Silent Sinus Syndrome Secondary to Lymphoma: An Unusual Case With Radiological Evidence of Rapid Progression

Objective: To describe a case of silent sinus syndrome secondary to malignancy and discuss the pertinent clinical findings. Silent Sinus Syndrome (SSS) refers to a rare, asymptomatic condition whereby occlusion of the maxillary sinus ostium results in gradual resorption of air, creation of negative pressure and collapse of the maxillary walls. Methods: Review of medical records and literature review using NCBI/PubMed. Results: We describe a case of a 54-year-old gentleman presenting solely with enophthalmos. He had been diagnosed with stage IVa small lymphocytic lymphoma (SLL) 1.5 years prior to this, which was being managed with active surveillance. CT demonstrated severe bowing of the anterior and posterolateral wall, inferior displacement of the floor of the orbit and right enophthalmos, thus supporting a diagnosis of silent sinus syndrome. Compared to previous staging CT at the time of the lymphoma diagnosis these findings were entirely new, and soft tissue in the pterygomaxillary fissure was found to be enlarged. The patient underwent endoscopic sinus surgery and a right maxillary mega-antrostomy was performed to ventilate the maxillary sinus and prevent progression of eye symptoms. A biopsy was taken from the pterygopalatine fossa, which was confirmed to be chronic lymphocytic leukemia (CLL). Conclusion: This case is unique both in being secondary to malignancy, as well as being rapidly progressive given the presence of radiologically normal appearances 1.5 years prior to presentation. Although a rare condition, prompt recognition of SSS is vital to prevent ophthalmological complications. This report highlights malignancy as a potential cause in cases with focal bony remodeling.

"Silent sinus syndrome": One more indication for functional endoscopic sinus surgery

Medicinski pregled ◽

10.2298/mpns14s1065j ◽

2014 ◽

Vol 67 (suppl. 1) ◽

pp. 65-68

Author(s):

Ljiljana Jovancevic ◽

Slobodan Savovic ◽

Slavica Sotirovic-Senicar ◽

Maja Buljcik-Cupic

Keyword(s):

Maxillary Sinus ◽

Rare Condition ◽

Functional Endoscopic Sinus Surgery ◽

Sinus Surgery ◽

Orbital Floor ◽

Orbital Trauma ◽

Silent Sinus Syndrome ◽

Slow Development ◽

The Right

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.

Silent sinus syndrome: an unusual case of facial numbness

Practical Neurology ◽

10.1136/practneurol-2017-001807 ◽

2018 ◽

Vol 18 (6) ◽

pp. 494-496 ◽

Cited By ~ 3

Author(s):

Samuel Tribich ◽

Colin J Mahoney ◽

Nicholas W Davies

Keyword(s):

Maxillary Sinus ◽

Complete Resolution ◽

Unusual Case ◽

Clinical Context ◽

Blurred Vision ◽

Silent Sinus Syndrome ◽

Osteomeatal Complex ◽

Middle Meatal Antrostomy ◽

Facial Numbness ◽

History Of

A 49-year-old man presented with a 1-week history of right facial paraesthesia with blurred vision and diplopia. Examination was normal apart from reduced facial sensation. Following appropriate neuroimaging, we considered a diagnosis of silent sinus syndrome. He underwent a middle meatal antrostomy with complete resolution of symptoms. Silent sinus syndrome results from occlusion of the osteomeatal complex, preventing normal aeration of the maxillary sinus. Maxillary sinus hypoventilation typically causes inferior displacement of the globe in the orbit (unilateral hypoglobus). Neurologists will only infrequently see people with silent sinus syndrome but it can have devastating consequences if left untreated and so must be considered in the appropriate clinical context.

Reevaluation of Maxillary Sinus Surgery: Experimental Study in Rabbits

Annals of Otology Rhinology & Laryngology ◽

10.1177/000348948909801112 ◽

1989 ◽

Vol 98 (11) ◽

pp. 901-906 ◽

Cited By ~ 59

Author(s):

David W. Kennedy ◽

Hisham Shaalan

Keyword(s):

