The Water View (Occipitomental Projection)
1. Clinical Definition
The Water View is a specific radiographic projection used to visualize the facial bones, particularly the paranasal sinuses. It is taken with the patient’s neck extended and the chin touching the film/detector, with the orbito-meatal line at an angle of 37° to the image receptor.
2. High-Yield Indications
- Maxillary Sinuses: Best view to visualize the maxillary sinuses (often described as “clearing” the petrous ridges from the maxillary sinuses).
- Facial Trauma: Used to evaluate for facial fractures, particularly of the zygomatic complex (tripod fractures), orbital floor (blowout fractures), and nasal bones.
3. Key Radiological Findings
| Pathology | Appearance on Water View |
|---|---|
| Sinusitis | Air-fluid levels or mucosal thickening (opacification). |
| Blowout Fracture | “Teardrop sign” (herniation of orbital contents into the maxillary sinus). |
4. Exam Pearls
- Advantage: The primary advantage of the Water view over the Caldwell view is that the petrous part of the temporal bone is projected below the maxillary antra, providing an unobstructed view of the sinuses.
- Modern Context: While still a board-exam staple, CT is now the gold standard for detailed evaluation of complex facial fractures.