Friction and vibration maxillary sinus

supine The operator is sitting at the head of the table and has applied the tips of middle fingers to the maxilla so that direct pressure can be used over the emission of the nerve. Vibration can be applied over the maxillary sinus in this position also. The patient's head is stabilized by the heels of the operator's hands.

Tips: Most useful where maxillary sinus is involved. Least useful where acute sinusitis makes pressure extremely uncomfortable. Extra considerations: Start gently and gradually increase pressure, perform technique for short periods and return several times during treatment session.

23.4 • (bottom left) Springing temporo-mandibular joint supine While sitting at the head of the table, the operator is holding back on the temporal bone with one hand and applying a repetitive force along the ramus of the jaw with the other. It is possible to make small adjustments to the angle of that force so that the articulation can be stressed in different ways according to the restriction of motion encountered. It is necessary for the patient to let the jaw sag to make the joint accessible; when the masseter is tense, the technique will not produce any effect.

Tips: Most useful in cases of unilateral temporo-mandibular joint dysfunction and intra-articular disc derangements. Least useful in cases of bruxism where it is more important to work on the muscles and occlusion than the joint. Extra considerations: While under stretch try antero-posterior movements and lateral movements to find the optimum.

23.5 • (see next page, bottom left) Articulation temporo-mandibular joints supine From the head of the table the operator can gently grip both sides of the mandible between fingers and thumbs and apply a direct distraction force to the joints on one or both sides. It is necessary for the patient to relax the jaw so as to take the muscles off tension to make this effective. The whole mandible can also be taken into a forwards or backwards direction as required, and if the patient slowly opens and closes the jaw while the distraction force is applied, adjustment of the 'tracking' during this action can be brought to their attention as this often is an essential part of any treatment to these joints.

Tips: Most useful in cases of mal-occlusion and bilateral joint dysfunction where the traction component is helpful. Least useful where muscle tissue is very tight and prevents effective traction. Extra considerations: Extreme tenderness at the angle of the jaw can be an indication of occipito-atlanto dysfunction.

192 Techniques for the sinuses and temporo-mandibular joints

192 Techniques for the sinuses and temporo-mandibular joints

Omm Technique Sinus

23.6 • Traction and articulation temporomandibular joint supine The operator is holding directly over the joint and palpating for sense of tension as the other hand pulls on the mandible to distract the joint in a variety of directions as necessary. It is also possible to hold over the articular disc, and sensing when the joint is on optimum tension, apply a force directly over it which may give an opportunity for the disc to relocate if it is mal-aligned in the joint. As in most temporo-mandibular joint techniques it is necessary for the patient to relax the jaw muscles during these procedures.

Tips: Most useful where muscle stretch is needed and intra-articular disc dysfunction exists. Extra considerations: Add antero-posterior and lateral movements for optimum tension.

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