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:: Silent Sinus Syndrome

52 year old man with unsteady gait. CT followed by MRI done to rule out cerebral infarction

Non-contributory - but possible vertical gaze asymmetry

• Small left maxillary sinus with concave sinus walls.
• Right orbit larger than left
• Downward displacement of left orbital floor.

• Hypoplastic Maxillary sinus
• "Silent Sinus Syndrome"
• Allergic Aspergillus Sinusitis

Dx: Silent Sinus Syndrome

Dx Confirmed by: Imaging and Clinical

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None

The unsteady gate may be related to diplopia caused by the collapsed sinus.

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Soparkar et al coined the term “silent sinus syndrome” for a constellation of features found in patients without sinus complaints. They named this condition after they reviewed the course of treatment of nineteen asymptomatic patients who presented with, unilateral, spontaneous, enophthalmos and hypoglobus (downward displacement of the eye, or globe ptosis).

The characteristic radiological manifestations in there cohort, and subsequent studies, included inferior displacement of the orbital floor with downward migration of the orbital contents. Different magnitudes of inward bowing of the antral walls were also identified. This was most consistently seen in the medial maxillary sinus wall. The orbital floor (maxillary roof) was always retracted and commonly thinned. The affected maxillary sinus volume was reduced. The resultant volume loss in the maxillary sinus accounts for the orbital enlargement and enophthalmos. The maxillary infundibulum was always occluded and the sinus is opacified. The uncinate process was retracted against the inferomedial aspect of the orbital wall.

The silent sinus syndrome, also called chronic maxillary sinus telecasts, is reportedly a rare condition and until the last decade was not described in the radiology literature. Rose et al applied the name “imploding antrum syndrome” to this condition after their review of a series of cases.

The most popular theory for development of this condition is that osteomeatal obstruction results in reduced aeration of the antrum, causing negative sinus pressure and atelectasis. Complete obstruction of the maxillary sinus antrum results in gas resorption and negative pressure formation. This is similar in manner to middle ear atelectasis due to Eustachian tube dysfunction. By definition, there is no history of acute or chronic sinusitis and no previous facial surgery or trauma.

Annino and Goguen describe the treatment of this condition, which consists of correction of the maxillary sinus atelectasis and the orbital defects. There is evidence that a two-stage repair may eliminate the need to perform the orbital repair. Due to the lateral position of the uncinate, endoscopic maxillotomy needs to be done with care to avoid injury to the orbital contents.

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