Pediatric chronic maxillary atelectasis

Abstract

Abstract Purpose : Chronic maxillary atelectasis (CMA) is an acquired condition characterized by decreased maxillary sinus volume with inward bowing of one or more antral walls, which may result in ipsilateral hypoglobus or enophthalmos. Its etiology is unclear. There are few reported cases in the pediatric literature. We present a case of CMA in a child with normal pre-disease CT scans, illustrating that this is an acquired condition occurring in the pediatric population. Theoretic mechanisms of pathogenesis are also discussed. Methods : A retrospective medical record review was conducted, as well a literature review to examine similar cases and proposed pathophysiologic mechanisms of the disease. Results : An 11-year-old female was referred to our Otolaryngology clinic for evaluation of frontal headaches. She had a history of right anterior table frontal sinus fracture and right ethmoid fracture after hitting her head on a school desk at age seven. She required frontal sinus obliteration after her initial trauma due to persistent fevers and headaches. Initial maxillofacial CT revealed normal appearing maxillary sinuses. Four years later a repeat CT showed an opacified, hypoplastic left maxillary sinus with inward bowing of medial and lateral walls, as well as a depressed left orbital floor. She was treated with endoscopic left maxillary antrostomy, and later underwent removal of hardware related to her frontal sinus obliteration. Her symptoms resolved after these interventions. Conclusion : Chronic maxillary atelectasis was first described nearly 50 years ago, and sparse literature exists on its impact in the pediatric population. Evidence exists which supports the theory of negative antral pressure leading to the observed anatomic defects. Primary management of the disease is surgical, and involves maxillary antrostomy with uncinectomy. Debate exists as to whether CMA and SSS are distinct entities or different descriptions of disease processes on a single spectrum.