It occurs secondary to maxillary sinus hypoventilation due to obstruction of the ostiomeatal unit. Frontiers silent sinus syndrome and williams syndrome. Silent sinus syndrome is a rare disorder, but it is probably underdiagnosed because of a lack of recognition. In this report, we are presenting a 40yearold male with chief complain of orbital asymmetry. However, in a small number of patients, trauma to the lateral nasal wall and ostiomeatal complex may be the cause, e. Following appropriate neuroimaging, we considered a diagnosis of silent sinus syndrome. The endoscopy is performed in antrostomy in which the obstruction of osteomeatal complex is treated along with enlarged maxillary ostium. Silent sinus syndrome symptoms, causes, treatment, surgery.
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. Silent sinus syndrome sss is a rare condition involving the maxillary sinus, characterized by unilateral collapse of the maxillary sinus and orbital floor, associated with negative antral pressure in the absence of sinus symptoms 1. Silent sinus syndrome epidemiology rareapproximately84reported casesbetween1964and2004. Silent sinus syndrome sss is a condition characterized by ophthalmologic features, such as spontaneous enophthalmos and hypoglobus. Scoliosis, clubfoot and tall stature are also characteristic. Silent sinus syndrome sss is a rare clinical syndrome associated with characteristic spontaneous and gradual downward bowing of the orbital floor caused by impaired sinus ventilation. Silent sinus syndrome results from occlusion of the. The endoscopic antrostomy is the gold standard to treat the silent sinus syndrome. Silent sinus syndrome is a rare disorder, but it is probably underdiagnosed because of a lack of recognition 1. It can cause painless facial asymmetry, diplopia and enophthalmos. Pdf delayed presentation of silent sinus syndrome after.
The diagnosis and treatment of chronic maxillary atelectasis in adults and children. However, this is an infrequent association, mainly in childhood. Silent sinus syndrome flair mri sequence showing sinus opacification and orbital floor retraction. Six months after the operation the patient is free from orbital or sinus disturbance. The spectrum of presentation of silent sinus syndrome. Silent sinus syndrome is a rare clinical condition. Diplopia is the most common ophthalmologic symptom, present in nearly 60% of patients with silent sinus syndrome, whereas visual acuity and extraocular movements or ductions are typically not significantly impaired 6. Sillence syndrome genetic and rare diseases information. It is also known as imploding antrum syndrome and typical radiological findings are ipsilateral depression of the orbital floor and opacification of a.
This condition is characterized by unilateral spontaneous enophthalmos and hypoglobus due to. All of these findings were consistent with the diagnosis of silent sinus syndrome. Traditionally, correction of the enophthalmos involved reconstruction of the orbital floor, which was performed simultaneously with sinus surgery. Chronic, subclinical inflammation and subsequent altered pressure gradient of the maxillary sinus leads to its eventual collapse. Silent sinus syndrome is a recognised cause of unilateral painless enophthalmos with characteristic radiological findings of maxillary sinus atelectasis and inferior bowing of the orbital floor. Patients may also present with eye asymmetry, unilateral ptosis, or diplopia.
Silent sinus syndrome usually presents in the 3 rd to 5 th decade, without a gender predilection. Silent sinus syndrome sss is a rare clinical condition. The silent sinus syndrome is a spontaneous unilateral maxillary atelectasis with complete or partial opacification of the sinus. Jan 01, 2016 silent sinus syndrome is a rare cause of hypoglobus and enophthalmos. Silent sinus syndrom is rare and slow progressive disorder associated with asymptomatic chronic maxillary sinusitis and collapse of the orbital floor. Close follow up of pediatric patients is advised and early intervention may be favorable to prevent long term orbital changes and complications. To provide insight into the epidemiology, pathogenesis and treatment of this disorder, a retrospective study of twelve. This is a report of an 8 yearold boy with silent sinus syndrome and associated ocular motility disorders. Silent sinus syndrome is very similar to type iii chronic atelectasis. This condition is characterized by painless enophthalmos and facial asymmetry caused by chronic maxillary sinus atelectasis. Ppt the silent sinus syndrome a rare manifestation of. Imploding antrum syndrome can be primary or secondary. Silent sinus syndrome is a rare condition that can pose a diagnostic challenge. Neurologists will only infrequently see people with silent sinus syndrome but it can.
