Skeletal Radiol (1992) 21:305-306
Skeletal Radiology
More than just lip service Stanley P. Bohrer, M.D., and Jeffrey A. Brody, M.D. Department of Radiology, Bowman Gray School of Medicine, Wake Forest University, Winston-Salem, North Carolina, USA
Dr. Keats t o o k on an enormous task when he published the first edition of his b o o k on normal variants that simulate disease [2]. He not only showed examples of the variants but also tried to explain those that were not obvious. He noted that the p r o o f of validity is in some cases largely subjective and is open to further p r o o f or future modification. I (S.P.B.) first observed a ring shadow around the upper cervical vertebrae (Fig. 1) several years ago. I saw my second case a year later. No one to w h o m I showed these cases had a good explanation for this finding. Only when I was told of similar appearances in the normal variant b o o k did I have a working explanation, albeit unproved [2, p. 773]. I then began to see this ring more frequently and, in one case, placed lead bead markers on the margins of the lips and repeated the film with the lips opened in differing degrees (Fig. 2). The beads stayed with the soft-tissue shadows, virtually proving that such shadows are due to the lips. Other cases showed the small central depression in the upper lip where the philtrum below the nose meets the lip (Fig. 3) and an asymmetric ring aligned with asymmetric teeth due to slight rotation (Fig. 4), providing m o r e than just lip service to Dr. Keat's explanation. All films showing this density were taken as anteroposterior views for the odontoid. I now see some degree of the lip shadow on almost all odontoid films. The lip shadow can also c o m m o n l y be seen, although with a different appearance, overlying the lower half of the maxillary antra on Water's views []]. Address reprint requests to: S.P. Bohrer, M.D., Department of Radiology, Bowman Gray School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157-1088, USA > Fig. 1. Original ring seen encircling C2 Fig. 2 A, B. Lead markers on lips move with the soft-tissue shadows (arrowheads). Lips in more of an " O " shape in B
9 2[992 International Skeletal Society
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S.P. Bohrer and J.A. Brody: Lips
Fig. 3. Depression centrally in upper lip at the philtrum (arrow-
heads). This can also be seen in Fig. 1 Fig. 4. Lip shadows asymmetric but aligned with teeth due to slight rotation >
References 1. Dixit JK (1988) "No lip" Waters view. AJR 151:839 2. Keats T (1988) Atlas of normal roentgen variants that may stimulate disease, 4th edn. Yearbook Medical, Chicago
Skeletal Radiology
More than just lip service Stanley P. Bohrer, M.D., and Jeffrey A. Brody, M.D. Department of Radiology, Bowman Gray School of Medicine, Wake Forest University, Winston-Salem, North Carolina, USA
Dr. Keats t o o k on an enormous task when he published the first edition of his b o o k on normal variants that simulate disease [2]. He not only showed examples of the variants but also tried to explain those that were not obvious. He noted that the p r o o f of validity is in some cases largely subjective and is open to further p r o o f or future modification. I (S.P.B.) first observed a ring shadow around the upper cervical vertebrae (Fig. 1) several years ago. I saw my second case a year later. No one to w h o m I showed these cases had a good explanation for this finding. Only when I was told of similar appearances in the normal variant b o o k did I have a working explanation, albeit unproved [2, p. 773]. I then began to see this ring more frequently and, in one case, placed lead bead markers on the margins of the lips and repeated the film with the lips opened in differing degrees (Fig. 2). The beads stayed with the soft-tissue shadows, virtually proving that such shadows are due to the lips. Other cases showed the small central depression in the upper lip where the philtrum below the nose meets the lip (Fig. 3) and an asymmetric ring aligned with asymmetric teeth due to slight rotation (Fig. 4), providing m o r e than just lip service to Dr. Keat's explanation. All films showing this density were taken as anteroposterior views for the odontoid. I now see some degree of the lip shadow on almost all odontoid films. The lip shadow can also c o m m o n l y be seen, although with a different appearance, overlying the lower half of the maxillary antra on Water's views []]. Address reprint requests to: S.P. Bohrer, M.D., Department of Radiology, Bowman Gray School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157-1088, USA > Fig. 1. Original ring seen encircling C2 Fig. 2 A, B. Lead markers on lips move with the soft-tissue shadows (arrowheads). Lips in more of an " O " shape in B
9 2[992 International Skeletal Society
306
S.P. Bohrer and J.A. Brody: Lips
Fig. 3. Depression centrally in upper lip at the philtrum (arrow-
heads). This can also be seen in Fig. 1 Fig. 4. Lip shadows asymmetric but aligned with teeth due to slight rotation >
References 1. Dixit JK (1988) "No lip" Waters view. AJR 151:839 2. Keats T (1988) Atlas of normal roentgen variants that may stimulate disease, 4th edn. Yearbook Medical, Chicago
