This document provides information on various radiographic views and examinations of the head and neck region. It discusses Water's view for imaging the maxillary sinuses, basic positioning for paranasal sinus views, Caldwell's view for the ethmoid and frontal sinuses, and examples of common sinus findings on radiography like mucosal thickening and retention cysts. It also summarizes techniques for imaging the nasopharynx, neck, cervical spine, trachea, and larynx. Common foreign body locations and aspiration findings are outlined. Sialography for salivary gland evaluation and bronchography are briefly described. Finally, it reviews skull radiographic views like PA, Caldwell, Chamberlain-Townes, and lateral projections as

1. RADIOLOGY
ENT

2. Water's - best for maxillary sinus
(Ethmoids and frontals too far from film)
45

3. Basic Patient Position
The patient sits erect facing the bucky, midsagittal plane
in the midline of the film, coronal plane parallel to the
film interpupillary line parallel to the floor. The chin is
raised to bring the orbital meatal line at 45 degrees to the
film.
In some centers the patient is imaged mouth open to
demonstrate the sphenoid sinuses.

5. Caldwell
best for ethmoids and frontal sinus
(Temporal bones overlie maxillary)

8. Xray PNS Water’s view showing
• Opacity in B/L
maxillary sinuses
• Diagnosis:
– B/L Maxillary sinusitis

9. Xray PNS Water’s view showing
• Opacity in Right
maxillary sinus
• Diagnosis:
– Rt. Maxillary sinusitis

10. Xray PNS Water’s view showing
• Radiodense lesion /
opacity in Left
maxillary sinus & Left
nasal cavity
• Diagnosis:
– Lt. AntroChoanal Polyp

11. Xray of PNS – Water’s view
showing Rt. Antral Polyp
• Opacity seen in Rt.
Maxillary sinus
• Convexity upwards

12. Xray PNS Water’s view showing
• Opacity seen in Rt.
Maxillary sinus
• Tooth on the medial
wall
• Thinned out Sinus
walls
DIAGNOSIS:
Dentigerous cyst

13. Xray PNS Water’s view showing
• Opacity seen in Rt.
Maxillary, ethmoidal
& Frontal sinuses
DIAGNOSIS:Rt.
Pansinusitis

15. Common radiologic abnormalities:
Air-fluid levels suggest an acute process
• Opacification = secretions, polyps, etc.
• Thickened mucosa (check lateral maxillary wall):
Suggests chronic inflammation
• Maxillary sinus retention cysts
– Very frequent finding
– Harmless unless symptomatic
• Frontal sinus mucocele
– Nasofrontal duct obstruction (head injury?)
– Potentially serious problem
– Look for loss of scalloped edge

16. Nasopharynx

17. enlargement of the adenoids (red arrow)
The white arrow points toenlarged lingual tonsils at
the base of the tongue.

19. Neck lateral veiw
1. Cervical vertebrae
• Erosion of vertebral bodies- No.
• Loss of cervical Lordosis – due to prevertebral muscle
spasm
2. Pre-vertebral soft tissue shadow
• Should be < 2/3 of AP diameter of cervical vertebral
body (c2-6mm, c6-22 mm)
• If > suspect Retropharyngeal abscess
• Look for FB / Air fluid level / Gas shadow
3. Air collumn in trachea
4. Hyoid bone & Laryngeal cartilage ossifications

22. Chronic Retropharyngeal abscess
•Secondary to TB spine(Pott’s spine)
•Erosion of cervical vertebra
•Treatment with ATT

24. FB Cricopharynx with Acute
retropharyngeal abscess

29. Foreign Body Aspiration
Radiography
PA & lateral views of chest & neck
Inspiration & expiration
Lateral decubitus views
25% have normal radiography

30. • Radiopaque FB easily seen with xray
• Radiolucent FB (the majority) may have
obliterated bronchial air
column, atelectasis, mediastinal shifts, or air-
trapping in the affected lung
• Inspiratory hypoinflation and expiratory
hyperinflation in hallmark of bronchial FB
• Decubitus films – dependent lung should collapse
but will remain inflated if FB

31. Foreign Body Aspiration

32. X ray neck AP view
•Round radio opaque
object ( Coin)
•In Esophagus
•Because the
esophagus is an AP
compressed tubular
structure
•A coin would
occupy this
position
•Can be confirmed
by lateral view

33. X ray neck Lateral view

34. Foreign Body Ingestion
Common locations in esophagus
Cricopharyngeus
Aorta/left mainstem bronchus
Gastroesophageal junction

36. Sialography
Radiologic examination of the salivary glands
The submandibular and parotid glands are
investigated by this method
The sublingual gland is usually not evaluated this
way
Difficulty in cannulation

