Silent sinus syndrome

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.

Silent sinus syndrome
Other namesImploding antrum syndrome
SpecialtyENT surgery
Symptomsfacial asymmetry, vision problems, headache
Diagnostic methodsymptoms, CT scan
Differential diagnosissinus atelectasis, congenital sinus hypoplasia
Treatmentsurgery (endoscopic endonasal surgery)
Frequencyrare, most 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). 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. It may also affect the frontal sinus or the ethmoid sinus. When the maxillary sinus is involved, the inferior oblique muscle may be damaged.[1]

The cause of silent sinus syndrome is not well understood. Bacteria in the maxillary sinus may be involved. 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. A CT scan can be used to confirm a diagnosis. This can have characteristic features, including maxillary sinus outlet obstruction, sinus opacification, and sinus volume loss caused by inward retraction of the sinus walls.[1]

Differential diagnosis

Silent sinus syndrome is a subtype of stage three chronic maxillary atelectasis. The distinguishing factor is that in silent sinus syndrome, there is an absence of sinusitis symptoms.[3][4][5] To be clear, chronic maxillary sinusitis may be a primary causitive factor in a significant number of silent sinus syndrome cases, it just may be asymptomatic.[6][7][8][9][10][11] Silent sinus syndrome also must be distinguished from maxillary sinus hypoplasia, which is congenital.[12][1]

Treatment

Silent sinus syndrome is usually treated with surgery. The first stage involves restoring sinus function, most often by performing an endoscopic uncinectomy (removal of uncinate process) and maxillary antrostomy. The second stage, if needed, involves reconstruction of the orbital floor. While some clinics perform the two stages simultaneously,[13][14][15] most authorities recommend waiting a minimum of 6 or as many as 18 months, as spontaneous remodeling of the orbital floor after the sinus repair will occur in many if not most cases.[4][16][17][18] Any prolapsed contents (such as those from the orbit) must be put back in place, though this is an rare occurrence in an already rare syndrome.[2] If the inferior oblique muscle is damaged, it may be partially removed (known as myectomy). 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. It occurs equally in sinuses on each side of the face.[1]

History

Silent sinus syndrome was first described in 1964.[1]

