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X-ray of the paranasal sinuses and bones of the nose to the child and adult
Last reviewed: 23.04.2024
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Radiography refers to the methods of radiation diagnosis and is a non-invasive examination of the internal structure of a certain part of the body by radiating it with X-rays and obtaining a projection of the image on a special film. This is one of the main diagnostic tests that entered medical practice from the end of the previous century and is still relevant today due to its availability and high information content. The x-ray of the sinuses and bones of the nose is prescribed after the injury, with the suspicion of an acute disease of this localization, neoplasm or to monitor the results of treatment.
Ionizing radiation during the study is really capable of having a harmful effect on the body, and everyone knows this. However, is the x-ray of the sinuses of the nose harmful? And how much?
Passing through the tissues of a living organism, X-rays ionize neutral atoms and molecules, transforming them into charged particles. However, the danger is, first of all, long-term exposure to radiation, and also - intensive. In diagnostic equipment, short-term low-intensity irradiation is used. He is considered to be almost safe even after repeated repetition.
Moreover, we do not go through the x-ray of the nose at all as often as, for example, fluorography, so if necessary and no contraindications, there will be no harm from a single procedure, even if after a while you will be assigned one more control study.
Radiography of the nose is necessary for the otolaryngologist to assess the condition of the bony structure of the nose and surrounding tissues, the extent of their damage, in order to establish the correct diagnosis and not make mistakes in the choice of the method and tactics of treatment.
How often can I take x-rays of sinuses and nose bones?
The maximum permissible total annual dose of radiation received from all sources is 150 mSv (milliSivert). Such a dose can be obtained by a person with the need for regular radiation diagnosis according to vital indications (about 100 surveys per year).
If there is no such need, then within a year the average citizen gets a dose within 5-15 mSv.
Once in x-ray of the sinuses of the nose on the most modern digital equipment, the irradiation will be 0.12 mSv, at the most "seedy" - 1.18 mSv. So even a few examinations, if they are necessary, will not result in a lethal dose for the patient.
It is believed that more than two examinations per year pass undesirable, because you may also need X-rays of other parts of the body. Nevertheless, the frequency of the radiography will be determined by your attending physician, in this matter you have to trust him, because the evaluation of the effectiveness of treatment is of great importance for confirming its correctness. For example, patients with a fractured nose bones with bias should regularly monitor how the recovery process is going on, and several unscheduled diagnostic procedures will do much less harm than improper blind treatment.
Indications for the procedure
Radiographic examination of the paranasal sinuses is prescribed with the following symptoms, which allow one to suspect the presence of an inflammatory process:
- obstruction of the nasal passages, difficulty breathing, prolonged runny nose;
- periodic nasal bleeding;
- feeling of bursting, heaviness in the cavity of the paranasal sinuses, photophobia, lacrimation;
- a sudden increase in temperature or a constant subfebrile condition for no apparent reason;
- swelling and redness of the skin in the nose;
- pain in the forehead, increasing when trying to tilt the head to the chest.
The x-ray of the nose with genyantritis and other inflammatory processes in the sinuses of the nose makes it possible to determine the pathological accumulation of a liquid substance in them and to differentiate the localization of inflammation, for example, etmoiditis (inflammation localized in the trellised labyrinth) from the frontitis (frontal sinus injury) or sinusitis.
In addition, the x-ray of the sinuses and bones of the nose can be diagnosed:
- presence of a foreign object in the nose;
- tumors, cysts, polyps, papillomas;
- curvature of the septum of the nose;
- osteomyelitis;
- osteoporosis.
The x-ray of the nose is always prescribed if there are suspicions of fractures or cracks in the bones of the nose with bruises and blows with the facial part of the head. It is necessary for visualizing the type of damage to the bones of the nose, the presence of displacements, determining the urgency of care. For example, on the roentgenogram, you will see the presence of such a dangerous complication of the fracture as the ingress of air into the frontal part of the skull. In this case, the account will go on for hours. Therefore, when getting injured, you do not need to delay the trip to the X-ray room.
