Why radiography is needed in maxillary sinusitis
To assess the condition of the paranasal sinuses, two main methods are used: radiography and computed tomography (CT). Radiography is considered the most objective way to get an idea of sinus pneumatization (aeration), which is why it historically remains the first step in diagnosing acute and chronic maxillary sinusitis. For a comprehensive assessment, radiographs are taken not in one, but in multiple projections—this is important because different sinuses are visualized differently in various positioning setups.
What projections are used
- Naso-mental projection is the most common and informative. It allows visualization and assessment of all paranasal sinuses at once: maxillary, frontal, sphenoid, and ethmoid labyrinth.
- Naso-frontal projection is used selectively when it is necessary to examine the frontal sinuses in detail, as they are better visualized in this positioning.
Thus, the naso-mental projection is the baseline, and the naso-frontal is an adjunct for targeted assessment of the frontal sinuses.
How to read the radiograph: normal vs. pathology
The main landmark when evaluating a radiograph is comparing the intensity of the sinus shadows with the shadow of the orbits:
| Condition | Sign on the radiograph |
|---|---|
| Normal | Sinus opacification matches orbital opacification |
| Abnormal | Sinus opacification is more pronounced than in the orbits |
If the sinus is “brighter” and does not reach the expected level of the orbit, its pneumatization is impaired, meaning air in the sinus is replaced by pathological contents (edematous mucosa, exudate, pus).
Radiological picture in chronic maxillary sinusitis
In chronic processes, radiography is performed specifically in the naso-mental projection, and the nature of the shadow allows one to suspect the form of inflammation:
- Homogeneous opacification — typical for the purulent form.
- Mural mucosal thickening — characteristic of the catarrhal form.
- Mottled shadow — a sign of the polypoid form.
It is important to remember: radiography provides only an approximate picture of the form of the process. CT of the paranasal sinuses is considered a more informative method for chronic maxillary sinusitis, and the diagnosis is often finalized by sinus puncture, which clarifies the nature of the inflammation and yields material for bacteriological examination.
"Nose-chin — you see everything, nose-forehead — you see the forehead" — this is an easy way to remember which projection is used for what. As for forms of chronic sinusitis: Purulent → Homogeneous shadow, Catarrhal → Contour (mucosal thickening), Polypoid → Mottling.
Class and exam questions
Which radiography projection is the most informative in maxillary sinusitis?
Naso-mental projection, because it visualizes all paranasal sinuses at once, including the maxillary sinuses.
Why is the naso-frontal projection additionally performed?
It is used selectively for better visualization of the frontal sinuses, which are less visible in the naso-mental projection.
By what sign on the radiograph is a normal sinus determined?
The degree of sinus opacification is compared with the orbit: if they match, sinus pneumatization is unimpaired.
What does homogeneous sinus opacification on the radiograph indicate?
This is a typical radiological sign of the purulent form of chronic maxillary sinusitis.
What else to study on this topic
- Computed tomography of the paranasal sinuses as a more accurate method in chronic maxillary sinusitis
- Maxillary sinus puncture: diagnostic and therapeutic role
- Forms of chronic maxillary sinusitis and their clinical-radiological differences
- Odontogenic maxillary sinusitis: etiology and masked clinical presentation features
- Complications of maxillary sinusitis during exacerbation
- Endoscopic sinus surgery as an alternative to radical surgery
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