The majority of cases of maxillary sinus hypoplasia will have the orbital floor changes characteristic of sss. Enophthalmos is present in all cases of silent sinus syndrome and ranges from 2 to 5 mm with a mean of 3 mm 3. In addition, all the specialist in the medical or the dental fields should communicate well together to reach an earlier diagnosis of the situation. The key features in a patient who presents with sss are painless progressive unilateral maxillary sinus disease in the absence of rhinosinusitis, trauma, or surgery. Bilateral enophthalmos due to silent sinus syndrome. Silent sinus syndrome clinmed international library. Though the treatment of silent sinus syndrome can be challenging, we demonstrate the successful use of a customized orbital implant in the treatment of diplopia and enophthalmos from silent sinus syndrome using a twostage approach. The silent sinus syndrome represents maxillary sinus atelectasis that results in. In this report, we are presenting a 58 years old woman with chief complain of right global pain. Patency of maxillary sinus ostium was achieved with an endoscopic approach under general anaesthesia.
The most common manifestations are enophtalmos, hypoglobus and pseudoretraction upper eyelid. Silent sinus syndrome sss is a rare disorder characterized by ipsilateral enophthalmos and hypoglobus, caused by an alteration of the orbital architecture due to maxillary sinus collapse with. Examination was normal apart from reduced facial sensation. Unilateral, spontaneous enophthalmos and hypoglobus. The silent sinus syndrome is a rare entity that is wellknown to the ophthalmologist and ent surgeons.
The resulting depression of the orbital floor often leads to. Pdf queen meresankh iii the oldest case of bilateral. Pdf the silent sinus syndrome consists of painless facial asymmetry characterized by unilateral. How to fix silent sinus syndrome naturally free case study how i get rid of chronic congestion and breathe better. The patient may present with unilateral ptosis or retraction, a deep superior sulcus or orbital asymmetry. Usually the diagnosis is suspected clinically, and it can be confirmed radiologically by characteristic imaging features that include. Subsequently, gases are resorbed into the capillaries of the closed sinus cavity, creating negative pressure. Silent sinus syndrome is a rare disorder characterized by progressive enophthalmos, hypoglobus inferior displacement of the globe in the orbit and painless facial asymmetry due to a spontaneous, asymptomatic collapse of the maxillary sinus and orbital floor associated with chronic maxillary sinusitis and negative sinus pressures 1. The silent sinus syndrome consists of painless facial asymmetry and enophthalmos caused by chronic maxillary sinus atelectasis.
Maxillary sinus hypoventilation typically causes inferior displacement of the globe in the orbit unilateral hypoglobus. Silent sinus syndrome sss is a rare condition with multiple ophthalmic findings of significance. Pathophysiology optimal management of silent sinus syndrome requires an understanding of the underlying pathophysiology. It is possible that my right sinus did not develop fully and. Unusual ocular manifestations of silent sinus syndrome. Silent sinus syndrome is characterised by painless enophthalmos associated with involution of the maxillary sinus after infundibular occlusion. The computerized tomography ct showed a collapsed maxillary and frontal sinus and a lateral deviation of the nasal septum that led us to the diagnosis. Silent sinus syndrome is characterised by spontaneous enophthalmos and. Recent findings silent sinus syndrome lies on a spectrum of other forms of sinus related orbitopathy. Discussion the clinical features of silent sinus syndrome are described, as well as the need to distinguish it from maxillary sinusitis. Silent sinus syndrome is characterized by a painless enophtalmos with involution of maxillary sinus due to an ostial occlusion 48. Silent sinus syndrome is a clinical entity with the constellation of progressive enophthalmos and hypoglobus due to gradual collapse of the orbital floor with opacification of the maxillary sinus, in the presence of subclinical maxillary sinusitis. Silent sinus syndrome solanki sm, munde yw, kulkarni vm.
