Silent Sinus Syndrome Research Articles

A Case of Bilateral Silent Sinus Syndrome Presenting With Chronic Ocular Surface Disease

The silent sinus syndrome is characterized by atelectasis of the maxillary sinus in the setting of subclinical maxillary sinusitis and obstruction of the osteomeatal unit. The resultant expansion of orbital volume causes enophthalmos and hypoglobus. A review of the literature reveals only unilateral cases. The authors present a case of bilateral silent sinus syndrome presenting with chronic ocular surface disease. A 56-year-old man was referred for tarsorrhaphy to treat a chronic recurrent corneal ulcer. Exam revealed an area of corneal thinning in the left eye. The patient appeared cachectic and there was enophthalmos, hypoglobus, and lagophthalmos on both sides, left worse than right. Due to the patient's appearance and a history of sinonasal malignancy, recurrent malignancy was suspected. A systemic workup was unrevealing, and radiographic studies showed the features of silent sinus syndrome bilaterally. The patient underwent sinus surgery and placement of a left orbital floor implant.

Silent sinus syndrome

Silent sinus syndrome is defined as a spontaneous and progressive enophthalmos and hypoglobus with hypoplasia of the maxillary sinus and resorption of the orbital floor. It is caused by atelectasis of the maxillary sinus in the presence of ipsilateral chronic hypoventilation of the sinus. The problem may be idiopathic, but the term is now also used to describe cases that follow operation or trauma. We describe three cases, each with a different aetiology, and discuss the clinical and radiographic evaluation of the condition, theories regarding its pathophysiology, and surgical correction.

Bilateral Silent Sinus Syndrome: Case Report and Surgical Solution

Silent sinus syndrome (SSS) is a rare disorder characterized by ipsilateral enophthalmos and hypoglobus, caused by an alteration of the orbital architecture due to maxillary sinus collapse with chronic hypoventilation. 1 Its treatment is surgical, and despite controversies in the literature, simultaneous management of enophthalmos and sinus pathologies existing in the floor of the orbit, reconstruction, and endoscopic uncinectomy and antrostomy should be considered as some of the main options for treatment. 2

Silent Sinus Syndrome after Lateral Fracture of the Inferior Turbinate

Silent Sinus Syndrome after Lateral Fracture of the Inferior Turbinate

Re: “A Case of Bilateral Silent Sinus Syndrome Presenting With Chronic Ocular Surface Disease”

Ophthalmic Plastic & Reconstructive Surgery: September 2011 - Volume 27 - Issue 5 - p 393 doi: 10.1097/IOP.0b013e318227160f

Reply re: “A Case of Bilateral Silent Sinus Syndrome Presenting With Chronic Ocular Surface Disease”

Reply re: “A Case of Bilateral Silent Sinus Syndrome Presenting With Chronic Ocular Surface Disease”

Silent sinus syndrome: dynamic changes in the position of the orbital floor after restoration of normal sinus pressure

Silent sinus syndrome is characterised by spontaneous enophthalmos and hypoglobus, in association with chronic atelectasis of the maxillary sinus, and in the absence of signs or symptoms of intrinsic sinonasal inflammatory disease. Traditionally, correction of the enophthalmos involved reconstruction of the orbital floor, which was performed simultaneously with sinus surgery. Recently, there has been increasing evidence to support the performance of uncinectomy and antrostomy alone, then orbital floor reconstruction as a second-stage procedure if needed. We performed a retrospective review of 23 cases of chronic maxillary atelectasis managed in our unit with endoscopic uncinectomy and antrostomy alone. All patients were operated upon by the same surgeon. Twenty-two of the 23 patients had either complete or partial resolution. One patient had ongoing enophthalmos, and was considered for an orbital floor reconstruction as a second-stage procedure. Our case series demonstrates that dynamic changes in orbital floor position can occur after sinus re-ventilation. These findings support the approach of delaying orbital floor reconstruction in cases of silent sinus syndrome treated with sinus re-ventilation, as such reconstruction may prove unnecessary over time.

