Relevance of the conventional Waters' view in evaluating chronic bacterial maxillary sinusitis

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Abstract
Waters'' view was developed by Waters and Waldron in 1915 as a modification of the occipito-frontal projection. It was essentially designed to provide a view of the maxillary sinus unobstructed by the petrous bone, and it has been regarded as the best single view for the maxillary sinuses (Merriel, 1959; Yanagisawa and Smith, 1976; Dodd and Jing, 1977). Since that time Waters'' view has been the subject of conflicting opinions, and few investigations have been carried out to assess its diagnostic capabilities. Almost all of the previous investigations consisted of comparing the results of roentgen examination and antral lavage, ultrasonic examination or sinoscopy (Vuorinen et al., 1962; Axelsson et al., 1970; Illum et al., 1972; Revonta, 1980; Jannert et al., 1982; Kay et al., 1984). On the other hand, no one has yet compared the predictive accuracy of Waters'' view with the operative findings in these cases. The aim of the present investigation is to establish the relevance of the different radiographic signs displayed on Waters'' view in diagnosing chronic bacterial maxillary sinusitis and to determine to what degree these signs can reflect real sinus disease. The shortcomings of the view will be exposed, and factors affecting the correctness of the radiographic evaluation of the disease will be demonstrated and discussed.