CBCT IMAGING OF “SILENT SINUS SYNDROME”—CASE REPORTS AND LITERATURE REVIEW

Abstract

<h3>BACKGROUND</h3> Silent sinus syndrome (SSS) is familiar to otolaryngologists and ophthalmologists but is a rare clinical entity in dentistry and likely to be underdiagnosed because of lack of awareness. It presents a diagnostic challenge to dentists because patients typically have no history of trauma or sinusitis. The exact pathophysiology of SSS is still debated. Here we report 3 cases of SSS in adults. <h3>CASE REPORT</h3> As documented in cases reviewed at our institution, the typical feature of SSS is a gradual retreat of the maxillary sinus walls resulting in enophthalmos and hypoglobus. Analysis of axial and coronal cone beam computed tomography (CBCT) sections displayed characteristics such as unilateral volume loss in the maxillary sinus, retracted sinus walls, partial to complete soft tissue opacification of the affected maxillary sinus, and inferior bowing of the orbital floor. The radiographic differential diagnosis of SSS includes congenital maxillary sinus hypoplasia, chronic sinusitis, mucocele, and changes seen after maxillary sinus and orbital trauma. Some of the distinguishing features of congenital maxillary sinus hypoplasia include arrest of development of sinuses due to infection or trauma, congenital first arch syndrome, and other developmental anomalies. Congenital anomalies such as Treacher Collins syndrome are associated with unilateral maxillary sinus hypoplasia. All features of maxillary hypoplasia were absent in the presented 3 cases. <h3>DISCUSSION/CONCLUSIONS</h3> This report highlights the incidental finding of a relatively rarely reported and often underdiagnosed sinus pathosis on CBCT, SSS. Furthermore, the literature review underlines features observed on a higher spatial resolution modality with significant reduction in radiation doses. It is important for dental professionals to recognize the existence of SSS in otherwise asymptomatic patients and institute management where needed.