{"id":1142,"date":"2014-05-01T16:46:37","date_gmt":"2014-05-01T16:46:37","guid":{"rendered":"http:\/\/phosdev.com\/todaysveterinarypractice\/?p=1142"},"modified":"2022-02-16T16:00:42","modified_gmt":"2022-02-16T16:00:42","slug":"imaging-essentials-radiography-of-the-small-animal-skull-temporomandibular-joints-tympanic-bullae-2","status":"publish","type":"post","link":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/radiology-imaging\/imaging-essentials-radiography-of-the-small-animal-skull-temporomandibular-joints-tympanic-bullae-2\/","title":{"rendered":"Radiography of the Small Animal Skull: Temporomandibular Joints &amp; Tympanic Bullae"},"content":{"rendered":"<p><strong>Imaging Essentials<\/strong> provides comprehensive information on small animal radiography techniques. The following anatomic areas have been addressed in previous columns; these articles are available at <strong>tvpjournal.com<\/strong> (search &#8220;Imaging Essentials&#8221;).<\/p>\n<ul>\n<li>Thorax<\/li>\n<li>Elbow and antebrachium<\/li>\n<li>Abdomen<\/li>\n<li>Carpus and manus<\/li>\n<li>Pelvis<\/li>\n<li>Tarsus and pes<\/li>\n<li>Stifle joint and crus<\/li>\n<li>Cervical, thoracic, and lumbar spine<\/li>\n<li>Scapula, shoulder, and humerus<\/li>\n<li>Nasofacial and frontal sinuses<\/li>\n<\/ul>\n<hr \/>\n<div class=\"orange-box\">\n<p>The anatomy of the skull, temporomandibular joints (TMJ), and region of the tympanic bullae in the dog and cat is complex because of superimposition of cavities, sinuses, mandible, maxilla, dental arcades, and neurocalvarium. Radiography of specific areas requires close attention to the details of normal anatomy that will aid in proper positioning for each image, based on the type of study being done.<\/p>\n<\/div>\n<p class=\"indent-125\"><span class=\"x07-helvetica-9-5-pt\">I<\/span><span class=\"garamond-9-5\">mproperly positioned radiographs can lead to anatomic distortion of the skull anatomy, resulting in potential false positive diagnoses.<\/span><\/p>\n<h2 class=\"left-justified\"><span class=\"font_purple\">RADIOGRAPHIC EXPOSURE<\/span><\/h2>\n<p class=\"left-justified\"><span class=\"garamond-9-5\">Exposures should be made using:\u00a0<\/span><\/p>\n<ul>\n<li class=\"purple-bullets-black-text-\"><span class=\"garamond-9-5\"><strong>High mAs<\/strong>: Lowest mA that, if there is an option, allows use of a small focal spot in order to improve geometric sharpness and, thus, ability to see fine osseous detail.\u00a0<\/span><\/li>\n<li class=\"purple-bullets-black-text-\"><span class=\"garamond-9-5\"><strong>Grids<\/strong>: Use if areas thicker than 10 cm are being imaged; otherwise, tabletop technique is recommended.<\/span><\/li>\n<\/ul>\n<div class=\"orange-box\">\n<h3><span class=\"font_purple\">The Need for Anesthesia<\/span><\/h3>\n<p>Although some basic skull views may be obtained with heavy sedation, general anesthesia is required to obtain diagnostic skull radiographs for several reasons:<\/p>\n<ul>\n<li>During each imaging series of the skull, one of the projections requires the mouth of the dog or cat to be open when an exposure is made.<\/li>\n<li>The oblique and skyline projections require exact positioning that is not possible in an awake dog or cat, even if heavily sedated.