Maxillary Sinus ◽

Complex Disease ◽

Mucociliary Clearance ◽

Functional Endoscopic Sinus Surgery ◽

Sinus Surgery ◽

Control Group ◽

Ostiomeatal Complex ◽

The Status ◽

Sinus Ostium ◽

Sinus Mucosa

Functional endoscopic sinus surgery concentrates primarily on the removal of ostiomeatal complex disease. When required, maxillary sinus ostioplasty is performed. However, surgical widening of a sinus ostium is contrary to common precepts. A study therefore was performed to reevaluate the effects of antrostomies and of intrasinus mucosal removal. Widening of the natural ostium, a separate antrostomy at some distance from the ostium, or radical mucosal removal was performed on 30 rabbits. Fifteen sinuses were used as controls. After 6 to 8 weeks the status of the sinus mucosa and mucociliary clearance was studied. The study confirmed that mucociliary clearance continued toward the natural ostium following inferior antrostomy. Following widening of the natural ostium, mucociliary clearance through the ostium redeveloped in 11 of 18 sinuses but was typically imperfect. There were no cases of ostial closure; however, the incidence of infection was significantly higher in all three experimental groups than in the control group.

Silent sinus syndrome associated with natural childbirth

Polski Przegląd Otorynolaryngologiczny ◽

10.5604/01.3001.0012.7723 ◽

2018 ◽

Vol 7 (4) ◽

pp. 1-5

Author(s):

Aleksandra Sobolewska ◽

Pedro Clarós

Keyword(s):

Maxillary Sinus ◽

Nasal Congestion ◽

Rare Condition ◽

Orbital Floor ◽

Ipsilateral Side ◽

Natural Childbirth ◽

Silent Sinus Syndrome ◽

Unusual Association ◽

History Of ◽

One Step

Spontaneous, painless enophthalmos, hypoglobus with orbital floor resorption and maxillary sinus collapse on the ipsilateral side is recognised as a rare condition known as the silent sinus syndrome. This paper aimed to present an unusual association of natural childbirth and the onset of orbital floor displacement caused by silent sinus syndrome. We wanted to present a case of a 31-year-old woman presented with a 3-month history of painless, progressive right enophthalmos otherwise utterly asymptomatic who developed symptoms shortly after natural childbirth. That association have never been presented before in literature. We also wanted to discuss the pregnancy-related nasal congestion. We present our experience with these case treated with a single-stage procedure, focusing on the advantages of this one-step approach.

Computed tomography findings after endoscopic sinus surgery with preserving or enlarging maxillary sinus ostium surgery

Rhinology Journal ◽

10.4193/rhino10.111 ◽

2011 ◽

Vol 49 (4) ◽

pp. 438-444

Author(s):

J. Myller ◽

P. Dastidar ◽

T. Torkkeli ◽

M. Rautiainen ◽

S. Toppila-Salmi

Keyword(s):

Computed Tomography ◽

Maxillary Sinus ◽

Symptom Relief ◽

Sinus Surgery ◽

Ct Scans ◽

Ct Findings ◽

Middle Meatal Antrostomy ◽

Sinus Ostium ◽

Subjective Outcomes

Endoscopic sinus surgery (ESS) is the main surgical approach in the treatment of chronic rhinosinusitis (CRS) after failure of medical treatment. ESS is based on the theory that obstruction of the maxillary sinus ostium is mainly behind the pathogenesis of CRS. Controversy remains concerning the enlargement of the natural maxillary sinus ostium. The aim of this study was to compare computed tomography (CT) findings after preservation or enlargement of the maxillary sinus ostium. Thirty patients with non-polypous CRS underwent randomized endoscopic sinus surgery with uncinectomy on one side and additional middle meatal antrostomy on the other side. Lund-Mackay (LM) scores and the ostium diameters were analysed from CT scans taken preoperatively and nine months postoperatively, and were used for comparison of the two operative techniques. In addition, the correlation between CT findings and subjective outcomes was studied. Comparison of the preoperative and postoperative CT scans revealed that significant reduction of LM score was achieved on both sides, regardless of the type of procedure performed. The postoperative area of the ostium remained significantly larger on the antrostomy side compared to the uncinectomy side. A large maxillary sinus ostium size seems to associate with lower postoperative LM score, but does not seem to provide superior symptom relief.