References
  1. 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. 80 (1): 113.e1–113.e8. doi:10.1016/j.joms.2021.08.166. ISSN 0278-2391. PMID 34597532. S2CID 238249024.
  2. 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. PMID 18197017. S2CID 35744217.
  3. Sivrice, M.; Yasan, H.; Okur, N.; Okur, E.; Buyukcelik, B.; Kumbul, Y. (10 Jan 2022). "Prevalence of chronic maxillary atelectasis: A radiological study". Journal of Laryngology & Otology. 136 (12): 1240–1244. doi:10.1017/S0022215122000056. PMID 35000660. S2CID 253512002. Retrieved 20 Apr 2022.
  4. Ho, J.; Wong, E.; Gunaratne, D.; Singh, N. (18 Feb 2019). "Chronic maxillary atelectasis (including silent sinus syndrome) can present bilaterally". Journal of Laryngology & Otology. 133 (3): 251–255. doi:10.1017/S0022215119000252. PMID 30773158. S2CID 73497631. Retrieved 20 Apr 2022.
  5. de Dorlodot, C.; Collet, S.; Rombaux, P.; Horoi, M.; Hassid, S.; Eloy, P. (2017). "Chronic maxillary atelectasis and silent sinus syndrome: two faces of the same clinical entity". Eur Arch Otorhinolaryngol. 274 (9): 3367–73. doi:10.1007/s00405-017-4622-8. PMID 28573375. S2CID 7917436.
  6. Albadr, Fahad B. (2020). "Silent Sinus Syndrome: Interesting Computed Tomography and Magnetic Resonance Imaging Findings". Journal of Clinical Imaging Science. 10: 38. doi:10.25259/JCIS_62_2020. PMC 7332466. PMID 32637229.
  7. Hlaváčová, Radka; Kuběna, Tomáš; Černošek, Pavel (2019). "Silent sinus syndrome". Czech and Slovak Ophthalmology. 74 (6): 245–248. doi:10.31348/2018/6/5. PMID 31238693. S2CID 192493349.
  8. Kikuta, Shu; Horikiri, Kyohei; Kanaya, Kaori; Kagoya, Ryoji; Kondo, Kenji; Yamasoba, Tatsuya (2017). "Repetitive Sinus-Related Symptoms May Accelerate the Progression of Chronic Maxillary Atelectasis". Case Reports in Otolaryngology. 2017: 1–5. doi:10.1155/2017/4296195. PMC 5512096. PMID 28758040.
  9. Mangussi-Gomes, João; Nakanishi, Márcio; Chalita, Maria Regina; Damasco, Fabiana; Oliveira, Carlos Augusto Costa Pires (2013). "Stage II Chronic Maxillary Atelectasis Associated with Subclinical Visual Field Defect". International Archives of Otorhinolaryngology. 17 (4): 409–412. doi:10.1055/s-0033-1351679. PMC 4399176. PMID 25992047.
  10. George, Jonathan; Durr, Megan; Pletcher, Steven (2011). "Endoscopic Treatment of Silent Sinus Syndrome with Dramatic Resolution". The Laryngoscope. 121: S230. doi:10.1002/lary.22116. S2CID 71631041.
  11. Hunt, Scott M; Tami, Thomas A (August 2000). "Sinusitis-induced enophthalmos: The sllent sinus syndrome". Ear, Nose & Throat Journal. 79 (8): 576–584. doi:10.1177/014556130007900810. S2CID 44310054.
  12. Gunaratne, Dakshika A.; Hasan, Zubair; Floros, Peter; Singh, Narinder (2016). "Bilateral stage I chronic maxillary atelectasis: a case report". Int J Surg Case Rep. 26: 53–6. doi:10.1016/j.ijscr.2016.07.014. PMC 4961494. PMID 27451129.
  13. Arnon, R; Gluck, O; Winter, H; Pikkel, J; Rubinov, A (2019). "Combined Single-Step Procedure for Correction of Silent Sinus Syndrome". Case Rep Ophthalmol. 10 (1): 95–100. doi:10.1159/000498964. PMC 6489024. PMID 31097950.
  14. Cardesín, Alda; Escamilla, Yolanda; Romera, Manuel; Molina, Juan Antonio (2013). "Single Surgical Step for Endoscopic Surgery and Orbital Reconstruction of a Silent Sinus Syndrome". Acta Otorrinolaringologica (English Edition). 64 (4): 297–299. doi:10.1016/j.otoeng.2013.08.010. ISSN 2173-5735. PMID 22421390.
  15. Sesenna, Enrico; Oretti, Gabriele; Anghinoni, Marilena Laura; Ferri, Andrea (2010). "Simultaneous management of the enophthalmos and sinus pathology in silent sinus syndrome: A report of three cases". Journal of Cranio-Maxillofacial Surgery. 38 (6): 469–472. doi:10.1016/j.jcms.2009.12.003. PMID 20096597.
  16. Sivasubramaniam, R; Sacks, R; Thornton, M (2011). "Silent sinus syndrome: dynamic changes in the position of the orbital floor after restoration of normal sinus pressure". Journal of Laryngology & Otology. 125 (12): 1239–1243. doi:10.1017/S0022215111001952. PMID 21835074. S2CID 23539528.
  17. Babar-Craigh, H.; Kayhanian, H.; De Silva D.J.; Rose, G.E.; Lund, V.J. (2011). "Spontaneous silent sinus syndrome (imploding antrum syndrome): Case series of 16 patients". Rhinology. 49 (3): 315–317. doi:10.4193/Rhino10.103. PMID 21858262.
  18. Thomas, Robert; Graham, Scott; Carter, Keith; Nerad, Jeffrey (Mar 2003). "Management of the Orbital Floor in Silent Sinus Syndrome". American Journal of Rhinology. 17 (2): 97–100. doi:10.1177/194589240301700206. PMID 12751704. S2CID 24006400.

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. doi:10.1177/000348940511400906. PMID 16240931. S2CID 19348879.
  • 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.
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