<\/li>\n<\/ul>\n<\/div>\n<p class=\"left-justified\"><strong><span class=\"navyblueheader\">Routine Projections:<br \/>\nSkull, TMJ, &amp; Tympanic Bullae<\/span><\/strong><\/p>\n<h2 class=\"left-justified\"><span class=\"font_purple\">LATERAL PROJECTION (<strong>Figure 1<\/strong>)<\/span><\/h2>\n<p class=\"left-justified\"><a href=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2014\/05\/Screen-Shot-2015-06-18-at-10.36.14-AM.png\"><img fetchpriority=\"high\" decoding=\"async\" class=\"alignnone wp-image-4705 size-medium\" src=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2014\/05\/Screen-Shot-2015-06-18-at-10.36.14-AM-290x300.png\" alt=\"Screen Shot 2015-06-18 at 10.36.14 AM\" width=\"290\" height=\"300\" srcset=\"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2014\/05\/Screen-Shot-2015-06-18-at-10.36.14-AM-290x300.png 290w, https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2014\/05\/Screen-Shot-2015-06-18-at-10.36.14-AM.png 576w\" sizes=\"(max-width: 290px) 100vw, 290px\" \/><\/a><\/p>\n<h3 class=\"left-justified\"><span class=\"bold\">Positioning<\/span><\/h3>\n<ol class=\"list1\">\n<li class=\"purple-numbers\"><span class=\"purple-40-40-0-10-\">For the right lateral projection, place the patient in right lateral recumbency, with the nose and skull in an extended position.<\/span><\/li>\n<li class=\"purple-numbers\"><span class=\"purple-40-40-0-10-\">In dolichocephalic and mesaticephalic dog breeds, place a small rectangular sponge under the tip of the nose to keep it parallel with the table. For brachycephalic dog breeds and cats, use a 45-degree oblique sponge (wide end away from the head).<\/span><\/li>\n<li class=\"purple-numbers\"><span class=\"purple-40-40-0-10-\">Place the cervical spine, thoracic limbs, and thorax in a lateral straight position relative to the skull.<\/span><\/li>\n<li class=\"purple-numbers\"><span class=\"purple-40-40-0-10-\">Pull the thoracic limbs caudally.<\/span><\/li>\n<\/ol>\n<p class=\"left-justified\"><span class=\"garamond-9-5\">To ensure the patient is straight in a lateral position:<\/span><\/p>\n<ul>\n<li class=\"purple-bullets-black-text-\"><span class=\"garamond-9-5\">Place your hand along the ventral mandibles, positioning your hand perpendicular to the table and the mandibles.<\/span><\/li>\n<li class=\"purple-bullets-black-text-\"><span class=\"garamond-9-5\">Feel for the external occipital protuberance along the caudodorsal margin of the skull (not as prominent in brachycephalic breeds).<\/span><\/li>\n<li class=\"purple-bullets-black-text-\"><span class=\"garamond-9-5\">Compare the relative level with the middorsal aspect of the nasal cavity; this imaginary line should be parallel to the table.<\/span><\/li>\n<\/ul>\n<h3 class=\"left-justified\"><span class=\"helvetica-bold\"><strong>Collimation<\/strong><\/span><\/h3>\n<ol class=\"list1\">\n<li class=\"purple-numbers\"><span class=\"purple-40-40-0-10-\">Set the central beam to the mid cranium, with the collimator opened to just include the cranium and nasal cavity (cross hairs just caudal and ventral to the eyes).<\/span><\/li>\n<li class=\"purple-numbers\"><span class=\"purple-40-40-0-10-\">Place an external radiopaque marker ventral to the caudal mandible on the table or radiographic cassette.<\/span><\/li>\n<li class=\"purple-numbers\"><span class=\"purple-40-40-0-10-\">If the area of interest is lateralized to one side, place the side of interest closest to the detector, in which case, the marker indicates which recumbency the patient has been placed.<\/span><\/li>\n<li class=\"purple-numbers\"><span class=\"purple-40-40-0-10-\">If the area of interest is at the level of the maxilla or mandible, the upper and lower jaw can be separated (opened) by placing a syringe case between the mandibular and maxillary canines.<\/span><\/li>\n<\/ol>\n<h3 class=\"left-justified\"><span class=\"helvetica-bold\"><strong>Ensuring Image Quality<\/strong><\/span><\/h3>\n<p class=\"left-justified\"><span class=\"garamond-9-5\">The lateral projection of the skull should extend from the rostral end of the nose (nasal planum) through the first cervical vertebra (C1). The wings of the atlas and C1 should be even and superimposed, and all aspects of the skull should be superimposed, such as the zygomatic arches, mandibles, and tympanic bullae.