water’s baru
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Sinus paranasalisSinus paranasalis
Rosy SetiawatiRosy Setiawati
Departement of RadiologyDepartement of RadiologyDr. Soetomo HospitalDr. Soetomo Hospital
SurabayaSurabaya
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Paranasal sinuses are air filled cavity and
covered by mucous membrane
Both etmoidal & maxillary sinuses
sincebirth
rontal sinuse ! yrs
Sphenoid sinuses " yrs#sually frontal sinuse are not developed
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$ptimal pneumati%ation
rontal '()* years
Sphenoid *()+ years,thmoidal !()- years
axilary !(!" years
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,ach sinus has its osteal / orifice which is
opened and communicate with nasal
cavity 0 meatus1
eatus is surrounded by turbinate / concha
which contain bone structur & erectile soft
tissue
" turbinate / concha 2 Superior3 middle3
inferior
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Sinusitis
4n normal circumstance sinus productminimal mucous fluid
4nflammation process 0 alergic or infection1
ucous will have profuse mucoid production 2 lead to bacterial infection
Pus accumulation in sinus cavity
Pus is trapped and can not find the way out
through the nasal cavity and cause high
pressure inside sinus
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Plain
Ha%%yness of sinus
5ac6 delineation of sinus wall
luid level 07189 Scan
ucosal thic6ening of sinus
luid collection 2 fluid level 071
Retention cyst / polyp / mucocele
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R4
∼ 89 Scan
4ntracranial complication
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PA Axial Skull (Caldwell projection for sinuses )
B
':
;ood for sinuses 0frontal and anterior ethmoidal sinuses1. <lso showsother inflammatory conditions 0secondary osteomyelitis3 sinus polyps1.
Patient=s nose and forehead against film3 nec6 extended so that $5 is
):° from the hori%ontal
Film: HD )-x!' cm
CP: >aison 0to occiput to exit at level of lower orbital margins1.
CR: ?+° hori%ontal to film center 0or ):° caudal with $5 ?+° to the
film1.
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AP Axial (Towne’s projection) B
'*
or occipital bone3 cranial @s3 neoplasms3 and Paget=s disease. <lso for <P
dorsum sellae3 and advanced pathology of the temporal bone 0advanced
acoustic neuroma13 anterior clinoids3 foramen magnum3 mastoids3 foramen
magnum.
Patient supine3 or in erect <P sitting3 chin is depressed 0$5 ?+° to film13 no
rotation of the head
Film: HD !'x"+ cm
CP: * cm above the glabella 0! cm superior to level of ,<s1.
CR: "+° caudal 0"+° caudal for the
posterior clinoids1.
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Lateral Skull (for nasal bones)
B
or nasal bone fractures.
Head in true lateral 0same position as for lateral s6ull as in Sim=sposition1 or erect3 chin adAusted so that both 4P5 and 4$5 are ?+° tocouch top.
Film: HD )-x!' cm
CP: ).!: cm inferior to naisonCR: ?+° to film center
>B/ < long narrow cone should be used.
'
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Lateral Skull (for sinuses) B
or inflammatory conditions Secondary osteomyelitis3 sinusitis3 and sinuspolyps 0good for sphenoid3 frontal3 ethmoid3 and maxillary sinuses1.
Patient erect sitting3 head in true lateral 04P5 ?+° to film1
Film: HD )-x!' cm
CP: idway between outer canthus and ,<
CR: ?+
°
hori%ontal to film center
'-
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Lateral 15° (odified Law for T!s)
S
or advanced bony pathology of the mastoid process.
Patient prone or erect3 head in lateral3 4P5 ?+° to film3 face0 and SP1 then rotated ):° toward the film.
Film: HD )-x!' cm
CP: ' cm superior to upside ,<
CR: ):° caudal to pass through the downside 9C.
'?
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Axiolateral (Sc"#ller for $astoids)
S
or advanced bony pathology of the mastoid air cells.
Patient prone or erect3 head in the true lateral3 4P5 ?+° to film3SP parallel to the film.
Film: HD )-x!' cm
CP: downside mastoid tip 0' cm superior3 ' cm posterior toupside ,<1.
CR: !:° ( "+° caudal.
:+
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Axioanterior %bli&ue (Sten'ers for $astoids)
B
or advanced pathology of temporal bone3 e.g.3 acoustic neuroma.Both sides are to be examined.
Patient prone or erect3 4$5 ?+° to film3 chin adAusted so that headis rotated ':° obliEue with the couch3 side of interest down3 downsidemastoid region centered to film.
Film: HD )-x!' cm
CP: 2 )+ cm posterior3 and ).!: cm inferior to upside ,< to exit
through downside mastoid process.
CR: )!° cephalic.
:)
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Axiolateral %bli&ue (odified Law for $astoids) B
or advanced pathology of mastoids.
Patient prone or erect3 each auricle taped forward3 head in lateral3
then rotated ):° obliEue toward the film3 4P5 ?+° to couch3 side of
interest down.
Film: HD )-x!' cm
CP: ,xit downside mastoid tip 0) inch posterior3 !.: cm posterior3 !.:
cm superior to upside ,<1.
CR: ):° caudal
:!
( ) f f
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Parietoorbital ("ese *iew) for optic fora$ina
S
:"
or bony abnormalities of the optic foramen. Both sides must bedone for comparison.
Patient prone or erect3 chin3 chee63 and nose against couch3 headadAusted so that the SP ma6es :"° with the couch top3 theacanthiomeatal line <5 ma6es ?+° to the film3 a long narrow coneshould be used.
Film: HD )-x!' cm
CP: Downside orbit 0 cm above and cm behind the up ,<1.
CR: ?+° to 4$5
P i t t"i l (%) (+ t *i f i )
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Parietoacant"ial (%) (+aters *iew for sinuses )
B
:'
Best for maxillary and frontal sinuses and nasal fossae. <lso shows other
inflammatory conditions 0secondary ostemyelitis3 and sinus polyps1.
Patient erect3 nec6 extended3 chin and nose against couch3 head adAusted till
5 is ?+° to the film3 $5 ma6es "° with film. <5 ma6es ?+° to the film3 a
long narrow cone should be used.
Film: HD )-x!' cm
CP: <t level of lower border of the orbits to exit at the acanthion.
CR: ?+° hori%ontal to film center
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Parietoacant"ial (%) (%penout" +aters for
sinuses ) S
::
Same as for Faters..
Same position as for Faters view3 but with open mouth 0patientdrops his Aaw without moving the head1.
Film: HD )-x!' cm.
CP: <t level of lower border of the orbits to exit at the acanthion.
CR: ?+° hori%ontal to film center