Diplopia in Silent Sinus Syndrome – From Diagnosis to Minimal Surgical Intervention

Abstract

Abstract Silent sinus syndrome (SSS) is a rare disease mostly affecting the maxillary sinus. It is described as a slowly progressive painless enophthalmos with hypoglobus secondary to atelectasis of the maxillary sinus in patients with an unremarkable history of preexisting sinonasal or ophthalmological pathologies. Diplopia is an unusual presentation of SSS and opting for orbital floor correction is a matter of debate. Limited reports in the literature show the efficacy of endoscopic maxillary antrostomy alone without orbital floor reconstruction in patients with diplopia. This study reports a case of an unusual presentation of SSS. The paper also reviews the diagnostic approach and focuses on the treatment by minimally invasive endoscopic antrostomy for aeration of the maxillary sinus without the need of orbital floor reconstruction for correction of diplopia and enophthalmos. This paper discusses a 41-year-old previously healthy male presenting with gradually progressive hypoglobus and enophthalmos associated with diplopia and mild facial asymmetry. There was no past medical history of sinonasal or ophthalmological diseases, surgeries, or trauma. The differential diagnoses initially were variable. Endoscopic evaluation in the outpatient clinic along with computed tomography and magnetic resonance imaging of the paranasal sinuses and orbit confirmed the diagnosis of SSS. Relieving the negative maxillary pressure with endoscopic wide middle meatal maxillary antrostomy without orbital floor reconstruction restored the normal extraocular muscle movement and improved the diplopia, hypoglobus, and enophthalmos. Our case report demonstrates the association between SSS and diplopia, and it reviews the diagnostic approach to the disease including comprehensive clinical assessment, endoscopic evaluation, and radiological studies. The case report also signifies the effectiveness of endoscopic maxillary antrostomy without orbital floor reconstruction in re-establishing the ventilation of the atelectatic maxillary sinus and allowing spontaneous resolution of diplopia, enophthalmos, and hypoglobus.