Facial Tenderness 1. Ask the patient to tell you if these maneuvers causes excessive discomfort or pain. ++ 2. Press upward under both eyebrows with your thumbs. 3. Press upward under both maxilla with your thumbs. 4. Excessive discomfort on one side or significant pain suggests sinusitis. Sinus Trans illumination 1. Darken the room as much as possible. ++ 2. Place a bright otoscope or other point light source on the maxilla. 3. Ask the patient to open their mouth and look for an orange glow on the hard palate. 4. A decreased or absent glow suggests that the sinus is filled with something other than air. Temporomandibular Joint 1. Place the tips of your index fingers directly in front of the tragus of each ear. ++ 2. Ask the patient to open and close their mouth. 3. Note any decreased range of motion, tenderness, or swelling.