I Maxillofacial Imaging T.A. Larheim · P.-L.Westesson III T.A. Larheim P.-L.Westesson Maxillofacial Imaging With 425 Figures (approx. 1450 Illustrations) 123 IV ISBN 10 3-540-25423-4 Library of Congress Control Number: 2005923311 ISBN 13 978-3-540-25423-2 Springer Berlin Heidelberg NewYork This work is subject to copyright. All rights are reserved, whether the whole or part of the material is concerned, specif- ically the rights of translation,reprinting,reuse of illustrations, recitation, broadcasting, reproduction on microfilm or in any other way, and storage in data banks. Duplication of this pub- lication or parts thereof is permitted only under the provisions of the German Copyright Law of September 9, 1965, in its cur- rent version, and permission for use must always be obtained from Springer. Violations are liable for prosecution under the German Copyright Law. 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Editor: Dr. Ute Heilmann, Heidelberg Desk editor: Dörthe Mennecke-Bühler, Heidelberg Production editor: LE-TeX Jelonek, Schmidt & Vöckler GbR, Leipzig Cover design: F.Steinen, eStudio Calamar, Spain Reproduction and Typesetting: AM-productions GmbH, Wiesloch Printing and bookbinding: Stürtz AG, Würzburg 21/3150 – 5 43210 Printed on acid-free paper To our wives Sigrid and Ann-Margret And our children Tor Eirik and Arnstein and Karin, Oscar and Nils Besides the fascinating field of radiology, you mean everything to us. VII Preface There are substantial textbooks on head and neck imaging as well as on dental imaging, but since the early 1990s there has been no book focusing on the gap between imaging in dentistry and in medicine, namely maxillofacial imaging. Emanating from den- tistry, maxillofacial radiology uses principles and techniques from medical radiology. There has been significant advance in imaging technology during the last 15 years, and this maxillofacial imaging book demonstrates how advanced medical imaging tech- nology can be successfully applied to dental and maxillofacial conditions. Dental radiology is mainly based on intraoral and panoramic examinations with an ongoing replace- ment of plain films with their digital counterparts. Dr. Westesson (left) and Dr. Larheim (right) relaxing Medical radiology, on the other hand, is moving away after finishing the book from projectional radiography and is using more and more cross-sectional imaging modalities such as computed tomography (CT), magnetic resonance the foundation for building a formal curriculum in (MR) imaging, ultrasound, and positron emission to- maxillofacial radiology. mography (PET). These contemporary and advanced The book is divided into 14 chapters starting with techniques have not been widely applied to maxillo- a quite comprehensive chapter on normal imaging facial imaging and the purpose of this extensively anatomy of the maxillofacial structures followed by illustrated book is to show how advanced imaging four chapters on advanced imaging of conditions of modalities, primarily CT and MRI, can be applied to dental or non-dental etiology, affecting the mandible maxillofacial imaging. and maxilla. When dentists get more and more in- We have built this book around the images rather volved in imaging of maxillofacial soft tissues, than an extensive text since we think others are like knowledge of both hard and soft tissues becomes us – we like to see the images and read the text only if mandatory. Although the majority of patients with necessary. Thus, the book is atlas-like with a con- jaw problems are diagnosed with intraoral and densed and bulleted text. With all images of the pa- panoramic (film or digital) examinations, advanced tient on one or two pages, the reader will very quick- imaging has become necessary for a reliable diagnos- ly obtain an image overview of the specific condition. tic assessment of a number of conditions. The sixth Demonstrating the use of advanced imaging tech- chapter is on the temporomandibular joint. This is niques in dentistry is particularly important since valuable for professionals in both medicine and den- maxillofacial radiology has been accepted as a spe- tistry since many patients with facial pain seek any cialty of dentistry in several countries and the inter- doctor who gives hope of being able to help them ir- national trend is a closer cooperation between pro- respective of training background and subspecialty. fessionals in dentistry and medicine to provide the The four following chapters