Pdf delayed presentation of silent sinus syndrome after. There is yet another condition called the hypo plastic condition where the region becomes thicker and opaque. Radiographic findings include ipsilateral maxillary sinus opacification, lateralization of the uncinate and middle turbinate, and infundibular occlusion. Background 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. Determine the incidence of dental disease in patients with silent sinus syndrome. It is well recognised among otorhinolaryngologists and ophthalmologists but remains relatively unknown among radiologists. The silent sinus syndrome sss is a rare cause of diplopia and facial asymmetry. Diagnosis and management of silent sinus syndrome american. Although the diagnosis is usually suspected clinically, it is confirmed radiologically by characteristic imaging features that include maxillary sinus outlet obstruction, sinus opacification, and sinus volume loss. It can cause painless facial asymmetry, diplopia and enophthalmos. Pathophysiology optimal management of silent sinus syndrome requires an understanding of the underlying pathophysiology. Discussion of the presentation, treatment, and theory regarding pathogenesis of the syndrome follows.
Chiu silent sinus syndrome sss, is a rare disorder involving the maxillary antrum, characterized by an indolent course of subclinical maxillary sinusitis that leads to progressive contraction of the maxillary sinus. Silent sinus syndrome is an unusual cause of progressive enophthalmos and hypoglobus due to atelectasia of the maxillary sinus associated with osteolysis of the orbital floor. Silent sinus syndrome sss is known to be a rare clinical condition, characterized by spontaneous and progressive enophthalmos and hypoglobus associated with atelectasis of the maxillary sinus and alteration of the orbital floor. In magnetic resonance imaging mri of paranasal sinuses, right. It is believed that the condition is often undiagnosed or misdiagnosed. Dental disease and its role in silent sinus syndrome. The authors report an unusual case revealed by mild dental. Optimal management of silent sinus syndrome requires an understanding of the underlying pathophysiology.
There are two treatment approach of silent sinus syndrome i. The aim of this case report is to alert clinicians to this entity, which should be included in the differential diagnosis of facial asymmetry, and also to briefly describe its clinical and imaging characteristics. Can nasal irrigation cure silent sinus syndromesss. The diagnosis based on clinical features and data of computed tomography. It was clear even to me from the scans that this was the problem. Silent sinus syndrome is a rare disorder, but it is probably underdiagnosed because of a lack of recognition. The anatomical variations lead to the occlusion in maxillary sinus and as a result silent sinus syndrome occur. I have now been to the ent and i have a severe infection in my right maxillary sinus. Silent sinus syndrome symptoms, causes, treatment, surgery. The silent sinus syndrome consists of painless facial asymmetry and enophthalmos caused by chronic maxillary sinus atelectasis. Silent sinus syndrome is a condition in which chronic asymptomatic maxillary sinus disease presents with spontaneous unilateral enophthalmos and hypoglobus. Following appropriate neuroimaging, we considered a diagnosis of silent sinus syndrome. Purpose the purpose of this study is to describe the clinical and pathologic features of a form of chronic maxillary atelectasis referred to as the silent sinus syndrome, which is characterized by progressive enophthalmos secondary to maxillary collapse resulting from maxillary sinus hypoventilation.
Hypoplasia of maxillary sinus caused by its longterm hypoventilation due to anatomical changes in osteomeatal complex. The typical patient with silent sinus syndrome is an adult in the third. The silent sinus syndrome is a spontaneous unilateral maxillary atelectasis with complete or partial opacification of the sinus. It is thought to be secondary to chronic maxillary sinus atelectasis cma with reabsorbed bone and subsequent displacement of the orbital floor. Traditionally, correction of the enophthalmos involved reconstruction of the orbital floor, which was performed simultaneously with sinus surgery. The medical world has not been able to exactly distinguish the differences between these two conditions in the initial stages of the illness. Participant eligibility includes age, gender, type and stage of disease, and previous treatments or health concerns. Silent sinus syndrome usually presents in the 3 rd to 5 th decade, without a gender predilection. The typical patient with silent sinus syndrome is an adult in the third through fifth decades of life who. Chronic maxillary atelectasis including silent sinus syndrome can present bilaterally volume 3 issue 3 j p k ho, e wong, d a gunaratne, n singh. Although reported in the ophthalmology and otolaryngology literature, there is no mention of silent sinus syndrome in the plastic surgery literature.
