Multidisciplinary Approach to Management of Silent Sinus Syndrome

Abstract

Objectives: To report the results of a multidisciplinary approach to silent sinus syndrome, a rare entity with both ophthalmologic and rhinologic manifestations. Study Design: Retrospective, interventional case series. Methods: The records of all patients with silent sinus syndrome treated at a tertiary medical center in the last three years were reviewed. Inclusion required imaging demonstrating maxillary sinus atelectasis and orbital floor resorption. Data collected included age, gender, findings during endoscopic sinus surgery, measurement of eyelid and globe position, and presence of diplopia on alternate cover testing. Results: Four patients were male and one patient was female with a mean age of 40.6 years. All patients presented initially with ophthalmologic complaints. Each patient had a deep superior eyelid sulcus on the affected side with a mean enophthalmos of 3.8mm and hypoglobus of 2.8mm. All patients underwent simultaneous endoscopic maxillary sinus surgery with creation of a large antrostomy and orbital floor reconstruction using either porous polyethylene implants or autologous bone grafting. All patients experienced improvement of hypoglobus and globe position as measured by exophthalmometry. One patient developed transient hypesthesia of the midface. Conclusions: Silent sinus syndrome is rare condition and may present with either ophthalmologic or rhinologic symptoms. Recognition of the ocular adnexal changes and characteristic findings on imaging are essential in making this diagnosis. Treatment should be multidisciplinary and can be safely performed simultaneously.