PLAIN RADIOGRAPHY OF

PARANASAL SINUS
• Plain radiographs have been replaced by high-resolution CT (HRCT) for the
evaluation of sinus inflammatory disease.

• Plain radiographs do not allow adequate evaluation of the ostiomeatal complex

or of the sphenoid and ethmoid sinuses, because of overlapping structures.
Caldwell

• Caldwell's view (or Occipitofrontal view) is a radiographic view of

skull, where X-ray plate is angled at 20° to orbitomeatal line. The rays
pass from behind the head and are perpendicular to radiographic
plate. It is commonly used to get better view of frontal sinuses.
Waters
• Waters' view (Occipitomental view) is
where an X-ray beam is angled at 45°
to the orbitomeatal line. The rays pass
from behind the head and are
perpendicular to the radiographic
plate. It is commonly used to get a
better view of the maxillary sinuses.
Lateral
Submentovertex/basal project
Frontal sinuses
• The frontal sinuses are evaluated best in the Caldwell and Water’s projections.

• Lateral and base (submentovertex) views are used to evaluate the anterior and
posterior walls of the frontal sinuses.
• A properly positioned Caldwell
view will show the petrous
pyramids in the lower third of the
orbits and is the best projection for
examining the frontal and ethmoid
sinuses in the frontal projection
Ethmoid sinuses
• The ethmoid sinuses are evaluated best on the Caldwell view. Therefore, when
only a few ethmoid air cells are opacified while the others are normally
pneumatised, the diseased cells may be masked, giving the appearances of a
completely normal ethmoid sinus. In these situations, CT may be required . On
Water’s view only the most anterior ethmoid cells can be visualized, while the
middle and posterior cells are overlapped with the nasal fossae.
Maxillary sinuses

• Best visualized on the Water’s view. The medial wall is best seen on
the Caldwell view. The important area of the ostiomeatal unit is not
well visualized. The inferior extension of the sinus and its relationship
to the teeth and hard palate is seen well on lateral views.
Sphenoid

• Lateral, base and open mouth Water’s views are best for evaluating
the sphenoids. The lateral view shows the relationship of the sinus
with the sella, the floor of which forms the sphenoid sinus roof.
CT SCAN OF PARANASAL
SINUS
• Reading the CT scan from anterior to posterior (on coronal views) or
from top to bottom (on axial sections) can help organize one's
approach in analyzing structures to be interpreted.
• Coronal view demonstrating well-pneumatized frontal sinuses (FS), the ethmoid
bulla (b), and the lamina papyracea (LP)
• CT scans typically obtained for visualizing the paranasal sinus should include
coronal and axial (3-mm) cross sections.

• The use of intravenous contrast material just prior to scanning can help define
soft tissue lesions and delineate vascularized structures, such as vascular
tumors. Contrast-enhanced CT is particularly useful in evaluating neoplastic,
chronic, and inflammatory processes.
• For axial views, the patient's hard palate is placed perpendicular to
the CT scanner table. External auditory canal is in line with the
inferior orbital rim.
• For coronal images, the gantry is perpendicular to the patient's hard
palate
Coronal view demonstrating the blockage of the ostiomeatal complex by a large concha bullosa (CB). Important components
of the ostiomeatal complex that can be seen include the uncinate process (U) and maxillary sinus ostium (MO). The
attachments of the middle turbinate (MT*) to the cribriform plate (cb) and of the uncinate process (U*) to the skull base can
be appreciated. The fovea ethmoidalis (fv) and crista galli (^) can also be seen.
• Acute edema of sinonasal mucosa in response to infection or
allergens contribute to acute and chronic sinusitis.
• CT findings of sinus opacification, air-fluid levels, and thickened
localized mucosa are all findings of acute sinusitis.
• Axial image at the level of the inferior turbinates demonstrating maxillary
mucoceles and mucosal thickening