paranasal sinuses are air filled cavities. various radiographic techniques are used to examine areas of sinuses .

1. PNS - View
Dr.NeeNa MuNeer

2. CoNteNts
• Introduction
• Extraoral landmarks
• Paranasal sinuses views
• Granger view
• Campwell view
• Orbitomeatal views
• PA water’s view
• Bregman menton view
• Conclusion

3. ParaNasaL sINuses
 The large, air-filled cavities sometimes called the accessory
nasal sinuses because they are lined with mucous
membrane, which is continuous with the nasal cavity.

4. HIstorY

5. Mucous was not a product of brain but on the
contrary was secreted by the lining mucosa of
paranasal sinuses
Detailed anatomical description of paranasal
sinuses
accurate description of maxillary sinusHighmore
in 1651
C. V.
Schneider
19th
century
Zukerkandl

6. • sinuses - four groups

8. MaxILLarY sINus
.

10. FroNtaL sINus

12. etHMoID sINus

14. sPHeNoID sINus

15. • v

16. extraoraL LaNDMarKs
For PatIeNt PosItIoNINg

17. a) The Median Plane of the Head(Midsagittal
Plane)
b) The Orbitomeatal Line (Canthomeatal Line)
c) The Frankfort Horizontal Line

20. raDIoLogY oF Para NasaL sINuses

21. Posterior anterior Projection(occiPito frontal
Projection of nasal sinuses)

23. occiPito frontal Projection of the nasal
sinuses

24. GranGer Projection
 Structures seen:
Inner and Middle ear
Anterior ethmoid cells
Petrous pyramid
Frontal sinuses
Sphenoidal sinus
Upper part of antrum

25. • Indications:
b) Investigations of the frontal sinuses
c) Conditions affecting the cranium, particularly,
Paget’s disease
Multiple myeloma
Hyperparathyroidism
d) Evaluate facial growth & development
e) Trauma
f) Developmental abnormalities

26.  Film Placement
 The cassette is placed perpendicular to the floor in a
cassette holding device
 Long axis of cassette is positioned vertically

27.  Position of patient
 Midsagittal plane should be vertical and perpendicular
to the plane of cassette
 Only forehead and nose should touch the cassette
 Radiographic baseline is at 90 degree to film

28.  Central Ray:
 Directed to the midline of skull so that X-ray beam
passes through the canthomeatal plane
perpendicular to the film plane

29.  Exposure parmetersExposure parmeters:
mA – 10kVp – 65
Seconds - 3

31. caldwell Projection
Structures Shown:
Orbits
Ethmoid air
cells

32. Film Placement:
• Cassette is placed perpendicular to the floor in a
cassette holding device
• Long axis of cassette is positioned vertically

33. Position of patient:
• Mid sagittal plane is vertical and
perpendicular to the cassette
• Only the forehead and nose touch the
cassette

34. Central Ray:Central Ray:
• Directed 23 degree to the canthomeatal
line
• Entering the skull about 3cm above the
external occipital protuberance and exiting
at the glabella

35. Exposure Parameters:Exposure Parameters:
mA 60 –
kVp – 70-80
Seconds –
1.6

37. radioGraPhy of maxillary
sinus

38. standard occiPito meatal
projection
 Structures seen:
Facial skeleton
Maxilary antra
Avoids superimposition of dense
bones of the base of the skull

39. • Indications:

40. • Film placement:
• Cassette placed perpendicular to the floor in a cassette holding
device
• Long axis of the cassete is positioned vertically

41. • Position of patientPosition of patient:
• Midsagittal plane should be vertical and
perpendicular to plane of cassette
• Nose and chin should touch the cassette
• Head is tipped back so that the radiographic
baseline is at 45degree to the film

43. • Exposure parameters:
KVp -65
Seconds- 2-3
mA- 10

45. Each zygoma and zygomatic
arch resembles the head and
trunk of an elephant

46. LEFORT 1 FRACTURE

47. MOdiFiEd METhOd (30dEgREE OCCipiTOMEnTAL
pROjECTiOns)
• Structures shownStructures shown:

48. • Film placementFilm placement:
• Cassette placed perpendicular to floor in a cassette holding
device
• Long axis of cassette is positioned vertically

49. • Position of patientPosition of patient:
• Mid sagittal plane is vertical and perpendicular to the cassette
• Head is centered so that the nasion is in the center of the
cassette
• Only the nose and chin touch the cassette, The head is tipped
back so that the radiographic baseline is at 45 degree to the
film