On the roentgenogram, deviations from the norm can be detected at any stage of their development: hematomas, fractures and other destructive changes in the bones of the nose, damage to the nervous tissue and blood vessels. Even if you did not do an x-ray of the nose right after the injury, it's never too late to do it, especially if you are worried about discomfort or if breathing is disturbed.
Radiography of the nose is prescribed to patients before planned surgical interventions in this part of the skull in order to visualize the anatomical features of this area, which can become an obstacle to a standard operation.
Preparation
No special preparation is required before the X-ray examination. It is necessary to warn the doctor about the presence in the examination area of metal non-removable objects, for example, dental crowns, and remove the metal jewelry (chains, remove the ring from the nose).
Patients in the X-ray room are given special vests with lead plates sewn into them during the procedure so as not to irradiate other parts of the body unnecessarily.
To obtain a clear image, the patient should take a certain position and do not move for several seconds.
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Technique of the x-ray of the sinuses and bones of the nose
Sinuses or paranasal sinuses are located in the facial and partly brain bones of the skull. The epithelial surface of the sinuses is an extension of the nasal mucosa. X-ray of the paranasal sinuses is done in the nasolabial, chin and axial projections, each of which is used to visualize a specific anatomical structure. Sometimes additional stacking is applied, allowing to examine defects in more detail. The final choice of the projection remains with the radiologist, who can make adjustments in the appointment of an otolaryngologist.
When examining the sinuses, the patient takes a vertical position (standing or sitting) or horizontal (lying) position, depending on the possibilities of the available equipment.
The maxillary or maxillary sinuses are, as can be seen from their name, in the body of the upper jaw. The x-ray of the maxillary sinuses is done in most cases in the chin projection. In the picture from this position they are shown most openly. Most often with this procedure, the patient sits or stands near the vertical radiographic rack, sometimes the patient is placed on the table.
In the nasolabial projection, the pyramids of the temporal bones are prevented from clearly viewing the maxillary sinuses completely along the entire length, overlapping the lower third of the view, and sometimes completely closing it. To neutralize this visualization defect by performing the x-ray of the maxillary sinus in this projection, the patient is asked to open his mouth during the survey, while the temporal bones are lowered, opening the view. To detect fluid in the maxillary sinus, the image is taken in an upright position. If such measures are not enough, then perform a gynorography - an x-ray with the introduction of a contrast agent in the maxillary sinuses. This method allows you to detect the formation inside the sinuses - polyps and cysts. The left and right sinus syncope is done alternately, not simultaneously.
The X-ray of the frontal sinuses of the nose is prescribed when suspicion of the frontitis. It is performed in a direct projection with a centralization on the frontal bone, under which these sinuses are located. The patient stands with his chin resting on a special support. Radiologist or laboratory assistant helps him to take the right position. Sometimes the X-ray in this projection is performed in a prone position.
The images of the posterior nasal cavities are performed in an axial projection, on which the wedge-shaped and latticed sinuses are clearly visible, and also in this projection the rocky part of the temporal bone, the skull base holes and the damage to these bones, if any, are clearly visible. If defects are found in the image, additional sighting more clearly defined radiographs are made in the axial projection if necessary. Also, a patient's side laying can be used to visualize the paranasal sinuses.
The X-ray of the septum allows time to reveal its curvature, congenital or acquired. Such a pathology causes a disruption of the function of nasal breathing and increases the likelihood of sinusitis. The curvature of the nasal septum can be clearly seen in pictures in the nasolobic projection.
X-rays of the bones of the nose are usually performed in a straight (nasolabial or nosolobnoy) and lateral (on the right or left) projections. The diagnostic procedure is performed as soon as possible after receiving a stroke in the face area.
