X-ray of the paranasal sinuses is performed in two projections: the chin and nasal chin. Each x-ray allows you to visualize a specific anatomical structure. Due to the many different nuances and subtleties, the appointment of the attending doctor before radiography must be analyzed by a radiologist. This specialist can prescribe an alternative projection or completely cancel the appointment of the main doctor.
What is displayed on the x-ray?
X-ray of the paranasal sinuses in the frontal projection displays the following anatomical structures:
- The structure of the trellis maze.
- Display of the right and left half of the sphenoid sinus.
It should be noted that sinusitis with such radiography is unfortunately impossible to determine. This is actually so, therefore, frontal projection in the study of pneumatization of the sinuses is rarely used. A chin projection as part of the study of sinusitis is most preferred. It displays the sinuses as accessible and open as possible.
A description of the X-ray of the paranasal sinuses will be presented below.
When using the nasal chin, the temporal bone pyramids are superimposed on the area of the maxillary sinuses. Against the background of poor-quality implementation of the nasal-chin projection, the structures of the temporal bones can almost completely close the review.
To eliminate the above-described defect, sometimes the patient is asked to open his mouth. With this type of laying, the temporal bones may fall down. The beam can be directed vertically at an angle of thirty degrees to the vertical. On such radiographs, it is possible to clearly monitor the condition of the sinus of the sphenoid bone.
What can be supplemented?
In the event that the above projection is not enough, then the x-ray of the paranasal sinuses can be supplemented by sinusography or tomographic examination. Tomography is a layered study. It allows you to study the anatomical structures that lie deep in the tissue. Sinusitis involves the introduction of contrast medium into the patient's area of the paranasal sinuses. This technique is often used in case of detecting an annular shadow that resembles a cyst.
How is the study and description of the procedure
X-ray of the paranasal sinuses as part of the chin projection can be carried out in an upright position. Or this is done in a horizontal version, that is, when the patient is laid. Most often, during the procedure, a person sits or stands near an x-ray vertical rack. Such styling makes it possible to obtain optimal pictures in cases of suspected sinusitis. How is an x-ray of the paranasal sinuses?
- The patient should stand along a counter equipped with a fixed grill.
- The human head is set so that the chin can touch the rack, and the nose is located at a distance of two centimeters from it.
- The midline of the head is sagittal.
- The exposure is produced on a cassette 13 to 18.
- In this case, a focal length of one hundred centimeters is maintained.
The use of contrast medium
Carrying out an x-ray of the paranasal sinuses using a contrast agent allows you to fully explore the structure of anatomical structures, and in addition, this manipulation makes it possible to identify additional plus shadows, which often turn out to be formed by cysts, tumors or polyps.
Additional nuances of the procedure
Before an x-ray of the paranasal sinuses, there is no need to carry out any additional preparatory procedures. You just need to come to the X-ray room, providing the diagnostician with a referral. Next, the patient removes all his metal jewelry with clothes that have iron inserts, then puts on a special apron. Actually this is all the basic preparation for the x-ray of the paranasal sinuses.
What does the algorithm depend on?
The algorithm for x-ray manipulation largely depends on the indications:
- In order to examine the sinuses, pictures are taken from the occipital chin projection, and in addition, from the frontal side.
- As part of the study of the presence of bone formation, the picture is taken immediately in three planes, namely: in the left, in the straight and in the right, sometimes even the fourth projection (nasal-chin) is made by the diagnosticians.
From the radiologist during the procedure, as a rule, precise recommendations and instructions regarding the proper position of the patient are received. While taking a picture, you must definitely take a deep breath, and then hold your breath. The examination can last from one to several minutes.
The results of the procedure, as a rule, are transmitted directly to the attending physician (usually this nuance is indicated in the direction) or after thirty minutes directly to the patient himself. The doctor evaluates the images and makes a conclusion, followed by a treatment schedule and recommendations. It is worth noting that this type of examination is strictly contraindicated to carry out more often than once every six months.
Contraindications to the procedure
Strongly do not recommend an X-ray of the paranasal sinuses of the women in the position, since it has long been known about the extremely negative effect of rays on the development of the embryo. It is also necessary to abandon this manipulation if the patient has facial, dental or cranial metal prostheses.
It is necessary to refuse this type of research even if the patient was diagnosed with cancer. Otherwise, this type of X-ray does not have any other contraindications, nevertheless, it is nevertheless recommended to consult a doctor.
