On some patients you will not be able to achieve a satisfactory demonstration of the odontoid process using the conventional AP open-mouth technique. Fuch's technique provides an alternative technique to use in patients who do not have an acute cervical spine injury.

You may have noticed that you can visualise the odontoid peg on the occipito-mental (OM) image of the facial bones. A coned OM view can be considered as an alternative technique for imaging the odontoid peg. The disadvantage of this projection is that the odontoid peg and related anatomy are projected over the occiput of the skull. If you're lucky, the foramen magnum will be conveniently positioned. Important note: extending a patient's neck to achieve an OM position is conta-indicated in a trauma patient

Fuch's View

This image is a coned OM for odontoid peg (Fuch's View). The original cone marks are displayed. A frequent failing of this view is underexposure (this image is slightly underexposed). The exposure technique should be as for an OM projection of the facial bones rather than an AP cervical spine projection. Further information here http://bloggingradiography.blogspot.com/2007/05/odontoid-trouble.html

	This patient presented for cervical spine radiography. The lateral projection image suggests that the majority of the odontoid process will not be demonstrated on a convectional open-mouth technique image. The white line approximates the superimposition of the upper dentition with the occiput.
	The radiographer has successfully lined up the upper dentition with the occiput on first attempt. The odontoid process is largely obscured by the upper central incisors. The radiographer decided to employ the Fuch's method to demonstrate the odontoid process
	Fuch's projection superimposes C1/C2 over the occiput. Despite this limitation, the C1/C2 anatomy, including the odontoid process, is demonstrated.

Fuch's method should not be attempted in patients with acute cervical spine injury- when in doubt..don't

Further information can be found on Jeremy Enfinger's excellent radiography blog at http://bloggingradiography.blogspot.com/2007/05/odontoid-trouble.html