|Year : 2014 | Volume
| Issue : 4 | Page : 390-392
Simplified zygomatic arch radiographic technique to overcome the drawback of jug handle view
Siddana Gouda Siddana1, Manjunath Muniraju2
1 Department of Oral Medicine and Radiology, College of Dental Science, Bhavnagar, Gujarat, India
2 Department of Oral Medicine and Radiology, Vokkaligara Sangha Dental College and Hospital, Bengaluru, Karnataka, India
|Date of Submission||15-Sep-2014|
|Date of Acceptance||03-Apr-2015|
|Date of Web Publication||22-Apr-2015|
Siddana Gouda Siddana
Department of Oral Medicine and Radiology, College of Dental Science, Amargadh, District - Bhavnagar, Gujarat
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Introduction: The imaging of the zygomatic arch is very important in the diagnosis and management of zygomatic arch fractures. It is accomplished by jug handle radiography (a variation of the submentovertex view) and sometimes with modifications like the tangential or tea cup projection. For these techniques, the patient has to be positioned in a way which makes it non-applicable in cases having cervical injuries or suspected cervical injuries. Aims and Objectives: To devise a new approach with which the image of the zygomatic arch can be obtained with normal head position, in either sitting or supine position, using a dental X-ray machine and an occlusal film, which can even be used in patients with cervical injuries or suspected cervical injuries, without any complications. Materials and Methods: The present approach requires a dental X-ray machine and an occlusal X-ray film thereby eliminating the need for additional equipment like a general X-ray machine and extraoral film cassette. This approach can be carried out in a conventional dental setup to rule out zygomatic arch fractures. Conclusion: This technique can be applied in patients having cervical injuries or suspected cervical injuries, thus overcoming the drawback of the jug handle view, and is easy to master. This technique can be used in a conventional dental setup and holds good with the ALARA (as low as reasonably achievable) principle of radiation protection and safety.
Keywords: Jug handle view, radiograph, zygomatic arch
|How to cite this article:|
Siddana SG, Muniraju M. Simplified zygomatic arch radiographic technique to overcome the drawback of jug handle view. J Indian Acad Oral Med Radiol 2014;26:390-2
|How to cite this URL:|
Siddana SG, Muniraju M. Simplified zygomatic arch radiographic technique to overcome the drawback of jug handle view. J Indian Acad Oral Med Radiol [serial online] 2014 [cited 2020 Jun 1];26:390-2. Available from: http://www.jiaomr.in/text.asp?2014/26/4/390/155677
| Introduction|| |
The zygomatic arch is formed by the zygomatic process of the temporal bone and the temporal process of the zygomatic bone, with an oblique suture in between. The tendon of the temporalis passes medial to the arch to gain insertion into the coronoid process of the mandible.  Zygomatic arch is the one of the commonest bone of the face to get fractured in a facial injury. Clinically, the fracture of the zygomatic arch causes a depression over the side of the face with restriction of mouth opening due to interference with the movement of the coronoid process, requiring immediate attention. 
The imaging of the zygomatic arch is very important for diagnosis and management of such cases which is accomplished by making a jug handle view radiograph (a variation of the submentovertex view) and its modifications like the tangential or tea cup projection.  For these techniques, the patient is positioned in a way that there might be complications in cases having cervical injuries or suspected cervical injuries.
| Aims and Objectives|| |
In this new approach which we are suggesting, the zygomatic arch image can obtained with normal head position in either sitting or supine position using a dental X-ray machine and an occlusal film. The technique can be used in cases having cervical injuries or suspected cervical injuries, and is easy to master. The technique can be applied in a conventional dental setup and holds good with principles of radiation protection and safety such as the ALARA (as low as reasonably achievable) principle.
| Materials and Methods|| |
- Dental X-ray machine with dental chair.
- Occlusal X-ray film.
- Lead apron.
- Film hanger.
- Dark room equipment.
- Cabinet drier.
Voltage: 70 kilovolts (kVp).
Current: 10 Milliamperes (mA).
Exposure time: 0.65 seconds.
In the upright sitting position- The patient is made to sit in the dental chair with a lead apron in an upright position with proper head support. The midsagittal plane must be perpendicular and occlusal plane must be parallel to the floor [Figure 1].