D ue to the close anatomic relationship between the orbit and paranasal sinuses, ophthalmologists must be cognizant of certain sinonasal diseases that may present with ocular manifestations. Guidelines differ from study to study, and identify. Silent sinus syndrome sss is a disease in which the natural orifice of the maxillary sinus becomes obstructed and the pressure in the sinus becomes negative due to hypoventilation, causing. A similar process may be responsible for the appearance of the opacified hypoplastic maxillary sinus, an entity with imaging findings similar to that of the silent sinus syndrome and often used interchangeably with the silent sinus syndrome in the literature 1, 3, 12. Understand the progression of silent sinus syndrome in patients with dental disease. Silent sinus syndrome is a spontaneous, asymptomatic collapse of the maxillary sinus and orbital floor associated with negative sinus pressures. Chronic maxillary atelectasis including silent sinus.
P333 silent sinus syndrome in children case report. Examination was normal apart from reduced facial sensation. The silent sinus syndrome consists of painless facial asymmetry characterized by unilateral enophthalmos. The silent sinus syndrome sss is a rare condition that causes facial asymmetry, unilateral enophthalmos and diplopia. Reabsorbed bone with displacement of the orbital floor is a constant finding.
Before you allow the doctor who diagnosed you to perform surgery, i would strongly recommend you get a second opinion from a doctor at a teaching hospital who specializes in treating these sorts. This syndrome is classically idiopathic, but the term is also used to describe traumatic or iatrogenic surgical orbital decompression cases. 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. One such disease process, silent sinus syndrome, is a progressive condition in which maxillary sinus pathology causes inferior displacement of the orbital floor, resulting in enophthalmos and hypoglobus. He underwent a middle meatal antrostomy with complete resolution of symptoms. Diagnosis and management of silent sinus syndrome s. Delayed presentation of silent sinus syndrome after orbital trauma. Hi i wrote last week and had the wrong appointment date in my discussion. Clinicians from multiple disciplines should be familiar with presenting features. The silent sinus syndrome is a rare clinical entity of spontaneous enophthalmos and hypoglobus caused by an alteration of the normal orbital architecture and function from maxillary sinus collapse. Silent sinus syndrome sss, is a rare disorder involving the maxillary antrum, characterized by an indolent course of subclinical maxillary sinusitis that leads to progressive contraction of the maxillary sinus. Silent sinus syndrome is characterised by painless enophthalmos associated with involution of the maxillary sinus after infundibular occlusion. Silent sinus syndrome is a rare clinical entity typically characterized by spontaneous and progressive enophthalmos and hypoglobus caused by an alteration of the normal orbital architecture and function from maxillary collapse in the setting of the chronic maxillary sinus hypoventilation.
Silent sinus syndrome symptoms, diagnosis, treatments and. Traditionally, correction of the enophthalmos involved reconstruction of the orbital floor, which was performed simultaneously with sinus. Imploding antrum or silent sinus syndrome following naso. Dental disease and its role in silent sinus syndrome mayo.
Abstract the silent sinus syndrome sss is a rare phenomenon originally described in 1964 by montgomery, which often occurs unilaterally in the maxillary sinus with opacification and collapse. Silent sinus syndrome is an acquired condition in which there is a gradual collapse of the orbital floor and inward retraction of the maxillary sinus atelectasis of the maxillary sinus. Beating the silent sinus syndrome naturally wfm health. Silent sinus syndrome is a rare clinical condition. Sss is caused because of negative pressure causing collapse of sinus it may be be. Silent sinus syndrome sss is known as a rare clinical condition, characterized by spontaneous and progressive enophthalmos and hypoglobus associated with atelectasis of the maxillary sinus and alteration of the orbital floor. Silent sinus syndrome sss is a rare disorder that is defined as spontaneous and gradual retraction of the maxillary sinus. Chronic maxillary atelectasis including silent sinus syndrome can present bilaterally volume 3 issue 3 j p k ho, e wong, d a gunaratne, n singh skip to main content accessibility help we use cookies to distinguish you from other users and to provide you with a. It is characterized by ipsilateral enophthalmos and hypoglobus or mistakenly as an exophthalmos of the contralateral eye. Despite the use of differing taxonomy, it appears that these two terms describe the same clinical entity. Silent sinus syndrome an otherwise healthy 34yearold man became aware of progressive left side deepening of the superior orbital. 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. This condition is characterized by painless enophthalmos and facial asymmetry caused by chronic maxillary sinus atelectasis 1,2,3,4,5,6,7. May 11, 2017 a 49yearold woman presented with 6 months of progressive left superior sulcus hollowing unassociated with diplopia, trauma, sinus disease, or use of prostaglandin agonist drops.
