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Sidebar: How to evaluate the paranasal air sinuses
Articulation of facial bones. Here one is exerting pressure on the various facial bones to move slightly the bone being “pressed” across the suture lines of the adjacent bones. The easiest to access is the maxillary bone. The concept here is that the mucosal linings of the sinuses underlying the bony sutures being inflamed will not like the subtle movement of the bones, and the patient will report discomfort.
Percussion of facial bones uses the same concept of inflamed mucosal linings triggering a pain response when the sinuses are percussed. A positive response of pain indicates mucosal lining inflammation and infection.
Transillumination of the sinuses is most readily done by transilluminating the maxillary and frontal sinuses. To transilluminate the maxillary sinus, place your transilluminator tip behind the orbital rim, angled downward to the orbital floor, have the patient tilt their head back, and in a completely darkened room view the hard palate with the mouth open. A clear maxillary sinus will result in readily seen transillumination of the maxillary sinus, whereas a congested sinus will block the light.
Source: James L. Fanelli, OD, FAAO