Update: March 2018
X-ray – relatively fast, inexpensive and non-invasive
a study that allows you to judge not only the state of the bone
structures, but (mostly indirectly) and about changes in soft
tissues. Not surprisingly, the method remains relevant after
the emergence of more accurate (but more complex and expensive) surveys,
such as MRI and CT.
X-ray of the paranasal sinuses is one of the most informative.
methods of diagnosis in otorhinolaryngology, which allows to identify how
inflammatory processes, so neoplasms, fractures and other
Withдаточные пазухи (синусы) носа – это полости в костях черепа,
lined by mucous membrane and communicating with the nasal cavity.
Withдаточные пазухи не только уменьшают вес костных структур, но и
warm the air passing into the lungs, moisten it, serve
resonator for voice and “buffer” for injuries.
Indications for examination
Radiography of the paranasal sinuses is used for
- inflammatory processes;
- neoplasms (tumors, true and pseudocyst);
- the presence and localization of foreign bodies;
- the nature of head injuries, especially the facial part of the skull (after
- anatomical anomalies of the sinuses.
Symptoms for which an x-ray of the paranasal can be indicated
- acute or chronic headache, more often – paroxysmal
(especially in the frontal part, in the area of the nose, as well as pain,
aggravated by bending forward);
- discomfort, pain in the area of the dentition and the entire upper jaw,
painful chewing combined with nasal discharge and impairment
smell from the same side;
- difficulty nasal breathing, nasal congestion;
- hypersensitivity to light and tearing;
- swelling of the soft tissues in the face, local redness and
- discharge from the nasal passages (mucous, purulent,
X-ray examination of the paranasal sinuses is used
to determine the effectiveness of treatment (control pictures), as well as
in the period of preoperative preparation to determine the volume and
technical features of surgical intervention in a specific
How often can x-ray sinuses?
- Maximum dose set by the Ministry of Health
exposure for healthy people per year – 1 mSv (millisievert).
- The average radiation dose in the head radiograph is 0.1 mSv for
film apparatus and 0.04 for digital.
The simplest calculation shows that you can safely make up to 10
x-rays of the paranasal sinuses for the year. However, when it comes to
It is about life testimony, the number of examinations is determined
first of all medical necessity.
Состояния, при которых нельзя сделать рентген sinuses:
- severe (terminal) condition of the patient (coma,
decompensated cardiovascular or respiratory
- strong mental arousal;
- acute situations requiring surgery
(massive bleeding, open pneumothorax);
X-ray contrast examination of the paranasal sinuses
- iodine allergies;
- nasal bleeding.
It is not recommended to x-ray the sinuses of a child up to 7 years old,
except for situations where the examination is appointed for life
indications, such as traumatic bone damage
facial skull. But in general, the feasibility of x-rays
пазух носа ребенку зависит от возраста the patient. More precisely, from
the age at which the final anatomical occurs
the formation of sinuses. So, ethmoiditis may occur immediately after
birth, sinusitis – after 3 years, frontal – in a child over 5 years old,
sphenoiditis – from 10 years.
How do x-rays of the sinuses
The procedure does not require prior preparation. In conditions
X-ray studies are done by lying, sitting or standing, choosing
projection depending on the individual clinical task. Sometimes
the sinus is pre-filled with a contrast – special
X-ray trapping agent. Research with
contrast is carried out with suspected tumors, cysts, polypous
X-rays are made in several projections.
- Nasolabial (occipital-frontal) projection – to create it
the patient lies, his forehead and the tip of the nose tightly attached to the cassette.
It turns out frontal picture of the sinuses.
- Nasopodborochnaya (occipital-chin) projection –
the person being laid is placed face down, asking to open his mouth wide and
touch the cassette with your chin and nose. This projection is exactly
displays the features of both the maxillary sinuses and the frontal,
wedge-shaped and trellised labyrinth. With подозрении на уровень
fluids in the sinuses (blood, pus) study is conducted in
vertical position of the head and neck of the patient (more often – sitting).
- Lateral (bitemporal) projection allows you to see the side
frontal and sphenoid sinuses, and to a lesser extent, the cells
trellised labyrinth. The feature of the snapshot is that
the image of the right and left sinuses are superimposed on each friend it
allows you to identify changes in the sinuses in general, however
differentiate the severity of unilateral lesion on such
roentgenogram impossible. Get this shot when the patient’s head
its side surface is attached to the cassette, x-rays
at the same time they pass a little ahead of the ear trestle (a small protrusion in
areas of the lower third of the auricle).
- Axial (sub-vertical) projection is obtained when
supine position of the patient (on the back) when tilting the head
back when its parietal part fits tightly to the cassette. This
projection allows you to get an exact image of both wedge-shaped
The nasal chord and nasol projections are the most widely
applicable. The rest are appointed to clarify the diagnosis.
After examination on film devices, the resulting plate
need to show, so the result will have to wait half an hour
(if there is an opportunity to be examined urgently, most often it is
paid X-ray) up to several days. Digital devices “issue”
image immediately on the monitor screen, and the timing of the results
will depend solely on the workload of the radiologist,
which will make an x-ray description.
