SINUS

Question 1

Sinus SNS innervation

Answer 1

• T1-4, passes through cervical ganglia
• check in these areas for viscera-somatic changes
• superior cervical ganglia

Question 2

Sinus PNS innervation

Answer 2

• CN VII (sphenopalatine ganglion)
• treat dysfunctional temporals, sphenoid, maxillary, and palatine bones
• also can treat ganglia with the pterygoid fascial stretch

Question 3

Goals of Sinus OMT treatments

Answer 3

• relieve obstruction and pain, improve venous and lymphatic flow from the area, affect reflex changes, and improve mucociliary clearance
• upper thoracic and cervical dysfunctions should be evaluated and treated
• increase SNS; decrease PNS (runny nose=PNS)

Question 4

Contraindications to Sinus OMT treatment

Answer 4

• fever greater than 102
• not on antibiotics if bacterial infection
• inflamed LN at the site

Question 5

Pre- and Post-auricular drainage indication

Answer 5

-any dysfunction or lymphatic congestion in the ear region (i.e. otitis media or external with goal of improving lymphatic drainage of the anterior and posterior LN

Question 6

Pre-and Post-auricular drainage treatment

Answer 6

• patient supine with head turned slightly toward physician seated at the side
• physician stabilizes patients head with cephalad hand and caudad hand is placed flat against side of head with finger pads over nodes with ear between third and fourth fingers
• caudad hand makes clockwise and counterclockwise circular motions, moving the skin and fascia over surface of skull
• procedure applied for 30 seconds to 2 minutes

Question 7

Galbreath’s Technique (mandibular drainage) indications

Answer 7

• any dysfunction or lymphatic congestion in the ENT or submandibular region (speicfic aim of opening eustachian tubes) such as otitis media or increased barometric pressure (altitude changes) that induce ear pain or symptoms
• caution in patients with active TMJ dysfunction

Question 8

Galbreath’s technique

Answer 8

• patient supine with head turned slightly toward doc standing or seated opposite side of dysfunction
• physician’s cephalad hand stabilizes the patient’s head, while caudad hand grasps the posterior ramus of the mandible with third, fourth, and fifth fingertips and hypothenar eminence resting alone the body of the mandible
• patient opens mouth slightly and doc applies an anterior (forward), medial and caudal traction and is then released
• procedure applied and released in a slow rhythmic fashion for 30 seconds to 2 minutes

Question 9

Ear pull

Answer 9

-pull posteriorly and laterally along axis of the external auditory canal and wait for tissue release

Question 10

Submandibular “walking” technique

Answer 10

-fingertips under angle of jaw and walk fingers toward chin and then walk them back

Question 11

Anterior tracheal/deep cervical technique

Answer 11

• physician places fingers along lateral borders of trachea and gently induces movement from side to side
• may also pull superior to inferior to increase lymph and blood flow

Question 12

Direct pressure and sinus milking

Answer 12

-patient supine, eyes closed and relaxed while doc is seated at head of table

Question 13

Sinus milking for frontal sinus

Answer 13

• with thumbs, apply direct pressure over the frontal sinuses
• increase pressure gradually and release in a gentle, rhythmic motion
• cycle is repeated several times

Question 14

Sinus milking for supraorbital notch

Answer 14

• gentle pressure applied over the supraorbital notch

- slide thumbs laterally along the eyebrow ridge bilaterally

Question 15

Sinus milking maxillary sinus

Answer 15

• apply pressure over sinuses with thumbs

- milk nasal passages by applying downward pressure on either side of nose while sweeping laterally across the maxilla

Question 16

Crossed thumb technique

Answer 16

• patient supine with the student seated at the head of the table
• the student crosses the thumbs so that the left thumb contacts the right nasal region and the right thumb contacts the left nasal region
• the student applies a force with the left thumb towards the midline and then releases followed by the same force with the right thumb
• this is continued by alternating the forces in a rhythmical manner
• this can be followed by a liking motion laterally across the maxillary sinuses bilaterally

Question 17

Direct pressure to temporal area

Answer 17

• patient supine, eyes closed and relaxed while doc is seated at head of table
• direct pressure may be applied over the temporal areas by gently placing the thenar eminences in the temporal fossae bilaterally and compressing these areas between the hands.
• pressure is applied and released in gentle, rhythmic motions

Question 18

Steps of counterstrain

Answer 18

• diagnose SD
• find a significant tender point
• establish pain scale
• wrap around the TP while monitoring
• reduce pain at least 70% (patient in position of comfort)
• slowly and passively return patient to neutral
• reassess somatic dysfunction (tender point)

Question 19

Maxillary sinus TP counterstrain

Answer 19

• TP located just inferior to the infraorbital notch
• contact lateral curve of the zygoma with the thenar eminence of your hand
• compress medially and lift

Question 20

Supraorbital TP counterstrain

Answer 20

• TP located over the supraorbital notch
• physician places one hand on forehead, pulling superiorly
• physician uses the other hand to pinch the nose and pull in the caudad direction

Question 21

Condylar decompression

Answer 21

-physician cradles occiput with fingers and translates occiput superiorly, spreading the condyles apart

Question 22

CV4 technique

Answer 22

• patient is supine with physician seated at the head of the table
• physician places thenar eminences on occiput medial to OM suture
• Follow extension (motion of the occiput is anterior) and resist cranial flexion until you reach a still point, then let CRI come back