Osteopathic Cranial Treatment: Sinus Drainage

by Sheldon C. Yao, DO

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    00:00 Venous Sinus Drainage: Venous sinus drainage is a technique that we could utilize to try to help improve venous flow away from the head. What we want to do is to place our fingers over the venous sinuses. So, what we’re going to do is we’re going to start by placing our fingers, pinkies at the inion and letting the rest of the fingers fall midline, inferior to the inion.

    00:24 We’re going to hold that position until we feel a little bit of a softening, or relaxing, or increased flow. Then we’re going to address the transverse sinus.

    00:32 So again, pinkies are still on the inion but then we go across the nuchal line where the transverse sinus would lie and again holding it until we feel a release.

    00:41 We’re going to project, add a little bit of anterior projection for the straight sinus.

    00:47 So remember, the straight sinus lies between the superior and inferior sagittal sinuses.

    00:52 We’re going to just project forward. Either you could use your pinkies or some people like to use their thumbs right on the inion projecting forward, almost towards the patient’s nose. Then we’re going to address the superior sagittal sinus. So, we’re going to have our fingers kind of overlap and walk one step at a time over superior sagittal sinus. Then we’re going to finish at the metopic suture on the frontal bone. What we're going to do again is make sure you find the landmark, find the inion, and then pinkies on the inion and letting the rest of your fingers fall in line inferior to that.

    01:28 Again, we’re going to hold that until we feel release underneath our fingers here.

    01:33 Once we feel release, we're going to then move to the transverse sinus.

    01:37 So, pinkies on the inion and our fingers are going to go across now the nuchal line and allowing the head to kind of just rest on our fingers and allowing us to get a sense of a softening underneath our fingers. Once we feel release, we’re going to go and focus on the straight sinus. So now, I’m just focusing on my pinkies aiming straight up to the nose. You could also use your thumbs and again, just a little bit of a pressure getting a sense of a softening by the inion.

    02:12 We’re going to find lambda and then from there, do a little bit of a spread across the sagittal suture. So, you're kind of taking your thumbs and pushing laterally to create some space and to soften up along the sagittal suture. Then once you reached the frontal bones, you’re going to line up your fingers along the metopic suture and apply a little bit of lateral spread at the metopic suture.

    02:39 Once you perform the technique, you can go back and recheck.

    02:43 A lot of times when you treat the venous sinuses, that will also help to reduce some tension along the dura. You can recheck the vault or any other cranial hole to see if there is improved flow and decreased tension throughout the head.

    02:57 Sinus Drainage Techniques: Our facial sinuses sometimes could become clogged.

    03:03 Patients have increased congestion. Sometimes patients have sinusitis where they have infection of the sinuses. These techniques could help treat the facial bones and allow for improved drainage. So, make sure that you open up the thoracic inlet first. What we're going to do first are the different lifts for the frontal, the nasion spread, and the maxilla through the zygomatic lift.

    03:26 So for the frontal lift, we're going to contact the frontal bone. You want to make sure you’re on the frontal bones with your fingers. You could either use your two-finger contact with your thumbs crossing or you could use your hypothenar eminences and perform the frontal lift this way.

    03:43 So, either contact is fine. You're going to contact the frontal bone and then provide a lift which is going to be at a 45-degree angle towards you, so a little bit more superior towards the ceiling and also back towards the operator.

    04:00 You're going to hold this. You're going to know any sort of restriction or tension.

    04:03 There might be a little bit more tightness on one side versus the other and just kind of meet that tension. Hold it. When you feel a release, then you could return and then reassess by doing a little bit of a lift.

    04:15 The nasion spread, we're going to hold onto the frontal bone and get on the nasal bones gently with our fingers here.

    04:24 Then we're going to spread our fingers apart. So, we’re spreading nasion here trying to get good mobility of the nasal bones and making sure that there's no restriction here. The same with all the lifts, we’re going to just kind of hold this until we feel a little bit more of a give and freedom and then come back.

    04:42 Then when you reapply the lift, that's how you could reassess whether or not there's still tension there. The last lift for the sinus drainage technique is the zygomatic lift. You want to find the zygoma and you want to be anterior to the temporal bones. You want to make sure you're not too posterior on the arch here.

    04:58 So, we’re going to get on the zygoma. Again, the context could be with two fingers on the zygoma or you could use your hypothenar eminence or thenar eminence again and just kind of bring your palms together gently and lift up towards the ceiling or use the two-finger contact here with your thumbs touching.

    05:15 Here, your lift is straight up towards the ceiling. So, we're going to contact the zygoma.

    05:20 Again, provide a gentle lift and hold this and see if we could get a sense of decreased tension. To promote lymphatic drainage from the sinuses, we could do a little bit of a pumping and then effleurage.

    05:33 So, we start with the frontal sinuses. We place our thumbs over the eyebrows and just gently pump the frontal sinuses seven times.

    05:42 Then after doing the gentle pump seven times, we want to do a gentle effleurage, sweeping our thumbs across the frontal sinuses to the region right in front of the ear. Again, we do these motions for seven times.

    05:59 After the frontal effleurage, we could address the nasal sinuses.

    06:04 So, for the nasal passageway, what we're going to do is we're going to take our thumbs and kind of alternate our thumbs down the nose.

    06:11 We're kind of going to push on one side and then the other.

    06:14 You don't want to get too far down just so long the nasal bone is fine.

    06:20 Then you kind of work your way down the nose. After doing that seven times, what we're going to do is then address the maxillary sinus.

    06:29 So, you're going to get your thumbs on either side of the nose, a little bit of gentle pressure seven times. After pumping the sinuses seven times, we're going to do effleurage starting next to the nose and coming to the region right anterior, inferior to the ear. So again, seven times of gentle sweeping motion with the thumb trying to improve lymphatic drainage clearance from the sinuses.

    07:00 Then finally, we improve drainage down the neck. Usually, I'll turn the patient's head.

    07:08 Remember, the sinuses will drain along the lymph nodes along the neck.

    07:13 So, we're going to take our thumb and just gently perform effleurage along the sternocleidomastoid, and again seven times on one side and then seven times on the other. You just have to be careful.

    07:28 You don't want to do this, really patients that may have severe lymphadenopathy or really swollen lymph nodes. Patients with mono may have really swollen and painful lymph nodes. So, just be a little bit more wary about performing this technique on the cervical spine with too much pressure in those cases.

    07:47 So, that's the sinus drainage technique. Again, to summarize, we're going to do our lifts, and then a little pumping and effleurage, and then effleurage down the neck making sure that the thoracic inlet has been addressed and opened up to start.

    About the Lecture

    The lecture Osteopathic Cranial Treatment: Sinus Drainage by Sheldon C. Yao, DO is from the course Osteopathic Treatment and Clinical Application by Region. It contains the following chapters:

    • Venous Sinus Drainage
    • Sinus Drainage Techniques

    Author of lecture Osteopathic Cranial Treatment: Sinus Drainage

     Sheldon C. Yao, DO

    Sheldon C. Yao, DO

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