Today’s OMM question involves a 36-year-old man with five days of rhinorrhea, sinus congestion, and feeling like he has fluid in his ears. Which of the following techniques should be avoided in this patient?
A 36-year-old man presents to your clinic with five days of rhinorrhea, sinus congestion, and feeling like he has fluid in his ears. He has no fever, myalgias, shortness of breath, or cough. Past medical history is significant for mononucleosis when he was 16 years old; bilateral temporomandibular joint dysfunction, for which he sees a dentist and otolaryngologist; and mild intermittent asthma. His temperature is 37.8 ºC (100.0 ºF), pulse is 90/min, respirations are 12/min, and blood pressure is 133/78 mmHg. On physical examination, he has tenderness to palpation along his maxillary sinuses. There are mildly tender and symmetrically enlarged lymph nodes at both angles of his mandible. There is a small amount of fluid behind both tympanic membranes and some mild erythema of his posterior oropharynx. His nasal turbinates are erythematous with a thick yellow mucus. Which of the following techniques should be avoided in this patient?
A. Submandibular myofascial release
B. Splenic pump
C. Counterstrain of the mandible
D. Active thoracic pump
E. Mandibular drainage (Galbreath technique)Scroll down for the correct answer!
The correct answer to today’s OMM Question is…
E. Mandibular drainage (Galbreath technique)
Before we get to the Main Explanation, let’s look at the incorrect answer explanations. Skip to the bottom if you want to see the correct answer right away!
Incorrect answer explanations
The incorrect answers to today’s OMM Question are…
A. Submandibular myofascial release
This is an indirect and gentle technique in which you move the submandibular tissue into its directions of ease. This can be used safely in virtually any patient.
B. Splenic pump
While splenomegaly or active mononucleosis is a contraindication to this technique, having mononucleosis 20 years ago is not a contraindication.
C. Counterstrain of the mandible
Counterstrain of the mandible is a gentle technique which can be used safely in virtually any patient. It can sometimes help with mandibular or temporomandibular joint dysfunction.
D. Active thoracic pump
Asthma that is uncontrolled or in exacerbation is a contraindication to this technique. In this patient it is mild and intermittent, and he does not clinically appear to have an exacerbation.
Main Explanation
There are many osteopathic techniques that can be used to help improve lymphatic drainage and are usually safe in active ENT infections. Lymphatic treatments should always begin with treating the thoracic inlet to maximize lymphatic flow toward the thoracic duct. After that, there are several ENT and thoracic techniques, as well as splenic pump, hepatic pump, pedal pump, and many others to help improve lymphatic drainage.
Mandibular drainage (Galbreath technique) works well for improving cervical lymphatic drainage. It involves gently and repetitively pulling the mandible anteriorly and medially at the angle of the mandible in a rhythmic fashion, causing distraction at the temporomandibular joint (TMJ). Galbreath technique is contraindicated in patients with TMJ dysfunction as it involves repetitive distraction at that joint.
Major Takeaway
There are many osteopathic techniques that can be used to help improve lymphatic drainage and are usually safe in active ENT infections. Mandibular drainage (Galbreath technique) works well for improving cervical lymphatic drainage but is contraindicated in patients with TMJ dysfunction as it involves repetitive distraction at that joint.
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