パノラマ X 線撮影とウォーターズ法による上顎洞病変の検出に関する臨床的研究

抄録

One hundred cases of maxillary sinus disease were analyzed to compare the diagnostic ability of panoramic and Waters' projections. Abnormal radiographic findings of the maxillary sinus on both panoramic and Waters' views were used. A dome-shaped radiopacity, diffuse radiopacity, thickening of mucous membrane, and bony sclerosis of the maxillary sinus were regarded as abnormal radiographic findings. An apical lesion in the maxilla was also regarded as an abnormal radiographic finding. The results obtained are summarized as follows : 1. Dome-shaped radiopacities were seen in the 5 cases (5%) of panoramic views. Of these 5 cases only 2 cases were detected in Water's views. 2. Diffuse radiopacities were seen in the 29 sides (15%) of the maxillary sinus in panoramic views and in the 59 sides (30%) of Waters' views. If the Waters' projection is considered as the accurate projection, then the panoramic projection shows a 34% false positive and a 23% false negative diagnosis on the detection of diffuse radiopacity of the maxillary sinus. 3. Thickening of the mucous membrane was seen in the 38 sides (19%) of the maxillary sinus in panoramic views and in the 69 sides (35%) of Waters' views. If the Waters' projection is considered as the accurate projection, then the panoramic projection shows a 45% false positive and a 29% false negative diagnosis on the detection of thickening of the mucous membrane of the maxillary sinus. 4. Bony sclerosis was seen in the 52 cases (26%) of the maxillary sinus in panoramic views and in the 85 sides (43%) of Waters' views. If the Waters' projection is considered as the accurate projection, then the panoramic projection shows a 6% false positive and a 7% false negative diagnosis on the detection of bony sclerosis of the maxillary sinus. 5. Apical lesions were seen in the 38 sides (19%) of the maxilla in panoramic views and in the 3 sides (2%) of Waters' views. If the panoramic projection is considered as the accurate projection, then the Waters' projection shows a 18% false negative diagnosis in the detection of maxillary apical lesion. False positive diagnosis of maxillary apical lesions was not detected in the Waters' projection. 6. On the visualization of the maxillary sinus on a panoramic radiograph, the maximum convexity of the posterior wall was most clearly detected (59%). Good visualizations continue at the panoramic innominate line (27%), pterygopalatine fossa (17%), boundaries of anterior and medial walls of the maxillary sinus (16%), and maxillary sinus floor. From the above results, it can be said that the panoramic projection is superior to the Waters' projection in the detection of dome-shaped radiopacity in the maxillary sinus and maxillary apical lesion. On the other hand, Waters' projection is superior to the panoramic projection for the detection of diffuse radiopacity and thickening of mucous membrane of the maxillary sinus. On a panoramic radiograph, the maximum convexity of the posterior wall of the maxillary sinus can be a good radiological anatomic landmark.