The lateral projection of the facial bones is typically a unilateral projection.

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Citation:

Er A, Murphy A, Nasal bones (lateral view). Reference article, Radiopaedia.org (Accessed on 04 Dec 2022) https://doi.org/10.53347/rID-85033

The lateral nasal bones view is a nonangled lateral radiograph showcasing two small oblong bones situated side by side, together forming the nasal ridge.

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This view is often primarily used in assessing various nasal bone fractures in the trauma setting. Depending on the department, this view may be done bilaterally (for comparison of affected versus unaffected side) or unilaterally (only affected side).

• rest the lateral aspect of the patient's head (with the side of interest) against the image detector
• adjust the head into a true lateral position, with the midsagittal plane (Figure 1) parallel to the image detector
• for patient's comfort, adjust the patient's body into an oblique position

• lateral projection
• centering point
  • 1.25 cm inferior to nasion
• collimation
  • within 5 cm of the nasal bones on all sides 1
• orientation  
  • for unilateral side: portrait
  • for bilateral side: landscape
• detector size
  • 24 cm x 18 cm
• exposure
  • 60-70 kVp
  • 5-10 mAs
• SID
  • 100 cm
• grid
  • no

• nasal bones with soft tissue nasal structure, frontonasal suture (superior) and anterior nasal spine should be demonstrated
• nasal bones should be seen with no rotation

• remove glasses and nose piercings to avoid artefact obscuring important pathology
• this view should not replace a lateral facial bones x-ray
  • as this projection is often requested together with a facial bones series 3, there may be the temptation to combine the request and only image a lateral facial bones x-ray as per ALARA. However, nasal bones and their soft tissue nasal structures are less dense compared to the denser facial bones and should hence be imaged separately to prevent over exposure of the less dense region

References

Related articles: Imaging in practice

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Last revised by Henry Knipe ◉ ◈ on 23 May 2022

Citation, DOI & article data

Citation:

Knipe H, Murphy A, Er A, et al. Facial bones (Waters view). Reference article, Radiopaedia.org (Accessed on 04 Dec 2022) https://doi.org/10.53347/rID-43200

The occipitomental (OM) or Waters view is an angled PA radiograph of the skull, with the patient gazing slightly upwards.

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It can be used to assess for facial fractures, as well as for acute sinusitis. In general, radiographs of the skull and facial bones are rapidly becoming obsolete, being replaced by much more sensitive CT scans.

• the patient is erect facing the upright detector 
• the chin is raised until the mento-mandibular line (MML) is perpendicular to the receptor (OML will be 37° from receptor)
• ensure patient's head is straight

• posteroanterior projection
• centering point
  • the beam is exiting at the acanthion 
• collimation
  • superior to the skin margins
  • inferior to include the most inferior aspects of the skull
  • lateral to include the skin margin
• orientation  
  • portrait
• detector size
  • 24 cm x 30 cm
• exposure
  • 75-80 kVp
  • 20-25 mAs
• SID
  • 100 cm
• grid
  • yes (this can vary departmentally)

• the petrous ridge should be inferior to the maxillary sinuses
• assess for rotation via the assessments of the coronoid process symmetry
• generally, the base of the mandible and the occiput will be superimposed

• learn your skull positioning lines, it makes for reading position guides a lot easier
• guarantee that the patient is not 'hunched' over when they are being examined. This can cause an artifact from the shoulders and the patient is more likely to be rotated; it is best to move the chair up close to the detector so they are sitting up straight for the image
• use a side marker and regularly place in PA. Skulls can get tricky with figuring out which side is which. Many vendors tend to 'flip' images to make them appear AP

History and etymology

This view was first described by Charles A. Waters and C. W. Waldron, American radiologists in 1915 3.

References

Related articles: Imaging in practice

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