In summary, the silent sinus syndrome is a rare entity that is wellknown to the ophthalmologist and the ear, nose, and throat surgeon. I was diagnosed with silent sinus syndrome 18mths ago after months of trying to convince my gp that my eye looked different and i was having intermittent diplopia and feeling of sinus fullness. Silent sinus syndrome epidemiology rareapproximately84reported casesbetween1964and2004. A 49yearold man presented with a 1week history of right facial paraesthesia with blurred vision and diplopia. Silent sinus syndrome is a rare cause of hypoglobus and enophthalmos. We present the first case of silent sinus syndrome with both normal predisease imaging findings and documented negative maxillary sinus pressure, demonstrating unequivocally the acquired nature and possible etiologic association with negative maxillary sinus pressure in at least some cases of silent sinus syndrome. It is commonly attributed to a sinus atelectasis secondary to ostiomeatal obstruction. This is a report of an 8 yearold boy with silent sinus syndrome and.
Purpose the purpose of this study is to describe the clinical and pathologic features of a form of chronic maxillary atelectasis referred to as the silent sinus syndrome, which is characterized by progressive enophthalmos secondary to maxillary collapse resulting from maxillary sinus. The patient often presents with a droopy eyelid and a deep superior sulcus. Coronal reformatted ct image a and coronal t1weighted b and t2weighted fatsaturated c mri show some characteristic findings of silent sinus syndrome. Radiologic findings involving the maxillary sinus and orbit confirm the diagnosis of the silent sinus syndrome. Silent sinus syndrome without opacification of ipsilateral. Jan 14, 2020 silent sinus syndrome sss is a condition characterized by ophthalmologic features, such as spontaneous enophthalmos and hypoglobus with ipsilateral maxillary sinus atelectasis and an otherwise asymptomatic presentation. The silent sinus syndrome refers to the collapse of the orbital floor and maxillary sinus which can cause changes in facial appearance. International journal of surgery case reports 23 2016 fig. This in turn may cause associated ocular occurrences of enophthalmos and hypotropia. I had fess surgery and orbital reconstruction with great results. The diagnosis based on clinical features and data of computed. Silent sinus syndrome sss constitutes unilateral spontaneous enophthalmos due to increased orbital volume and retraction of the orbital floor. Silent sinus syndrome is a very rare condition that is usually caused by some type of physical trauma or one of a handful of rare u deploying diseases.
This syndrome was first described in 1964 by montgomery, but it was named silent sinus syndrome in 1994 by soparkar et al. Usually the diagnosis is suspected clinically, and it can be confirmed radiologically by characteristic imaging features that include. The most widely accepted theory is that an inciting event causes occlusion of the ostiomeatal complex through which the maxillary sinus drains into the middle meatus of the nasal antrum. Silent sinus syndrome sss is a condition characterized by ophthalmologic features, such as spontaneous enophthalmos and hypoglobus with ipsilateral maxillary sinus atelectasis and an otherwise asymptomatic presentation. The authors report an unusual case revealed by mild dental pain, present the imaging before, during and. Silent sinus syndrome or chronic maxillary sinus atelectasis characterised by asymptomatic hypoplasia of maxillary sinus, progressive enophthalmos, facial asymmetry. This process can eventually lead to prolapse of the orbital contents, enophthalmos. 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. Most of the patients with this syndrome present with ophthalmological complaints without any nasal sinus symptoms, and it typically has a painless course and slow.
Maxillary sinus wall thickening in silent sinus syndrome. Black e, nesi f, calvano c, gladstone g, levine m eds smith and nesis ophthalmic plastic and reconstructive surgery. However, in a small number of patients, trauma to the lateral nasal wall and ostiomeatal complex may be the cause, e. Silent sinus is said to be mainly caused by the inward withdrawal of the walls on maxillary sinus region. The opacified hypoplastic maxillary sinus may represent a less severe form. Silent sinus syndrome is a rare disorder, but it is probably underdiagnosed because of a lack of recognition 1. In this study, we present a case of true silent sinus syndrome. Review treatment outcomes of patients with silent sinus syndrome. Examination revealed left superior sulcus deepening with 1. The condition is quite uncommon and usually causes no pain when it occurs. Rare radiological feature in silent sinus syndrome jama. Look past the eye how to detect and manage this rare condition, which can be associated with a range of symptoms.
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