
Line
CR: Perpendicular
 Acanthiomeatal line (AML)
SS: Petrous pyramid completely filled the orbits;
 Mentomeatal line (MML)
frontal bone
 Between OML & IOML: 7o difference
 Between OML & GML: 8o difference
AP PROJECTION
PP: Supine; MSP & OML perpendicular to IR
PATHOLOGY
RP: Nasion
1. ) Basal Fx
CR: Perpendicular
 Fx located at the base of the skull SS: Same as PA, but the image is MAGNIFIED
2) Blowout Fx
 Fx of the floor of the orbit MODIFIED CALDWELL METHOD
3.) Contre-Coup Fx PA AXIAL PROJECTION
 Fx to one side of a structure caused by PP: Prone; forehead & nose against IR; OML
trauma to the other side perpendicular to IR; MSP perpendicular to IR
4.) Depressed Fx RP: Nasion
 Fx causing a portion of the skull to be CR: 15o caudad
depressed into the cranial cavity SS:
5.) Le Fort Fx -General Survey Examination:
 Bilateral horizontal fxs of the maxillae  Anterior & side walls of the cranium
6.) Linear Fx  Temporal fossae
 Irregular or jagged fx of the skull  Frontal sinuses & anterior ethmoid sinus
7.) Tripod Fx  Crista galli
 Fx of the zygomatic arch & orbital floor/rim  Upper 2/3 of orbits
& dislocation of the frontozygomatic suture  Petrous pyramid to lower 1/3 of orbit
8.) Mastoiditis -Superior orbital fissure/sphenoid fissure (20-25o
 Inflammation of mastoid antrum & air cells caudad) & foramen rotundum (25-30o caudad)
9.) Paget’s Disease
 Thick, soft bone marked by bowing fxs AP AXIAL PROJECTION
10.) Sinusitis PP: Supine; OML perpendicular to IR
 Inflammation of one or more of the RP: Nasion
paranasal sinuses CR: 15o cephalad
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SS: Same as PA axial but orbits are magnified & SS:

the distance b/n lateral margin of orbits & temporal -“SPDOP”
bones are less on AP than PA  Symmetric petrous pyramid
 Posterior portion of foramen magnum
TRUE/ORIGINAL CALDWELL  Dorsum sellae & posterior clinoid process
PP: Prone; forehead & nose against IR; GML w/in shadow of foramen magnum
perpendicular to IR; MSP perpendicular to IR  Occipital bone
RP: Nasion  Posterior portion of parietal bone
CR: 23o caudad -Tomographic studies of ears, facial canal, jugular
SS: Same as above foramina & rotundum foramina
-Entire foramen magnum jugular foramina (40-60o
LATERAL PROJECTION caudad to OML)
PP: Semiprone; MSP & IOML parallel to IR; IPL -Posterior portion of cranial vault (CR ┴ to midway
perpendicular to IR b/n frontal tuberosities)
RP: 2 in. Above EAM or midway b/n inion &
glabella TOWNE/ALTSCHUL/GRASHEY/CHAMBER
CR: Perpendicular LAINE METHOD
SS: AP AXIAL PROJECTION
-General survey examination PP: Lateral decubitus; OML/IOML & MSP
 Sella turcica perpendicular to IR
 Anterior & posterior clinoid processes, RP: 2.5-3 in. above glabella
 Dorsum sellae CR: 30o caudad (OML ┴); 37o caudad (IOML ┴)
 Superimposed mandibular rami SS: Same as above
 Mastoid region ER: For patient w/ pathologic condition, trauma or
 EAM & TMJ deformity (strongly accentuated dorsal kyphosis)

CROSSTABLE LATERAL HAAS METHOD

PP: Dorsal decubitus (Robinson, Meares & Goree PA AXIAL PROJECTION
recommendation); MSP perpendicular to IR PP: Prone; MSP & OML perpendicular to IR;
RP: 2 in. Above EAM forehead & nose against the table; IR center 1 in. to
CR: Horizontal nasion
ER: For traumatic sphenoid sinus effusion (basal RP: 1.5 in. below inion (entrance); 1.5 in. superior
skull fx) to nasion (exit)
CR: 25o cephalad to OML
TOWNE/ALTSCHUL/GRASHEY/CHAMBER SS:
LAINE METHOD  Occipital bone
AP AXIAL PROJECTION  Symmetric petrous pyramid
PP: Supine; OML/IOML & MSP perpendicular to  Dorsum sellae & posterior clinoid processes
IR; w/in shadow of foramen magnum
RP: 2.5-3 in. above glabella ER: For obtaining image of sellar structures (DS &
CR: 30o caudad (OML ┴); 37o caudad (IOML ┴) PCP) w/in FM on hypersthenic & obese patient
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SCHULLER/PFEIFFER METHOD LYSHOLM METHOD

