This condition is characterized by painless enophthalmos and facial asymmetry caused by chronic maxillary sinus atelectasis 1,2,3,4,5,6,7. Many times it also involves the uv scanning of maxillary sinus region. Dental disease and its role in silent sinus syndrome mayo. Rare radiological feature in silent sinus syndrome jama. Sick sinus syndrome jama internal medicine jama network. Radiographic findings include ipsilateral maxillary sinus opacification, lateralization of the uncinate and middle turbinate, and infundibular occlusion. Balloon sinuplasty has recently been described as a less invasive, alternative option to treat silent sinus syndrome by correcting the position of the uncinate process and enlarging the maxillary sinus. This article is from clinical and molecular allergy. The silent sinus syndrome consists of painless facial asymmetry and enophthalmos caused by chronic maxillary sinus atelectasis. He underwent a middle meatal antrostomy with complete resolution of symptoms. Such anatomic modifications occur over time, and therefore it is possible to encounter different stages of the same disease with. Chronic maxillary atelectasis including silent sinus syndrome can present bilaterally volume 3 issue 3 j p k ho, e wong, d a gunaratne, n singh skip to main content accessibility help we use cookies to distinguish you from other users and to provide you with a better experience on our websites. The medical world has not been able to exactly distinguish the differences between these two conditions in the initial stages of the illness.
A missouri womans squint turned out to be silent sinus syndrome, which happens when a cheek sinus is clogged and secretions become trapped over time. It is caused by atelectasis of the maxillary sinus in the presence of ipsilateral chronic hypoventilation of the sinus. The secret of the silence of the silent maxillary sinus syndrome. I was diagnosed with silent sinus syndrome 18mths ago after months of trying to convince my gp that my eye looked different and i was having intermittent diplopia and feeling of sinus fullness. Most of the patients with this syndrome present with ophthalmological complaints without any nasal sinus. Silent sinus syndrome sss is known to be a rare clinical condition, characterized by spontaneous and progressive enophthalmos and hypoglobus associated with atelectasis of the maxillary sinus. Diagnosis and management of silent sinus syndrome american. The sick sinus syndrome describes a rather heterogeneous group of patients whose presenting symptoms are primarily cerebrovascular in nature stokesadams attacks, dizziness, and cerebrovascular accidents. Unusual ocular manifestations of silent sinus syndrome. In summary, the silent sinus syndrome is a rare entity that is wellknown to the ophthalmologist and the ear, nose, and throat surgeon. Silent sinus syndrome epidemiology rareapproximately84reported casesbetween1964and2004. The opacified hypoplastic maxillary sinus may represent a less severe form. A diagnosis of silent sinus syndrome was made, for which the patient was referred to the otolaryngology service for functional endoscopic surgery to decompress and evacuate.
Silent sinus syndrome is defined as a spontaneous and progressive enophthalmos and hypoglobus with hypoplasia of the maxillary sinus and resorption of the orbital floor. Pathophysiology optimal management of silent sinus syndrome requires an understanding of the underlying pathophysiology. Silent sinus syndrome is an unusual cause of progressive enophthalmos and hypoglobus due to atelectasia of the maxillary sinus associated with osteolysis of the orbital floor. I have now been to the ent and i have a severe infection in my right maxillary sinus. Before you allow the doctor who diagnosed you to perform surgery, i would strongly recommend you get a second opinion from a doctor at a teaching hospital who specializes in treating these sorts. Silent sinus syndrome is a rare disorder, but it is probably underdiagnosed because of a lack of recognition. Silent sinus syndrome symptoms, diagnosis, treatments and. Spontaneous enophthalmos and hypoglobus, in the absence of other symptoms and unrelated to trauma or surgery, may be alarming to both physician and patient. The articles prior to january 20 are part of the back file collection and are not available with a current paid subscription.
Examination was normal apart from reduced facial sensation. The diagnosis based on clinical features and data of computed tomography. Silent sinus syndrome abstract the silent sinus syndrome consists of painless facial asymmetry characterized by unilateral enophtalmos. Diplopia is seen in about 28 to 65% of cases regarding silent sinus syndrome. Chronic maxillary atelectasis including silent sinus. Silent sinus syndrome symptoms, causes, treatment, surgery. Sick sinus syndrome sss, is a group of abnormal heart rhythms arrhythmias presumably caused by a malfunction of the sinus node, the hearts primary pacemaker. P333 silent sinus syndrome in children case report. This is a report of an 8 yearold boy with silent sinus syndrome and. The diagnosis is suggested by clinical findings and confirmed. He prescribed a strong antibotic and said he could not even see the problem becaus i had so much puss in my right sinus. It is commonly attributed to a sinus atelectasis secondary to ostiomeatal obstruction. The silent sinus syndrome sss is a rare cause of diplopia and facial asymmetry. Diagnosis and management of silent sinus syndrome s.