50. • Central RayCentral Ray:
• Directed 30 degree to the horizontal ,centered through the
lower border of orbit

53. pA WATER’s
• Structures seen:Structures seen:

54. • Film PlacementFilm Placement:
• Cassette placed perpendicular to the floor in a cassette holding
device
• Long axis of cassette is positioned vertically

55. Mid sagittal plane should be vertical
and perpendicular to plane of film
Canthomeatal line should be 37 degree
to plane of the film
line from external auditory meatus to
the mental protuberance should be
perpendicular to film
Patient’s head extended so that only
chin touches the cassette
Cassette centered on the Acanthion
(Anterior nasal spine)

57. • Central RayCentral Ray:
• Perpendicular to the midpoint of film
• It enters from vertex and exists from acanthion

58. Step 1
• Interpretation:
• Evaluate the calvarium and sutures starting in the left temporal
area over the supraorbital to the right temporal area. Look for
intracranial calcifications

59. Step 2
Evaluate the orbits and the frontal sinuses. Identify the
supraorbital and infraorbital rim, the inferior orbital foramen, the
floor of the orbit, the zygomaticofrontal sutures and the
innominate line of the infratemporal fossa crossing on the lateral
aspect of each orbit.

60. Step 3
• Evaluate the maxillary sinuses & nasal cavity. Identify the
superior, medial & lateral Walls of the maxillary sinuses; the
nasal septum & the floor & lateral walls of the nasal cavity

61. Step 4
• Evaluate the zygomatic arches. Identify the frontal,
maxillary, and temporal processes of the zygoma and
the zygomaticofrontal suture

62. Step 5
• Evaluate the condylar and coronoid processes of the
mandible

64. • There are three anatomic contours best seen on the Waters
view (occipitomental view )of the face, and they were first
popularized by Dolan et al called Dolan’s line
• The 3 lines of Dolan lead the eye along some facially
important structures. Lee Rogers pointed out that the 2nd and
3rd lines together form the profile of an elephant

65. • McGrigor-Campbell lines
• The ' McGrigor-Campbell lines' are
visible on OM and OM30 views and
can act as anatomical references to
assess the facial bones for injury
• Upper line - (Red) passes through the
zygomatico-frontal sutures (asterisks)
and across the upper edge of the orbits
• Middle line - (Orange) follows the
zygomatic arch (elephant's trunk),
crosses the zygomatic bone and
follows the inferior orbital margins to
the opposite side
• Lower line - (Green) passes through
the condyle (1) and coronoid process
(2) of the mandible and through the
lateral and medial walls of the
maxillary antra on each side
• Midline - used to assess symmetry

66. Campbell’s and Trapnell’s Lines

67. Careful examination of the three Dolan’s lines on the waters view is key
to the identification of ZMC fracture

68. • Isolated zygomatic arch
fracture
• Disruption of the middle
McGrigor-Campbell line is
due to a comminuted
fracture of the right
zygomatic arch
• Following the upper and
lower lines shows no
fracture

69. • Tripod' fracture
• 1 - The zygoma (asterisk) is
separated from the frontal
bone at the zygomatico-
frontal suture
• 2 - Comminuted fracture of
the zygomatic arch
• 3 - Orbital floor fracture
• 4 - Breach of the lateral wall
of the maxillary antrum

70. • Orbital 'blowout' fracture-
Teardrop sign
• On the left a 'teardrop' of
soft tissue has herniated
from the orbit into the
maxillary antrum

71. Bregmon menton
• Structures shown:

72. • Film Placement:
• Cassette is placed perpendicular to floor in a cassette holding
device
• Long axis of cassette positioned vertically

73. • Position of patient:
• Midsagittal plane should be perpendicular to the plane of film
• Patient’s head extended as far as comfortable to make the
lower border of mandible as parallel to the cassette as possible
• Only chin touches cassette
• Canthomeatal line approximately parallel to plane of film

74. • Central ray:
• Entry through Bregma
• Exit at menton

77. reFerenCeS
1.White SC, Pharoah MJ. Oral radiology: principles and
interpretation,5th edition,
2. Karjodkar FR. Text book of dental and maxillofacial
radiology, 1st edition, Jaypee brothers medical publishers
inciples and interpretation,5th edition,
3.Whites E. Essentials of dental radiography and radiology, 3rd
edition, Churchill

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