focus on dental implants, best patient care. During the writing of this book it maxillofacial trauma and fractures, face and skull has evolved into a rather comprehensive description deformities, and paranasal sinuses. These regions of maxillofacial imaging and could easily be used as are closely related to the jaw and many conditions VIII Preface involve both the dental structures proper and the and interventional neuroradiology at the University adjacent regions. of Rochester. Their combined experience is reflected The following two chapters cover soft-tissue imag- in this current book on maxillofacial imaging. ing of the oral cavity and salivary glands. These are Dr. Larheim completed this work during a sabbat- important topics, since traditional dental and max- ical stay at the University of Rochester Medical Cen- illofacial imaging has been limited to evaluation of ter, Division of Diagnostic and Interventional Neuro- the hard tissue. In chapter 13 we have focused on radiology, and is highly grateful for the support he imaging abnormalities of structures adjacent to the got from the Faculty of Dentistry, University of Oslo, maxillofacial region, namely the cervical spine, neck, Norway and the Research Council of Norway. With- skull base, and orbit. It is not our intention to in- out this support the book would never have been corporate these areas into maxillofacial radiology, accomplished. but we think it is important that the maxillofacial We would like to express our sincere gratitude to radiologist has a working understanding of what our collaborators (in alphabetical order) Drs.Susan I. there is in the areas neighboring the maxillofacial Blaser, Naoya Kakimoto, Alf Kolbenstvedt, Masaki region. At the end we have included a chapter on Oka, Ravinder Sidhu, Hans-Jørgen Smith, Hanna interventional maxillofacial radiology.Interventional Strømme-Koppang and Geir Støre, for the fruitful radiology is the fastest growing area of general med- discussion of the text and contribution of good qual- ical radiology,but has not been extensively applied to ity images. A special thanks goes to Dr. Kakimoto for maxillofacial imaging. Our intention in this chapter his hard work in obtaining the best possible image is to show how minimally invasive interventional quality throughout the book. radiologic techniques can be successfully used for We thank Dr. Sven Ekholm at the University of maxillofacial conditions. Rochester Medical Center and Drs. Linda Arvidsson, This book is an attribute to the early work of Dr. Bjørn Mork Knutsen and medical radiographer Karl-Åke Omnell, who was the pioneer of maxillo- Magne Borge at the Institute of Clinical Dentistry, facial radiology. Already in the late 1960’s Dr. Omnell University of Oslo, for supplying us with images had the vision of centralized advanced maxillofacial when we were in need, as well as all others from imaging as a specialty of dentistry working closely whom we borrowed their images; they are acknowl- with medical radiology. Dr. Omnell initiated the first edged in the legends. hospital-based clinic for maxillofacial radiology in The secretarial work of Bjørg Jacobsen, Institute Sweden and he promoted the recognition of oral and of Clinical Dentistry, University of Oslo, Norway, and maxillofacial radiology as a specialty of dentistry.His Regina Cullen and Belinda De Libero, University of pioneer work has later been followed by many.We are Rochester Medical Center, Rochester, NY is highly proud to present this contemporary book on maxillo- appreciated with special thanks to Bjørg reviewing facial imaging as an attribute to his pioneer work. the reference lists. This book has evolved from a friendship of more We are grateful to graphic designer Margaret than 25 years and professional cooperation between Kowaluk, University of Rochester Medical Center, Drs. Larheim and Westesson. It started around 1980 Rochester, NY and photographer Håkon Størmer, when Dr. Larheim from the dental school in Oslo, Faculty of Dentistry, University of Oslo, for profes- Norway, crossed the border to the neighboring coun- sional work with the scanning of many images and try, Sweden, and visited Dr. Westesson at the dental obtaining some of the photos. school in Malmö to observe the performance of Editor Ute Heilman,desk editor Dörthe Mennecke- double-contrast arthrotomography of the temporo- Bühler at the Springer, as well as production editor mandibular joint.Both have been working as maxillo- Michael Reinfarth