Plain films are useful screens for maxillofacial injury and are available in all hospitals. For the uninitiated, the numerous overlapping lines and complex shadows make interpretation challenging.
One of the most useful approaches is to assess symmetry. Consider the right and left sides as mirror images. Are there lucencies or shadows that are unilateral? Are the sutures and sinuses symmetrical? Look for bony integrity and subcutaneous air. While air/fluid levels in the sinuses may occur with acute sinusitis, in the presence of trauma they are nearly pathognomonic for sinus fracture. Clouding of a sinus may be secondary to soft tissue swelling, or due to complete filling of the sinus with blood. When seen in the superior aspect of the maxillary sinus, a soft tissue density may represent herniation of orbital contents through the orbital floor
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