The Influence of the Size of the Maxillary Sinus Ostium on the Nasal and Sinus Nitric Oxide Levels

American Journal of Rhinology ◽

10.1177/194589240201600508 ◽

2002 ◽

Vol 16 (5) ◽

pp. 261-264 ◽

Cited By ~ 36

Author(s):

Ravi K.D.R.A. Kirihene ◽

Guy Rees ◽

Peter-John Wormald

Keyword(s):

Nitric Oxide ◽

Nasal Cavity ◽

Maxillary Sinus ◽

Antibacterial Properties ◽

Topical Steroid ◽

Recurrent Infection ◽

Sinus Surgery ◽

Breath Holding ◽

Background Nitric oxide (NO) is produced in significant quantities in the nasal sinuses and is thought to have a beneficial effect on the mucociliary transport of the sinuses and nose and to have significant antibacterial properties that contribute to the health of the sinuses. Recently, the concept of “mini-functional endoscopic sinus surgery” has been introduced where the uncinate is removed without enlargement of the maxillary ostium. Although no scientific evidence has been published, enlargement of the ostium is thought to possibly disrupt the mucociliary pathway and decrease the concentration of NO in the nose and sinuses. The aim of this study was to establish the effect of enlargement of the maxillary ostium on sinus and nasal NO. Methods Twenty-nine patients who were post-endoscopic sinus surgery were included with 52 who were maxillary sinus ostia cannulated. There were 22 large maxillary sinus ostia and 30 small ostia. Smoking, allergy status, and topical steroid use were recorded. NO levels were measured in the nose and maxillary sinus after decongestion with patients mouth breathing and breath holding. Results This study shows that enlargement of the maxillary sinus ostium above its normal size (20 mm2) produces a significant decrease in both the maxillary sinus and the nasal cavity NO levels. In addition, the size of the ostium showed a significant correlation to the sinus NO level. Use of topical nasal steroid sprays and topical decongestants were shown to effect NO levels in the sinuses and nasal cavity. The lowered levels of NO were found irrespective of the technique of measurement of the NO. Conclusions The effect of this lowered NO level on the susceptibility of the maxillary sinuses to recurrent infection is yet to be determined.

Posterior Maxillary Sinus Wall: A Landmark for Identifying the Sphenoid Sinus Ostium

Annals of Otology Rhinology & Laryngology ◽

10.1177/0003489418816725 ◽

2018 ◽

Vol 128 (3) ◽

pp. 215-219 ◽

Cited By ~ 1

Author(s):

Raj D. Dedhia ◽

Tsung-yen Hsieh ◽

Yecenia Rubalcava ◽

Paul Lee ◽

Peter Shen ◽

...

Keyword(s):

Maxillary Sinus ◽

Sphenoid Sinus ◽

Average Distance ◽

Posterior Wall ◽

Sinus Surgery ◽

Endoscopic Endonasal ◽

Sinus Wall ◽

Significant Difference ◽

Importance: Safe entry into sphenoid sinus is critical in endoscopic sinus and skull base surgery. A number of surgical landmarks have been used to identify the sphenoid sinus ostium during endoscopic endonasal surgery with variable reliability and intraoperative feasibility. Objective: To determine if the posterior wall of the maxillary sinus is a reliable landmark to determine the depth of the sphenoid sinus ostium during anterior to posterior dissection. Design, Setting, and Participants: Prospective study of adult patients undergoing endoscopic sinus surgery between August 2016 and September 2017. Measurements were made intraoperatively between the depth of the posterior maxillary sinus wall and sphenoid sinus ostium. Main Outcomes and Measures: The primary measurement is the distance between the depth of the posterior maxillary sinus wall and sphenoid sinus ostium. Additional data points included age, gender, surgical indication, and primary versus revision endoscopic sinus surgery. Results: Forty-five patients (38% male, 62% female) with an average age of 56 were enrolled, resulting in 88 operated sides. The average distance between the depth of the posterior wall of the maxillary sinus and the sphenoid ostium was 1.5 mm ± 1.4 mm. The most common position of the sphenoid sinus ostium was posterior to the level of the posterior maxillary sinus wall (54%), followed by same level (23%) and anterior (23%). There was no significant difference between different disease states ( P = .75) and between primary and revision cases ( P = .13). Conclusions and Relevance: The posterior wall of the maxillary sinus serves as an adjunctive intraoperative landmark to determine the depth of the sphenoid sinus ostium. While the posterior wall of the maxillary sinus approximates the depth of the sphenoid sinus ostium, the relative position is variable and can be anterior or posterior.

