X-RAY VIEWS OF PNS

PLAIN CONVENTIONAL
RADIOGRAPHY
Versatile diagnostic tool.
ADVANTAGES
Inexpensive
Easy to obtain
Affordable.
PLAIN CONVENTIONAL
RADIOGRAPHY

 DISADVANTAGES

 2-D RECORD OF 3-D OBJECT

 SUPERIMPOSITION OF VARIOUS STRUCTURES
ABOVE AND BELOW THE REGION OF INTEREST
 REQUIRES MULTIPLE PROJECTIONS
 POOR UNDERSTANDING OF

STRUCTURAL RELATIONSHIPS
Lines and plain used in basic skull
radiography
Radiographic baseline(orbitomeatal baseline) –line
drawn from outer canthus of the eye to the centre of
ext auc meatus
Infra orbital planes (frankfurt plane).-this passes thro
lower orbital margins and the roof ext aud canal.10
degree angle exist b/w orbitomeatal baseline and
frankfurt plane.
Median sagittal plane –anteroposterior line bisecting
skull into 2 equal halves.
Coronal plane –vertical plane right angle to sagittal
plane.
Standard positions of sinus radiographs:
 three positions:
1. Two anatomical - namely cornal and sagittal
2. One radiographic - termed as radiographic base
line.
The various radiographic positions used to study
paranasal sinuses are:
1. Occipito-mental view (Water's view)
2. Occipital-frontal view (Caldwel view)
3. Submento-vertical position (Hirtz position)
4. Lateral view
5. Oblique view 39 Degrees oblique (Rhese position)
Occipito mental view: (Water's view).
commonest view.
 The patient is made to sit facing the radiographic
base line tilted to an angle of 45 degrees to the
horizontal making the sagittal plane vertical.
 The radiological beam is horizontal and is centered
over a point 1 inch above the external occipital
protruberance.
The mouth is kept open and the sphenoid sinus will
be visible through the open mouth.

waters
If the radiograph is obtained in a correct position
the skull shows a foreshortened view of the
maxillary sinuses, with the petrous apex bone lying
just beneath the floor of the maxillary antrum.
In this view the maxillary sinuses, frontal sinuses
and anterior ethmoidal sinuses are seen. The
sphenoid sinus can be seen through the open
mouth.
Nasal bone, nasal septum, zygomatic arches
waters
Occipito frontal view (Caldwell view)

ideally suited for studying frontal sinuses.

 frontal sinuses are in direct contact with the film
hence there is no chance for any distortion or
geometric blur to occur.
the patient is made to sit in front of the film with
the radiographic base line tilted to an angle of 15 -
20 degrees upwards.
The incident beam is horizontal and is centered 1/2
inch below the external occipital protruberance.
This view is also known as the frontal sinus view.
Occipito frontal
Structures seen

Frontal sinus
Max sinus
Ethmoid sinus
Orbits
Inf & middle turbinates
Septum
Sup orbital fissure
Submentovertical view(BASAL)
is primarily taken to demonstrate sphenoid sinuses.
 the back of the patient is arched as far as possible
so that the base of skull is parallel to the film.
The x ray beam is centered in the midline at a point
between the angles of the jaws.
In elderly patients this view can be easier to achieve
if carried out in the supine position with the head
hanging back over the end of the table.
also demonstrates the relative thicknesses of the
bony walls of the antrum and the frontal sinuses.
Structures seen
Sphenoid
Post ethmoid
Maxillary sinus
Zygoma
Mandible
Foramina-ovale & spinosum
Pterygoid plates
Lateral view
 helps in distinguishing the various pathologies
involving the frontal sinuses.
 It helps in determining whether the loss of
translucency is due to thickening of the anterior
bony wall or infection of the frontal sinus per se.
 demonstrates fluid levels in the antrum.
gives information on the naso pharynx and soft
palate. This is infact a standard projection used to
ascertain enlargement of adenoid tissue.
Lateral view
 the patient is made to sit with the sagittal plane
parallel to the xray film and the radiographic base
line is horizontal.
 The incident ray is horizontal and the incident
beam is centered at the mid point of the antrum.
lateral
Structures seen

Frontal sinus
Sphenoid sinus
Nasopharynx
Adenoids
Palate
mandible
lateral
Oblique view

helps in demonstrating posterior ethmoid air cells

and optic foramen.
the patient is made to sit facing the film. The head
is rotated so that the sagittal plane is tured to an
angle of 39 degrees. The radiographic base line is at
an angle of 30 degrees to the horizontal.
The incident beam is horizontal and is centered so
that the beam passes through the centre of the orbir
nearest to the film.
 