SUBMENTOVERTICAL PROJECTION AXIOLATERAL METHOD
PP: Supine or Seated-upright (more comfortable); PP: Semiprone; MSP parallel to IR; IOML parallel
IOML parallel to IR; MSP perpendicular to IR; to transverse axis of IR; IPL perpendicular to IR
head rested on vertex; neck hyperextended RP: 1 in. distal to lower EAM (exit)
RP: ¾ in. anterior to EAM (sella turcica) CR: 30-35o caudad
CR: Perpendicular to IOML; MSP of throat b/n SS: Oblique position of lateral aspect of cranial
gonion (entrance) base closest to IR
SS: Cranial base ER: For patients who cannot extend their head
 Foramen ovale & spinosum (best enough for a satisfactory SMV projection
demonstrated)
 Symmetric petrosae VALDINI METHOD
 Mastoid processes PA AXIAL PROJECTION
 Carotid canals PP: Recumbent or seated-erect (more comfortable);
 Sphenoidal & ethmoidal sinuses upper frontal region of skull against IR; MSP
 Mandible perpendicular to IR; head acutely flexed; IOML
50o/OML 50o; line extending from inion to 0.5 cm
 Bony nasal septum
distal to nasion form 28o to CR
 Dens of axis
RP: 0.5 cm distal to nasion (dorsum sellae);
 Occipital bone
foramen magnum/slightly above level of EAM
 Maxillary sinus superimposed over the
(petrosae)
mandible
CR: Perpendicular; inion (entrance); 0.5 cm distal
 Zygomatic arches (well demonstrated if
to nasion (exit)
exposure factors are decreased)
SS:
 Axial tomography of orbits, optic canals,
 DILA (IOML 50o): Dorsum sellae; Internal
ethmoid bone, maxillary sinuses & mastoid
Auditory Meatus (IAM); LAbyrinth
processes
 ETB “EaT Bulaga” (OML 50o): External
auditory meatus; Tymphanic cavity; Bony
SCHULLER METHOD
part of Eustachian tube
VERTICOSUBMENTAL PROJECTION
 Dorsum sellae & posterior clinod processes
PP: Prone; chin fully hyperextended; MSP
within or above shadow of foramen magnum
perpendicular to IR
 Tubeculum sellae, anterior clinoid processes
RP: ¾ in. anterior to EAM (sella turcica)\
& sella turcica below shadow of foramen
CR: Perpendicular to IOML; MSP of throat b/n
magnum
gonion (entrance)
 Mastoid pneumatization
SS: Same as SMV
 Distorted & magnified basal structures
B.) SELLA TURCICA
 Useful for anterior cranial base &
sphenoidal sinuses
LATERAL PROJECTION
o IR in contact with the throat
PP: Semiprone; MSP & IOML parallel to IR; IPL
o Reduces magnification & distortion
perpendicular to IR
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RP: ¾ in. anterior & ¾ in. superior to EAM SS: Dorsum sellae, tuberculum sellae, anterior &
CR: Perpendicular posterior clinoid processes through frontal bone
SS: Superimposed anterior & posterior clinoid above ethmoidal sinuses
processes; dorsum sellae
C.) OPTIC CANAL/FORAMEN
TOWNE METHOD
PP: Supine; OML/IOML & MSP perpendicular to RHESE METHOD
IR; PARIETO-ORBITAL OBLIQUE
RP: 2.5-3 in. above glabella PROJECTION
CR: 30o caudad (OML ┴); 37o caudad (IOML ┴) PP: Prone; affected orbit closest to IR; zygoma,
SS: Sellar region nose & chin against IR (3-pt Lower Landing); AML
 Dorsum sellae, tuberculum sellae & anterior perpendicular to IR; MSP 53o angle to IR
clinoid processes through occipital bone RP: Affected orbit closest to IR
above shadow of foramen magnum (30o CR: Perpendicular
caudad) SS: Optic canal/foramen (inferior & lateral quadrant
 Dorsum sellae & posterior clinoid processes of orbital shadow)
w/in shadow of foramen magnum (37o  PAZAM: Prone; Affected orbit against IR;
caudad) Zynoch; AML ┴; MSP 53o to IR
 Symmetric petrous pyramid
RHESE METHOD
HAAS METHOD ORBITO-PARIETAL OBLIQUE
PA AXIAL PROJECTION PROJECTION
PP: Prone; MSP & OML perpendicular to IR; PP: Supine; affected orbit away from IR; AML
forehead & nose against the table; IR center 1 in. to perpendicular to IR; MSP 53o angle to IR
nasion RP: Inferior and lateral margin of uppermost orbit
RP: 1.5 in. below inion (entrance); 1.5 in. superior CR: Perpendicular
to nasion (exit) SS: Magnified optic canal/foramen
CR: 25o cephalad to OML  Increased radiation dose to lens of eye
SS:
 Dorsum sellae & posterior clinoid processes ALEXANDER METHOD
w/in shadow of foramen magnum ORBITO-PARIETAL OBLIQUE
 Symmetric petrous pyramid PROJECTION
ER: For obtaining image of sellar structures (DS & PP: Erect/supine; IR 15o angle from vertical; MSP
PCP) w/in FM on hypersthenic & obese patients 40o to IR; AML perpendicular to IR
RP: Inferior and lateral margin of uppermost orbit
PA PROJECTION CR: Perpendicular
PP: Prone; forehead & nose against IR; MSP & SS: Optic canal/foramen
OML perpendicular to IR
RP: Glabella
CR: 10o cephalad

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MODIFIED LYSHOLM METHOD  Well demonstrated at 15o caudal angle

ECCENTRIC ANGLE PARIETO-ORBITAL (Caldwell)
OBLIQUE PROJECTION  Petrous portions at or below the inferior
PP: Prone; forehead & nose against IR; IOML orbital margin
perpendicular to IR; MSP 20o from vertical;
RP: Affected orbit (exit) F.) INFERIOR ORBITAL FISSURES
CR: 20o caudad or 30o caudad
SS: Optic canal/foramen & anterior clinoid BERTEL METHOD
processes (20o); superior orbital fissure (30o) PA AXIAL PROJECTION
PP: Prone; forehead & nose against IR; IOML
D.) SPHENOID STRUT perpendicular to IR
-the inferior root of lesser wing of sphenoid RP: Nasion
bone- CR: 20-25o cephalad
SS: Inferior orbital fissures
HOUGH METHOD  b/n shadows of pterygoid process of
PARIETO-ORBITAL OBLIQUE sphenoid bone & mandibular ramus
PROJECTION  Anterior image of each orbital floor
PP: Prone; superciliary ridge/arch & side of the
nose against IR; IOML perpendicular to IR; MSP G.) EYE- FOREIGN BODY LOCALIZATION
20o from vertical; MSP 20o toward the side of
interest LATERAL PROJECTION
RP: Affected orbit (exit) PP: Semiprone; MSP parallel to IR; IPL
CR: 7o caudad perpendicular to IR; instruct patient to look straight
SS: Unobstructed & undistorted image of the ahead during exposure
sphenoid strut (lie b/n sphenoidal sinus & combined RP: Outer canthus
shadows of anterior clinoid processes & lesser wing CR: Perpendicular
of sphenoid bone) SS: Superimposed orbital roofs

E.) SUPERIOR ORBITAL/SPHENOID PA AXIAL PROJECTION

FISSURES PP: Prone; forehead & nose against IR; MSP &
OML perpendicular to IR; instruct patient to close
CALDWELL METHOD the eyes
PA AXIAL PROJECTION RP: Midorbits
PP: Prone; forehead & nose against IR; OML CR: 30o caudad
perpendicular to IR SS: Petrous pyramids lying below orbital shadows
RP: Nasion
CR: 20-25o caudad or 15o caudad MODIFIED WATERS METHOD
SS: Superior orbital fissures PARIETOACANTHIAL PROJECTION
 Lying on the medial side of orbits b/n PP: Prone; chin against IR; MSP perpendicular to
greater & lesser wings of sphenoid) IR; OML 50o to IR (new); OML 25-37o to IR (old);
instruct patient to close the eyes
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RP: Midorbits  CR perpendicular

