Sinus XRay

In adults, Sinus CT is far preferred over XRay if sinus imaging is needed
1. Consider Sinus XRay in children (or in under-resourced regions)
Evaluation of Suspected Chronic Sinusitis
Evaluation of Acute Sinusitis:
1. Persistent symptoms despite adequate treatment
2. High risk patients
  1. Diabetes Mellitus
  2. Immunosuppressive Drugs
3. Suspected involvement in multiple Paranasal Sinuses

Ethmoid or Sphenoid Sinusitis
Age under 3 years
1. Undeveloped sinuses
2. High False Positive opacification rate

General
1. Sinuses normally appear black on XRay (air density)
2. Opacification or fluid will appear white (fluid density)
Maxillary Sinus: Waters' View (Occipitomental XRay)
1. Maxillary Sinus visualization
  1. Water's view alone is usually sufficient for sinus imaging
2. May identify Fractures (orbital rim, orbital floor, nasal septum and nasal bones)
Frontal Sinus: Caldwell-Luc
1. Frontal View (PA) with the patient's face against the film
2. Best visualizes Frontal Sinus (other sinuses overlap one another on this view)
3. Visualizes Fractures of the orbital rim and the medial orbital wall
4. Visualizes sagital Suture
5. Visualizes Zygomatic Bones, nasal bones, nasal septum and Mandible
Lateral XRay
1. Visualizes ethmoid and Sphenoid Sinuses with the patient seen in profile
2. Visualizes coronal Suture and lambdoid Suture
3. Visualizes Mandible and nasal bone