Silent sinus syndrome explained

Silent sinus syndrome
Synonyms:Imploding antrum syndrome
Field:ENT surgery
Symptoms:facial asymmetry, vision problems, headache
Diagnosis:symptoms, CT scan
Differential: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). 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.

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.[2] This can create negative pressure in the sinus, as secretions are reabsorbed.

Risk factors for silent sinus syndrome include any anatomic condition causing obstruction of the maxillary ostium, such as ipsilateral nasal septum deviation,ipsilateral laterally deviated middle turbinate, and narrowed infundibulum.

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.

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]

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.[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. If the inferior oblique muscle is damaged, it may be partially removed (known as myectomy). Mucus and secretions must be drained from the sinus. Earlier treatment has better outcomes.

Epidemiology

Silent sinus syndrome is fairly rare. 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.

History

Silent sinus syndrome was first described in 1964.

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. en. 10.1016/j.joms.2021.08.166. 0278-2391. 80. 1. 113.e1–113.e8. 34597532. 238249024. free.
  2. Annino. Donald J. Jr. Goguen. Laura A.. February 2008. Silent sinus syndrome. Current Opinion in Otolaryngology & Head and Neck Surgery. en-US. 16. 1. 22–25. 10.1097/MOO.0b013e3282f2c9aa. 18197017. 35744217. 1068-9508.
  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. 10.1017/S0022215122000056. 35000660. 253512002 . 20 Apr 2022. free.
  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. 10.1017/S0022215119000252. 30773158. 73497631. 20 Apr 2022.
  5. 10.1007/s00405-017-4622-8. Chronic maxillary atelectasis and silent sinus syndrome: two faces of the same clinical entity. de Dorlodot. C.. Collet. S.. Rombaux. P.. Horoi. M.. Hassid. S.. Eloy. P.. Eur Arch Otorhinolaryngol. 2017. 274. 9. 3367–73. 28573375. 7917436.
  6. Albadr. Fahad B.. Silent Sinus Syndrome: Interesting Computed Tomography and Magnetic Resonance Imaging Findings. Journal of Clinical Imaging Science. 2020. 10. 38. 10.25259/JCIS_62_2020 . 32637229. 7332466.
  7. Hlaváčová . Radka. Kuběna . Tomáš . Černošek . Pavel . Silent sinus syndrome . Czech and Slovak Ophthalmology . 2019. 74. 6. 245–248. 10.31348/2018/6/5. 31238693. 192493349. free.
  8. Kikuta. Shu. Horikiri. Kyohei. Kanaya. Kaori. Kagoya. Ryoji. Kondo. Kenji. Yamasoba. Tatsuya. Repetitive Sinus-Related Symptoms May Accelerate the Progression of Chronic Maxillary Atelectasis. Case Reports in Otolaryngology. 2017. 2017. 1–5. 10.1155/2017/4296195 . 28758040. 5512096. free.
  9. João. Mangussi-Gomes. Márcio. Nakanishi. Maria Regina. Chalita. Fabiana. Damasco. Carlos Augusto Costa Pires. Oliveira. Stage II Chronic Maxillary Atelectasis Associated with Subclinical Visual Field Defect. 2013. International Archives of Otorhinolaryngology. 10.1055/s-0033-1351679. 17. 4. 409–412. 25992047. 4399176.
  10. George. Jonathan. Durr. Megan. Pletcher. Steven. Endoscopic Treatment of Silent Sinus Syndrome with Dramatic Resolution. The Laryngoscope. 2011. 121. S230. 10.1002/lary.22116 . 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. 10.1177/014556130007900810 . 44310054 . free .
  12. 10.1016/j.ijscr.2016.07.014. Gunaratne. Dakshika A. . Hasan. Zubair . Floros. Peter . Singh. Narinder . Bilateral stage I chronic maxillary atelectasis: a case report. Int J Surg Case Rep. 2016. 26. 53–6. 27451129. 4961494.
  13. Arnon . R . Gluck . O . Winter . H . Pikkel . J . Rubinov . A . Combined Single-Step Procedure for Correction of Silent Sinus Syndrome . Case Rep Ophthalmol. 2019. 10. 1 . 95–100. 10.1159/000498964. 31097950 . 6489024 .
  14. Alda. Cardesín. Yolanda. Escamilla. Manuel. Romera. Juan Antonio. Molina. Single Surgical Step for Endoscopic Surgery and Orbital Reconstruction of a Silent Sinus Syndrome. Acta Otorrinolaringologica (English Edition). 64. 4. 2013. 297–299. 2173-5735. 10.1016/j.otoeng.2013.08.010. 22421390 .
  15. 10.1016/j.jcms.2009.12.003 . Simultaneous management of the enophthalmos and sinus pathology in silent sinus syndrome: A report of three cases . Sesenna. Enrico. Oretti. Gabriele. Anghinoni. Marilena Laura. Ferri. Andrea. Journal of Cranio-Maxillofacial Surgery. 2010 . 38. 6. 469–472. 20096597 .
  16. Silent sinus syndrome: dynamic changes in the position of the orbital floor after restoration of normal sinus pressure. Journal of Laryngology & Otology. 2011. 125. 1239–1243. R. Sivasubramaniam. R. Sacks. M. Thornton. 12. 10.1017/S0022215111001952. 21835074. 23539528. free.
  17. Babar-Craigh. H.. Kayhanian. H.. De Silva D.J.. G.E.. Rose. V.J.. Lund. Spontaneous silent sinus syndrome (imploding antrum syndrome): Case series of 16 patients. Rhinology. 2011. 49. 3. 315–317. 10.4193/Rhino10.103. 21858262. free.
  18. Thomas. Robert. Graham. Scott. Carter. Keith. Nerad. Jeffrey. Mar 2003. 97–100. Management of the Orbital Floor in Silent Sinus Syndrome. 17. American Journal of Rhinology. 2. 10.1177/194589240301700206. 12751704. 24006400.

Bibliography

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