Do You Know about the Schller Projection

When performing a Schüller projection, the central x-ray beam (an imaginary line running from the focus on the x-ray anode to the center of the image) is in line with the external opening of the auditory canal of the imaged side. The extent of pneuma-tization of the mastoid, the distribution and degree of aeration of the mastoid air cells, and the contour of the porus acusticus can be evaluated very well. Dedicated thin-section temporal bone CT is the study of choice for complex problems.

Xray Mastoid Air Cells

Fig. 13.11 a On the symptom-free side, the mastoid air cells are pneumatized normally posterior and superior to the prominent porus acusticus (arrow), which is surrounded by dense bone. Directly anterior to the porus, the mandibular condyle is seen in its articular niche. The faint arching structure a little above and anterior to the temporomandibular joint is the auricle, which is bent forward for this examination. b On the symptomatic side, the upper part of the mastoid is attenuated, which indicates a filling of the air cells with reactive secretions or pus (arrows).

Fig. 13.11 a On the symptom-free side, the mastoid air cells are pneumatized normally posterior and superior to the prominent porus acusticus (arrow), which is surrounded by dense bone. Directly anterior to the porus, the mandibular condyle is seen in its articular niche. The faint arching structure a little above and anterior to the temporomandibular joint is the auricle, which is bent forward for this examination. b On the symptomatic side, the upper part of the mastoid is attenuated, which indicates a filling of the air cells with reactive secretions or pus (arrows).

I Air in the Mastoid?

I Air in the Mastoid?

Right Mastoid Fluid

Fig. 13.12 This patient shows a significantly decreased pneu-matization of the mastoid air cells on the right side. Middle-ear infections are much more frequent in this setting. The fluid levels in both maxillary sinuses in this patient were due to trauma.

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