\u00a0<\/span><\/p>\n<p class=\"left-justified\"><span class=\"garamond-9-5\">Superimposition is more difficult in brachycephalic breeds because their skulls are much wider\u2014geometric distortion from the divergent nature of the x-ray beam may make superimposition of all structures impossible.\u00a0<\/span><\/p>\n<h2 class=\"left-justified\"><span class=\"font_purple\">VENTRODORSAL\/DORSOVENTRAL PROJECTION (Figure 2)\u00a0<\/span><\/h2>\n<p class=\"indent-125\"><span class=\"garamond-9-5\">Ventrodorsal (VD) or dorsoventral (DV) positioning is dependent on the breed of dog or cat; while deep-chested dogs are better imaged in VD position, brachycephalic and small breed dogs and cats may be better imaged in a DV position.\u00a0<\/span><\/p>\n<p class=\"indent-125\"><span class=\"garamond-9-5\">The area of interest should be as close to the film\/cassette\/detector as possible for the best overall detail and to reduce geometric magnification. The radiograph should be reviewed to ensure that the right and left sides of the skull are symmetrical for evaluation.<\/span><\/p>\n<p class=\"indent-125\"><a href=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2014\/05\/Screen-Shot-2015-06-18-at-10.38.32-AM.png\"><img decoding=\"async\" class=\"alignnone wp-image-4706 size-figure_img\" src=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2014\/05\/Screen-Shot-2015-06-18-at-10.38.32-AM-378x300.png\" alt=\"Screen Shot 2015-06-18 at 10.38.32 AM\" width=\"378\" height=\"300\" \/><\/a><\/p>\n<h3 class=\"left-justified\"><span class=\"helvetica-bold\"><strong>Positioning<\/strong><\/span><\/h3>\n<p class=\"left-justified\"><span class=\"garamond-9-5\">To obtain the VD projection:<\/span><\/p>\n<ol class=\"list1\">\n<li class=\"purple-numbers\"><span class=\"garamond-9-5\">Place the patient in dorsal recumbency.<\/span><\/li>\n<li class=\"purple-numbers\"><span class=\"garamond-9-5\">Extend the skull, with the external occipital protuberance resting on a thin sponge.<\/span><\/li>\n<li class=\"purple-numbers\"><span class=\"garamond-9-5\">Ensure the ventral aspect of the mandibles and the hard palate, which cannot be visualized because the animal\u2019s mouth is closed, are parallel to the table.<\/span><\/li>\n<li class=\"purple-numbers\"><span class=\"garamond-9-5\">Use a V-trough to help maintain the patient in a straight position.<\/span><\/li>\n<\/ol>\n<p class=\"left-justified\"><span class=\"garamond-9-5\">To obtain the DV projection:<\/span><\/p>\n<ol class=\"list1\">\n<li class=\"purple-numbers\"><span class=\"garamond-9-5\">Place the patient in ventral or sternal recumbency.<\/span><\/li>\n<li class=\"purple-numbers\"><span class=\"garamond-9-5\">Extend the skull, with the mandibular rami placed on the table\/cassette\/detector.<\/span><\/li>\n<li class=\"purple-numbers\"><span class=\"garamond-9-5\">To ensure stabilization, place a thin radiolucent sponge between the patient\u2019s ventral skull and the table\/cassette\/detector, as needed.<\/span><\/li>\n<\/ol>\n<p class=\"indent-125\"><span class=\"garamond-9-5\">To ensure the patient is properly positioned, place your hands:<\/span><\/p>\n<ul>\n<li class=\"purple-bullets-black-text-\"><span class=\"garamond-9-5\">On either side of the skull, feeling for the symmetry of the mandible and\/or zygomatic arches.<\/span><\/li>\n<li class=\"purple-bullets-black-text-\"><span class=\"garamond-9-5\">Relative to either anatomic location to be equidistant from the table on the right and left sides.