The Silent Sinus Syndrome is a form of Chronic Maxillary Atelectasis: A Systematic Review of all Reported Cases

Abstract

The terms chronic maxillary atelectasis (CMA) and silent sinus syndrome (SSS) have been used to describe spontaneous enophthalmos in association with a contracted ipsilateral maxillary sinus. Despite the use of differing taxonomy, it appears that these two terms describe the same clinical entity. Nevertheless, many reports still discuss CMA and SSS in isolation or as distinct conditions. A systematic review of all reported cases of CMA and SSS was performed (1964-2006). Case reports were excluded if they involved facial trauma, diagnosis of mucocele, or previous surgery. Eligible cases were reviewed and entered into a database. Data were evaluated based on literature of publication, reported diagnosis, demographics, ophthalmologic examination, results of imaging, and operative findings. Only complete data sets were included in an additional analysis whereby the diagnostic criteria for CMA and SSS were applied and the data sets were compared. Of the 105 cases reviewed, 55 contained complete data sets. Twenty-seven of these cases met the diagnostic criteria for SSS, and 48 could be diagnosed as CMA, with 23 meeting the criteria for both conditions. Comparing the cases across diagnoses, the only difference observed was that of the presence of sinus-related symptoms, which by definition distinguishes CMA III from SSS. The entity termed SSS fits within the staging classification of CMA. We propose abandoning the term SSS and recommend universal adoption of the CMA staging system, which uses nomenclature that more accurately portrays the pathophysiology and natural history of this condition.