The Efficacy of Endoscopic Sinus Surgery in the Management of Silent Sinus Syndrome

Objective: Evaluate the efficacy of endoscopic sinus surgery (ESS) without orbital floor augmentation in restoring maxillary sinus volume and resolving enophthalmos in patients with silent sinus syndrome. Method: A retrospective chart review was conducted in all patients with silent sinus syndrome managed with endoscopic sinus surgery at St Paul’s Hospital from 2005 to 2010. A comparison of pre- and postoperative ophthalmometric and CT scan maxillary sinus volumetric measurements were performed. Results: In total, there were 25 patients aged 24 to 71 years who were managed with ESS. All patients underwent ESS with maxillary sinus antrostomy. All patients had a significant improvement in postoperative maxillary sinus volumetric measurements, with a mean increase of 22.7%. Conclusion: ESS without orbital floor augmentation can be used to improve enophthalmos and reverse maxillary sinus atelectasis in most patients with silent sinus syndrome.

Spontaneous silent sinus syndrome (imploding antrum syndrome): case series of 16 patients

Silent sinus syndrome (SSS) is a rare idiopathic collapse of the maxillary sinus and orbital floor. We present the second largest series of sixteen patients with SSS and describe their management. A cohort of 16 patients with spontaneous SSS between 1999 and 2009 were reviewed at the Royal National Throat Nose and Ear Hospital. All patients were initially referred from a postgraduate ophthalmic hospital, Moorfields Hospital. Fourteen patients required endoscopic sinus surgery to re-establish maxillary sinus drainage and the remaining two settled with intranasal medical therapy consisting of steroids and decongestions. Follow- up ranged from 6 months to 4 years with a mean of 2.6 years. An improvement in enophthalmos and was seen in all surgically treated patients with a mean improvement of 2.2mm and range 0.5-4mm. SSS arises from congestion of the ostiomeatal complex resulting in negative pressure within the maxillary sinus and a gradual implosion of the antral cavity. Endoscopic sinus surgery successfully re-establishes maxillary aeration in our series and leads to clinical and aesthetic improvement in the degree of enophthalmos and has avoided the need for orbital floor repair in all but two cases.

Endonasal Endoscopic Repair of Orbital Floor Defects

Objective: We have previously published an endonasal endoscopic technique of inferior orbital floor reconstruction, for the surgical management of the “silent sinus syndrome” and “blow-out” orbital fractures. Based on the same principles, we present an alternative version of the technique with the advantage of an “overlay” approach to the bone defect. Method: After creating a large middle meatal antrostomy, an autologous septal bone graft is placed over the orbit floor defect, in the subperiostal plane between orbital contents and bony floor, through an incision on the lamina papyracea. Results: At long-term follow-up we achieve, in most, if not all, cases, resolution of enophthalmos and ipsilateral chronic maxillary sinus atelectasis, with minimal morbidity. Conclusion: This technique provides excellent functional and aesthetic results in the surgical reconstruction of the orbit floor.

Profound bradycardia with lidocaine during anesthesia induction in a silent sick sinus syndrome patient

Sick sinus syndrome is caused by sinus node dysfunction that renders it unable to function as a pacemaker. Patients with sick sinus syndrome are often asymptomatic or have symptoms that are mild and nonspecific. Lidocaine (0.5 mg/kg) injection is used for reduction of pain associated with intravenous injection of propofol. Episodes of marked bradycardia with sinus arrest after prophylactic lidocaine injection are reported in a 69-y-old man with no apparent preoperative cardiac disease or electrocardiographic abnormality. Surgery was postponed, and he was later diagnosed with sick sinus syndrome.

Case-Report of a Silent Sinus Syndrome: an Underdiagnosed Disease

It is known that orbital floor disruption leading to an enophthalmos and a hypoglobus can occur after surgery or trauma, or, in conditions such as osteomyelitis, malignancy, systemic inflammatory disease, etc. [1]. Silent sinus syndrome (SSS) is a rare cause of spontaneous and painless enophthalmos and hypoglobus [2]. It is thought to result from a negative pressure within the maxillary sinus (due to an acquired obstruction of the sinus outflow) that leads to a chronic sinus maxillary atelectasis [2].