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. Management of enophthalmos from silent sinus syndrome with. The association between silent sinus syndrome and ocular motility disturbance has been recently described in the literature. Silent sinus syndrome sss is an acquired unilateral maxillary atelectasis with complete or partial opacification of the sinus associated with enophtalmos and hypoglobus. Typically, endoscopic uncinectomy and opening of the maxillary sinus ostium are done. The silent sinus syndrome is characterized by painless enophthalmos associated with involution of the maxillary sinus after infundibular occlusion 1,2,3,4,5,6,7,8,9,10. Sixmonth and 2year followups after surgical treatment revealed satisfactory results and there was no need for reconstruction of the orbital floor. Silent sinus syndrome is a condition in which chronic asymptomatic maxillary sinus disease presents with spontaneous unilateral enophthalmos and hypoglobus. The largest risk factors is underlaying aberrant nasal anatomy. The silent sinus syndrome a rare manifestation of sinonasal disease is the property of its rightful owner. Chronic maxillary atelectasis including silent sinus. Management of enophthalmos from silent sinus syndrome with a. The diagnosis of sss is confirmed by ct scans of the nose and paranasal sinuses which characteristically show maxillary sinus opacification and collapse with inferior bowing of the orbital floor.
Silent sinus syndrome is a rare clinical condition caused by unilateral maxillary sinus atelectasis with complete or partial opacification of the sinus. Diagnosis and management of silent sinus syndrome s. This is what my silent sinus syndrome looks like on ct scan. Introduction silent sinus syndrome is a rare disorder that presents a diagnostic challenge, most of the patients with this syndrome present with ophthalmological complaints without any nasal sinus. The typical patient with silent sinus syndrome is an adult in the third. Chronic, subclinical maxillary sinus inflammation alters the pressure gradient, leading to eventual maxillary sinus collapse, orbital floor depression, enophthalmos, and diplopia. The subsequent osteomeatal complex obstruction leads to hypoventilation of the maxillary sinus and negative pressure development. In nonsurgical treatment, a gel is used to treat silent sinus syndrome. Queen meresankh iii the oldest case of bilateral silent sinus syndrome c. Silent sinus or imploding antrum syndrome is a very rare condition, consisting of. Silent sinus syndrome an otherwise healthy 34yearold man became aware of progressive left side deepening of the superior orbital sulcus causing visible asymmetry of the face. Most reported cases in the literature describe its occurrence in adults, but it can also affect children. Look past the eye how to detect and manage this rare condition, which can be associated with a range of symptoms. Management of enophthalmos from silent sinus syndrome.
Apr 28, 2020 silent sinus syndrome sss is a rare disease process characterized by progressive enophthalmos and hypoglobus due to ipsilateral maxillary sinus hypoplasia and orbital floor resorption. Clinical presentation is highly variable and nonspecific. Jul 01, 2008 sillence syndrome brachydactylysymphalangism syndrome resembles type a1 brachydactyly variable shortening of the middle phalanges of all digits with associated symphalangism producing a distal phalanx with the shape of a chess pawn. In magnetic resonance imaging mri of paranasal sinuses, right maxillary sinus volume was decreased but he had no sinonasal or visual symptoms. Silent sinus syndrome first case report, saudi arabia with. 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. The silent sinus syndrome is characterized by painless enophthalmia and hypotropia caused by chronic atelectasis of the maxillary sinus with onset in adulthood, typically between the third and the. Silent sinus syndrome is a rare condition with multiple ophthalmic findings of significance. Ct imaging of the orbits and paranasal sinuses can be helpful in excluding important causes of enophthalmos such as orbital fracture and tumours. He underwent a middle meatal antrostomy with complete resolution of symptoms. The typical patient with silent sinus syndrome is an adult in the third through fifth decades of life who. Although the diagnosis is usually suspected clinically, it is con.
