Silent sinus syndrome
| Silent sinus syndrome | |
|---|---|
| Other names | Imploding antrum syndrome |
| Specialty | ENT surgery |
| Symptoms | facial asymmetry, vision problems, headache |
| Diagnostic method | symptoms, CT scan |
| Differential diagnosis | sinus atelectasis, congenital sinus hypoplasia |
| Treatment | surgery (endoscopic endonasal surgery) |
| Frequency | rare, most common in middle age |
Silent sinus syndrome is a spontaneous, asymptomatic collapse of an air sinus (usually the maxillary sinus and orbital floor) associated with negative sinus pressures. It can cause painless facial asymmetry, diplopia and enophthalmos. Diagnosis is suspected based on symptoms, and can be confirmed using a CT scan. Treatment is surgical involving making an outlet for mucous drainage from the obstructed sinus, and, in some cases, paired with reconstruction of the orbital floor. It is slightly more common in middle age.
Signs and symptoms
Silent sinus syndrome can cause facial asymmetry (usually without pain), and vision problems (such as diplopia and enophthalmos).[1] It may also cause headaches, and a feeling of fullness in the nose.[1]
Mechanism
Silent sinus syndrome most often affects the maxillary sinus, usually with a collapse of the orbital floor.[1] It may also affect the frontal sinus or the ethmoid sinus.[1] When the maxillary sinus is involved, the inferior oblique muscle may be damaged.[1]
The cause of silent sinus syndrome is not well understood.[1] Bacteria in the maxillary sinus may be involved.[1] The connection to the nose may be blocked.[1][2] This can create negative pressure in the sinus, as secretions are reabsorbed.[1]
Diagnosis
Silent sinus syndrome is first suspected based on symptoms.[1] A CT scan can be used to confirm a diagnosis.[1] This can have characteristic features, including maxillary sinus outlet obstruction, sinus opacification, and sinus volume loss caused by inward retraction of the sinus walls.
Differential diagnosis
Silent sinus syndrome has to be distinguished from sinus atelectasis, and congenital sinus hypoplasia.[1]
Treatment
Silent sinus syndrome is usually treated with surgery.[1] Endoscopic endonasal surgery can be used to rebuild the inferior orbital wall.[1] Any prolapsed contents (such as those from the orbit) must be put back in place.[2] If the inferior oblique muscle is damaged, it may be partially removed (known as myectomy).[1] Mucus and secretions must be drained from the sinus.[1] Earlier treatment has better outcomes.
Epidemiology
Silent sinus syndrome is fairly rare.[1][2] It can occur at any age, but is slightly more common in middle-aged people.[1] It occurs equally in sinuses on each side of the face.[1]
History
Silent sinus syndrome was first described in 1964.[1]
References
- 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 Stryjewska-Makuch, Grażyna; Goroszkiewicz, Karolina; Szymocha, Jerzy; Lisowska, Grażyna; Misiołek, Maciej (3 September 2021). "Etiology, Early Diagnosis and Proper Treatment of Silent Sinus Syndrome Based on Review of the Literature and Own Experience". Journal of Oral and Maxillofacial Surgery. doi:10.1016/j.joms.2021.08.166. ISSN 0278-2391.
- 1 2 3 Annino, Donald J. Jr; Goguen, Laura A. (February 2008). "Silent sinus syndrome". Current Opinion in Otolaryngology & Head and Neck Surgery. 16 (1): 22–25. doi:10.1097/MOO.0b013e3282f2c9aa. ISSN 1068-9508.
Bibliography
- Illner A, Davidson HC, Harnsberger HR, Hoffman J (2002). "The silent sinus syndrome: clinical and radiographic findings". AJR Am J Roentgenol. 178 (2): 503–6. doi:10.2214/ajr.178.2.1780503. PMID 11804926. Full text
- Numa WA, Desai U, Gold DR, Heher KL, Annino DJ (2005). "Silent sinus syndrome: a case presentation and comprehensive review of all 84 reported cases". Ann Otol Rhinol Laryngol. 114 (9): 688–94. PMID 16240931.
- Habicht ME, Eppenberger PE, Galassi FM, Rühli FJ, Henneberg M (2018). "Queen Meresankh III – the oldest case of bilateral Silent Sinus Syndrome (c. 2620/10 - 2570 BC)?". Anthropologie. 56 (2): 103–113. doi:10.26720/anthro.17.09.25.2.