Post on 14-Apr-2018
7/29/2019 77141566-9-Cranial-Sinusitis-05-06
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Osteopathic Treatment For
Patients With Sinusitis
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3D frontal view
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47 Year old female with frontal
headache and yellow nasal
discharge
Fronto-occipital headache, face pain and
sore throat x 4 days Unable to clear secretions when blowing
nose
Post nasal drip with minimally productivecough
Gets 2-3 sinus infections/year
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PM/Surg/Soc/FamHX:
Occipital/Tension headaches
GERD, usually controlled but symptomatic when
has post nasal drip Irregular menses/perimenopausal
Environmental allergies trigger sinusitis in springand fall
sinus surgery 2 yrs ago helped, but didn’t resolve problems
Nonsmoker, no pets
Several siblings with chronic sinus problems
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Trauma/Birth History
Onset occipital headaches when stood up
into a 4x6 board 12 years ago, hitting on the
back of the head. Lost consciousness for afew minutes.
Was a “large baby”, otherwise unknown
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Meds/Allergies
Omeprazole, Loratidine, Multivitamin,
Calcium +D.
Azithromycin, Guaifenesin, nasal steroids
are the usual sinusitis regimen that resolves
her symptoms
NKDA
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Physical Exam
VSS
Afebrile
NAD HEENT: NC/AT, face
symmetrical
TM grey with good
landmarks but leftretracted. Noeffusion.
Nasal mucosa swollen
with yellow drainage
from ostia L Pharynx injected,
pebbled, without
exudate or tonsillar
enlargement
Yellow post-nasal drip
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Physical Exam
Tender to palpation frontal, nasal and leftmaxilla
No cervical, supraclavicular or infraclavicular adenopathy
Lungs CTAB
Heart RRR without murmur Minimal epigastric tenderness, no
mass/rebound tenderness/rigidity/guarding
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Structural Exam
Thoracic inlet sidebent right, rotated left
First rib superior on the left
Positive Left anterior subclavicular Chapman’s reflexes
Bilateral posterior upper cervical
Chapman’s reflexes C2 FRSR
OA FSLR R
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Anterior Chapman’s Reflex
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Posterior Chapman’s Reflex
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More Structural Exam
Decreased CRI
Poor compliance/tender at left mastoid
process and nasion
Left maxilla internally rotated
Left pterygopalatine fossa soft tissues
boggy
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What else should be
included?
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Impression/Plan
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Possible treatment sequence
for this patient Indirect or direct MFR to thoracic inlet and
thoracoabdominal diaphragm if needed
ME, FPR or BLT to left first rib
Treat posterior cervical Chapman’s reflexes.
Check to see if anterior reflexes less tender. If not, treat them too.
Treat upper cervicals with suboccipital release,
ME, BLT or Still Sacral motion restriction may need to be
addressed.
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Sympathetic
Relationships
in the
Cervical
Region:
Superior
cervical
ganglion
Inferior
cervical
ganglion
Middle
cervical
ganglion
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Where would you start for this
set of cranial findings?
– Decreased CRI
– Poor compliance/tender at left mastoid process and nasion
– Left maxilla internally rotated
– Left pterygopalatine fossa soft tissues
boggy
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Possible sinusitis techniques
Choose which apply to your site then delete theirrelevant slide(s)
Venous sinus drainage sequence (precede with OArelease and end with frontal/parietal lifts)
Fronto-zygomatic lift Alternating lateral rocking of the nasion
Sphenopalatine ganglion release
Percusssion/ “jello tap” over involved sinuses
Effleurage over frontals, nasals, maxillae andtowards mastoids
Supra & Infra orbital nerve stimulation
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Nasion,
Supraorbital
andInfraorbital
Foramina
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Fronto-nasal
Release
Cephalad Hand contactsthe frontal with two finger
pads
Caudad Hand contacts thetwo nasal bones withthumb and index
Gently distract
Can also be done for fronto-maxillary sutures.
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Supraorbital and Infraorbital
Foramina Locate the foramen along the superior
orbital ridge or the inferior orbit
Gentle finger pad contact is used to massagethe nerve and surrounding tissues
A slow rotary motion back and forth isoften quite effective.
This can be easily taught to the patient for home use.
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Trigeminal
Nerve,Sphenopalatine
Ganglion
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Intimate relationship
with the Maxillary
Branch of the
Trigeminal N.
Note Relative flatness
of pterygoid process
compared to rounded
maxilla
Sutherland, Teachings in the Science of Osteopathy, p. 96
Sphenopalatine Ganglion
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Note that the
spenopalatine
ganglion is suspended
from the maxillary
nerve
Sutherland, Teachings in the Science of Osteopathy, p. 96
Sphenopalatine Ganglion
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Treatment of the Sphenopalatine Ganglion
Stand opposite the side to be
treated
Caudal Hand: Introduce the
little finger of the caudal hand
softly & carefully along the
alveolar ridge past the tuberosity
of the maxilla on to the lateral
plate of the pterygoid – it is a
flatness in contrast to the curved
maxilla – The patient may have to move the
ramus of the jaw laterally to
create room for the finger
Craniosacrale Osteopathie II, p.99
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Treatment of the Sphenopalatine Ganglion
Craniosacrale Osteopathie II, p.99
•Once in position have the patient tip
the head against the pad of the littlefinger to tolerance, or
•apply gentle inhibitory pressure
medially & cranially in the direction of
the outer orbit•It can be quite painful
•Pressure on the ganglion will
stimulate it to action which will be
indicated by lacrimation
•Decreased tissue tension also
indicates completion of this technique
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References
Grant’s Atlas Digital Images
American Academy of
Otolaryngology - Head and NeckSurgeryOne Prince StreetAlexandria, VA 22314-3357
http://www.entnet.org/healthinfo/sinus/sinus_side.cfm
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Treatment of the Sphenopalatine Ganglion
Fluid-wave Technique:
– Cranial Hand’s Thumb is on the
coronal suture opposite thesphenopalatine ganglion contact –
at the longest diameter
– Gentle pressure is directed toward
the ganglion in coordination with
the cranial impulse
Craniosacrale Osteopathie II, p.99
Unwinding Technique:
Cranial Hand contact on
the greater wings to monitor
motion
Release will follow
from a forceful flexion
motion that can be felt By
the cranial hand
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Facilitators
Do not try to go through the venous sinus
drainage technique during the presentation.
It takes too long Students can be given a handout of it to take
home for practice.