<\/span><\/li>\n<\/ul>\n<h3 class=\"left-justified\"><span class=\"helvetica-bold\"><strong>Collimation<\/strong><\/span><\/h3>\n<ol class=\"list1\">\n<li class=\"purple-numbers\"><span class=\"garamond-9-5\">Set the central beam to the level of the caudal zygomatic arch (at a level just caudal to the eyes) with the collimator opened to include C1\/C2, the neurocranium, and the caudal portion of the nasal cavity (approximate level of maxillary premolar 3).<\/span><\/li>\n<li class=\"purple-numbers\"><span class=\"garamond-9-5\">Place the radiopaque marker on the right side of the dog or cat, taking care to avoid superimposition of the marker over any part of the skull.<\/span><\/li>\n<\/ol>\n<h3 class=\"left-justified\"><span class=\"helvetica-bold\"><strong>Ensuring Image Quality<\/strong><\/span><\/h3>\n<p class=\"indent-125\"><span class=\"garamond-9-5\">For VD or DV images of the skull, the rostral extent of the image should be the nasal planum, while the caudal extent is C1. Make sure the various parts of the skull are symmetrically positioned right and left, and not obliqued. This may be impossible in patients that have skull trauma with multiple fractures.<\/span><\/p>\n<p class=\"navyblueheader\"><strong>Specific Projections: TMJ &amp; Tympanic Bullae<\/strong><\/p>\n<h2 class=\"font_purple\">OPEN-MOUTH ROSTROCAUDAL OBLIQUE PROJECTION (Figure 3)<\/h2>\n<h3 class=\"left-justified\"><a href=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2014\/05\/IE-fig-3.png\"><img decoding=\"async\" class=\"alignnone wp-image-8608 size-medium\" src=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2014\/05\/IE-fig-3-283x300.png\" alt=\"IE fig 3\" width=\"283\" height=\"300\" srcset=\"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2014\/05\/IE-fig-3-283x300.png 283w, https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2014\/05\/IE-fig-3.png 580w\" sizes=\"(max-width: 283px) 100vw, 283px\" \/><\/a><\/h3>\n<h3 class=\"left-justified\"><span class=\"helvetica-bold\"><strong>Positioning<\/strong><\/span><\/h3>\n<ol class=\"list1\">\n<li class=\"purple-numbers\"><span class=\"garamond-9-5\">Place the patient in dorsal recumbency.<\/span><\/li>\n<li class=\"purple-numbers\"><span class=\"garamond-9-5\">Flex the neck, positioning the hard palate and mandibles perpendicular to the table and x-ray collimator system.<\/span><\/li>\n<li class=\"purple-numbers\"><span class=\"garamond-9-5\">Place small triangle sponges under the external occipital protuberance to help maintain a symmetric position on the table.<\/span><\/li>\n<li class=\"purple-numbers\"><span class=\"garamond-9-5\">Place tape\u2014starting from one side of the table at the level of the abdomen\u2014and pass it around the patient\u2019s nose, fastening it to the other side of the table at the same level.<\/span><\/li>\n<li class=\"purple-numbers\"><span class=\"garamond-9-5\">Angle the hard palate approximately 10 degrees rostral to the perpendicular plane of the body.<\/span><\/li>\n<li class=\"purple-numbers\"><span class=\"garamond-9-5\">Extend the mandible caudally (open mouth) with the endotracheal tube secured to the mandible, taking care to avoid kinking the tube and stopping the flow of oxygen\/inhalation of anesthetic agent.<\/span><\/li>\n<\/ol>\n<div class=\"orange-box\">\n<h3>Breed-Based Positioning<\/h3>\n<p>Although positioning for many of these projections is similar, use of sponges and tape will vary based on skull size and shape:<\/p>\n<ul>\n<li><strong>Dolichocephalic<\/strong> breeds (eg, Doberman pinscher) have long, narrower heads<\/li>\n<li><strong>Mesaticephalic<\/strong> breeds (eg, beagle) have medium sized and shaped heads<\/li>\n<li><strong>Brachycephalic<\/strong> breeds (eg, bulldog) have short, wide heads, with foreshortening of the nasal cavity and absence of frontal sinuses<\/li>\n<li><strong>Cats<\/strong> have more standard sized and shaped heads; however, some brachycephalic cat breeds (eg, Persian) require the same considerations as brachycephalic dog breeds.