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The Value of the Granger Line in the Diagnosis of Disease of the Sphenoid Sinus, with Illustrative Cases

1924; Radiological Society of North America; Volume: 3; Issue: 3 Linguagem: Inglês

10.1148/3.3.208

1527-1315

Amédée Granger,

Ophthalmology and Eye Disorders

Last year, the writer described (1) in detail the boundary landmarks of the sphenoid sinus and the ethmoidal cells seen in radiographs of skulls and heads held in his alveola-glabella position on 107° and 23° angle blocks, respectively. Experiments with filled skulls and practical work in a large radiological clinic proved that with this position it was possible to make exact duplicate radiographs of the same skull or head, and strikingly similar radiographs of very different shaped ones (2). Believing that it would be both important and interesting to determine positively what anatomical structures produced the line-shadows mentioned above, other radiographs were made before and after attaching pieces of fine lead wires to predetermined parts of a dried skull. These radiographs (Fig. 2) show that the Granger line (G) is produced by that portion of the upper surface of the sphenoid bone called the optic groove, and the line C is produced by the cerebral or inner plate of the orbital or horizontal portion of the frontal bone. Up to this time, the writer believed with other roentgenologists that this C line was produced by the lesser wing of the sphenoid. He found out that such was not the case when a radiograph, made after removing the lesser wing of the sphenoid on one side of the skull, showed the C line still present on both sides. The line X is produced by the posterior edge of the floor of the anterior cerebral fossa. (Fig. 3.) The line O is produced by the greater wing of the sphenoid. (Fig. 4) The line T, seen occasionally, is produced by the floor of the sella turcica (Fig. 2), and the line W is produced by the edge of the greater wing of the sphenoid. (Fig. 3.) The line O forms the anterior boundary of the sphenoid sinus; the line X the upper boundary of the sphenoid in the 23° angle view; the line C the upper boundary of the ethmoidal cells, and the line G the upper boundary of the sphenoid in the 107° angle view. It has already been pointed out that the line G is the most important of these lines (3). By a careful study of this line and of the subjacent area, the sphenoid region, included between the lines G and C, the writer has been able to determine whether the sphenoid sinus was diseased or not, and when diseased, to state with a degree of accuracy impossible up to this time, that it contained pus, polypi, or hyperplastic tissue. When studying this curved line G one must note carefully,— 1. If it is seen on both sides of the median line. 2. If the line is clear with well-defined outline throughout its entire course, or if it is thicker and more distinct, or thicker but less distinct, or irregularly broken or hazy, or so faint as to be hardly visible, on one or both sides. 3. If it is absent, whether absent on one or both sides. 4. If the subjacent sphenoid region is slightly dense, dense or very dense on one or both sides. Brief histories (with accompanying radiographs) of a few cases will suffice to demonstrate the practical clinical