Inflammatory myofibroblastic tumor in the maxillary sinus with asymptomatic course excised during endoscopic surgery - a case report and review of the literature

Polski Przegląd Otorynolaryngologiczny ◽

10.5604/01.3001.0013.5351 ◽

2019 ◽

Vol 8 (3) ◽

pp. 1-5

Author(s):

Krzysztof Poślednik ◽

Igor Anurin ◽

Ireneusz Kantor

Keyword(s):

Case Report ◽

Maxillary Sinus ◽

Endoscopic Surgery ◽

Rare Case ◽

Inflammatory Myofibroblastic Tumor ◽

Malignant Tumors ◽

Rare Condition ◽

Sinus Surgery ◽

Review Of The Literature ◽

Face Pain

Inflammatory myofibroblastic tumor (IMT) is a rare condition that can mimic potentially more dangerous states such as malignant tumors. The tumor itself can also show a local malignancy as well as malignant transformation. The paranasal sinus IMT is quite a rare case in the literature. The manifestation of the disease can include a face swelling, nasal obstruction, epistaxis, vision acuity worsening, numbness of face, pain. Etiology of this type of lesion still remains uncertain but there are a few assumptions on the issue: viral and genetic among the others, as well as posttraumatic and postinflammatory. We report the case of an adult woman with IMT detected in right maxillary sinus after endoscopic sinus surgery.

Anatomic patterns of maxillary sinus drainage

Romanian Journal of Rhinology ◽

10.1515/rjr-2015-0024 ◽

2015 ◽

Vol 5 (20) ◽

pp. 209-214

Author(s):

Andreea – Ioana Derjac-Arama ◽

Stefania Anca Mihai ◽

Mihai Sandulescu ◽

Mugurel Constantin Rusu

Keyword(s):

Maxillary Sinus ◽

Drainage System ◽

Sinus Surgery ◽

Type I ◽

Type Iv ◽

Ostiomeatal Complex ◽

Sinus Drainage ◽

Type V ◽

Air Cells ◽

AbstractBackground. Functional endoscopic sinus surgery may be indicated when certain anatomic variations impede the normal drainage of the paranasal sinuses through the ostiomeatal complex. We aimed at studying the drainage system of the maxillary sinus which consists of the maxillary infundibulum, the main ostium of the maxillary sinus, the ethmoidal infundibulum and the hiatus semilunaris inferior.Material and methods. The study was performed retrospectively on cone beam computed tomography (CBCT) scans of 60 subjects (N=120 maxillary sinuses). The anatomical pattern of the maxillary sinus drainage was studied on coronal scans.Results. As related to different morphological possibilities in the supero-lateral limit of the maxillary sinus drainage system, five different patterns were defined: in type I (55%) there was no pneumatization in that situs, in type II (18%) there was an infraorbital recess of the maxillary sinus placed above the sinus ostium, in type III (14%) an ethmoidal recess of the maxillary sinus was expanded within the ethmoid bone, above the ethmoidal infundibulum, in type IV (3%) there were Haller cells above the sinus ostium, while in type V (10%) there were non-infraorbital ethmoid air cells above and draining into the ethmoidal infundibulum.Conclusion. It appears that CBCT is a reliable tool to make an anatomical distinction of the variable pattern of pneumatization impeding a normal drainage of the maxillary sinus, between maxillary sinus- and ethmoid-derived air-filled spaces.

Bilateral antrochoanal polyp: case report, literature review and clinical guidelines

New Medicine ◽

10.25121/newmed.2018.22.4.155 ◽

2018 ◽

Vol 22 (4) ◽

Author(s):

Agata Wasilewska ◽

Lidia Zawadzka-Głos

Keyword(s):

Maxillary Sinus ◽

Complete Removal ◽

Paediatric Population ◽

Sinus Surgery ◽

Antrochoanal Polyp ◽

Benign Lesions ◽

Endoscopic Control ◽

High Incidence ◽

Antrochoanal polyps are unilateral benign lesions that arise within the maxillary sinus antrum. The purpose of this study was to review the clinical characteristics and treatment of antrochoanal polyp (ACP). A retrospective analysis was performed to investigate the case of one patient with an extremely rare bilateral polyp with a high incidence of recurrence. ACPs account for approximately one-third of polyps occurring in children. Most of them are unilateral. The recurrent course of ACP is more prevalent in the paediatric population than in adults. ACPs require differential diagnosis with malignancies. The mainstay of treatment is surgery. The gold standard is endoscopic sinus surgery with complete removal of polyp mass under endoscopic control and widening of the maxillary sinus ostium via the middle meatus. Postoperative follow-up of at least 2 years is very important to monitor patients for recurrence.