A snapshot in a direct projection shows only fractures with displacement. To establish the sides of the patient's damage are laid on each side of the side, sometimes it is necessary to take a picture in the nasolabial projection, where the structure of the bones of the nose and maxillary processes is clearly visible.
With impression fractures (when displacement occurs only transverse displacements), the images are taken in an axial projection. This displacement is also found on the targeted x-ray of the frontal sinus, where the nasal passages are clearly visible.
Special categories of patients
X-rays of sinuses during pregnancy are performed only in case of emergency. A pregnant woman must cover her belly with a protective lead vest.
X-rays of the sinuses of the nose are also performed only in cases when the benefits of the procedure exceed its harmful effects, since the X-ray radiation negatively affects the development of bone tissue. The indications for X-ray of the paranasal sinuses in childhood include trauma to the face, suspicion of getting into the nose of the foreign body, curvature of the nasal septum, suspected inflammation of the paranasal sinuses, congenital anomalies of the nose structure, adenoids. The child should have the following symptoms:
- noisy breathing, snoring, sleep disorders;
- nasal congestion and voice changes;
- elevated temperature;
- headache;
- disorders of development of facial bones of the skull.
An alternative diagnostic method for a child is magnetic resonance tomography, resolved from birth and not carrying a radiation load. However, its availability is limited.
In the child, the interosseous sutures of the facial bones are pronounced and have a cartilaginous structure. In cases of light bruises, they diverge in different directions, but their integrity is not violated. In childhood, the following traumatic disorders of the structure of the nasal bones are common: insertion of bones between the frontal processes and flattening of the nasal canopy. Their visual symptom is the westernization of the back of the nose, the increase in the distance between its bones - the nose becomes flattened, the edges of its bones may protrude. Radiography in such cases is not informative, and rhinoscopy is used to detect hematomas and tissue ruptures.
Contraindications to the procedure
Absolute contraindication to the procedure is a severe degree of mental disorder, in which the patient can not fulfill the conditions necessary for the procedure: take the right posture, hold your breath and so on.
In the presence of metallic non-removable prostheses in the radiographic zone, it is recommended to replace the radiography with another visualization study.
Pregnant women X-rays are contraindicated because of its teratogenic effect, children of preschool and primary school age - because of the negative impact on the growth and development of the skeleton.
People with reduced immunity can be deferred to a scheduled diagnosis until a more favorable period.
Emergency radiography for vital signs is carried out practically to all categories of the population, observing precautions.
Normal performance
The x-ray image provides almost complete information on the condition of the paranasal sinuses and nose bones, reveals the presence of the inflammatory process, neoplasms, bone and cartilage tissue injuries, and also to establish that the patient is OK on the part of this breathing organ.
An x-ray of the sinuses of a healthy person is characterized by the clarity of the lines and contours of the bones, the smooth contours of the paranasal sinuses, the absence of thickening of the mucous membrane enveloping the bone walls. Absolute symmetry of nasal sinuses is not necessary.
In the paranasal sinuses, only the air should be found, their coloring on the x-ray is light gray, comparable to the coloration inside the eye sockets (it is the benchmark for comparison). The patient has a smooth nasal septum, whole bones and clearly visible contours of the latticed cells.
What shows the x-ray of the sinuses of the nose, the transcript
The x-ray of the nose can detect various signs of disease. Their description with the installation of a presumptive diagnosis usually takes the radiologist about ten minutes. On several pictures taken in dynamics, it is also possible to track positive changes in the treatment process or their absence. With inflammation of the nasal sinuses, usually a few pictures are assigned: diagnostic and for monitoring the treatment. Decoding the x-ray of nasal sinuses includes not only a description of their condition, but deviations from the norm of other anatomical structures that are visible in the picture. Occasionally, asymptomatic pathologies can be detected, for example, neoplasms or neglected fused fractures that lead to bone defects.
