Patient Management

Question 1

MAXILLARY SINUSES

Answer 1

• Largest of the paranasal sinuses
• Begin to develop in the fetal stage and fully develop and aerated at birth
• roughly pyramidal
• usually symmetric
• Drain into the middle nasal meatus

Question 2

FRONTAL SINUSES

Answer 2

• Usually the second largest sinuses
• Fully develop by 6-7 years of age
• Normally paired and rarely symmetric
• Separated into two halves by the intersinus septum
• Drains into the middle nasal meatus

Question 3

ETHMOIDAL SINUS

Answer 3

• Develop within the lateral masses of the laby
• Divided into three groups- Anterior, middle, and posterior ethmoids
• Last to fully develop
• Begin to fully develop during puberty and mature around 17-18 years
• Anterior and middle 2-8 cells drain into the middle nasal meatus
• posterior ethmoid 2-6 cells drain into the superior nasal sinus

Question 4

SPHENOIDAL SINUSES

Answer 4

• Develop in the sphenoidal bone
• Usually paired but often singular
• Distinguishable at 6-7 years
• Usually asymmetric
• Located inferior to the sella turcica
• Drain into the superior nasal meatus

Question 5

PARANASAL SINUSES POSITIONING REQUIREMENTS

Answer 5

Must be done erect always

• To show air fluid levels if present
• To differentiate between fluid and pathology

Question 6

LATER SINUSES PROJECTION

Answer 6

• Patient seated or upright position
• Side of interest closest to the IR
• Head in true lateral position
• IPL perpendicular to IR
• MSP parallel to the IR
• IOML parallel with the transverse axis of the IR
• CR directed horizontally to enter 1,3- 2,5cm posterior to out canthus

Question 7

LATER SINUSES PROJECTION

STRUCTURES DEMONSTRATED

Answer 7

• All Four sinuses

- Sphenoidal sinuses is of primary importance

Question 8

PA AXIAL SINUSES CALDWELL METHOD

Answer 8

• Patient in upright position facing the IR
• Vertical Grid tilted 15 deg down/ raise chin 15deg
• Patient Restes forehead and nose on grid
• MSP perpendicular to IR
• OML perpendicular to IR
• CR horizontal to exit the nasion

Question 9

PA AXIAL SINUSES CALDWELL METHOD

STRUCTURES DEMONSTRATED

Answer 9

• Frontal sinuses lying superior to the frontonasal suture

- Anterior ethmoidal sinuses lying on either side of nasal fossae

Question 10

CLOSED MOUTH WATERS

Answer 10

• Patient in upright position
• Patients chin rested on Bucky
• MSP perpendicular to IR
• OML 37 deg to IR
• Tip of nose approx 1-1,5 cm from IR
• MML perpendicular to IR
• CR exiting the acanthion perpendicular to IR

Question 11

CLOSED MOUTH WATERS

STRUCTURES DEMONSTRATED

Answer 11

• Petrous ridges are seen inferior to the maxillary sinuses
• Foramen Rotunden
• Distorted frontal and ethmoid sinuses

Question 12

OPEN MOUTH WATERS

PROJECTION

Answer 12

Patient in upright position

• Patients chin rested on Bucky
• MSP perpendicular to IR
• OML 37 deg to IR
• Tip of nose approx 1-1,5 cm from IR
• MML perpendicular to IR
• CR exiting the acanthion perpendicular to IR
• Instruct patient to open mouth by dropping the chin without moving the head
• CR perpendicular to IR exiting the acanthion

Question 13

OPEN MOUTH WATERS PROJECTION

STRUCTURES DEMONSTRATED

Answer 13

• Sphenoid sinuses through the open mouth

- Maxillary sinuses and the nasal fossae