CR: Perpendicular  CR 15-25o cephalad
SS: Petrous pyramids lying well below orbital
shadows PFEIFFER-COMBERG METHOD
 A leaded contact lens is placed directly over
VOGT-BONE-FREE POSITION the cornea
 Taken to detect small or low density foreign  Apparatus:
particles located in the anterior segment of o Contact lens localization device
the eyeball/eyelids o Pedestal type of film holder
 2 Projections: lateral & superoinferior  2 Projections:
 2 Movements: o Waters Method:
o Vertical: 2 exposures (for lateral)  CR horizontal
 Look up as far as possible o Lateral:
 Look down as far as possible  CR perpendicular
o Horizontal: 2 exposures (for
superoinferior) H.) FACIAL BONE
 Look to extreme right
 Look to extreme left LATERAL PROJECTION
PP: Semiprone; MSP & IOML parallel to IR; IPL
PARALLAX METHOD perpendicular to IR
 First described by Richards RP: Zygoma/malar bone
 It determines whether the foreign body is CR: Perpendicular
located within the eyeball requires no SS: Superimposed facial bones
special apparatus  Superimposed mandibular rami & orbital
 Not considered as precision localization roofs
procedure
 Widely used as preliminary check only WATERS METHOD
 2 Projections: PARIETO-ACANTHIAL PROJECTION
o Lateral: 2 exposures PP: Prone; MSP & MML perpendicular to IR;
OML 37o to IR; nose ¾ in. (1.9 cm) away from IR
o PA: 2 exposures RP: Acanthion (exit)
CR: Perpendicular
SWEET METHOD SS: Orbits, maxillae & zygomatic arches
 It determines the exact location of a foreign  Best projection for facial bones
body by use of a geometric calculations  Petrous ridges below the maxillae
 Apparatus:  Blow out fractures
o Sweet localizing device
o Sweet film pedestal MODIFIED WATERS
 1 Projection: PP: Prone; MSP & MML perpendicular to IR;
o Lateral: 2 exposures OML 55o to IR
RP: Acanthion (exit)
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CR: Perpendicular  Zygomatic bone

SS: Facial bones w/ less axial angulation  Anterior wall of maxillary sinus of side up
 Petrous ridges below the inferior border of
orbits I.) NASAL BONE

REVERSE WATERS METHOD LATERAL PROJECTION

AP AXIAL PROJECTION PP: Semiprone; MSP & IOML parallel to IR; IPL
PP: Supine; MSP & MML perpendicular to IR; perpendicular to IR
OML 37o to IR; chin up RP: ¾ in. (old) or ½ in. (new) distal to nasion
RP: Acanthion (exit) CR: Perpendicular
CR: Perpendicular SS: Nasal bones of side down & soft tissue
SS: Superior facial bones; same as True/Original structures
Waters, but the image is MAGNIFIED
ER: For patient who cannot be placed in the prone TANGENTIAL PROJECTION
position PP:
 Extraoral Film (Cassette): prone; chin rested
CALDWELL METHOD on sandbags; chin fully extended; MSP &
PA AXIAL PROJECTION GAL perpendicular to IR
PP: Prone; forehead & nose against IR; OML  Intraoral Film (Occlusal Film): supine; head
perpendicular to IR elevated; MSP perpendicular to sponge;
RP: Nasion GAL parallel to sponge & perpendicular to
CR: 15o caudad or 30o caudad (Exaggerated film
Caldwell) RP: Glabelloalveolar line
SS: Orbital rims, maxillae, nasal septum, zygomatic CR: Perpendicular
bones & anterior nasal spine SS: Nasal bones with minimal superimposition
 Petrous ridges at lower third of orbits (15o ER: For demonstration of any medial or lateral
caudad) displacement of fragments in fractures
 Petrous ridges below the inferior orbital Contraindications:
margins (30o caudad)  Children or adults who have very short nasal
 Orbital floors (30o caudad) bones, concave face or protruding upper
teeth
LAW METHOD
PA OBLIQUE AXIAL PROJECTION WATERS METHOD
PP: Semiprone; zygoma, nose & chin against IR; PARIETO-ACANTHIAL PROJECTION
unaffected side against IR; OML perpendicular to PP: Prone; MSP & MML perpendicular to IR;
IR; Center IR 2 in. above floor of maxillary sinuses OML 37o to IR; nose ¾ in. (1.9 cm) away from IR
RP: Lower antrum RP: Acanthion (exit)
CR: 25-30o cephalad; posterior to gonion (entrance) CR: Perpendicular
SS: Floor & posterior wall of maxillary sinus ER: Displacement of bony nasal septum &
(antrum) of side down depressed fx of nasal wings
 External orbital wall
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J.) ZYGOMATIC ARCHES SS: Bilateral symmetric zygomatic arches free of

superimposition
SCHULLER/PFEIFFER METHOD
SUBMENTOVERTICAL PROJECTION K.) MANDIBLE
PP: Supine or Seated-upright (more comfortable);
IOML parallel to IR; MSP perpendicular to IR; PA PROJECTION
head rested on vertex; neck hyperextended PP: Prone; forehead & nose against IR; OML &
RP: 1 in. posterior to outer canthi MSP perpendicular to IR
CR: Perpendicular to IOML; MSP of throat b/n RP: Acanthion (exit)
gonion (entrance) CR: Perpendicular
SS: Best demonstrates bilateral symmetric SS: Mandibular rami
zygomatic arches ER: To demonstrate any medial or lateral
displacement of fragments in fractures of the rami
MODIFIED TITTERINGTON METHOD
PA AXIAL (SUPEROINFIOR) PROJECTION PA AXIAL PROJECTION
PP: Prone; nose & chin against IR; MSP PP: Prone; forehead & nose against IR; OML &
perpendicular to IR MSP perpendicular to IR
RP: Vertex midway b/n zygomatic arches RP: Acanthion (exit)
CR: 23-38o caudad CR: 20 or 25o cephalad
SS: Well shown zygomatic arches SS: Condylar processes; mandibular rami
ER: To demonstrate any medial or lateral
MAY METHOD displacement of fragments in fractures of the rami
TANGENTIAL PROJECTION
PP: Prone/seated; neck fully extended; IOML PA PROJECTION
parallel to IR; MSP rotated 15o toward the side of PP: Prone; nose & chin against IR; AML & MSP
interest; head tilted 15o perpendicular to IR
RP: Zygomatic arch at 1.5 in. posterior to outer RP: Level of lips
canthus CR: Perpendicular
CR: Perpendicular to IOML SS: Mandibular body
SS: Zygomatic arch free of superimposition
ER: Useful with patients who have depressed PA AXIAL PROJECTION
fractures or flat cheekbones PP: Prone; nose & chin against IR; AML & MSP
perpendicular to IR; fill the mouth with air to
MODIFIED TOWNE METHOD obtained better contrast around TMJs (Zanelli
AP AXIAL PROJECTION recommendation)
JUG HANDLE VIEW RP: Midway b/n TMJs
PP: Supine; OML/IOML & MSP perpendicular to CR: 30o cephalad
IR; SS: Mandibular body; TMJs; condylar processes
RP: Glabella (1 in. above nasion)
CR: 30o caudad (OML ┴); 37o caudad (IOML ┴)