Darkening of the sinus in comparison with the standard indicates the presence of inflammation (sinusitis). The roentgen clearly shows its localization: in the frontal part (frontitis); maxillary sinuses (sinusitis); sphenoidal (sphenoiditis), latticed cells (etmoiditis). Often several paranasal sinuses are involved in the inflammatory process: bilateral - hemisinusitis, affecting all the sinuses - pansinusitis.
In addition, the X-ray image can accurately determine the type of inflammatory process: simple or catarrhal, serous, purulent, exudative. These processes differ only in the form of the substance accumulated in the sinuses, which is determined by puncturing. The accumulation of liquid looks like a darker than air section with an upper horizontal level. Sometimes the boundary of a liquid substance has the form of a parabolic curve with a vertex at the bottom. This form of it speaks of violations of the sinus communication with the nasal cavity.
Also, literally by two X-ray images, one can distinguish an acute process from a chronic one. To do this, when carrying out the repeated radiography move the patient's head in any direction. In acute inflammation, the boundary of the fluid also shifts, with chronic inflammation not.
Clearly visualized parieto-hyperplastic sinusitis, as well as polyposis. The first form is characterized by darkening along the contour of the walls of the nasal sinuses. This is because in the mucous membrane that covers the bone walls, a hyperplastic process occurs, due to which it thickens. The contour of the sinuses in this case is turned inside the sinus and has an uneven or wavy edge. In advanced cases, the sinus is darkened completely and turns into an airless space.
The polyp in the nose or their multiple growths visually look like protrusion of the wall on the stalk, facing the inside of the sinus.
Tumors look like darkened areas. The cyst is visualized as a weak or more pronounced shade of a rounded shape, bounded by a straight, even line.
Neoplasms usually show up unexpectedly. Expressed clinical signs, in addition to frequent inflammations in the nasal sinuses and some difficulty in breathing, they do not. Upon detection, surgical treatment is prescribed.
Fracture of nose
X-ray images of a broken nose can determine fracture lines, the presence of displacements of fragments and fragments, as well as their presence in soft tissues and sinuses, help to assess the degree of damage to paranasal tissues. Minimal damage is an isolated fracture of the nasal bone without displacement.
X-ray diagnostics with a fracture of the nose is a highly informative method that allows you to detect fractures and cracks in the early stages, when the inflammatory process did not affect the soft tissues to a large extent. Also this method is important for monitoring the process of bone fusion and the formation of bone callus.
Due to radiography, you can determine the type of fracture: straight, oblique or transverse; multi-lobed or in the form of a bird's beak; absence of bias; differentiate the fracture from the curvature of the nasal septum.
Fractures are also classified by the mechanism of injury, which is important for forensic medical examination.
A snapshot in the nasolabial projection allows one to detect such a complication as hemorrhage into the sinuses.
Sometimes a radiograph of the skull and nasal sinuses reveals a "symptom of an air bubble" - a complication in the form of air entering the frontal part of the skull. In the picture it is visible under the arch of the skull and frontal bones.
Of great importance are the anatomical features of the organ. If the nose has a thin and short structure, the line of enlightenment (fracture) can be beyond the resolution and not be determined.
Large and long bones of the nose are damaged more often, and the resulting defects in the picture are seen very well.
Injuries of the nasal bones of mild severity are characterized by a crack and hemorrhage in the quadrangular cartilage region; brittle lower edge. Bones in this case are deformed, and the curvature of the pear-shaped hole is traced.
If the blow to the nose came from the side, the X-ray shows the displacement of both bones. The picture resembles a fracture, but the line of enlightenment and displacement of bone fragments is not visible.
Fractures of the bones of the nose with a lateral impact look like an extension of the front bones, since a crack arises in the abutment of the nasal bones to the orbits.
For a top-down impact, the following are characteristic: Impression and / or vertical fracture of both bones of the nose; deformation of the frontal processes. In cases of cartilage damage, the line of enlightenment (fracture) is often not visible, since this type of tissue is characterized by elasticity. Nevertheless, in this direction of impact there is a crack in the quadrangular cartilage, and also - a displacement of the septum is possible. There are many nuances that can be visualized using sighting radiographs.
