Endoscopic Treatment of Silent Sinus Syndrome with Dramatic Resolution

Abstract

Discussion In this article, silent sinus syndrome developed in a young woman followed for chronic sinusitis. Spontaneous enophthalmos developed in the setting of an obstructed sinus outflow tract, and was associated with orbital pressure and pain. The patient was taken to the operating room for FESS. The remarkable component of her post-operative course is the resolution of the bony involution of the posterior wall of the maxillary sinus, which resolved after about six months post-operatively. She was found on postoperative CT scan to have fully restored maxillary sinus architecture. We conclude that the atelectasia of the bony sinus walls resolved spontaneously through aeration from maxillary sinus decompression alone. Specifically, resolution of the posterior maxillary sinus wall inbowing has not been reported. Thus, the osseous changes of SSS can spontaneously resolve after FESS-induced aeration alone and without direct manipulation. These findings call into question the necessity for routine orbital floor recons truction in these patients, which is current standard practice in the setting of enophthalmos. Several authors have indeed noted resolution of the inferior bowing of the orbital floor through FESS alone and without reconstructive manipulation of the orbital floor. Habibi et al reported on a 16 year-old girl with facial asymmetry due to left enophthalmos. 13 CT revealed left maxillary sinus atelectasis with an opacified le ft maxillary antrum. The patient underwent FESS. Six-month and 2-year followups after surgical treatment revealed aeration of the maxillary sinus and resolution of the enophthalmos. Babinski et al also reported 3 cases of SSS whose enophthalmos was completely resolved without orbital floor repair. 14 In this case, the maxillary sinus wall changes resolved after FESS, with notable resolution of the prior inbowing of the posterior sinus wall. It remains to be seen if the patient’s enophthal mos will resolve, and she is being followed clinical for this. She will elect for reconstructive repair if it does not resolve. This case highlights the spontaneous resolution of the bony changes seen in chronic maxillary atelectasis – especially the resolution of the posterior maxillary sinus – through FESS-induced aeration of the sinus alone. This calls into question t he need for reconstructive repair of the orbital floor.