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AXIOLATERAL OBLIQUE PROJECTION PANORAMIC TOMOGRAHY/

PP: Seated/semiprone/semisupine; head in true
lateral & IPL perpendicular to IR (ramus); head
rotated 30o toward IR (body); head rotated 45o
toward IR (symphysis); head rotated 10-15o toward
IR (general survey); mouth closed; neck extended
(prevent superimposition of cervical spine)
RP: Mandibular region of interest
CR: 25o cephalad
SS: Mandibular body & TMJs
ER: To place the desired portion of the mandible
parallel with the IR
Muscular/Hypersthenic Patients: MSP 15o & CR
10o cephalad
 To reduce the possibility of projecting
shoulder over the mandible
PANTOMOGRAPHY/ROTATIONAL
TOMOGRAPHY
-technique employed to produced tomograms of
curved surfaces-
 Provides panoramic image of the entire
mandible, TMJ, dental arches
 Provides distortion-free lateral image of the
entire mandible
 Patients who sustained severe mandibular or
TMJ trauma
 Useful for general survey studies of dental
abnormalities
 Adjuvant for pre-bone marrow transplant
L.) TEMPOROMANDIBULAR JOINTS

SCHULLER/PFEIFFER METHOD TOWNE METHOD

SUBMENTOVERTICAL PROJECTION
PP: Supine or Seated-upright (more comfortable);
IOML parallel to IR; MSP perpendicular to IR;
head rested on vertex; neck hyperextended
RP: Midway b/n gonions
CR: Perpendicular to IOML
SS: Mandibular body; coronoid & condyloid
processes of rami
SCHULLER METHOD
VERTICOSUBMENTAL PROJECTION
PP: Prone; chin fully hyperextended; IR against
throat; MSP perpendicular to IR
RP: Level just posterior to outer canthi
CR: Perpendicular to IOML or occlusal plane
SS: Condyle & neck of condylar processes are
better shown (CR ┴ occlusal plane)
AP AXIAL PROJECTION
PP: Supine; MSP & OML perpendicular to IR
 Closed-mouth Position: posterior teeth in
contact not incisors
o Rationale: prevents mandibular
protrusion & condyles to be carried
out of mandibular fossae
 Opened-mouth Position: open as wide as
possible
o Mandible not protruded (jutted
forward)
o Not perform in trauma patients
RP: 3 in. above nasion
CR: 35o caudad
SS: Mandibular condyles & mandibular fossae of
temporal bones
 Closed-mouth: condyle lying in mandibular
fossa
 Opened-mouth: condyles lying inferior to
articular tubercle

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AXIOLATERAL PROJECTION SS: TMJ

PP: Semiprone; head in lateral position; IPL
perpendicular to IR; MSP parallel to IR; closed-
mouth & opened-mouth position
RP: 0.5 in. anterior & 2 in. superior to upside EAM
CR: 25-30o caudad
SS: TMJ anterior to EAM
 Closed-mouth: condyle lying in mandibular
fossa
 Opened-mouth: condyles lying inferior to
articular tubercle
SCHULLER METHOD
AXIOLATERAL OBLIQUE/LATERAL
TRANSCRANIAL/AXIAL TRANSCRANIAL
PROJECTION
PP: Semiprone; MSP rotated 15o toward the IR;
AML parallel to transverse axis of IR;
RP: 1.5 in. superior to upside EAM
CR: 15o caudad; TMJ of sidedown (exit)
SS: Condyles & neck of the mandible
 Closed-mouth: fracture of the neck &
condyle of ramus
 Opened-mouth: mandibular fossa; inferior &
anterior excursion of the condyle
ZANELLI METHOD
LATERAL TRANSFACIAL POSITION
PP: Lateral recumbent; head in true lateral; head
resting on parietal region; MSP 30o to IR
RP: Uppermost gonion (entrance)
CR: Perpendicular
SS: TMJ
M.) SINUSES
Cross & Flecker: pointed out the value of erect
position
 To demonstrate presence or absence of fluid
 To differentiate between shadows caused by
fluid & those caused by pathology
LATERAL PROJECTION
PP: Upright RAO/LAO or dorsal decubitus (can’t
assume upright); head in true lateral; MSP parallel
to IR; IPL perpendicular to IR; IOML parallel to
transverse axis of IR;
RP: 0.5-1 in. posterior to outer canthus
CR: Perpendicular
SS: All paranasal sinuses

INFEROSUPERIOR TRANSFACIAL PA PROJECTION

POSITION PP: Upright; forehead & nose against IR; MSP &
PP: Semiprone; head in true lateral; IPL 10-15o OML perpendicular to IR
from perpendicular; MSP 15o from IR RP: Nasion (┴); glabella (10o cephalad); midregion
RP: Uppermost gonion of maxillary sinuses (┴)
CR: 30o cephalad CR: Perpendicular; 10o cephalad; perpendicular
SS: TMJ SS:
 Posterior ethmoid sinuses inferior to cranial
ALBERS-SCHONBERG METHOD bones & superior to anterior ethmoid sinuses
LATERAL TRANSFACIAL POSITION (┴)
PP: Semiprone; head in true lateral; IPL  Sphenoidal sinuses through frontal bone &
perpendicular to IR; MSP parallel to IR; IOML superior to frontal & ethmoid sinuses
parallel to transverse axis of IR  Maxillary sinuses inferior to cranial base
RP: TMJ closes to IR (exit)
CR: 20o cephalad
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CALDWELL METHOD SCHULLER METHOD

