O.341 Orbital floor reconstruction in silent sinus syndrome

Background Enophthalmos in a patient with an opacified hypoplastic maxillary sinus, without sinus symptomatology, describes the silent sinus syndrome. A current trend is to perform endoscopic maxillary antrostomy and orbital floor reconstruction as a single-staged operation. A two-staged approach is performed at our institution to avoid placement of an orbital floor implant in the midst of potential infection and allow for the possibility that enophthalmos and global ptosis may resolve with endoscopic antrostomy alone, obviating the need for orbital floor reconstruction. Methods A retrospective review identified four patients with silent sinus syndrome evaluated between June 1999 and August 2001. Patients presented to our ophthalmology department with ocular asymmetry, and computerized tomography (CT) scanning confirmed the diagnosis in each case. Results There were three men and one woman, with ages ranging from 27 to 40 years. All patients underwent endoscopic maxillary antrostomy. Preoperative enophthalmos determined by Hertel's measurements ranged from 3 to 4 mm. After endoscopic maxillary antrostomy, the range of reduction in enophthalmos was 1–2 mm. Case 2 had a preoperative CT scan and a CT scan 9 months after left endoscopic maxillary antrostomy. Volumetric analysis of the left maxillary sinus revealed a preoperative volume of 16.85 ± 0.06 cm3 and a postoperative volume of 19.56 ± 0.07 cm3. This represented a 16% increase in maxillary sinus volume postoperatively. Orbital floor augmentation was avoided in two patients because of satisfactory improvement in enophthalmos. In the other two patients, orbital reconstruction was performed as a second-stage procedure. There were no complications. Conclusion Orbital floor augmentation can be offered as a second-stage procedure for patients with silent sinus syndrome. Some patients’ enophthalmos may improve with endoscopic antrostomy alone.

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Orbital floor reconstruction planning in the course of silent sinus syndrome using online fab lab – case report

Journal of Stomatology ◽

10.5604/00114553.1144377 ◽

2015 ◽

Vol 68 (1) ◽

pp. 95-103

Author(s):

Paweł Berczyński ◽

Tomasz Smektała ◽

Dorota Oskwarek ◽

Krzysztof Dowgierd ◽

Grzegorz Trybek ◽

...

Keyword(s):

Case Report ◽

Orbital Floor ◽

Silent Sinus Syndrome ◽

Orbital Floor Reconstruction ◽

Reconstruction Planning

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The Silent Sinus Syndrome: A Clinical Review

Clinical Rhinology An International Journal ◽

10.5005/jp-journals-10013-1030 ◽

2010 ◽

Vol 3 (2) ◽

pp. 69-72

Author(s):

Natasha Choudhury ◽

Joe Marais

Keyword(s):

Gold Standard ◽

Standard Treatment ◽

Sinus Surgery ◽

Orbital Floor ◽

Younger Patients ◽

The Third ◽

Silent Sinus Syndrome ◽

Orbital Floor Reconstruction ◽

Negative Pressures ◽

Sinonasal Disease

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.

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Successful Treatment of Silent Sinus Syndrome With Combined Endoscopic Sinus Surgery and Blepharoplasty Without Orbital Floor Reconstruction

Journal of Craniofacial Surgery ◽

10.1097/scs.0000000000002998 ◽

2016 ◽

Vol 27 (6) ◽

pp. e586-e588 ◽

Cited By ~ 3

Author(s):

Se-Hyung Kim

Keyword(s):

Successful Treatment ◽

Endoscopic Sinus Surgery ◽

Sinus Surgery ◽

Orbital Floor ◽

Silent Sinus Syndrome ◽

Orbital Floor Reconstruction

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

The Journal of Laryngology & Otology ◽

10.1017/s0022215111001952 ◽

2011 ◽

Vol 125 (12) ◽

pp. 1239-1243 ◽

Cited By ~ 33

Author(s):

R Sivasubramaniam ◽

R Sacks ◽

M Thornton

Keyword(s):

Case Series ◽

Sinus Surgery ◽

Orbital Floor ◽

Dynamic Changes ◽

Second Stage ◽

Silent Sinus Syndrome ◽

Normal Sinus ◽

Orbital Floor Reconstruction ◽

Over Time ◽

Sinus Pressure

AbstractBackground: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.Methods: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.Results: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.Conclusion: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.

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