Silent sinus syndrome is a spontaneous, asymptomatic collapse of the maxillary sinus and orbital floor associated with negative sinus pressures. Examination was normal apart from reduced facial sensation. Abstract the silent sinus syndrome sss is a rare phenomenon originally described in 1964 by montgomery, which often occurs unilaterally in the maxillary sinus with opacification and collapse. Silent sinus syndrome epidemiology rareapproximately84reported casesbetween1964and2004. The anatomical variations lead to the occlusion in maxillary sinus and as a result silent sinus syndrome occur. Silent sinus syndrome an otherwise healthy 34yearold man became aware of progressive left side deepening of the superior orbital sulcus causing visible asymmetry of the face. Coronal reformatted ct image a and coronal t1weighted b and t2weighted fatsaturated c mri show some characteristic findings of silent sinus syndrome.
The medical world has not been able to exactly distinguish the differences between these two conditions in the initial stages of the illness. Traditionally, correction of the enophthalmos involved reconstruction of the orbital floor, which was performed simultaneously with sinus. Silent sinus syndrome symptoms, diagnosis, treatments and. Silent sinus syndrome sss is a rare disorder that is defined as spontaneous and gradual retraction of the maxillary sinus. The authors report an unusual case revealed by mild dental. In this study, we present a case of true silent sinus syndrome. Clinical presentation is highly variable and nonspecific. The authors report an unusual case revealed by mild dental pain, present the imaging before, during and. Silent sinus syndrome is an unusual cause of progressive enophthalmos and hypoglobus due to atelectasia of the maxillary sinus associated with osteolysis of the orbital floor. Silent sinus syndrome is a rare disorder, but it is probably underdiagnosed because of a lack of recognition. Silent sinus syndrome is a very rare condition that is usually caused by some type of physical trauma or one of a handful of rare u deploying diseases. It can cause painless facial asymmetry, diplopia and enophthalmos. Silent sinus syndrome is a condition in which chronic asymptomatic maxillary sinus disease presents with spontaneous unilateral enophthalmos and hypoglobus. Clinicians from multiple disciplines should be familiar with presenting features.
The silent sinus syndrome is a rare clinical entity of spontaneous enophthalmos and hypoglobus caused by an alteration of the normal orbital architecture and function from maxillary sinus collapse. This syndrome is classically idiopathic, but the term is also used to describe traumatic or iatrogenic surgical orbital decompression cases. Before you allow the doctor who diagnosed you to perform surgery, i would strongly recommend you get a second opinion from a doctor at a teaching hospital who specializes in treating these sorts. Delayed presentation of silent sinus syndrome after orbital trauma. The silent sinus syndrome is a spontaneous unilateral maxillary atelectasis with complete or partial opacification of the sinus. This process can eventually lead to prolapse of the orbital contents, enophthalmos. Look past the eye how to detect and manage this rare condition, which can be associated with a range of symptoms. Review treatment outcomes of patients with silent sinus syndrome.
Dental disease and its role in silent sinus syndrome. D ue to the close anatomic relationship between the orbit and paranasal sinuses, ophthalmologists must be cognizant of certain sinonasal diseases that may present with ocular manifestations. Purpose the purpose of this study is to describe the clinical and pathologic features of a form of chronic maxillary atelectasis referred to as the silent sinus syndrome, which is characterized by progressive enophthalmos secondary to maxillary collapse resulting from maxillary sinus. Imploding antrum or silent sinus syndrome following naso. Most of the patients with this syndrome present with ophthalmological complaints without any nasal sinus symptoms, and it typically has a painless course and slow. The silent sinus syndrome is a form of chronic maxillary. Silent sinus syndrome sss is a condition characterized by ophthalmologic features, such as spontaneous enophthalmos and hypoglobus with ipsilateral maxillary sinus atelectasis and an otherwise asymptomatic presentation. I have now been to the ent and i have a severe infection in my right maxillary sinus.
The aim of this case report is to alert clinicians to this entity, which should be included in the differential diagnosis of facial asymmetry, and also to briefly describe its clinical and imaging characteristics. Chiu silent sinus syndrome sss, is a rare disorder involving the maxillary antrum, characterized by an indolent course of subclinical maxillary sinusitis that leads to progressive contraction of the maxillary sinus. This syndrome was first described in 1964 by montgomery, but it was named silent sinus syndrome in 1994 by soparkar et al. The terms chronic maxillary atelectasis cma and silent sinus syndrome sss have been used to describe spontaneous enophthalmos in association with a contracted ipsilateral maxillary sinus. Silent sinus syndrome sss is known to be a rare clinical condition, characterized by spontaneous and progressive enophthalmos and hypoglobus associated with atelectasis of the maxillary sinus and alteration of the orbital floor.
