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

Introduction. Silent sinus syndrome is a rare condition, characterized by spontaneous and progressive enophthalmos and hypoglobus associated with atelectasis of the maxillary sinus and downward displacement of the orbital floor. Patients with this syndrome present with ophthalmological complaints, without any nasal or sinus symptoms. Silent sinus syndrome has a painless course and slow development. It seems to be a consequence of maxillary sinus hypoventilation due to obstruction of the ostiomeatal unit. The CT scan findings are typical and definitely confirm the diagnosis of silent sinus syndrome. Case report. We present the case of a 35-year-old woman, with no history of orbital trauma or surgery. She had slight righthemifacial pressure with no sinonasal symptoms. The patient had no double vision nor other ophthalmological symptoms. The diagnosis of silent sinus syndrome was based on the gradual onset of enophthalmos and hypoglobus, in the absence of orbital trauma (including surgery) or prior symptoms of sinus disease. On paranasal CT scans there was a complete opacification and atelectasis of the right maxillary sinus with downward bowing of the orbital floor. The patient was treated with functional endoscopic sinus surgery, with no orbital repair. Conclusion. Silent sinus syndrome presents with orbithopaties but is in fact a rhinologic disease, so all ophthalmologists, rhinologists and radiologists should know about it. The treatment of choice for silent sinus syndrome is functional endoscopic sinus surgery, which should be performed with extra care, by an experienced rhinosurgeon.

Download Full-text

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

Rhinology Journal ◽

10.4193/rhino10.103 ◽

2011 ◽

Vol 49 (3) ◽

pp. 315-317

Author(s):

H. Babar-Craig ◽

H. Kayhanian ◽

D.J. De Silva ◽

G.E. Rose ◽

V.J. Lund

Keyword(s):

Maxillary Sinus ◽

Endoscopic Sinus Surgery ◽

Case Series ◽

Sinus Surgery ◽

Orbital Floor ◽

Silent Sinus Syndrome ◽

Ostiomeatal Complex ◽

Sinus Drainage ◽

Ophthalmic Hospital

INTRODUCTION: 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. METHODS: 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. RESULTS: 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. DISCUSSION: 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.

Download Full-text

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.

Download Full-text

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.

Download Full-text

Management of the Orbital Floor in Silent Sinus Syndrome

American Journal of Rhinology ◽

10.1177/194589240301700206 ◽

2003 ◽

Vol 17 (2) ◽

pp. 97-100 ◽

Cited By ~ 50

Author(s):

Robert D. Thomas ◽

Scott M. Graham ◽

Keith D. Carter ◽

Jeffrey A. Nerad

Keyword(s):

Ct Scan ◽

Maxillary Sinus ◽

Current Trend ◽

Ct Scanning ◽

Volumetric Analysis ◽

Orbital Floor ◽

Second Stage ◽

Silent Sinus Syndrome ◽

Orbital Floor Reconstruction ◽

Preoperative Ct

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.

Download Full-text

Enophthalmos secondary to maxillary sinus disease: single-stage operative management

The Journal of Laryngology & Otology ◽

10.1017/s0022215100131536 ◽

1995 ◽

Vol 109 (9) ◽

pp. 868-870 ◽

Cited By ~ 5

Author(s):

N. J. P. Beasley ◽

N. S. Jones ◽

R. N. Downes

Keyword(s):

Maxillary Sinus ◽

Endoscopic Sinus Surgery ◽

Operative Management ◽

Single Stage ◽

Sinus Surgery ◽

Orbital Floor ◽

Sinus Disease

AbstractMaxillary sinus disease can lead to dehiscence of the orbital floor. Using endoscopic sinus surgery it is possible to simultaneously reconstruct the orbital floor and to assess and treat underlying sinus disease.

Download Full-text