If a patient has symptoms referable to sinus problems, transillumination of the sinuses is performed. This examination is performed in a darkened room, and a bright light source is placed in the patient's mouth on one side of the hard palate. The light is transmitted through the maxillary sinus cavity and is seen as a crescent-shaped dull glow under the eye. The other side is then examined. Normally, the glow on each side is equal. If one sinus contains fluid, a mass, or mucosal thickening, there is a decrease in the glow, indicating loss of aeration on that side. An alternative method of examining the maxillary sinus is to direct a light downward from under the medial aspect of the eye. The patient is asked to open the mouth, and the glow is observed in the hard palate. This technique is illustrated in Figure 11-25. The frontal sinus can be examined in a similar manner by directing the light upward under the medial aspect of the eyebrow and observing the glow above the eye.
The ethmoid and sphenoid sinuses cannot be examined by transillumination.
The patient-to-patient variability of sinus transillumination is tremendous. In the absence of sinus symptoms, these differences in transillumination are nonspecific.
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