Diagnosis and management of silent sinus syndrome s. Pdf delayed presentation of silent sinus syndrome after. In summary, the silent sinus syndrome is a rare entity that is wellknown to the ophthalmologist and the ear, nose, and throat surgeon. However, in a small number of patients, trauma to the lateral nasal wall and ostiomeatal complex may be the cause, e. Can nasal irrigation cure silent sinus syndromesss. The most widely accepted theory is that an inciting event causes occlusion of the ostiomeatal complex through which the maxillary sinus drains into the middle meatus of the nasal antrum.
There is yet another condition called the hypo plastic condition where the region becomes thicker and opaque. There are two treatment approach of silent sinus syndrome i. Silent sinus syndrome is an acquired condition that occurs in adults with unilateral, progressive, spontaneous enophthalmos and hypoglobus secondary to maxillary sinus hypoventilation caused by blockage of the ostiomeatal complex. Negative sinus pressure and normal predisease imaging in. Radiographic findings include ipsilateral maxillary sinus opacification, lateralization of the uncinate and middle turbinate, and infundibular occlusion. The silent sinus syndrome refers to the collapse of the orbital floor and maxillary sinus which can cause changes in facial appearance. Dental disease and its role in silent sinus syndrome mayo. The opacified hypoplastic maxillary sinus may represent a less severe form. Silent sinus syndrome sss is known as a rare clinical condition, characterized by spontaneous and progressive enophthalmos and hypoglobus associated with atelectasis of the maxillary sinus and alteration of the orbital floor.
It is thought to be secondary to chronic maxillary sinus atelectasis cma with reabsorbed bone and subsequent displacement of the orbital floor. Hypoplasia of maxillary sinus caused by its longterm hypoventilation due to anatomical changes in osteomeatal complex. The typical patient with silent sinus syndrome is an adult in the third. Silent sinus syndrome sss constitutes unilateral spontaneous enophthalmos due to increased orbital volume and retraction of the orbital floor. This in turn may cause associated ocular occurrences of enophthalmos and hypotropia.
The diagnosis based on clinical features and data of computed tomography. Silent sinus syndrome is an acquired condition in which there is a gradual collapse of the orbital floor and inward retraction of the maxillary sinus atelectasis of the maxillary sinus. The silent sinus syndrome consists of painless facial asymmetry and enophthalmos caused by chronic maxillary sinus atelectasis. A 49yearold man presented with a 1week history of right facial paraesthesia with blurred vision and diplopia. Silent sinus syndrome symptoms, causes, treatment, surgery. It is commonly attributed to a sinus atelectasis secondary to ostiomeatal obstruction. One such disease process, silent sinus syndrome, is a progressive condition in which maxillary sinus pathology causes inferior displacement of the orbital floor, resulting in enophthalmos and hypoglobus. Silent sinus syndrome usually presents in the 3 rd to 5 th decade, without a gender predilection. Determine the incidence of dental disease in patients with silent sinus syndrome. Background silent sinus syndrome is characterised by spontaneous enophthalmos and hypoglobus, in association with chronic atelectasis of the maxillary sinus, and in the absence of signs or symptoms of intrinsic sinonasal inflammatory disease. Silent sinus syndrome sss is a rare disease characterized by spontaneous enophthalmos and hypoglobus secondary to collapse of the orbital floor in patients with asymptomatic maxillary sinusitis. Guidelines differ from study to study, and identify. Silent sinus syndrome sss is a disease in which the natural orifice of the maxillary sinus becomes obstructed and the pressure in the sinus becomes negative due to hypoventilation, causing.
In magnetic resonance imaging mri of paranasal sinuses, right. I was diagnosed with silent sinus syndrome 18mths ago after months of trying to convince my gp that my eye looked different and i was having intermittent diplopia and feeling of sinus fullness. Diagnosis and management of silent sinus syndrome american. Radiologic findings involving the maxillary sinus and orbit confirm the diagnosis of the silent sinus syndrome. It is characterized by ipsilateral enophthalmos and hypoglobus or mistakenly as an exophthalmos of the contralateral eye. Beating the silent sinus syndrome naturally wfm health. The silent sinus syndrome sss is a rare condition that causes facial asymmetry, unilateral enophthalmos and diplopia. Silent sinus syndrome without opacification of ipsilateral. We present the first case of silent sinus syndrome with both normal predisease imaging findings and documented negative maxillary sinus pressure, demonstrating unequivocally the acquired nature and possible etiologic association with negative maxillary sinus pressure in at least some cases of silent sinus syndrome.
