The slit basal view of the zygoma is both an effective view for demonstration of fractures of the zygoma and an aesthetically pleasing image when executed successfully. I did not perform this view for the first 20 years of my radiography career- I thought it was too difficult a position to obtain reliable results. Since being shown by a colleague how easy it was to achieve, I very rarely perform a slit townes view to demonstrate the zygomatic arches. One of the advantages of the slit basal and teacup view is that it provides a true representation of the degree of depression of a zygoma fracture- this is likely to be influential in the decision to perform a surgical zygoma elevation operation.

Slit Basal

The patient is seated with their back to the wall bucky/IR. The mid-saggital plane of the skull is at right angles to IR and the beam is angled at 90 degrees to the zygomatic arch. Center to the level of the middle of the zygomatic arch in the mid-saggital plane.	This view can be achieved with the patient in the erect AP or supine position. A sponge under the patients shoulders can assist the patient to achieve greater neck extension.

Teacup View

When imaging one side only, the positioning is similar to the slit basal view. The following should be noted cone to include the anatomy of interest centre to the zygoma of interest laterally flex the patient's head away from the side of interest radiographers are known to confuse which direction to laterally flex the patient's neck for a teacup view. It may be of assistance to think of the patient as having a face that is slightly wedge-shaped. To achieve a teacup view position, the patient's head is laterally flexed not rotated.

At the risk of stating the obvious, this view gets its name from the handle of a teacup.

Notes

• The slit basal and teacup views are contraindicated in a patient that may have a cervical spine injury.
• There is considerable flexibility in the beam angulation relative to the zygomatic arch. If the beam is not perfectly directed at 90 degrees to the zygoma, the results are likely to still be acceptable.
• You will learn to read a patient's zygomatic arches- patients with chiselledchiseled features and "high cheek bones" tend to have zygomatic arches that sit proud of the skull and are therefore easy to image. Some patients have facial bone structure tat does not accomodateaccommodate successful application of the slit basal technique.
  

A round cone can be employed to good effect when performing slat basal radiography of the zygomatic arches.

Slit basal projection with round cone demonstrating a left comminuted and depressed fracture of the zygoma

same again

Case 1

This patient presented to the Emergency Department following facial bone trauma. The radiographer has performed a slit basal view of the zygomatic arches. The patient's head is laterally flexed to the left. This positioning error tends to favour demonstration of one zygoma (in the case the right zygoma) at the expense of the contra-lateral side. Rather than repeat the slit basal view, the radiographer has performed a teacup view of the left zygoma.

The teacup view demonstrates the left zygomatic arch successfully.

Case 1 Discussion

This case raises a few questions. If the patient has sustained a blow to the left zygoma alone, why not perform a teacup view of the affected side only? Alternatively, if your departmental routine is to image both zygomas, why not laterally flex the patient's head to favour the zygoma of interest? Irrespective of your answers to these questions, I would suggest that radiographers should be mindful of these options, and, if your scope of practice allows you to, modify the series to suit the clinical situation.

Case 2

When performing a slit basal view with the patient in the supine position, it is very easy to overlook potential image artifacts from items on the patient's chest. This zipper artifact could be avoided by removing the artifact or by extending the patient's head further and angling the beam more to match.

Case 3

The first attempt favours the left zygoma at the expense of the right. The right image shows correction of the left lateral flexion positioning error.

The slit basal and teacup view techniques of the zygoma are learnable and reliable techniques. TheOnce the positioning technique is mastered, the results are usually superior than that acchievedachieved with a slit Townes technique.

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