Where to place your thumbs when palpating the maxillary sinuses: a practical nursing guide

Maxillary sinuses and the skilled touch: a clear path to reliable assessment

Let’s unpack a small but mighty skill in physical assessment: palpating the maxillary sinuses. You’ll see this come up in many clinical scenarios, and getting the technique right makes all the difference. The maxillary sinuses live in the cheek area, just above the upper jaw. When they’re inflamed or blocked, tenderness and pressure often show up in that very spot. So, how should you position your hands to palpate accurately? Here’s the straight answer: place the thumbs below the cheekbones with the fingers alongside the head.

Why this particular placement matters

You might be wondering, what’s the big deal about where your thumbs go? Simply put, the maxillary sinuses are tucked into the cheekbone area. If your thumbs are above the eyebrows or on the bridge of the nose, you’re not directly contacting the sinus beds. You risk missing tenderness or misjudging where the pressure is coming from. By docking your thumbs below the cheekbones and letting the fingers trail along the sides of the head, you align your touch with the actual sinus regions. It’s a small adjustment, but it keeps the assessment focused where it should be.

Let me explain the setup in practical terms

• Have the patient sit upright or lie with head supported, whichever feels most stable. A relaxed head reduces muscle tensing that can skew tenderness.

• Stand or sit slightly to the side so you can bring both thumbs to the cheekbone area without twisting the neck.

• Place your thumbs below the cheekbones. Your fingers should naturally trace along the sides of the head, not crossing the midline.

• Apply gentle, steady pressure with a circular or firm press, depending on your evaluation needs. You’re testing for tenderness, fullness, swelling, or any palpable mass.

• Compare sides, but do it respectfully. A small difference can matter, especially if one side is tender while the other isn’t.

What you’re listening for and how to respond

The main aim here is to detect tenderness that indicates sinus inflammation or infection. If a patient experiences pain on palpation in the maxillary region, you document the location, intensity, and duration. Note whether tenderness is unilateral (one side) or bilateral (both sides). Bilateral tenderness often correlates with conditions like viral rhinosinusitis, whereas unilateral tenderness might point to a localized issue or dental origin that requires further follow-up.

The touch itself should be gentle, not a jab. You’re not grabbing or squeezing; you’re applying consistent pressure to feel what’s underneath the cheekbone. If tenderness is elicited, you may want to explore accompanying symptoms: nasal congestion, fever, facial fullness, dental discomfort, or crusting. These clues help paint a clearer clinical picture.

Common mistakes to avoid (so you don’t miss a beat)

• Pressing too high on the face. Remember, the maxillary sinuses sit beneath the cheekbones, not near the brow ridge. Misplaced pressure can lead to confusing findings.

• Using overly strong pressure. It’s not about brute force; it’s about a thoughtful touch that feels like a careful, slow “press and release.”

• Skipping the comparison. Side-to-side differences can matter. Make a quick, respectful comparison as part of your routine.

• Overlooking patient comfort. If pressure causes significant discomfort, pause, adjust, and check in with the patient. Comfort can affect response and reliability.

• Rushing the exam. Take your time to position the patient, locate the landmarks, and apply consistent pressure. Rushed palpation often misses subtle tenderness.

A quick map of the facial sinuses for context

If you’re comparing maxillary with other sinuses, here’s a simple mental map to keep straight:

• Maxillary sinuses: located in the cheek area, just above the upper jaw.

• Frontal sinuses: sit above the eyes, behind the forehead.

• Ethmoid and sphenoid sinuses: deeper in the skull, behind the bridge of the nose and between the eyes.

• The maxillary sinuses are the ones you palpate by placing thumbs below the cheekbones, as discussed. This direct, accessible approach is the most practical way to assess tenderness in that region.

Practical tips that help in the real world

• Communicate as you go. A quick “let me check your sinuses here” keeps the patient informed and at ease.

• Use a light touch at first, then adjust pressure based on the patient’s feedback. If tenderness is present, you’ll know quickly whether to ease off or press a little more in a controlled way.

• Document not just tenderness, but also any swelling, asymmetry, or facial tenderness that doesn’t line up with sinus disease. Context matters for a complete assessment.

• If the patient has facial trauma, dental issues, or prior sinus surgery, let that history guide your approach. You may need to tailor the technique slightly or defer palpation in sensitive cases.

A moment to connect with the bigger picture

This isn’t just about ticking a checkbox on a checklist. Palpation of the maxillary sinuses is a practical example of how anatomy meets bedside technique. You’re translating anatomical knowledge into a tactile skill that can reveal clues about a patient’s health. The same mindset applies across the whole ATI Physical Assessment set of skills: know the landmarks, apply the right touch, observe the patient’s responses, and document clearly. It’s a rhythm that makes sense in a busy clinical environment and yields reliable information that clinicians can act on.

How this fits into a broader assessment routine

After you’ve completed the maxillary sinus palpation, you typically continue with a full head-to-toe or focused respiratory assessment, depending on the presenting symptoms. You’ll compare findings with nasal inspection, throat examination, and dental health notes. Sometimes a patient’s dental history or recent upper respiratory symptoms will color your interpretation. The beauty of this approach is its modular nature: you add one skill to the stack, and it complements others. The end result is a cohesive picture that helps guide treatment decisions.

A gentle reminder about technique variations

No two patients are exactly the same. If someone has a prominent cheekbone structure or a lot of facial hair, your approach might require small adaptations. The thumbs remain the same position, but your hand angle or pressure might adjust to maintain consistent contact with the sinus bed. The goal is to keep your touch steady and your landmarks clear, even when the faces you assess aren’t textbook-perfect.

From theory to everyday care

For students and professionals alike, this kind of palpation is a reminder that clinical skills live where anatomy meets experience. You’ll find this technique described in reputable clinical texts and nursing education resources. It isn’t about memorizing a single perfect move; it’s about building a reliable, repeatable method you can rely on in diverse patient situations. And that reliability is what patients notice. When you touch with confidence and explain what you’re doing, you foster trust and comfort—two elements every good clinician nurtures.

Bringing it together

So, if you’re ever asked how to position your thumbs during a maxillary sinus assessment, you’ve got a clear answer: place them below the cheekbones with the fingers along the sides of the head. It’s a simple stance with a direct aim—evaluate tenderness, fullness, or swelling in the cheek area, and use that information as part of a broader diagnostic conversation.

If you’re exploring the broader world of clinical assessment, you’ll encounter a lot of moments where a precise touch matters. Small adjustments in technique often lead to big differences in accuracy. That’s the essence of good clinical practice: combine solid knowledge with thoughtful, patient-centered execution.

A quick wrap-up for easy recall

• Location matters: maxillary sinuses are in the cheek region, just above the upper jaw.

• Thumb placement is key: below the cheekbones, fingers along the head.

• Assess with care: gentle pressure, observe tenderness, compare sides, and note any accompanying symptoms.

• Integrate with the bigger picture: this skill fits into a full head-to-toe or focused respiratory assessment.

• Keep the patient at the center: clear communication and comfortable touch build trust and improve the quality of information you gather.

If you ever find yourself describing this technique to a peer or a patient, you’ll be armed with a concrete image and a simple, repeatable method. That clarity can make a real difference—not just in the classroom, but in real patient care where every touch carries meaning.

Want more bite-sized clarity on other assessment landmarks? We can map out each area—how to locate them, how to touch them, and what findings to note—so you feel confident at every step. The journey through clinical assessment is a series of small, solid moves that accumulate into real expertise. And yes, you’ll probably smile a little the first time you palpate a maxillary sinus and it just feels… right.