Waters' view

Method of obtaining Waters' view

Waters' view (also known as the Occipitomental view) is a radiographic view, where an X-ray beam is angled at 45° to the orbitomeatal line.^[1] The rays pass from behind the head and are perpendicular to the radiographic plate. It is commonly used to get a better view of the maxillary sinuses. Another variation of the waters according to Merrill's Atlas of Radiographic Positioning and Procedures places the orbitomeatal line at a 37° angle to the image receptor.

Structures observed

• Maxillary sinuses
• Frontal sinuses (oblique view)
• Ethmoidal cells
• Sphenoid sinus (through open mouth)
• Odontoid process (if it is just below the mentum, it confirms adequate extension of the head)

Possible observations

Pathology	Observation
None (Normal)	Odontoid process lies exactly below mentum. Maxillary sinuses are more radiolucent than orbits.
Maxillary sinusitis	Differentiating pathology in maxillary sinus Maxillary sinus shows radiopacity. Mucous membrane shows thickening. Air-fluid level may be observed if the radiograph is taken in "head-up" position. It is not seen in radiograph taken in lying down position. The concavity of fluid opacity points upwards.
Polyp	Maxillary sinus shows radiopacity; which is present despite of the position in which the radiograph is taken. Usually, the radiopacity has convexity pointing upward.
Malignancy	Onhgren's line Sinus is radioopaque. Sometimes, destruction of walls of sinus is seen and is diagnostic of malignancy Distance between antero-lateral wall of maxilla and coronoid process of the mandible is measured. If it is increased on one side, it indicates involvement of infratemporal fossa by the malignancy. This is called Handousa's sign. Prognosis of malignancy is determined by position of tumour on basis Onhgren's line.

References

1. Butler, Paul; Mitchell, Adam W. M. (Oct 28, 1999). Applied Radiological Anatomy. p. 97. ISBN 9780521481106.

Merrill's Atlas of Radiographic Positioning and Procedures vol 2 pg 328