What shows in normal
On the radiograph, the radiologist determines the condition
- nasal cavity;
- eye orbits;
- frontal bone;
- trellised labyrinth;
- upper jaw;
- sphenoid bone;
- воздушные полости околоносовых sinuses
On a normal radiograph of the paranasal sinuses:
- triangular nasal cavity, the septum is flat, visible
- the boundaries of the sinuses are clear, the contours of all airborne
- the transparency of the sinuses is equal to the transparency of the orbital
- the sinuses are symmetrical.
A variant of the norm is incomplete separation of the sinus bony
partitions of small thickness.
Radiological best determine the maxillary sinus. They
located on both sides of the nasal cavity. In the pictures
x-rays in front projections they are visible as enlightenment
triangular in shape, sharply and clearly delineated. On radiographs in
lateral projections – approximately quadrangular
The frontal sinuses are located, as the name implies, in the frontal
bones, above the sockets. Their shape is close to the pyramid set on
one of the angles, sizes can range from extremely small to
extensive when the sinuses form supraorbital coves.
The ethmoid sinuses are located on the sides of the nasal septum,
on the front shots, their projection is most often superimposed on
projection of the main sinuses, but nevertheless, pneumatisation
(transparency) should be maintained.
Radiograph with pathology
The main diagnosis is to identify the state of dense
(bone structures), mucous membrane (its swelling, overgrowth),
as well as detecting the presence or absence of fluid in the cavity
It is important to note that any dense tissue (inflammatory
exudate, pus, hemorrhage, overgrowth of the mucous in the form
granulations, tumor cells) reduce the cavity of the sinus, leading to
its dimming. Blackout can be:
- total (complete) – the entire sinus is filled with pathological
content; less often total blackout displays innate
lack of sinus, which can lead to diagnostic
- dimming in the lower parts of the sinus with the available horizontal
level – indicates the presence in the sinus fluid: blood, pus,
- parietal – most often indicates thickening
mucous membrane due to inflammation or allergic edema;
- limited – it looks like the formation more often of a rounded shape,
emanating from one wall of the sinus, it is characteristic of tumors and
tumor formations (cysts, polyps).
The intensity of the darkening of the sinuses can be:
- high – shadow density corresponds to bone shadows
structures (usually compared with the intensity of the display of teeth) –
with foreign bodies, fragments of bones, the presence of additional in the sinus
a set of teeth, etc .;
- medium intensity – compared to the soft tissue shadow –
with purulent exudate and neoplasms;
- low intensity – slightly darker than orbits – with serous
exudate (mucous discharge), characteristic of viral infections
Features for some diseases
It appears on the radiograph as a strip of narrow shadow along
the edges of the sinus, which displays swelling and infiltration of the mucous
shell. Cavity transparency decreases, probably full
its darkening during accumulation of inflammatory exudate. With
the horizontal position of the head is revealed
liquid, gas may be above it. If acute sinusitis
complicated by the transition process to the bone structure of the sinus, on
radiographs revealed thickening of the bony walls, periosteal
layering, destruction of bone (destruction).
Long hyperplastic inflammatory process
accompanied by the growth of the mucous. Therefore, X-rays
visible pronounced thickening in the region of the edge of the bony walls in the form
intense blackouts with inward reversed, clear, slightly
wavy or uneven contours.
When sinusitis (inflammation of the maxillary sinuses) on
the radiograph determines the horizontal level of the fluid (at
level of the upper, middle or lower third of the maxillary sinus).
It is also possible to completely darken its cavity. Odontogenic sinusitis
(caused by the transfer of infection from the root of the tooth), as a rule
one-sided, unlike rhinogenic ones, which are more often
двусторонние.Sinusitis (с выпотом) лучше всего выявляется при
Feature of chronic allergic inflammatory processes
is the probability of having additional pincushion
formations (protrusions of the mucous membrane), which give the effect
With polypous sinusitis, these near-wall darkening
uneven, determined by the deformation of the lumen of the cavity of the sinus,
arcuate clear contours of polyps come to light.
With traumatic injury, a bone fracture is detected.
structures that form the sinuses are determined by the fracture gap, and
also possible displacement of fragments. At the same time darkening of
paranasal sinus can be regarded as a hemorrhage. With
air penetration into the cavity through cracks in the bony walls
bubbles are detected in the form of rounded enlightenments on the background of dense
tissue or fluid.
Most often develop in the maxillary sinuses. Usually,
formed from tissue mucosa, contain liquid inside
light yellow shade. On radiographs are defined as
round or oval-shaped formations adjacent to the wall
синуса.With выявлении кисты случае важно отдифференцировать,
whether it originated from the mucous membrane of the maxillary sinus directly or
has a dental origin when a retention cyst grows into
maxillary sinus from the alveolar dental process. For
this conduct a radiography of the teeth, which reveals
the relationship of cysts, dental roots and maxillary sinus.
Neoplasms are defined as round, ovoid or other
shadow shapes, characters both flat and uneven contours. Sometimes
tumors are very dense (for example, chondromas), have a bone structure
and wavy contours. Less intense shadows give angiofibromas,
forming knots of soft tissue, destroying the bones of the facial and
brain skull. Malignant (cancer, sarcoma) in a short time
destroy the bone wall of the sinus and lead to a pronounced darkening
her cavity on x-rays.
Despite more than a century of history of radiography as a method
diagnostics she still has no equal in that
identify the state of the paranasal sinuses. MRI and CT are good at
diagnosis of tumors, but when it comes to routine diagnosis
sinusitis and trauma effects, radiograph of the paranasal sinuses
The nose remains the primary method of investigation.