Complications after the procedure
In medical examinations using X-rays, low-intensity irradiation is applied for several seconds. The x-ray of the sinuses and bones of the nose among radiographic examinations of different parts of the body is one of the shortest and safest in terms of the dose of the received irradiation. Even with repeated repetition of this diagnostic measure, no immediate consequences after the procedure can arise. And the long-term consequences, for example, the risk of developing cancer in the future in people who have undergone this examination, and who have never been practically the same.
The carrier of radiation radiation in diagnostic equipment is electromagnetic waves that disappear immediately after the end of the procedure. They are not capable of accumulating in the body, like radioactive chemicals, and therefore, no radiation-removal measures are required after X-ray examination.
Nevertheless, an X-ray examination should be performed only at the doctor's prescription and follow the dose of radiation received during a lifetime.
So, we found out that complications after the procedure of radiography do not arise. But the rejection of diagnosis can lead to serious consequences, the easiest of which is the curvature of the nasal septum. Without visualization of lesions of any genesis, the diseases of the nose are complicated by the development of respiratory failure, suppuration of the muscles and tissues of the face, and also by infection of the brain. You can "view" hematomas, neoplasms, hyperplasia. Inadequate treatment leads to chronic inflammation, permanent swelling of the soft tissues of the face.
Analogues to an X-ray
An alternative radiation method of diagnosis is computed tomography. Unlike an x-ray, the doctor receives a clearer three-dimensional image, which can be copied to a laser disc or USB flash drive, sent by e-mail. However, computed tomography gives the most significant radiation load. The radiation dose for computed tomography of the skull and paranasal sinuses is 0.6 mSv. Compared with a modern X-ray machine, this is true, with one x-ray you will receive 0.12 mSv. Even if you do it in two projections. On the antediluvian equipment, the received dose will amount to 1.18 mSv, with two projections - twice as much. So, the radiation load from CT does not always exceed the X-ray. The price of the issue is the cost of the procedure.
Investigation of internal organs with the help of ultrasonic waves (echosinusoscopy) is considered the safest, it is shown even to pregnant women - ultrasound scanning is subjected to an unborn child. Nevertheless, ultrasound scanning some organs remain partially inaccessible. Among them - bone tissue and paranasal sinuses, because they normally contain air. Ultrasound diagnostics are available frontal and maxillary sinuses of the nose, it can detect in them neoplasms and the presence of fluid or foreign bodies. Ultrasound can diagnose the curvature of the nasal septum. However, this method, in addition to its main advantage - security, also has a number of shortcomings. Ultrasound data often leads to overdiagnosis (they may indicate a pathology that does not exist), so anyway many doctors need to clarify the diagnosis on the x-ray. X-rays are considered more informative. Ultrasound in the study of anatomical structures of the nose is often prescribed as an additional research method that does not exclude radiography.
Magnetic resonance tomography is quite informative, it is considered safe. It can also be used to diagnose injuries and diseases of the nose. However, in addition to the high cost of the study, ray methods (X-rays and computed tomography) are considered more informative when examining the bony structures of the facial skeleton. MRI improves visualization of soft tissues, vessels and nerves, as well as neoplasms in them.
In the study of nasal structures, various methods can be used, but the X-ray is the most universal and informative, and, importantly, is available.
Feedback about the procedure is most favorable, it is short-lived, does not cause any unpleasant sensations and the patient's condition before and after the procedure does not change. Thanks to the cheapness of radiography, the availability of radiological laboratories in almost all out-patient departments, as well as high information content, it is very common. The only advice that "experienced" patients give: if possible, do X-rays in offices equipped with the most modern equipment. It has many advantages - from the comfort of the patient himself and a better image to the lowest radiation doses.