Waters' view

{{Short description|Radiographic view}}

{{Infobox medical intervention

|Name=Waters' view

|specialty=Radiology

|image=Medical X-Ray imaging PZJ06 nevit.jpg

|caption=A Waters' view radiograph showing the paranasal sinuses}}

Waters' view (also known as the occipitomental view or parietoacanthial projection) is a radiographic view of the skull. It is commonly used to get a better view of the maxillary sinuses. An x-ray beam is angled at 45° to the orbitomeatal line. The rays pass from behind the head and are perpendicular to the radiographic plate. Another variation of the waters places the orbitomeatal line at a 37° angle to the image receptor. It is named after the American radiologist Charles Alexander Waters.

Uses

= Structures observed =

Waters' view can be used to best visualise a number of structures in the skull.

The Waters' view may not show the frontal sinus in detail.{{Cite book|last1=Freeman|first1=M. Brandon|chapter-url=https://www.sciencedirect.com/science/article/pii/B9780323034708000442|title=Plastic Surgery Secrets Plus|last2=Harshbarger|first2=Raymond J.|publisher=Mosby|year=2010|isbn=978-0-323-03470-8|edition=2nd|pages=291–294|language=en|chapter=44 - Fractures of the Frontal Sinus|doi=10.1016/B978-0-323-03470-8.00044-2}}

= Interpretation of results =

class="wikitable"
PathologyObservation
None (Normal)* Odontoid process lies exactly below mentum.

  • Maxillary sinuses are more radiolucent than orbits.
Maxillary sinusitis{{Cite book|last1=Ruprecht|first1=Axel|chapter-url=https://www.sciencedirect.com/science/article/pii/B9780323096331000262|title=Oral Radiology - Principles and Interpretation|last2=Lam|first2=Ernest W. M.|publisher=Mosby|year=2014|isbn=978-0-323-09633-1|edition=7th|pages=472–491|language=en|chapter=26 - Paranasal Sinus Diseases|doi=10.1016/B978-0-323-09633-1.00026-2}}File:Waters' view sinus pathology.svg
  • Maxillary sinus shows radiopacity.{{Cite book|last1=Ruprecht|first1=Axel|chapter-url=https://www.sciencedirect.com/science/article/pii/B9780323096331000262|title=Oral Radiology - Principles and Interpretation|last2=Lam|first2=Ernest W. M.|publisher=Mosby|year=2014|isbn=978-0-323-09633-1|edition=7th|pages=472–491|language=en|chapter=26 - Paranasal Sinus Diseases|doi=10.1016/B978-0-323-09633-1.00026-2}}
  • Mucous membrane shows thickening.{{Cite book|last1=Ruprecht|first1=Axel|chapter-url=https://www.sciencedirect.com/science/article/pii/B9780323096331000262|title=Oral Radiology - Principles and Interpretation|last2=Lam|first2=Ernest W. M.|publisher=Mosby|year=2014|isbn=978-0-323-09633-1|edition=7th|pages=472–491|language=en|chapter=26 - Paranasal Sinus Diseases|doi=10.1016/B978-0-323-09633-1.00026-2}}
  • Air-fluid level may be observed if the radiograph is taken in "head-up" position.{{Cite book|last1=Ruprecht|first1=Axel|chapter-url=https://www.sciencedirect.com/science/article/pii/B9780323096331000262|title=Oral Radiology - Principles and Interpretation|last2=Lam|first2=Ernest W. M.|publisher=Mosby|year=2014|isbn=978-0-323-09633-1|edition=7th|pages=472–491|language=en|chapter=26 - Paranasal Sinus Diseases|doi=10.1016/B978-0-323-09633-1.00026-2}} It is not seen in radiograph taken in lying down position. The concavity of fluid opacity points upwards.
  • Polyp* Maxillary sinus shows radiopacity; which is present despite the position in which the radiograph is taken.
  • Usually, the radiopacity has convexity pointing upward.
  • MalignancyFile:Onhgren's line.svg
  • Sinus is radioopaque.
  • Sometimes, destruction of walls of sinus is seen and is diagnostic of malignancy
  • Distance between antero-lateral wall of maxilla and coronoid process of the mandible is measured. If it is increased on one side, it indicates involvement of infratemporal fossa by the malignancy. This is called Handousa's sign. Prognosis of malignancy is determined by position of tumour on basis Onhgren's line.
  • Procedure

    file:Waters' view.svg

    Typically, the x-ray beam is angled at 45° to the orbitomeatal line.{{cite book|last1=Butler|first1=Paul|title=Applied Radiological Anatomy|last2=Mitchell|first2=Adam W. M.|date=Oct 28, 1999|isbn=9780521481106|pages=97}} Another variation of the waters places the orbitomeatal line at a 37° angle to the image receptor,{{Cite book|title=Merrill's Atlas of Radiographic Positioning and Procedures|volume=2|pages=328}} or 30°.{{Cite book|last1=Archer-Arroyo|first1=Krystal|chapter-url=https://www.sciencedirect.com/science/article/pii/B9780323497558000104|title=Facial Trauma Surgery - From Primary Repair to Reconstruction|last2=Mirvis|first2=Stuart E.|publisher=Elsevier|year=2020|isbn=978-0-323-49755-8|pages=16–31|language=en|chapter=1.2 - Radiological Evaluation of the Craniofacial Skeleton|doi=10.1016/B978-0-323-49755-8.00010-4|s2cid=198282822 }}

    History

    File:Charles Alexander Waters (1888–1961).png

    Waters' view is named after the American radiologist Charles Alexander Waters.{{Cite book|last=Chiu|first=Tor Wo|url=https://www.worldcat.org/oclc/1060523898|title=Stone's plastic surgery facts : a revision guide|date=2019|publisher=CRC Press|isbn=978-1-315-18567-5|edition=4|location=Boca Raton, FL|oclc=1060523898}} It is also known as the occipitomental view.{{Cite book|last1=Archer-Arroyo|first1=Krystal|chapter-url=https://www.sciencedirect.com/science/article/pii/B9780323497558000104|title=Facial Trauma Surgery - From Primary Repair to Reconstruction|last2=Mirvis|first2=Stuart E.|publisher=Elsevier|year=2020|isbn=978-0-323-49755-8|pages=16–31|language=en|chapter=1.2 - Radiological Evaluation of the Craniofacial Skeleton|doi=10.1016/B978-0-323-49755-8.00010-4|s2cid=198282822 }}

    References