37. Procedure
1. Obtain preliminary radiographs
• Any condition that is visibe w/o contrast
• Optimum technique obtained
2. 2-3 min before procedure give lemon
3. Contrast media (iohexol) injected into main duct
4. After procedure suck on lemon to clear contrast
5. 10 min after procedure take radiograph

38. Parotid Radiographs Set-Up

39. Parotid Radiographs

41. Lateral Parotid Gland Radiograph

42. Lateral Submandibular Set-Up

43. Lateral Submandibular Glands

44. bronchogram
Radiographic examination of the tracheobronchial
tree by radiopaque iodinated compound
(dianosil,iohexaol) in a low viscous suspension.
rarely performed today, having been superseded by
high resolution computed tomography HRCT

46. BARIUM SWALLOW
procedure used to examine upper gastrointestinal
tract,which include the pharynx, esophagus, cardia of
stomach.
The contrast used is barium sulfate.

47. CONTRAST
TYPES OF CONTRAST STUDY
(i) SINGLE CONTRAST STUDY
(ii) DOUBLE CONTRAST STUDY

48. CONTRAINDICATION
Suspected esophageal perforation.
Tracheo-esophageal fistula
If strong clincal suspicion of aspiration or TEF,then
omnipaque swallow (iohexol) advised.

49. XRAY VIEW
SOFT TISSUE NECK,CHEST – AP & LAT –
SCOUT
NECK-AP & LATERAL
THORAX-RAO VIEW

50. NORMAL-AP /LAT VIEW - SCOUT

51. AP/LAT VIEW WITH BARIUM

52. RAO VIEW

53. TECHNIQUE
PHARYNX
-One mouthful contrast bolus with high
density(250% w/v).
-Patient is asked to swallow once and stop
swallowing there after.
-This is to get optimum mucosal coating.
-frontal and lateral view x-ray taken.

54. ESOPHAGUS
Single contrast
-Multiple mouthful barium suspension given.
-prone swallow to assess esophageal contraction.
-useful in esophageal compression, displacement
or disordered motility.

55. EFT: Lateral view: Epiglottis (red arrow). Post
cricoid impression (yellow arrows).
Cricopharyngeous impression (white arrow).RIGHT:
AP-view: Small lateral pharyngeal pouches (arrows)

56. PHARYNGEAL WEB
.
P

57. Partially obstructing cervical
esophageal web.
Frontal view shows a
circumferential, radiolucent ring
(straight white arrows) in the proximal
cervical esophagus. Partial obstruction
is suggested by a jet phenomenon
(black arrows), with barium spurting
through the ring, and by mild
dilatation of the proximal cervical
esophagus .

59. A Zenker's diverticulum is a pulsion hypopharyngeal
false diverticulum with only mucosa and submucosa
protruding through triangular posterior wall weak site
(Killian's dehiscence) between horizontal and oblique
components of cricopharyngeus muscle

60. CARCINOMA
Preferably high viscosity
with normal density barium
is used.
Classical finding in
carcinoma –rat tail
appearance.

61. CA ESOPHAGUSWith shouldering
The stenotic segment is long giving a “" *rat-tail” appearance
Barium swallow shows mild dilatation of the esophagus with irregular
stenotic lesion in the lower end of the esophagus “moth eaten appearance

62. ACHALASIA CARDIA
Bird beak appearance

63. 63
P-A Skull
Patient seated or standing
facing the Bucky.
Nose and forehead touching
the Bucky to get the
canthomeatal line
perpendicular to film.

65. 65
P-A Skull Film
.There should be no rotation.
The petrous ridges will be
superimposed with the orbits.
To clear the ridges, the
Caldwell view can be taken.

66. 66
Chamberlain-Townes
Patient is seated facing the
tube.The chin is tucked into the
chest until the canthomeatal line
is perpendicular to film. A chair
the allows some reclining will
make this easier for the patient.

67. 67
Chamberlain-Townes Film
The entire skull and especially
the occipital region of the skull
must be on the film.
Structure seen include the
foramen magnum, petrous
ridges, IAC’s and TM Joints
No rotation of skull

68. 68
Skull Lateral
Patient seated of standing
facing the Bucky. Rotate the
body into an oblique position.
Turn skull so the affected side
is next to the Bucky.
The interpupillary line must be
perpendicular to film and tube.
Mid sagittal plane parallel to
the film.

70. 70
Skull Lateral Film
Entire skull must be on the
film.
There should be no rotation of
the skull, orbits and mandible
ramus superimposed.
The facial bones are sinuses
will be dark (over exposed).
Usually both lateral views are
taken.