PA AXIAL PROJECTION SUBMENTOVERTICAL PROJECTION
PP: Upright PP: Upright; IOML parallel to IR; MSP
 Angle grid technique: nose & forehead perpendicular to IR; head rested on vertex; neck
against IR; IR tilted 15o; MSP & OML hyperextended
perpendicular to IR RP: ¾ in. anterior to EAM (sella turcica)
 Vertical grip technique: nose against IR; CR: Perpendicular to IOML; MSP of throat b/n
OML 15o from IR; sponge b/n forehead & gonion (entrance)
IR; MSP perpendicular to IR SS: Sphenoidal & ethmoidal sinuses
RP: Nasion  Anterior portion of the base of the skull
CR: Horizontal
SS: Frontal sinuses & anterior ethmoidal sinuses SCHULLER METHOD
VERTICOSUBMENTAL PROJECTION
WATERS METHOD PP: Seated-erect; chin fully hyperextended; MSP
PARIETOACANTHIAL PROJECTION perpendicular to IR
PP: Upright; neck hyperextended & rested against RP: ¾ in. anterior to EAM (sella turcica)
IR; OML 37o to IR; MML perpendicular to IR CR: Perpendicular to IOML; MSP of throat b/n
RP: Acanthion gonion (entrance)
CR: Horizontal SS: Sphenoidal sinuses
SS: Maxillary sinuses  Posterior ethmoidal sinuses
 Petrous pyramids inferior to floor of  Maxillary sinuses
maxillary sinus  Nasal fossae
 Foramen rotundum
 Distorted frontal & ethmoidal sinuses PIRIE METHOD
AXIAL TRANSORAL POSITION
OPEN-MOUTH WATERS METHOD PP: Upright (prone; nose & chin against IR; mouth
PARIETOACANTHIAL PROJECTION wide open; MSP perpendicular to IR; phonate “ah”
PP: Upright; neck hyperextended & rested against during exposure
IR; OML 37o to IR; MML perpendicular to IR; RP: ¾ in. anterior to EAM (sella turcica)
mouth wide open CR: Perpendicular
RP: Acanthion SS: Sphenoidal sinuses projected through open
CR: Horizontal mouth
SS: Sphenoidal sinuses projected through open  Maxillary sinuses
mouth  Nasal fossae
 Petrous pyramids inferior to floor of
maxillary sinus RHESE METHOD
ER: For the patients who cannot be placed in PA OBLIQUE POSITION
position for SMV PP: Seated-erect; zygoma, nose & chin against IR;
AML perpendicular to IR; MSP 53o from IR
RP: Upper parietal region
CR: Perpendicular
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SS: Oblique image of posterior & anterior  Sigmoid sinus

ethmoidal sinuses  Lateral portion of pars petrosa
 Frontal & sphenoidal sinuses  Tegmen tymphani
 Profile image of the optic canal  Superimposed internal & external auditory
meatuses
LAW METHOD  Mastoid emissary vessel (when present)
PA OBLIQUE POSITION
PP: Seated-erect; zygoma, nose & chin against IR; MODIFIED HICKEY METHOD
neck fully extended AP TANGENTIAL POSITION
RP: Uppermost gonion PP: Supine; tape auricles forward; face rotated
CR: 25-30o cephalad away from side of interest; MSP 55o from IR or 35o
SS: Relationship of teeth to maxillary sinuses from vertical; IOML perpendicular to IR; IR
caudally inclined 15o
N.) MASTOID RP: 1 in. superior to tip of mastoid process
CR: 15o caudad
LAW METHOD SS: Mastoid process free of superimposition
AXIOLATERAL POSITION  Projected below the shadow of occipital
Double Angulation Method bone
PP: Prone; head in true lateral; tape auricle forward;
MSP & IOML parallel to IR; IPL perpendicular to PA TANGENTIAL POSITION
IR PP: Prone; IR cranially inclined 15o; tape auricles
RP: 2 in. posterior & 2 in. superior to uppermost forward; cheek against IR; face rotated away from
EAM side of interest; MSP 55o from IR or 35o from
CR: 15o caudad & 15o anterior vertical; IOML perpendicular to IR
Lange Recommendations: RP: 1 in. superior to tip of mastoid process
 25o caudad & 20o anterior CR: 15o cephalad
 Auricles taped forward SS: Mastoid process free of superimposition
Single Angulation Method  Projected below the shadow of occipital
PP: Prone; tape auricle forward; MSP rotated 15o bone
toward IR
RP: 2 in. posterior & 2 in. superior to uppermost TOWNE METHOD
EAM AP AXIAL PROJECTION
CR: 15o caudad PP: Supine; OML/IOML & MSP perpendicular to
Part Angulation Method IR;
PP: Prone; head rested on flat surface of cheek; RP: 2 in. above glabella or 2.5 in. above nasion
tape auricle forward; MSP rotated 15o towards IR; CR: 30o caudad (OML ┴); 37o caudad (IOML ┴)
IPL 15o from vertical SS:
RP: 2 in. posterior & 2 in. superior to uppermost  Internal auditory canals
EAM  Petrous portion of temporal bone
CR: ┴  Labyrinths
SS: Mastoid cells
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 Mastoid antrum  Labyrinths

