Sinus paranasalis

Rosy Setiawati
Departement of Radiology
Dr. Soetomo Hospital
Surabaya

Paranasal sinuses are air filled cavity and

covered by mucous membrane
Both etmoidal & maxillary sinuses since
birth
Frontal sinuse 2 yrs
Sphenoid sinuses 3 yrs
Usually frontal sinuse are not developed

Optimal pneumatization :
Frontal : 4-16 years
Sphenoid : 6-10 years
Ethmoidal : 2-18 years
Maxilary : 2-23 years

Each sinus has its osteal / orifice which is

opened and communicate with nasal
cavity ( meatus)
Meatus is surrounded by turbinate / concha
which contain bone structur & erectile soft
tissue
3 turbinate / concha Superior, middle,
inferior

Sinusitis
In normal circumstance sinus product
minimal mucous fluid
Inflammation process ( alergic or infection)
Mucous will have profuse mucoid production
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

Sinusitis

Plain :
Hazzyness of sinus
Lack delineation of sinus wall
Fluid level (+)
CT Scan :
Mucosal thickening of sinus
Fluid collection fluid level (+)
Retention cyst / polyp / mucocele

MRI :
CT Scan
Intracranial complication

Umur 2 thn

CT SCAN SINUS PARANASALIS

MRI vs. CT

PA Axial Skull (Caldwell projection for sinuses )

B
Good for sinuses (frontal and anterior ethmoidal sinuses). Also shows
other inflammatory conditions (secondary osteomyelitis, sinus polyps).
Patients nose and forehead against film, neck extended so that OML is
15 from the horizontal
Film: HD 18x24 cm
CP: Naison (to occiput to exit at level of lower orbital margins).
CR: 90 horizontal to film center (or 15 caudal with OML 90 to the
film).

45

AP Axial (Townes projection)

For occipital bone, cranial #s, neoplasms, and Pagets disease. Also for AP
dorsum sellae, and advanced pathology of the temporal bone (advanced
acoustic neuroma), anterior clinoids, foramen magnum, mastoids, foramen
magnum.
Patient supine, or in erect AP sitting, chin is depressed (OML 90 to film), no
rotation of the head
Film: HD 24x30 cm
CP: 6 cm above the glabella (2 cm superior to level of EAMs).
CR: 30 caudal (30 caudal for the
posterior clinoids).

46

Lateral Skull (for nasal bones)

B
For nasal bone fractures.
Head in true lateral (same position as for lateral skull as in Sims
position) or erect, chin adjusted so that both IPL and IOML are 90 to
couch top.
Film:
CP:
CR:
NB/

HD 18x24 cm
1.25 cm inferior to naison
90 to film center
A long narrow cone should be used.

47

Lateral Skull (for sinuses)

For inflammatory conditions: Secondary osteomyelitis, sinusitis, and sinus

polyps (good for sphenoid, frontal, ethmoid, and maxillary sinuses).
Patient erect sitting, head in true lateral (IPL 90 to film)
Film: HD 18x24 cm
CP: Midway between outer canthus and EAM
CR: 90 horizontal to film center

48

Lateral 15 (Modified Law for TMJs)

S

For advanced bony pathology of the mastoid process.

Patient prone or erect, head in lateral, IPL 90 to film, face
( and MSP) then rotated 15 toward the film.
Film: HD 18x24 cm
CP: 4 cm superior to upside EAM
CR: 15 caudal to pass through the downside TMJ.

49

Axiolateral (Schller for mastoids)

S
For advanced bony pathology of the mastoid air cells.
Patient prone or erect, head in the true lateral, IPL 90 to film,
MSP parallel to the film.
Film: HD 18x24 cm
CP:
downside mastoid tip (4 cm superior, 4 cm posterior to
upside EAM).
CR:

25 - 30 caudal.

50

Axioanterior Oblique (Stenvers for mastoids)

B

For advanced pathology of temporal bone, e.g., acoustic neuroma.

Both sides are to be examined.

Patient prone or erect, IOML 90 to film, chin adjusted so that head

is rotated 45 oblique with the couch, side of interest down, downside
mastoid region centered to film.

Film: HD 18x24 cm
CP: 7 10 cm posterior, and 1.25 cm inferior to upside EAM to exit
through downside mastoid process.

CR: 12 cephalic.

51

Axiolateral Oblique (Modified Law for mastoids)

B

For advanced pathology of mastoids.

Patient prone or erect, each auricle taped forward, head in lateral,
then rotated 15 oblique toward the film, IPL 90 to couch, side of
interest down.
Film: HD 18x24 cm
CP: Exit downside mastoid tip (1 inch posterior, 2.5 cm posterior, 2.5
cm superior to upside EAM).
CR: 15 caudal

52

Parieto-orbital (Rhese View) for optic foramina

S
For bony abnormalities of the optic foramen. Both sides must be
done for comparison.
Patient prone or erect, chin, cheek, and nose against couch, head
adjusted so that the MSP makes 53 with the couch top, the
acanthiomeatal line AML makes 90 to the film, a long narrow cone
should be used.
Film: HD 18x24 cm
CP:
Downside orbit (7 cm above and 7 cm behind the up EAM).
CR:

90 to IOML

53

Parietoacanthial (OM) (Waters View for sinuses )

B
Best for maxillary and frontal sinuses and nasal fossae. Also shows other
inflammatory conditions (secondary ostemyelitis, and sinus polyps).
Patient erect, neck extended, chin and nose against couch, head adjusted till
MML is 90 to the film, OML makes 37 with film. AML makes 90 to the film, a
long narrow cone should be used.
Film: HD 18x24 cm
CP:

At level of lower border of the orbits to exit at the acanthion.

CR:

90 horizontal to film center

54

Parietoacanthial (OM) (Open-Mouth Waters for

sinuses )

Same as for Waters..

Same position as for Waters view, but with open mouth (patient
drops his jaw without moving the head).
Film: HD 18x24 cm.
CP:

At level of lower border of the orbits to exit at the acanthion.

CR:

90 horizontal to film center

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