77141566-9-Cranial-Sinusitis-05-06

7/29/2019 77141566-9-Cranial-Sinusitis-05-06

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Osteopathic Treatment For

Patients With Sinusitis



3D frontal view



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



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



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



Meds/Allergies

Omeprazole, Loratidine, Multivitamin,

Calcium +D.

Azithromycin, Guaifenesin, nasal steroids

are the usual sinusitis regimen that resolves

her symptoms

NKDA



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



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



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



Anterior Chapman’s Reflex



Posterior Chapman’s Reflex



More Structural Exam

Decreased CRI

Poor compliance/tender at left mastoid

process and nasion

Left maxilla internally rotated

Left pterygopalatine fossa soft tissues

boggy



What else should be

included?



Impression/Plan



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.



Sympathetic

Relationships

in the

Cervical

Region:

Superior

cervical

ganglion

Inferior

cervical

ganglion

Middle

cervical

ganglion



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



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



Nasion,

Supraorbital

andInfraorbital

Foramina



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.



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.



Trigeminal

Nerve,Sphenopalatine

Ganglion



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



Note that the

spenopalatine

ganglion is suspended

from the maxillary

nerve

Sutherland, Teachings in the Science of Osteopathy, p. 96

Sphenopalatine Ganglion



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





•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



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




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


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



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.

77141566-9-Cranial-Sinusitis-05-06

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