Deciphering of the X-ray of the paranasal sinuses
A high-quality x-ray of the sinuses, unfortunately, does not display additional shadows (the so-called artifacts). But at the same time, the anatomical structures are, as a rule, symmetrical and clearly traceable. In the presence of sinusitis, a fluid level can be visualized, which is located from the medial to lateral walls. Chronic inflammatory process in the sinuses (for example, with hypertrophic sinusitis) is usually accompanied by a thickening of the mucous membranes with concave external contours (according to the principle of a parabolic curve).
Why an x-ray of the paranasal sinuses is performed, many are interested.
In order to distinguish acute processes from chronic symptoms, it is advisable to shift the patient's head to the right or left when conducting a second study. In the event that the inflammatory process is fresh, then the liquid level will certainly shift. With a chronic change, the X-ray symptoms of the pathology will not change. The criteria used to evaluate image quality are as follows:
- The presence of a clear structure of the bone walls.
- The presence of symmetrical styling.
- The presence of a white-gray shadow. This criterion determines the technical feature of the exposure.
Why do x-rays of the paranasal sinuses? In the resulting image, one can always discern various neoplasms and cysts along with the presence of foreign bodies, the formation of cracks, debris and fractures. In addition, the doctor may notice all kinds of eclipses that demonstrate the inflammatory process.
In the absence of disease
In the absence of any diseases, all structures of the nose will differ even, and at the same time, with clear contours, and the sinuses will appear in the form of semi-oval smooth niches. Sinuses, as a rule, should be completely darkened. In the event that there are light inclusions, then this is an indicator of the presence of one or another inflammatory process.
In situations where the doctor cannot be reliably diagnosed with x-rays, patients are advised to undergo magnetic resonance and computed tomography. Of course, such studies will cost the patient a little more, but the information content, and at the same time, safety will be an order of magnitude higher.
How do x-rays of the paranasal sinuses with sinusography?
Sinusography
Sinusitis makes it possible to determine the intra-sinus formation. It is also applicable for the diagnosis of cysts and polyps. How is sinusography performed:
- Immediately after anesthesia, a puncture of the sinus wall is performed.
- Through it, the paranasal sinuses are washed with a solution of furatsilina to the patient.
- Then, with a needle, a solution with heated iodipol is injected.
- Next, take pictures in the nasal chin, nasolabial and lateral projections.
When conducting sinusography, it is forbidden to take an x-ray at the same time of both sinuses. In such a situation, the possibility of a clear visualization of the anatomical structure due to overlapping exposure from the opposite sinus is excluded.
X-ray of the posterior nasal cavity
The following anatomical structures are referred to the posterior paranasal sinuses in anatomy:
- Wedge-shaped structure.
- The structure of the lattice cells.
To study these anatomical structures, the use of the nasal chin and chin projection is not suitable. Axial projection is used here. The rocky part of the temporal bones along with the openings of the base of the skull and its fractures can also be seen using this projection. The sphenoid bone has a wide variety of structures. The radiologist must have a lot of experience in order to correctly decrypt the radiography. Axial projections always clearly show the wings of the sphenoid bone along with the basilar apophysis.
In such a projection, a round, back ragged and oval hole can be traced very well . In the presence of skull injuries (against a fall on the head, when striking the crown of the head or neck), a fracture line may occur. During the observation, the lines of the lower jaw and fracture are visible, and in addition, the bases of the apophysis of the occipital bone. If a disease is detected in one of these anatomical structures, the x-ray is supplemented with an aim x-ray for a clearer display.
It must be emphasized that the x-ray of the skull, as well as the paranasal sinuses, is one of the most difficult areas of radiology. Due to the many formations, often on the radiograph you can see the symptoms formed by the overlap or the imposition of various anatomical details between themselves. At the same time, a great deal of practical experience is required in order to be able to distinguish the norm from the disease in the images of the skull and paranasal sinuses.
What X-ray shows, we now know.
Where to perform the procedure?
Usually, absolutely every clinic has its own X-ray room. Diagnostics can also be performed in specialized otolaryngological centers (this is especially recommended for children) or in other large clinics.
Referral to the procedure should only be issued by a doctor. In this case, self-administration can be fraught with extremely negative consequences for the patient.
After passing through each procedure using X-rays, appropriate marks are made in the patient's card. Frequent x-ray diagnostics can adversely affect the state of the entire human body: teeth, hair, nails and the like. In this case, rapid aging processes can be triggered.
We examined what the X-ray of the paranasal sinuses shows. A description of the procedure is also provided.