 Middle ears  Mastoid antrum
 Dorsum sellae w/in foramen magnum  Middle ears
 Dorsum sellae w/in shadow of foramen
HENSCHEN, SCHULLER, & LYSHOLM magnum
METHODS
AXIOLATERAL POSITIONS HAAS METHOD
PP: Semiprone; head in true lateral; MSP parallel to PA AXIAL PROJECTION
IR; IPL perpendicular to IR; IOML parallel to PP: Prone; MSP & OML perpendicular to IR;
transverse axis of IR; auricles taped forward forehead & nose against the table; IR center 1 in. to
RP: Dependent EAM closest to IR nasion
CR: 15o caudad (Henschen/Cushing); 25o caudad RP: Nasion
(Schuller); 35o caudad (Lysholm/Runstrom II) CR: 25o cephalad
SS: Mastoid & petrous portion SS: Symmetric axial frontal image of petrous
 Mastoid cells, mastoid antrum, IAM & portions projected above the base of the skull
EAM & tegmen tympani (Henschen)  IAM
 Tumors of the acoustic nerve (Cushing)  Labyrinths
 Pneumatic structures of mastoid process,  Mastoid antrums
mastoid antrum, tegmen tympani, IAM &  Middle ears
EAM, sinus & dural plates & mastoid  Dorsum sellae & posterior clinoid processes
emissary when present (Schuller) w/in shadow of foramen magnum
 Mastoid cells, matoid antrum, IAM & EAM, ER: For patients who cannot assume AP axial
tegmen tympani, labyrinthine area & carotid position
canal (Lysholm/Runstrom II)
Runstrom Recommendation: VALDINI METHOD
 Exposure made with open mouth PA AXIAL PROJECTION
 For visualization of petrous apex between PP: Recumbent or seated-erect (more comfortable);
anterior wall of EAM & mandibular condyle upper frontal region of skull against IR; MSP
perpendicular to IR; head acutely flexed; IOML
O.) PETROUS PORTION 50o/OML 50o; line extending from inion to 0.5 cm
distal to nasion form 28o to CR
TOWNE METHOD RP: 0.5 cm distal to nasion (dorsum sellae);
AP AXIAL PROJECTION foramen magnum at or slightly above level of EAM
PP: Supine; OML/IOML & MSP perpendicular to (petrosae)
IR; CR: Perpendicular; inion (entrance); 0.5 cm distal
RP: MSP b/n EAMs to nasion (exit)
CR: 30o caudad (OML ┴); 37o caudad (IOML ┴) SS:
SS: Petrosae above base of the skull  DILA (IOML 50o): Dorsum sellae; Internal
 IAM Auditory Meatus (IAM); LAbyrinth
 Arcuate eminences

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 ETB “EaT Bulaga” (OML 50o): External  Mastoid antrum

auditory meatus; Tymphanic cavity; Bony Owen Modifications: cited by Pendergrass,
part of Eustachian tube Schaeffer & Hodes
 PP: MSP 40o to IR; IR & head angled 10o
SCHULLER/PFEIFFER METHOD caudally
SUBMENTOVERTICAL (SUBBASAL)  CR: 28o caudally
PROJECTION Owen Modifications: described by Etter & Cross
PP: Supine or Seated-upright (more comfortable);  PP: MSP 30o to IR
OML parallel to IR or CR perpendicular to OML  CR: 25-30o caudally
Owen Modifications: described by Compere
(cannot fully extend the neck) or supraorbitomeatal  PP: MSP 30-45o to IR
line (SOML) parallel to IR; MSP perpendicular to
IR; head rested on vertex; neck hyperextended  CR: 30o caudally
RP: ¾ in. anterior to EAM (sella turcica) Owen Modifications: used by Zizmor
CR: Perpendicular to OML at midway b/n EAMs or  PP: MSP 15o to IR
15-20o anteriorly at MSP of throat 1 in. anterior to
 CR: 35o caudally
EAMs
SS: Symmetric petrosae
STENVERS METHOD
 Mastoid processes
POSTERIOR PROFILE POSITION
 Labyrinths PP: Prone; forehead, nose & zygoma against IR (3-
 EAMs pt Upper Landing); IOML parallel to transverse axis
 Tympanic cavities of IR; face rotated away from side of interest; MSP
 Acoustic/auditory ossicles 45o to IR
Hirtz Method: RP: 1 in. anterior to EAM closest to IR (exit)
 RP: Midway b/n & 1 in. anterior to EAMs CR: 12o cephalad
 CR: 5o anteriorly SS: Pars petrosa closest to IR
 Petrous ridge
MAYER METHOD  Cellular structure of mastoid process
AXIOLATERAL OBLIQUE PROJECTION  Mastoid antrum
PP: Supine; auricles taped forward; outer side of IR  Area of tympanic cavity
elevated (reduces part-film distance); MSP 45o from  Labyrinth
IR; chin depressed; IOML parallel to IR
 IAM
RP: Dependent EAM
 Cellular structure of petrous apex
CR: 45o caudad
SS: Axial oblique of petrosa
ARCELIN METHOD
 Petrosa inferior to mastoid air cells
ANTERIOR PROFILE POSITION
 EAM REVERSE STENVERS METHOD
 Tympanic cavity & ossicles PP: Supine; IOML perpendicular to IR; face rotated
 Epitympanic recess (attic) away from side of interest; MSP 45o to IR
 Aditus

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RP: 1 in. anterior & ¾ in. superior to EAM closest

to IR (exit)
CR: 10o caudad
SS: Magnified pars petrosa away from IR
ER: Useful with children & with adults who cannot
be position for Stenvers Method

MODIFIED LAW METHOD

AXIOLATERAL POSITION
Single Angulation Method
PP: Prone; taped auricle forward; Head rotated 15o
toward IR; MSP 15o
RP: 2 in. posterior & 2 in. superior to uppermost
EAM
CR: 15o caudad
SS:
 Mastoid cells
 Lateral portion of pars petrosa
 Superimposed IAM & EAM
 Mastoid emissary vessel (when present)

