OtoRhinoLaryngology Portal

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Frontal Sinus: X-ray

X-ray of normal frontal sinus. Note the lucency and scallope edges.

Mucosal thickening of left frontal sinus with air-fluid level in a patient with sinusitis.

Paranasal Sinus X-ray: Developmental Variation and Anomalies

Note: 5 year old child- frontal sinus not developed yet!

Incidental finding of hypoplastic frontal sinus in an adult.

Asymmetric and under-pneumatized frontal sinus.

 Absent right frontal sinus (occipitomental view).

Paranasal Sinus X-ray: Meniscus Sign

his occipitomental view of paranasal sinus X-ray shows an opacity with a meniscus sign involving the right maxillary sinus indicating presence of fluid usually mucopus in acute rhinosinusitis.  Odontogenic sinusitis has to be ruled out in recurrent unilateral cases.

Right-sided maxillary sinus opacity with meniscus sign.

Air-fluid level (arrow) in a patient with acute maxillary sinusitis. 

 Bilateral maxillary sinus opacities with meniscus sign.

Paranasal Sinus X-ray: Complete Opacity of Maxillary Sinus

Complete opacity of left maxillary sinus.


 Another example of complete opacity of left maxillary sinus.


 Complete opacity of right maxillary sinus.


Opaque or hazy sinus may imply presence of fluid, diffuse mucosal thickening, polyposis, or maxillary malignancy.  Bony erosion or sclerosis give clues to more serious aetiology.

Paranasal Sinus X-ray: Concha Bullosa


CB - concha bullosa of middle turbinate, M - maxillary sinus 

The corresponding CT-scan slice confirming the concha bullosa existence.

Adenoids/Postnasal Space Lymphoid Hyperlasia as Seen on X-ray

                        In a child.                                            In an adult.

Nasal Bone Fractures

Comminuted undisplaced fractures.


Depressed nasal bone fracture (arrow).


 Undisplaced distal nasal bone fracture.

How To Read CT-scan of Paranasal Sinus

Maxillary Sinus

CT-scan: axial cut (Normal)

Bilateral air-fluid with meniscus levels in a patient with acute maxillary sinusitis.  Note severely deviated nasal septum towards left side with pronounced narrowing of nasal patency anteriorly.

Generalized maxillary sinus mucosal thickening

in a patient with subacute sinusitis.


Another example of severe mucosal thickening in a patient with acute pansinusitis.

Left-sided sinusitis with blocked osteomeatal complex, deviated nasal septum, and right inferior turbinate hypertrophy.  Odontogenic cause has been ruled out.


Right maxillary sinus sinus fractures (arrow) complicating trauma and antral fluid with meniscus level (+) representing haemosinus.

Ethmoid Sinus

CT-scan: axial cut.

Frontal Sinusitis: CT-scan

Complete opacity of right frontal sinus in chronic sinusitis with nasal polyposis.  Left frontal sinus mucosal thickening is shown separated by inter-frontal septum.


 Left-sided frontal sinus opacity with meniscus level due to trapped infected fluid in a patient with subacute sinusitis.

Chronic sinusitis with grossly thickened frontal sinus mucosa and polyps formation.

Sphenoid Sinus: Internal Carotid Artery on CT-scan


Internal carotid arteries anatomic relation in sphenoid sinus (arrows) which is of prime importance in endoscopic sphenoid sinus and transphenoidal hyphysectomy surgery.

Conchal Bullosa on CT-scan


i. Bilateral concha bullosa of middle turbinate.

ii. Low-lying anterior cranial fossa floor (Keros Type III).

iii. Deviated nasal septum to the left with compensatory inferior turbinate hypertrophy.

iv. Minimal mucosal thickening of right maxillary sinus.


Lateral opening of left concha bullosa (arrow).



Left concha bullosa with acute sinusitis.  

Onodi Cell and Haller Cell

3D Reconstructed CT-Scan

Nasal bones fractures as seen on 3D reconstructed CT-scan.

MRI: Concha Bullosa


Arrow - concha bullosa. 

Intracranial Arterial Circulation on MRA in Relation to Sphenoid Sinus