Bulletin of Clinical Acupuncture

Transcription

1 Bulletin of Clinical Acupuncture A Compendium of Clinical Methods Chief Editor: Dr. Holmes Keikobad MBBS DPH Dip Ac NCCAOM L Ac Editor: Carol Andrade PhD LAC. Editor: Vera Kaikobad LAc Vol VII Issue 119 Oct 2012 Copyright acu-free.com LLC Free Online Edition Published by acufree.com INC radiology for licensed Acupuncturists PART II SINUSES IN THE SKULL

2 2 TERMS OF USE This Bulletin can be studied only as a download from its home on the web page It is OK to download a copy to your computer for your own personal use. Making hard copies for distribution in any way without written permission violates Federal Copyright Laws creating a liability which could result in steep fines or worse. acu-free.com LLC All rights reserved Images acu-free.com and their Licensors It is not OK to excerpt material, part or whole, to teach, or include in a course. We really go to great lengths to research and write expert discussions and get the Bulletin to you, free of any cost or encumbrance. You can help us incredibly by making certain the Terms of Use are respected. In every sense of the word, Acupuncture is everyone s heritage. This Bulletin continues to guard and expand that great wisdom. With best wishes Dr. Holmes Keikobad Editor in Chief Copyright: acu-free.com LLC. All rights reserved. For educational purposes only.

3 3 radiology for licensed acupuncturists PART II Sinuses in the skull The PART I of this Series was well received. A significant number of readers intimated a preference for a continuation of this Series, as such we present PART II. This series dealing with Radiology presumes that at some stage the status of Licensed Acupuncturists will evolve to that of Doctors of Acupuncture. As such we are presenting the basics of Radiology, with X rays and case studies, to familiarize the Professionals with the salient aspects of the modality. Please be kind to the images, we have gone to great lengths to acquire these, and have fun on your journey. acu-free.com LLC All rights reserved Images acu-free.com and their Licensors Copyright: acu-free.com LLC. All rights reserved. For educational purposes only.

4 4 X-RAYS in Acupuncture practice By Dr. Holmes Keikobad MBBS DPH Dip AC NCCAOM LAC Bachelor of Medicine & Surgery, Diplomate in Public Health Diplomate in Acupuncture, National Board Certified Licensed Acupuncturist Revision - this and the next page revises basics. Part II begins from page 6. X rays have 2 fold penetration power on human tissue: Some rays do not pass through at all, being obstructed by compact structures like bone. These cast clear shapes seen in X rays. It is mainly this variety by which we examine X Ray plates. See bones of arm, ribs, and the heart shadow in this film. Some rays pass through completely, and cast no shadow at all, resulting in darkness, see upper left hand corner of this film. X-Ray Copyright Adrian Barnes. Image amended acu-free.com INC

5 5 Revision: The x ray picture in general Always make sure you study an x ray placed on a lighted display box in a dark room. This way you will see all details and come to a correct conclusion. In this plate again see all the bony structures such as shoulder joint, humerus, ribs, heart shadow. Here the x rays were obstructed by tissues. Now note the areas where the x rays have partially penetrated, such as between the ribs. Go over the film separating out structures more white than the others. These are bones and heart etc. Note also areas where rays have managed to pass through to some extent, as between the ribs. That is the lung tissue. X-Ray Copyright Adrian Barnes. Added artwork acu-free.com INC

6 6 Anatomy of sinuses Sinuses are hollow cavities in the skull. There are 4 sets, each bilaterally situated so that in all there are 8 sinus cavities in the skull. We will be dealing with the 2 main categories, the frontal and the maxillary, in this Issue. The commonest condition which alters the sinus shadow in an xray is chronic sinusitis, an infection of the lining of the sinus cavity. More serious conditions would include a fracture of the skull involving the sinus walls. Before we see xrays here is a picture which shows the anatomical location and shape of the 2 main sinuses: Frontal bone [forehead] Frontal sinuses Maxillary bone [cheek] Maxillary sinuses