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Bontrager Anatomy
8 cranial bones and 14 facial bones
Calvarium (skullcap)
Frontal, Parietals, Occipital
Floor
Temporals, Sphenoid, Ethmoid
FRONTAL BONE – articulates w/ parietals, sphenoid,
ethmoid (4)
1. Squamous/Vertical portion
Glabella – smooth raised prominence between eyebrows
SOG – slight depression above each eyebrow; floor of anterior
fossa of cranial vault (level of orbital plate or at highest level
of facial bone mass)
SOM – superior rim of each orbit
SON/SOF – small hole within SOM slightly medial to its
midpoint; SO nerve/artery passes
Frontal tuberosity/eminence – large rounded prominence
above SOG
2. Orbital/horizontal portion – SOMs, superciliary ridges,
glabella, frontal tuberosities
Orbital plate – forms superior orbit
Ethmoidal notch – separates each orbital plate; where ethmoid
bone fits
PARIETALS – lateral cranial wall and part of the roof; square,
concave internal surface; each articulates with FOTOp, S (5)
Parietal tubercles – widest portion of skull
OCCIPITAL – inferoposterior; articulates with PST, Atlas (6)
Squamous portion – external surface, rounded part; forms
most of the back of head
External occipital protuberance or inion – inferior to
squamous portion; prominent bump at the inferoposterior of
skull
Foramen magnum
Occipital condyles – lateral oval convex on each side of
foramen magnum; articulates with atlas forming atlanto-
occiptal joint
TEMPORALS – house organs of hearing and balance;
articulates with 3 cranial bones POS and 2 facial bones
Zygomatic process – anterior to squamous
Zygomatic arch – formed when zygoma process meets
temporal process of zygoma bone
TM fossa – inferior to zygoma process and anterior to EAM;
fits to form TMJ
Styloid process -inferior to mandible and anterior to EAM
3 parts:
Squamous – thin upper; most vulnerable portion of skull to
fracture
Mastoid – posterior to EAM; mastoid tip/process; air cells
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Petrous – petrous pyramid/pars petrosa; densest portion;
houses organ of hearing and equilibrium; petromastoid
portion; petrous ridge/apex (upper border of petrous pyramid)
Petrous ridge – level of TEA
Internal acoustic meatus – transmit nerves of hearing and
equilibrium; near center of petrous pyramid on posterior
surface superior to jugular foramen
SPHENOID – anchor of all eight cranial bones; articulates
with 7 other cranial; 5 facial PVZ
Body – central portion; midline of cranium floor; contains the
sphenoid sinus
Sella turcica – central depression of body; surrounds and
protects the hypophysis cerebri or pituitary gland
Dorsum sellae – posterior to sella
Clivus – shallow depression that begins in posteroinferior
aspect of dorsum and extends posteriorly to foramen magnum;
forms base support for pons and basilar artery
Lateral to body are two pairs of wings:
Lesser wings – superoanteriorly; smaller triangular nearly
horizontal ending medially to two anterior clinoid processes
Greater wings – lateral from sides of body; form a portion of
cranial floor and portion of cranial sides
Greater wings foramina:
Foramen rotundum, foramen ovale, foramen spinosum
Chiasmatic/optic groove – bet. anterior body and lesser wings;
leads to optic canal and ends at optic foramen (Rhese/PO
obliq)
Superior orbital fissure – slightly lateral and posterior to optic
foramen
Inferior surface of body contains four processes:
Lateral pterygoid processes/plates – more lateral flat
extensions
Medial pterygoid – medial which end inferiorly in small
hooklike processes called pterygoid hamuli
Pterygoid processes – form part of lateral walls of nasal
cavities
ETHMOID – below the floor; articulates with frontal and
sphenoid and 11 facial bones
Cribriform plate – small upper horizontal; contain small
openings thru w/c segmental branches of olfactory nerves pass
Crista galli – above cribriform plate; from rooster’s comb
Perpendicular plate – downline in midline; forms bony nasal
septum
Lateral labyrinths (masses) – suspended from undersurface of
cribriform plate on each side of perpendicular plate; contain
the ethmoid air cells and form the medial walls of orbits and
lateral walls of nasal cavity
Superior and middle nasal conchae – medial and downward
from medial wall of each labyrinth
JOINTS OF CRANIUM – SUTURES (fibrous, synarthrodial)
Adult Cranium
Coronal – frontal from parietal
Sagittal – parietal
Lambdoidal – occipital from parietal
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Squamosal – temporal from parietal
Bregma – anterior end of sagittal suture
Lambda – posterior end of sagittal suture
R&L pterions – point of junction between parietal, temporal
and greater wings of sphenoid
R&L asterions – point posterior to ear where squamosal and
lambdoidal sutures meet
Infant Cranium (6 fontanels)
Bregma and lambda in early life are not bony but are
membrane-covered openings or soft spots. These are termed
anterior and posterior fontanels.
INFANT ADULT
Anterior fontanel Bregma
Posterior fontanel Lambda
Right sphenoid fontanel Right pterion
Left sphenoid fontanel Left pterion
Right mastoid fontanel Right asterion
Left mastoid fontanel Left asterion
Sutural/wormian bones – small irregular bones that develop in
adult skull sutures sometimes; most in lambdoidal suture, also
in posterior fontanel; completely ossified in adult skull
ANATOMY OF ORGANS OF HEARING AND
EQUILIBRIUM (CT-MRI)
External Ear
Begins w/ Auricle/pinna – external is tragus
Tragus – small liplike anterior to EAM; partial shield to ear
opening
EAM – 2.5 cm; half is bony half is cartilaginous
Meatus narrows as it meets eardrum/tympanic membrane
Middle Ear
Irregularly shaped air containing cavity
3 parts: tympanic membrane, 3 auditory ossicles, tympanic
cavity
Tympanic membrane is considered part of middle ear.
2 parts of tympanic cavity:
Tympanic cavity proper – larger opposite to membrane
Attic/epitympanic recess – area above EAM level and eardrum
Drum crest/spur – separates EAM from recess; membrane is
attached to this structure
Tympanic cavity communicates anteriorly with nasopharynx
by eustachian tube or auditory tube
Eustachian tube – passage bet. middle ear and nasopharynx; 4
cm; equalize pressure
Mastoid air cells – second direct communication into middle
ear
Aditus – opening bet. epitympanic recess and mastoid portion
of temporal bone; connects with large portion of mastoid
termed antrum (connects to air cells)
Tegmen tympani – thin bone forming roof of antrum, aditus
and attic area
Auditory ossicles – MIS (malleus, incus, stapes)
Malleus – hammer; attached directly to inside of membrane
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Incus (central) – articulates with head of malleus; looks
premolar tooth w/ body and 2 roots in lateral
Stapes – stirrup; smallest; footplate is attached to oval window
which leads to inner ear
Internal Ear (lies w/in petrous pyramid)
2 main parts: osseous/bony labyrinth and membranous
labyrinth
Osseous houses the membranous (series of
intercommunicating ducts and sacs)
Endolymphatic duct – blind pouch/closed sac contained in
canal like bone
Osseous labyrinth – 3 parts: cochlea, vestibule, semicircular