<\/li>\n<\/ul>\n<\/div>\n<h3><span class=\"helvetica-bold\"><strong>Collimation<\/strong><\/span><\/h3>\n<ol class=\"list1\">\n<li class=\"purple-numbers\"><span class=\"garamond-9-5\">Set the central beam through the open mouth at the level of the soft palate.<\/span><\/li>\n<li class=\"purple-numbers\"><span class=\"garamond-9-5\">Take care to ensure the cranium is straight, without lateral rotation.\u00a0<\/span><\/li>\n<li class=\"purple-numbers\"><span class=\"garamond-9-5\">Assess this positioning by standing at the patient\u2019s head and placing your hands on either side of the cranium, at the level of mandibular rami, verifying both rami are equidistant to the table.<\/span><\/li>\n<\/ol>\n<h3 class=\"left-justified\"><span class=\"helvetica-bold\"><strong>Ensuring Image Quality<\/strong><\/span><\/h3>\n<p class=\"no-indent-\"><span class=\"garamond-9-5\">The open-mouth projection should include both TMJ and tympanic bullae without rotation or superimposition of the endotracheal tube. Collimation should extend caudally from C1 to include the full tympanic bullae rostrally.<\/span><\/p>\n<h2 class=\"left-justified\"><span class=\"font_purple\">LATERAL 30-DEGREE OBLIQUE PROJECTION (Figure 4)<\/span><\/h2>\n<p class=\"left-justified\"><a href=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2014\/05\/Screen-Shot-2015-06-18-at-10.38.47-AM.png\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone wp-image-4708\" src=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2014\/05\/Screen-Shot-2015-06-18-at-10.38.47-AM.png\" alt=\"Screen Shot 2015-06-18 at 10.38.47 AM\" width=\"300\" height=\"490\" srcset=\"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2014\/05\/Screen-Shot-2015-06-18-at-10.38.47-AM.png 568w, https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2014\/05\/Screen-Shot-2015-06-18-at-10.38.47-AM-184x300.png 184w\" sizes=\"(max-width: 300px) 100vw, 300px\" \/><\/a><\/p>\n<h3 class=\"left-justified\"><span class=\"helvetica-bold\"><strong>Positioning<\/strong><\/span><\/h3>\n<p class=\"indent-125\"><span class=\"garamond-9-5\">For a complete study, both right lateral and left lateral oblique projections are needed.<\/span><\/p>\n<ol class=\"list1\">\n<li class=\"purple-numbers\"><span class=\"garamond-9-5\">Place the patient in lateral recumbency, with the nose and skull in an extended position.<\/span><\/li>\n<li class=\"purple-numbers\"><span class=\"garamond-9-5\">Ensure the mouth remains open, which can be accomplished with a syringe case, and secure the endotracheal tube to the mandible.<\/span><\/li>\n<li class=\"purple-numbers\"><span class=\"garamond-9-5\">Place a 30-degree wedge sponge under the maxilla to ventrally oblique the skull.<\/span><\/li>\n<\/ol>\n<p class=\"indent-125\"><span class=\"garamond-9-5\">When the initial projection is finished, take the opposite oblique projection by:<\/span><\/p>\n<ol class=\"list1\">\n<li class=\"purple-numbers\"><span class=\"garamond-9-5\">Rolling the patient over, with the original nonrecumbent side now on the table.\u00a0<\/span><\/li>\n<li class=\"purple-numbers\"><span class=\"garamond-9-5\">Placing a wedge sponge under the maxilla to ventrally rotate the head by 30 degrees.<\/span><\/li>\n<\/ol>\n<h3 class=\"left-justified\"><span class=\"helvetica-bold\"><strong>Collimation<\/strong><\/span><\/h3>\n<ol class=\"list1\">\n<li class=\"purple-numbers\"><span class=\"garamond-9-5\">Position the central beam just ventral to the nonrecumbent external auditory canal (that closest to the tube head).