Silent Sinus Syndrome: A Rare Presentation After Botulinum Toxin Injection

Silent sinus syndrome is a unique diagnosis characterized by spontaneous enophthalmos and hypoglobus resulting from collapse of the orbital floor secondary to chronic subclinical sinusitis. Although reported in the ophthalmology and otolaryngology literature, there is no mention of silent sinus syndrome in the plastic surgery literature. The authors present a case report, along with a brief overview of silent sinus syndrome, so that knowledge of this rare but potentially devastating clinical entity may supplement plastic surgeons' differential to ensure proper diagnosis and treatment.

Endoscopic Treatment of Silent Sinus Syndrome with Dramatic Resolution

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.

Syndrome du sinus silencieux et ossification intrasinusienne

The silent sinus syndrome (SSS) is a rare cause of diplopia and facial asymmetry. It is commonly attributed to a sinus atelectasis secondary to ostiomeatal obstruction. Surgical dissection of the maxillary sinus mucosal lining is known to cause auto-obliteration by bone formation. A 45 year-old female patient was referred for vertical diplopia with enophthalmia, and a slight depression of the left cheekbone. Antrostomy was performed for chronic obstructive maxillary sinusitis six months before. CT scan revealed a major collapse of superior, anterior, and posterior left maxillary sinus with expansion of the orbital volume. The de novo maxillary sinus ossification evolved over two years of follow-up. It was normal lamellar bone. The left orbital floor was rebuilt. Diplopia progressively resolved. The association of SSS and intraluminal osteogenesis has never been reported. The first might be due to a peroperative dissection of the maxillary sinus mucosal lining. SSS was due to meatal obstruction secondary to inadequate antrostomy.

Silent sinus syndrome causing cyclovertical diplopia masquerading as superior oblique paresis in the fellow eye

Silent sinus syndrome is an insidious maxillary sinus inflammatory disease causing a lowering, thinning, or even absorption of the orbital floor. Patients usually present with progressive enophthalmos and hypoglobus. We report a 41-year-old man with silent sinus syndrome who presented with cyclovertical diplopia masquerading as superior oblique muscle paresis in the fellow eye. Inferior oblique myectomy in the fellow eye resulted in excellent alignment.

Ungewöhnlicher Fall eines atraumatischen Enophthalmus

An extensive spectrum of differential diagnoses has to be considered when a patient presents with enophthalmos. The most common causes of this presentation include orbital trauma or contraction and atrophy of the orbital contents secondary to scleroderma or radiotherapy. However radiologists also have to consider less common causes of enophthalmos, such as the imploding antrum syndrome or the ethmoid silent sinus syndrome. The latter involves the ethmoidal cells and results in medial orbital wall implosion. Along with the case presentation the pathogenesis, incidence and differential diagnoses of ethmoid silent sinus syndrome are elucidated. In particular the differentiation from normal anatomical variants, such as dehiscent lamina papyracea is discussed.

The Silent Sinus Syndrome: A Clinical Review

Abstract Silent sinus syndrome (SSS) is a rare and interesting clinical condition that is associated with spontaneous, painless, unilateral enophthalmos and hypoglobus resulting from downward bowing of the orbital floor, in the absence of any symptomatic sinonasal disease. It generally affects younger patients between the third and fifth decades of life. The pathogenesis of silent sinus syndrome is based on chronic maxillary sinus obstruction, related to occlusion of the maxillary infundibulum which results in a hypoventilated sinus and negative pressures. Endoscopic sinus surgery to create a wide maxillary antrostomy with or without orbital floor reconstruction is considered the gold standard treatment of choice.

Silent Sinus Syndrome

Silent sinus syndrome(SSS) is a rare clinical condition. In this report, we are presenting a 58 years old woman with chief complain of right global pain. All ophthalmic examinations were normal. In CT -scan of p ara nasal sinuses right maxillary sinus volume was decreased but she had no sinonasal symptoms.

P106 Enophthalmos and hypoglobus after facial trauma are not always due to orbital injury: silent sinus syndrome can cause changes in globe position

P106 Enophthalmos and hypoglobus after facial trauma are not always due to orbital injury: silent sinus syndrome can cause changes in globe position