Water’s Baru

7/17/2019 Water’s Baru

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Sinus paranasalisSinus paranasalis

Rosy SetiawatiRosy Setiawati

Departement of RadiologyDepartement of RadiologyDr. Soetomo HospitalDr. Soetomo Hospital

SurabayaSurabaya



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



$ptimal pneumati%ation

rontal '()* years

Sphenoid *()+ years,thmoidal !()- years

axilary !(!" years



,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



















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



Sinusitis



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



R4

∼ 89 Scan

4ntracranial complication







#mur ! thn

































CT SCAN SINUS PARANASALIS









R4 vs. 89













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.



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.



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.

'



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

'-



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.

'?



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.

:+



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.

:)



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



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 )



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



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



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