<\/span><\/li>\n<li class=\"purple-numbers\"><span class=\"garamond-9-5\">Adjust collimation to include only the tympanic bulla and TMJ from the level of the third maxillary premolar to C1\/C2.<\/span><\/li>\n<li class=\"purple-numbers\"><span class=\"garamond-9-5\">If the patient is in right lateral recumbency, for example, the left TMJ, tympanic bulla, and ear will move ventrally when positioned correctly.<\/span><\/li>\n<li class=\"purple-numbers\"><span class=\"garamond-9-5\">Place the radiopaque markers outside soft tissue structures: For the right lateral projection, place the right marker ventral to the oblique, recumbent bulla and the left marker just dorsal to the skull. For the left lateral projection, the opposite is true, with the left marker placed ventral to the oblique, recumbent bulla.\u00a0<\/span><\/li>\n<\/ol>\n<h3 class=\"left-justified\"><span class=\"helvetica-bold\"><strong>Ensuring Image Quality<\/strong><\/span><\/h3>\n<p class=\"purple-bullets-black-text-\"><span class=\"garamond-9-5\">The lateral oblique projection should extend from mid mandible to C1. One of the TMJs and tympanic bulla should appear ventral but without superimposition of the cranium. Care should be taken to avoid over rotating the patient, causing foreshortening of the vertical mandibular ramus and tympanic bulla.\u00a0<\/span><\/p>\n<h2 class=\"left-justified\"><span class=\"font_purple\">LATERAL 25- TO 30-DEGREE ROSTROCAUDAL OBLIQUE PROJECTION (Figure 5)<\/span><\/h2>\n<p class=\"left-justified\"><a href=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2014\/05\/Screen-Shot-2015-06-18-at-10.38.55-AM.png\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone wp-image-4709\" src=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2014\/05\/Screen-Shot-2015-06-18-at-10.38.55-AM-265x300.png\" alt=\"Screen Shot 2015-06-18 at 10.38.55 AM\" width=\"300\" height=\"339\" srcset=\"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2014\/05\/Screen-Shot-2015-06-18-at-10.38.55-AM-265x300.png 265w, https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2014\/05\/Screen-Shot-2015-06-18-at-10.38.55-AM.png 558w\" sizes=\"(max-width: 300px) 100vw, 300px\" \/><\/a><\/p>\n<h3 class=\"left-justified\"><span class=\"helvetica-bold\"><strong>Positioning<\/strong><\/span><\/h3>\n<p class=\"left-justified\"><span class=\"garamond-9-5\">For a complete study, both right lateral and left lateral oblique projections are needed.<\/span><\/p>\n<ol class=\"list1\">\n<li class=\"purple-numbers\"><span class=\"garamond-9-5\">Place the patient in lateral recumbency, with the cranium and nasal passages in true lateral position.<\/span><\/li>\n<li class=\"purple-numbers\"><span class=\"garamond-9-5\">Place a triangular- or wedge-shaped radiolucent sponge under the rostral aspect of the nose and mandible, which lifts the nasal planum, nasal cavity, and mandible 25- to 30-degrees away from the table.<\/span><\/li>\n<li class=\"purple-numbers\"><span class=\"garamond-9-5\">Ensure the mouth remains open, which can be accomplished by placing a syringe case between the upper and lower canines.<\/span><\/li>\n<\/ol>\n<p class=\"left-justified\"><span class=\"garamond-9-5\">When the initial projection is finished, take the opposite oblique projection by rolling the patient over, with the original, nonrecumbent side now on the table.