7 7 Xray of sinuses Now lets have a look at an xray of the skull & the same sinuses: Frontal bone Frontal sinuses Maxillary bone Maxillary sinuses

8 8 Xray of frontal sinuses Let s follow step by step over the first, and then the second image: Go to 1, roof of R orbit for the eye > 2, roof of R frontal sinus > 3, partition between two sinuses > 4 roof of L frontal sinus > 5, Lateral extent of L frontal sinus > 6, roof of L orbit > 7, upper end of nasal septum > 8 & 9, R & L frontal sinuses

9 9 Self assessment Would you like to test your knowledge about the object seen in this film relating to frontal sinus? Just go over the numbers, mentally naming each structure. If required, check previous page

10 10 Xray of maxillary sinuses Let s follow step by step over the image: Go to 1, roof of R sinus > 2, lateral wall of nasal passage > partition between two nasal passages > 4 roof of L sinus > 5 & 6. Floors of the two sinuses > 7 & 8, R & L maxillary sinuses > 9 exit of nasal passages where matter from choked sinuses will drain

11 11 Self assessment Would you like to test your knowledge about the objects seen in this film relating to maxillary sinus? Just go over the numbers, mentally naming each structure. If required, check previous page

12 12 Self assessment - Xray of sinuses Now lets have a look at the xray and see is you can locate the frontal and maxillary sinuses, the orbits for the eyes, the nasal cavity.:

13 13 Xray of a case of maxillary sinusitis See R maxillary sinus, a. Half the cavity is filled with some kind of exudate. You can clearly see the level, dotted line. Check the nasal septum, b, it is bent, that alone can cause obstruction of discharge of sinus into nasal cavity. This can also predispose to repeated bouts of sinusitis, and cause referred pain to R eye, and toothache in R upper molars and premolars. Sooner or later in your career you may get a case of chronic toothache in upper molars, where teeth are, according to the dentist, healthy. Suggest an xray to rule out maxillary sinusitis, because that may be the cause of pressure-pain on teeth. b b a b

14 14 What else can you see in this xray? Xrays can deliver a surprising amount of information to the trained eye: 1 R nostril, seems also to have some exudate, compare with > 2, which is clearer > 3, L nostril also seems clearer than L at that level > 4 there is definite exudate in lower portion of nostril, compare same to that in the sinus > 5 there is a small quantity of exudate in the R sinus showing that it is also being involved > 6 & 7 the frontal sinuses are clear > look at 8, can you make out the eye, it is shut, you can see the line of closed lids at the arrow.

15 15 Doctor, can you write a report for this xray? Suppose this xray came to you for reading. Pre diagnosis was R maxillary sinusitis. Go ahead and check features, taking cue from previous pages. Then write your report stating what you see. No need to write about structures normal, just a line or two on, can you confirm a diagnosis of maxillary sinusitis?

16 16 Sinusitis When the sinuses are involved in a pathological process the condition is called sinusitis. There is a physical basis to the pain, which is that it is caused by pressure of the discharge collected in the sinus when it does not exit into the nasal cavity. If you can facilitate the discharge by any means and the sinuses drain the pain can be relieved. Such a process is called sinus lavage, or facilitating the drainage of sinuses. Common causes by Western Medicine 1. Inflammation due to infection bacterial or viral 2. Allergy 3. Autoimmune issues Chronic sinusitis definition: an infection which lasts longer than three months. Symptoms and signs nasal congestion facial pain & headache general malaise, fever thick green or yellow discharge feeling of facial fullness or tightness that may worsen when bending over aching teeth anosmia, a reduced sense of smell Etiology in Traditional Medicine Most likely Elemental pattern: SP Yin Deficiency Aggressing onto Kidney with Pouring of Damp into sinuses. When a deficient SP cannot control Damp, it collects in the feet, lower warmer and bones, and in this case the cavity of the sinuses. Treatment [if this is the Pattern] GV 20, SP 3 Earth point on Earth channel, SP 9 Sea point on Earth channel, ST 36 Earth point on Earth channel, REN 12 moxa, ear point SP, K, Sub Cortex, Shenmen.

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