Despite the use of differing taxonomy, it appears that these two terms describe the same clinical entity. Purpose the purpose of this study is to describe the clinical and pathologic features of a form of chronic maxillary atelectasis referred to as the silent sinus syndrome, which is characterized by progressive enophthalmos secondary to maxillary collapse resulting from maxillary sinus hypoventilation. It is well recognised among otorhinolaryngologists and ophthalmologists but remains relatively unknown among radiologists. Although reported in the ophthalmology and otolaryngology literature, there is no mention of silent sinus syndrome in the plastic surgery literature. Hi, i am a general surgeon am not well versed with ent diseases but as of my knowledge silent sinus syndrome is a very rare diagnosis with a very few reported cases. The silent sinus syndrome consists of painless facial asymmetry characterized by unilateral enophthalmos. Silent sinus syndrome is characterised by spontaneous enophthalmos and hypoglobus, in association with chronic atelectasis of the maxillary sinus, and in the absence of signs or symptoms of intrinsic sinonasal inflammatory disease. Optimal management of silent sinus syndrome requires an understanding of the underlying pathophysiology. Jan 14, 2020 silent sinus syndrome sss is a condition characterized by ophthalmologic features, such as spontaneous enophthalmos and hypoglobus with ipsilateral maxillary sinus atelectasis and an otherwise asymptomatic presentation. It is believed that the condition is often undiagnosed or misdiagnosed. He prescribed a strong antibotic and said he could not even see the problem becaus i had so much puss in my right sinus. Maxillary sinus wall thickening in silent sinus syndrome.
Traditionally, correction of the enophthalmos involved reconstruction of the orbital floor, which was performed simultaneously with sinus surgery. The patient often presents with a droopy eyelid and a deep superior sulcus. Chronic maxillary atelectasis including silent sinus syndrome can present bilaterally volume 3 issue 3 j p k ho, e wong, d a gunaratne, n singh. Chronic maxillary atelectasis including silent sinus. Rare radiological feature in silent sinus syndrome jama. Silent sinus is said to be mainly caused by the inward withdrawal of the walls on maxillary sinus region. Silent sinus syndrome is characterised by painless enophthalmos associated with involution of the maxillary sinus after infundibular occlusion. Silent sinus syndrome is a rare cause of hypoglobus and enophthalmos. Silent sinus syndrome or chronic maxillary sinus atelectasis characterised by asymptomatic hypoplasia of maxillary sinus, progressive enophthalmos, facial asymmetry. Understand the progression of silent sinus syndrome in patients with dental disease. Unusual ocular manifestations of silent sinus syndrome. P333 silent sinus syndrome in children case report. Although the diagnosis is usually suspected clinically, it is confirmed radiologically by characteristic imaging features that include maxillary sinus outlet obstruction, sinus opacification, and sinus volume loss.
It was clear even to me from the scans that this was the problem. Silent sinus syndrome is a rare clinical entity typically characterized by spontaneous and progressive enophthalmos and hypoglobus caused by an alteration of the normal orbital architecture and function from maxillary collapse in the setting of the chronic maxillary sinus hypoventilation. Sss is caused because of negative pressure causing collapse of sinus it may be be. Participant eligibility includes age, gender, type and stage of disease, and previous treatments or health concerns. Silent sinus syndrome is a unique diagnosis characterized by spontaneous enophthalmos and hypoglobus resulting from collapse of the orbital floor secondary to chronic subclinical sinusitis. Silent sinus syndrome is a rare clinical condition.
I had fess surgery and orbital reconstruction with great results. Usually the diagnosis is suspected clinically, and it can be confirmed radiologically by characteristic imaging features that include. Reabsorbed bone with displacement of the orbital floor is a constant finding. In this report, we are presenting a 40yearold male with chief complain of orbital asymmetry. Silent sinus syndrome an otherwise healthy 34yearold man became aware of progressive left side deepening of the superior orbital. Pathophysiology optimal management of silent sinus syndrome requires an understanding of the underlying pathophysiology. The typical patient with silent sinus syndrome is an adult in the third through fifth decades of life who. A similar process may be responsible for the appearance of the opacified hypoplastic maxillary sinus, an entity with imaging findings similar to that of the silent sinus syndrome and often used interchangeably with the silent sinus syndrome in the literature 1, 3, 12. The condition is quite uncommon and usually causes no pain when it occurs. Silent sinus syndrome is a rare disorder, but it is probably underdiagnosed because of a lack of recognition 1. It is secondary to chronic maxillary sinus atelectasis. He underwent a middle meatal antrostomy with complete resolution of symptoms. The diagnosis based on clinical features and data of computed. This is a report of an 8 yearold boy with silent sinus syndrome and.
481 36 174 88 1381 1510 1213 546 309 603 515 200 93 278 504 958 119 933 329 430 601 453 689 649 733 759 1247 1479 793 818 1151 554