Structures seen

Post ethmoid
Optic foramen
Frontal sinus
Lesser wing of shenoid
Orbital apex
X-RAY VIEWS OF TEMPORAL
BONE
Lateral

Schuller
Law
Mayer
owens
Frontal oblique

Stenver
Chausse II
basal
FRONTAL

Transorbital
Guillen
ChausseIII
towne
Law’s view
 the sagittal plane of the skull is parallel to the film
and with a 15° cephalocaudal angulation of the x-ray
beam.
 The external & internal auditory canals are
superimposed.
An excellent view of the cellular development &
disease of the mastoid portion of the temporal bone is
obtained.
 It also shows the tegmen, the anterior wall of the
lateral sinus, the external auditory canal, the TM joint,
and the pneumatization of the anterior part of the
squamous portion of the temporal bone.
This view does not show the key area of the attic,
aditus, and antrum
1)cavity 2)Sclerosis
X-ray both mastoids – Green arrow shows cholesteatomatous
cavity and brown arrow shows operated cavity
SCHULLER’S VIEW
 the sagittal plane of the skull parallel to the film and
with a 30° cephalocaudal angulation of the x-ray
beam.
quite similar to the Law's view except that the x-ray
tube is angled caudally 30° instead of 15°.
 Thus it displaces the arcuate eminence of the petrous
bone downward and shows the antrum and the upper
part of the attic.
FIGURE 7–1. Schüller’s projection: (1) root of the zygoma, (2) condyle of the
mandible, (3) temporomandibular joint,
(7) malleus, (8) incus, (12) air cells, (14) anterior plate of the sigmoid sinus, (15) dural
plate, (25) petrous apex.
It also gives an excellent view of the extent of the
pneumatization of the mastoid,
 the distribution and the degree of aeration of the air
cells,
 the status of the trabecular pattern,
the position of the vertical portion of the lateral sinus.
MAYER’S VIEW
obtained with the head of the patient rotated 45°
toward the side under examination
the tube adjusted so that the central ray passes through
the EAC .
This gives an axial view of the petrous bone and the
mastoid cells.
Shows the mastoid antrum, EAC and the upper part of
the tympanic cavity
OWEN’S VIEW
 resembles the Mayer's view but offers the advantages
of less distortion.
The patient's head is first positioned as for a Schüller's
projection and it is then rotated with the face away
from the film at an angle of approx 30°.
 The x-ray beam is directed cephalocaudal with an
angle of 35°.
This view gives a "surgeon's eye view" of the key area
of the attic, aditus & antrum.
It usually shows the malleus and the incus
TRANSORBITAL VIEW
obtained with the patient's occiput to the film to
magnify the orbit.
The chin is slightly flexed until the orbitomeatal line is
perpendicular to the film.
In this view, the petrous pyramid, especially the
internal auditory canal, is clearly visualized through
the radiolucency of the orbit.
 also shows the cochlea, vestibule, and semicircular
canals
(4) external auditory canal, (12) air cells, (13) mastoid process, (19) cochlea, (20)
internal auditory canal, (21) orbital rim, (28) medial lip of the posterior wall of the
internal auditory canal, (29)
vestibule, (30) base of the skull
TOWNE’S VIEW
Towne's view is the anteroposterior projection with
30° tilt
The patient lies supine with posterior aspect of the
skull resting on a grid cassette.
• The head is adjusted to bring the median sagittal plane
at rightangles
to the cassette and so it is coincident with its midline.
• The orbito-meatal base line should be perpendicular to
the film.
•
The central ray is angled caudally so it makes an angle of
30 degrees to the orbito-meatal plane.
• Centre in the midline such that the beam passes
midway
between the external auditory meatuses. This is to a
point
approximately 5 cm above the glabella.
allows comparison of both petrous pyramids and
mastoids on the same film.
 The petrous apex, internal autidory canals, arcuate
eminence, mastoid antrum, and mastoid process can be
clearly identified.
 This is useful for evaluation of apical petrositis,
acoustic neuroma, and cerebellopontine angle tumor
CHAUSSE III VIEW
obtained by positioning the occiput on the film, the
head rotated approx 10-15° toward the side opposite to
the one under examination and the chin flexed on the
chest.
 There is no angulation of x-ray beam.
.
This view provides visualization of the attic, aditus,
mastoid antrum, and especially the anterior two-thirds
of the lateral wall of the attic.
 In contrast, the Owen's view shows the posterior or
aditus portion of the attic
STENVER’S VIEW
 obtained with the patient facing the film with the head
slightly flexed &rotated 45° toward the side opposite
to the side under examination.
The x-ray beam is angulated 14° caudad.
The long axis of the petrous pyramid becomes parallel
to the plane of the film and the entire pyramid is well
visualized, including its apex.
stenvers
This view clearly shows the entire pyramid, internal
auditory cana, horizontal and vertical semicircular
canal, vestibule, cochlea, mastoid antrum,and mastoid
tip. The internal auditory canal may appear
foreshortened because of rotation
STENVERS
stenvers
tenvers
STENVERS
BASAL/SMV/AXIAL
 taken from "under the chin"
has the advantage of showing both temporal bones on
the same film so that comparison of both sides can be
made.
 shows the external auditory canal, the eustachian tube,
the middle ear with the incus and the head of the
malleus, the mastoid air cells, the styloid process, the
internal auditory canal, and petrous apex.
. It also shows such structures of the base of the skull
as foramen ovale, foramen spinosum, and jugular
foramen .
 This view has the disadvantage of loss of clarity and
detail of the ear structures because of increased
antrum-to film distance