canals
Cochlea is most anterior; round/cochlear window is at the base
of cochlea; vestibule (central portion) contains oval/vestibular
window
3 semicircular canals (superior, posterior, lateral) – posterior
to other inner ear structures
Semicircular canals relate to sense of direction/equilibrium
Cochlea relates to sense of hearing
2 openings covered by membranes:
Oval/vestibular window – receive vibrations from external ear
thru distal stapes to vestibule
Vestibule houses semicircular canals
Round/cochlear window – base of first coil of cochlea
As oval window moves slightly inward with vibration, the
round window moves outward because this is a closed system
and fluid does not compress
FACIAL BONES (14)
2 single bones; 6 pairs x 2 = 12
2 maxillae
2 zygomatic bones
2 lacrimal bones
2 nasal bones
2 inferior nasal conchae
2 palatine
1 vomer
1 mandible
Maxillae – largest immovable facial bones
Mandible – larger than maxillae but movable
Maxillae
Each assist in formation of 3 cavities of face: mouth, nasal
cavity, one orbit
Consists of body and 4 processes
Body – central lateral to nose
Frontal process – project upward along lateral nose toward
frontal bone
Zygomatic process – lateral to unite w/ zygoma
Alveolar process – inferior of body (8 upper teeth occur)
Anterior nasal spine – upper part of 2 maxillae union
Acanthion – point above anterior nasal spine
Frontal view: frontal, zygomatic, alveolar
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Maxillary sinus – large air-filled cavity contained by body of
each maxillary bone
Palatine processes (synarthrodial) – form anterior portion of
roof of mouth called the hard or bony plate; cleft palate
Palatine bones – horizontal; forms posterior of hard palate
Each maxilla articulates with 2 cranial bones (FE) and with 7
facial bones (zygoma, lacrimal, nasal, palatine, inferior nasal
concha, vomer, adjacent maxilla)
Zygomatic bones (malar bones)
Lateral to zygomatic process of maxilla
Zygomatic arch – posterior to zygoma connecting w/
zygomatic process of temporal; delicate, sometimes fractured
or caved in by cheek blow
Zygoma – zygomatic arch – zygomatic process of temporal
Zygomatic prominence – prominent of zygoma
Each zygoma articulates w/ 3 cranial bones (FST) and maxilla
Nasal and Lacrimal – thinnest; most fragile
Lacrimal – fingernail; anteriorly on medial side of orbit
posterior to frontal process of maxilla; from word “tear”
Nasal bones – form bridge of nose; lie anterior and
superomedial to the frontal process of maxillae and inferior to
frontal bone
Nasion – point of junction of 2 nasal bones w/ frontal bone
Each lacrimal articulates w/ FE cranial, maxillae, inferior
nasal concha
Each nasal articulates with FE cranial, maxillae, adjacent nasal
Inferior Nasal Conchae
2 platelike curved facial bones; lateral walls of nasal cavity
3 parts of nasal conchae: superior and middle parts of ethmoid
bone while inferior pair consists of separate facial bones
Each inferior nasal concha articulates w/ ethmoid and
maxillae, lacrimal, palatine
Palatines
Roughly L-shaped; vertical extends upward bet. maxilla and
pterygoid plate of sphenoid; horizontal make posterior portion
of hard palate
Each palatine articulates w/ SE and maxilla, inferior nasal
concha, vomer and adjacent palatine
Nasal Septum
Ethmoid and vomer forms the bony nasal bony septum
Septum formed superiorly by perpendicular plate of ethmoid
bone and inferiorly by vomer
Nasal bone is cartilaginous anteriorly and termed septal
cartilage
Vomer – plowshare
Thin triangular that forms inferoposterior part of septum
Surfaces are marked by small furrow-like depressions for
small vessels (nosebleed)
Mandible – largest facial; only movable jaw in skull; form
into 1 by 1 y/o
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Gonion – divides each half of mandible into 2 main parts:
anterior to angle is body while superior is ramus
Alveolar process
Symphysis menti – junction between 2 bodies anteriorly
Mental protuberance – flat triangular area below symphysis
Mental point – center of mental protuberance
Mental foramina – located on each half of body
Mandibular notch – U-shaped terminal portion of ramus
Coronoid process – anterior end of mandibular notch
Condyloid process – posterior end of mandibular notch
2 parts of condyloid:
Condyle/head – rounded end
Neck – constricted below condyle
Condyle of condyloid process fits into TM fossa of temporal
bone to form TMJ
SMV – horseshoe shape of mandible
TMJ – anterior and slightly superior to EAM
TMJ – synovial diarthrodial; bicondylar and plane
Alveoli and roots of teeth – fibrous synarthrodial; gomphosis
PNS
Maxillary (2)
Frontal (2)
Ethmoid (many)
Sphenoid (1 or 2)
Only the maxillary sinuses are part of facial bone. The other 3
are contained in respective cranial bones
MS – only exhibit define cavity at birth
FS, SS – 6 or 7 y/o
ES – develop last
MS – largest, paired; antrum/antrum of Highmore
Vertical dimension of 3-4 cm
FS – bet. inner and outer tables of skull posterior to
glabella; rarely become aerated before age 6
Rarely symmetric, separated by septum, maybe absent, paired
or single
ES – contained w/in lateral masses of ethmoid
Air cells are grouped into anterior, middle and posterior
collections intercommunicating each other
SS – below sella
Basal skull fracture – blood or CSF leaks thru fracture to SS, a
condition termed sphenoid effusion
Osteomeatal Complex
Drainage bet. frontal, maxillary and ethmoid sinuses
MS – infundibulum – middle nasal meatus – inferior nasal
meatus
Uncinate process of ethmoid makes medial wall of
infundibulum passage.
Ethmoid bulla – receives drainage from frontal and ethmoid
sinus cells – middle nasal meatus – inferior – exterior nasal
orifice
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Orbits
Base – rim of orbit; outer circular portion of cone
Apex – optic foramen; posterior portion of cone
When head is placed in frontal with OML parallel to floor,
orbit would project superiorly at an angle of 30 0 and toward
MSP at 370
Circumference of orbit is composed of frontal bone, maxilla
and zygoma
Base of orbit – frontal, zygoma, maxilla
Medial – lacrimal
Posterior – sphenoid, ethmoid, palatine (innermost)
Orbit – 3 cranial (FES), 4 facial (MZLP)
3 openings of posterior orbit:
Optic foramen – small hole in sphenoid bone; optic nerve w/c
is continuation of retina
Superior orbital fissure – bet. greater and lesser wings of
sphenoid lateral to optic foramen; CN III to VI for eye and
eyelid
Inferior orbital fissure – bet. maxilla, zygomatic bone and
greater wing of sphenoid; CN V
Sphenoid strut – small root of bone separating SOF from optic
canal
Optic canal is a small canal into which optic foramen opens.

Skull Morphology
Mesocephalic – 15 cm bet. parietal eminence (lateral); 19 cm
AP; 23 cm from vertex to beneath chin (SMV); width is 75-
80% of length; petrous pyramids form an angle of 470

Brachycephalic – short broad head; width is 80% or greater

than length; petrous pyramids form an angle greater than 47 0
(54)

Dolicocephalic – long narrow head; width is less than 75% of

length

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