In the supine position- The patient is made to lie down on the radiographic table in a supine position with a lead apron, so that the midsagittal plane is oriented parallel and occlusal plane is oriented perpendicular to the floor.
In both these positions, there is no need for extension of the neck or tilting of the head.
The occlusal film is placed at the lower border of the mandible on the same side of the arch being radiographed with the medial side of the film approximately 1-cm medial to the lower border of the mandible and the lateral border of the film in line with the outer surface of the zygomatic arch. The anterior end of the film must be in line with the corner of the mouth. The film must be secured in the position with the patient's same side thumb [Figure 1].
Positioning the aiming device
In both the sitting and supine positions, the aiming device is positioned in line with the lateral surface of the skull over the temporal fossa so that the X-rays pass through the zygomatic process meeting the occlusal film at right angle [Figure 2].
| Discussion|| |
The zygomatic arch is the one of the commonest bone to get fractured in the face due to trauma  and the imaging of zygoma is conventionally done by the jug handle radiograph, a modification of the submentovertex radiograph.  This technique requires the patient to extend his/her neck, so that the vertex point of the skull touches the cassette. This position induces stress in the neck, making it not suitable for patients with neck injury. In these situations, the existing choice of imaging is computed tomographic (CT) scan; but, advising a CT scan for imaging the small bone considering the radiation dose, cost factor and availability of the facility, is questionable.
In the jug handle radiograph, by reducing the kVp, the quality of the beam (mean and total energy) is reduced, allowing the soft X-rays to get absorbed within the face and the skull. Though some modifications like collimating the beam to the arch of interest are indicated to reduce the patient exposure, the positioning of the patient remains the same.  In the suggested approach, the patient need not extend the neck making it possible to make the radiograph of the zygomatic arch even in cases with neck injuries, which otherwise would have been contraindication for making a jug handle view radiograph.
The present approach requires a dental X-ray machine and an occlusal X-ray film thereby eliminating the need for additional equipment like a general X-ray machine and extraoral film cassette. Hence, this technique is very useful in a conventional dental setup to rule out zygomatic arch fractures. The advantage of using a dental X-ray machine is that it reduces the quantity of radiation by using 10 mA as compared to the 50 mA of a general X-ray machine and it improves the quality of the X-ray beam by operating at 70 kVp as compared to 30-40 kVp used in the jug handle radiograph, thus producing considerable good quality images of the zygomatic arch [Figure 3] and [Figure 4]a-b. ,
|Figure 4: Occlusal radiographic film showing a normal zygomatic arch of the (a) left side, and (b) right side|
Click here to view
| Conclusion|| |
By reducing the quantity and increasing the quality of the X-ray beam, the dose accumulation within the patient is considerably reduced thus satisfying the principles of radiation safety and protection such as the ALARA principle. Considerable good quality images of the zygomatic arch can be acquired by this approach as compared to the jug handle view, which can even be used in patients with cervical injuries or suspected cervical injuries, without any complications.
| References|| |
Chaurasia BD, Garg K. Osteology of head and neck. In: Chaurasia BD, Garg K, editors. BD Chaurasia's Human Anatomy: Regional and Applied Dissection and Clinical. Head, Neck and Brain. 4 th
ed. Vol. 3. New Delhi: CBS Publishers and Distributors; 2004. p. 3-44.
Fonseca RJ, Marciani RD, Turvey TA. Management of zygomatic fractures. In: Fonseca RJ, Marciani RD, Turvey TA, editors. Oral and Maxillofacial Surgery. 2 nd
ed. Vol. 2. St. Louis, MO: Elsevier; 2009. p. 182-3.
Whitley AS, Sloane C, Hoadley G, Moore AD, Alsop CW. The facial bones and sinuses. In: Whitley AS, Sloane C, Hoadley G, Moore AD, Alsop CW, editors. Clark's Positioning in Radiography. 12 th
ed. London: Hodder Arnold; 2005. p. 268.
Watson AR. New view for zygomatic arch. Radiology 1974;110:724.
Tetradis S, Kantor ML. Extraoral radiographic examinations. In: White SC, Pharoah MJ, editors. Oral Radiology: Principles and Interpretation. 6 th
ed. St. Louis, Missouri: Mosby Elsevier; 2009. p. 191-206.
[Figure 1], [Figure 2], [Figure 3], [Figure 4]