<\/span><\/p>\n<p class=\"purple-numbers\"><span class=\"garamond-9-5\">It is important to note that, in left lateral recumbency, the:<\/span><\/p>\n<ul>\n<li class=\"purple-numbers\"><span class=\"garamond-9-5\">Right TMJ and tympanic bulla are caudal and, therefore, best visualized by this projection<\/span><\/li>\n<li class=\"purple-numbers\"><span class=\"garamond-9-5\">Left TMJ and tympanic bulla appear superimposed over the caudoventral aspect of the skull.<\/span><\/li>\n<\/ul>\n<p class=\"purple-numbers\"><span class=\"garamond-9-5\">The opposite is true for right lateral recumbency.<\/span><\/p>\n<h3 class=\"left-justified\"><span class=\"helvetica-bold\"><strong>Collimation<\/strong><\/span><\/h3>\n<ol class=\"list1\">\n<li class=\"purple-numbers\"><span class=\"garamond-9-5\">Direct the central beam just rostral to the TMJ (that closest to the tube head).<\/span><\/li>\n<li class=\"purple-numbers\"><span class=\"garamond-9-5\">Adjust collimation to include only the tympanic bulla and TMJ.<\/span><\/li>\n<li class=\"purple-numbers\"><span class=\"garamond-9-5\">Mark the recumbent side, which will appear <em>more rostral<\/em> on the radiograph.\u00a0<\/span><\/li>\n<\/ol>\n<h3 class=\"left-justified\"><span class=\"helvetica-bold\"><strong>Ensuring Image Quality<\/strong><\/span><\/h3>\n<p class=\"purple-bullets-black-text-\"><span class=\"garamond-9-5\">The rostrocaudal oblique projection should extend from mid mandible to C1. One of the TMJs and tympanic bulla should appear rostral to the other; the more rostral structures should be those on the recumbent side of the patient.<\/span><\/p>\n<h2 class=\"left-justified\"><span class=\"font_purple\">CLOSED-MOUTH ROSTROCAUDAL OBLIQUE PROJECTION (Figure 6)<\/span><\/h2>\n<p class=\"left-justified\"><span class=\"garamond-9-5\">This projection is used for rostrocaudal evaluation of the tympanic bulla in brachycephalic dogs and cats, and replaces the open-mouth rostrocaudal projection described earlier.<\/span><\/p>\n<p class=\"left-justified\"><a href=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2014\/05\/Screen-Shot-2015-06-18-at-10.39.01-AM.png\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone wp-image-4710 size-medium\" src=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2014\/05\/Screen-Shot-2015-06-18-at-10.39.01-AM-281x300.png\" alt=\"Screen Shot 2015-06-18 at 10.39.01 AM\" width=\"281\" height=\"300\" srcset=\"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2014\/05\/Screen-Shot-2015-06-18-at-10.39.01-AM-281x300.png 281w, https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2014\/05\/Screen-Shot-2015-06-18-at-10.39.01-AM.png 566w\" sizes=\"(max-width: 281px) 100vw, 281px\" \/><\/a><\/p>\n<h3 class=\"left-justified\"><span class=\"helvetica-bold\"><strong>Positioning<\/strong><\/span><\/h3>\n<ol class=\"list1\">\n<li class=\"purple-numbers\"><span class=\"garamond-9-5\">Place the patient in dorsal recumbency, supporting the body in a V-trough, as needed.<\/span><\/li>\n<li class=\"purple-numbers\"><span class=\"garamond-9-5\">Flex the neck, tilting the hard palate and mandibles 10- to 15-degrees rostral to the perpendicular plane of the table and x-ray collimator system.<\/span><\/li>\n<li class=\"purple-numbers\"><span class=\"garamond-9-5\">Use small triangle sponges under the external occipital protuberance to help maintain symmetry of the skull on the table.<\/span><\/li>\n<li class=\"purple-numbers\"><span class=\"garamond-9-5\">Flex the skull\u2014then take tape, and starting from one side of the table at the level of the abdomen, pass it around the patient\u2019s nose, fastening it to the other side of the table at the same level.<\/span><\/li>\n<li class=\"purple-numbers\"><span class=\"garamond-9-5\">Secure the endotracheal tube rostrally to the maxilla, keeping the mouth closed.