Enjoy the videos and music you love, upload original content, and share it all with friends, family, and the world on youtube. The diagnosis is usually made clinically, however, imaging of the sinuses can help in the diagnosis. Clinicians from multiple disciplines should be familiar with presenting features. The typical patient with silent sinus syndrome is an adult in the third through fifth decades of life who presents with spontaneous, painless, and occasionally progressive enophthalmos and hypoglobus 1, 2. An absence of familiarity with ambiguous and atypical presentations may complicate diagnosis and delay. Pdf patients with silent sinus syndrome typically present for investigation of facial asymmetry. Rose et al describe 14 cases of silent sinus syndrome sss, demographics. The patient was diagnosed to have silent sinus syndrome sss. Silent sinus syndrome should be included in the differential diagnosis of enophthalmos and hypoglobus in the absence of trauma, surgery, and nasal symptoms. This is a report of an 8 yearold boy with silent sinus syndrome and.
Silent sinus syndrome is almost a unilateral condition and is usually diagnosed in patients in their 30. Silent sinus syndrome sss is a rare condition that can pose a diagnostic challenge. It is a wellrecognized entity in the field of otolaryngology, but the syndrome remains relatively unknown among radiologists despite its characteristic radiologic features. It is well recognised among otorhinolaryngologists and ophthalmologists but remains relatively unknown among radiologists. Usually the diagnosis is suspected clinically, and it can be confirmed radiologically by characteristic imaging features that include maxillary sinus outlet obstruction, sinus.
The term silent sinus syndrome has been used to describe the constellation of progressive enophthalmos and hypoglobus due to gradual collapse of. This in turn may cause associated ocular occurrences of enophthalmos and hypotropia. Radiographic features of disease include an opacified and hypoplastic sinus, a lateralized uncinate process, depression of the orbital. Jan 01, 2020 silent sinus syndrome should remain a diagnostic consideration for patients with spontaneous enophthalmos and hypoglobus, even in the absence of maxillary sinus opacification. Silent sinus syndrome sss is an acquired unilateral maxillary atelectasis with. Silent sinus syndrome sss is a quite rare clinical entity characterized by unilateral enophthalmos and hypoglobus secondary to thinning and inward bowing of the maxillary sinus roof in the absence of signs or symptoms of intrinsic sinonasal inflammatory disease. Uncommon presentations and descriptions of sinus involvement other than the maxillary sinus add to the variability of presentation. The patient may present with unilateral ptosis this condition is characterized by unilateral spontaneous enophthalmos and hypoglobus due to increased orbital volume and retraction of the orbital floor. Silent sinus syndrome is a spontaneous, asymptomatic collapse of the maxillary sinus and orbital floor associated with negative sinus pressures.
Silent sinus syndrome sss is the spontaneous unilateral collapse of the maxillary sinus and orbital floor with complete or partial opacification of the collapsed sinus. There are two treatment approach of silent sinus syndrome i. Silent sinus syndrome can be treated surgically via two methods i. If so, share your ppt presentation slides online with. In addition to a thorough eye examination, axial and coronal computerized tomography of the sinus and orbits should be obtained to confirm the diagnosis. Introduction silent sinus syndrome is a disease entity characterized by pro. A 49yearold man presented with a 1week history of right facial paraesthesia with blurred vision and diplopia.
Imploding antrum or silent sinus syndrome following naso. They described a large group of 14 patients with spontaneous, unilateral enophthalmos and hypoglobus associated with asymptomatic, bone thinning, maxillary sinus disease seen on computed tomography ct scans. Silent sinus syndrome sss is a rare disorder with protean manifestations. 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.
This occurs because of atelectasis of the ipsilateral maxillary sinus and when the condition is left. Silent sinus syndrome results from occlusion of the osteomeatal complex, preventing normal aeration of the maxillary sinus. Although the underlying maxillary sinus pathology is silent it has been suggested recently that. The term silent sinus syndrome has been used to describe this process where, in particular, there is an absence of any sinonasal symptoms.
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