Silent Sinus Syndrome: Clinical Findings and Differential Diagnosis

Abstract

The Silent Sinus Syndrome (SSS) is a rare condition that causes facial asymmetry, unilateral enophthalmos and diplopia. It is thought to be secondary to chronic maxillary sinus atelectasis (CMA) with reabsorbed bone and subsequent displacement of the orbital floor. Such anatomic modifications occur over time, and therefore it is possible to encounter different stages of the same disease with or without orbital displacement. Clinical findings can be unclear so it makes sense to recognize potentially evolving SSS while other disturbances have to be ruled out. Our purpose is to underline clinical findings for different diagnosis and proper management. We consider Functional Endoscopic Sinus Surgery (FESS) indicated in CMA and SSS to halt the progression of the disease. Nevertheless restitution treatment of enophtalmos due to orbital floor displacement involves plastic reconstruction of the floor of the orbit via transconjunctival approach. We report a case of SSS and discuss distinctive features of non-neoplastic lesions involving the maxillary sinus that should be considered for differential diagnosis.

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“…Pode-se verificar também a presença de secreção não-patológica de coloração transparente e aspecto viscoso. (BOSSOLESI et al, 2014).…”

Silent Sinus Syndrome and Williams Syndrome: Two Rare Diseases Found in a Pediatric Patient

“…Patients may also present with eye asymmetry, unilateral ptosis, or diplopia. Most reported cases describe its occurrence in adults (2)(3)(4)(5)(6), but it can also affect children (1,7). The precise pathophysiology of SSS remains speculative, even though the most accepted theory is that occlusion of the maxillary ostium causes an interruption of normal sinus development during the first or second decade of life (1,3).…”

“…Due to ostial obstruction, hypoventilation and atelectasis of the maxillary sinus cause chronic negative pressure within the sinus, leading the sinus walls to migrate inward. Bone remodeling around the maxillary sinus can be significant, leading to enophthalmos (3,5). In SSS, the uncinate process is usually completely adherent to the lateral sinus wall, obstructing the maxillary natural ostium, although it is difficult to determine the exact causative factor leading to uncinate process displacement and ostial occlusion (1,5).…”

“…Bone remodeling around the maxillary sinus can be significant, leading to enophthalmos (3,5). In SSS, the uncinate process is usually completely adherent to the lateral sinus wall, obstructing the maxillary natural ostium, although it is difficult to determine the exact causative factor leading to uncinate process displacement and ostial occlusion (1,5). Orbitofacial imaging [computed tomography (CT) and magnetic resonance imaging (MRI) scans] is the gold standard for establishing the diagnosis.…”

“…Orbitofacial imaging [computed tomography (CT) and magnetic resonance imaging (MRI) scans] is the gold standard for establishing the diagnosis. The main radiological findings described are unilateral maxillary sinus opacification and collapse, thinning and depression of the orbital floor, lateralization of the uncinate process resulting in blockage of the ostiomeatal complex and retraction of the posterolateral and medial walls of the maxillary sinus (2)(3)(4)(5)(6). When the condition is left untreated, it may result in complete obliteration of the sinus with worsening enophthalmos and hypoglobus.…”