<\/span><\/li>\n<\/ol>\n<h3 class=\"left-justified\"><span class=\"helvetica-bold\"><strong>Collimation<\/strong><\/span><\/h3>\n<ol class=\"list1\">\n<li class=\"purple-numbers\"><span class=\"garamond-9-5\">Direct the central beam to the tympanic bulla.<\/span><\/li>\n<li class=\"purple-numbers\"><span class=\"garamond-9-5\">Take care to ensure the cranium is straight, without lateral rotation.\u00a0<\/span><\/li>\n<li class=\"purple-numbers\"><span class=\"garamond-9-5\">Assess this positioning by standing at the patient\u2019s head and placing your hands on either side of the cranium, at the level of mandibular rami, verifying both rami are equidistant to the table.<\/span><\/li>\n<\/ol>\n<h3 class=\"left-justified\"><span class=\"helvetica-bold\"><strong>Ensuring Image Quality<\/strong><\/span><\/h3>\n<p class=\"purple-numbers\"><span class=\"garamond-9-5\">This closed-mouth rostrocaudal oblique projection should include the tympanic bullae without rotation or superimposition of the endotracheal tube.<\/span><\/p>\n<h2 class=\"left-justified\"><span class=\"font_purple\">QUALITY CONTROL<\/span><\/h2>\n<p class=\"left-justified\"><span class=\"garamond-9-5\">For quality control of any diagnostic image, use a simple 3-step approach.\u00a0<\/span><\/p>\n<ol class=\"list1\">\n<li class=\"purple-numbers\"><span class=\"garamond-9-5\">Is the technique adequate, with appropriate exposure and development?<\/span><\/li>\n<li class=\"purple-numbers\"><span class=\"garamond-9-5\">Is the correct anatomy present within the image? Compare the images you obtain with the images in this article.<\/span><\/li>\n<li class=\"purple-numbers\"><span class=\"garamond-9-5\">Is positioning anatomically correct? Was correct anatomic coverage obtained?\u00a0<\/span><\/li>\n<\/ol>\n<p class=\"indent-125\"><span class=\"garamond-9-5\">Once it is determined that the technique is adequate, make sure the appropriate anatomy is present and positioning is correct, straight, and symmetric. Symmetry of the skull for VD\/DV images is critical when evaluating all structures and osseous anatomy.<\/span><\/p>\n<p class=\"indent-125\"><span class=\"garamond-9-5\">Use the figures in this article as a guide as well as the information provided in the Ensuring Image Quality sections.<\/span><\/p>\n<h2 class=\"left-justified\"><span class=\"font_purple\">SUMMARY<\/span><\/h2>\n<p class=\"left-justified\"><span class=\"garamond-9-5\">Radiographs of the skull allow evaluation of a number of clinical signs related to the skull, TMJ, and tympanic bullae. The images included in this article illustrate how to produce and evaluate the quality of these radiographs. High-quality, correctly positioned and collimated radiographs are required in order to accurately assess the TMJ and tympanic bullae.\u00a0<\/span><\/p>\n<p class=\"left-justified\"><span class=\"references\">C1 = first cervical vertebra; DV = dorsoventral; TMJ = temporomandibular joint; VD = ventrodorsal<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Imaging Essentials provides comprehensive information on small animal radiography techniques.<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"iawp_total_views":10125,"footnotes":""},"categories":[366],"tags":[13],"class_list":["post-1142","post","type-post","status-publish","format-standard","hentry","category-may-june-2014","tag-peer-reviewed","clinical_topics-radiology-imaging"],"acf":{"hide_sidebar":false,"hide_sidebar_ad":false,"hide_all_ads":false},"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v24.7 (Yoast SEO v27.3) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>Radiography of the Small Animal Skull: Temporomandibular Joints &amp; 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