One such disease process, silent sinus syndrome, is a progressive condition in which maxillary sinus pathology causes inferior displacement of the orbital floor, resulting in enophthalmos and hypoglobus. 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. The silent sinus syndrome is a spontaneous unilateral maxillary atelectasis with complete or partial opacification of the sinus. Abstract the silent sinus syndrome sss is a rare phenomenon originally described in 1964 by montgomery, which often occurs unilaterally in the maxillary sinus with opacification and collapse. The authors describe the clinicopathologic features of a benign syndrome silent sinus syndrome with this constellation of features and discuss the possible pathophysiology. Abstract silent sinus syndrome sss is known to be a rare clinical condition, characterized by spontaneous and progressive enophthalmos and hypoglobus associated with atelectasis of the maxillary sinus and alteration of the orbital floor. The anatomical variations lead to the occlusion in maxillary sinus and as a result silent sinus syndrome occur. Silent sinus syndrome kfdxkjtl something a simple as a cosmetic issue may actually be a sign of a serious problem. Silent sinus syndrome is a spontaneous, asymptomatic collapse of the maxillary sinus and orbital floor associated with negative sinus pressures. The code is valid for the year 2020 for the submission of hipaacovered transactions. Inflammation of the membranes of the brain or spinal cord. International journal of surgery case reports 23 2016 fig. The silent sinus syndrome refers to the collapse of the orbital floor and maxillary sinus which can cause changes in facial appearance. Materials and methods during a 10year period, four patients were clinically diagnosed with silent sinus syndrome by physicians in the ear, nose, and throat service at our institution.
In most cases, it is diagnosed clinically, however, using the characteristic imaging features including maxillary sinus outlet obstruction, sinus opacification, and sinus volume loss caused by inward. A case of a 46yearold man with silent sinus syndrome is presented. It is secondary to chronic maxillary sinus atelectasis. Diplopia the person see dual images and enophthalmos posterior displacement of an eye ball can also occur as a. Enophthalmos is the most common presenting feature of silent sinus syndrome, reported in 96% of cases.
This syndrome is classically idiopathic, but the term is also used to describe traumatic or iatrogenic surgical orbital decompression cases. The silent sinus syndrome consists of painless facial asymmetry characterized by unilateral enophthalmos. Langerhans cell histiocytosis, disseminated clinical. Silent sinus syndrome or chronic maxillary sinus atelectasis characterised by asymptomatic hypoplasia of maxillary sinus, progressive enophthalmos, facial asymmetry. Understand the progression of silent sinus syndrome in patients with dental disease. Axial bone window the right maxillary antrum is volume depleted and opacified consistent with silent sinus syndrome. Hi i wrote last week and had the wrong appointment date in my discussion. Nov 01, 2012 the patient was diagnosed to have silent sinus syndrome sss.
This is an unusual condition with an atelectasy of the uncinate process against the. People with the disorder have a droopy eyelid that gives them the appearance of squinting. 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. Isolated unilateral upper alveolar numbness in silent sinus syndrome hung tuan lau, keng hua lim summary we present a case of a 59yearold man with left upper alveolar numbness of 2 years duration in the absence of sinonasal symptoms. Diagnosis methods usually involve examination of pupillary region, evaluation of the cranial nerve, eyelid alignment, examination of neurogenic junction region etc. Silent sinus is said to be mainly caused by the inward withdrawal of the walls on maxillary sinus region.
Tachycardiabradycardia syndrome is a variant of sick sinus syndrome in which the arrhythmia alternates between slow and fast heart rates. Silent sinus syndrome without opacification of ipsilateral. Isolated unilateral upper alveolar numbness in silent. One such disease process, silent sinus syndrome, is a progressive condition in which maxillary sinus pathology causes inferior displacement of. The principal pathophysiological disturbance is sinus node dysfunction characterized by. The silent sinus syndrome sss is a rare condition that causes facial asymmetry, unilateral eno phthalmos and diplopia. Silent sinus syndrome treatment, if any, consists of functional endoscopic sinus surgery to reestablish functional drainage passage and reconstructive procedure of the orbital floor to manage asymmetric facial appearance.
Determine the incidence of dental disease in patients with silent sinus syndrome. Silent sinus syndrome sss is a rare disease characterized by spontaneous enophthalmos and hypoglobus secondary to collapse of the orbital floor in patients with asymptomatic maxillary sinusitis. This syndrome was first described in 1964 by montgomery, but it was named silent sinus syndrome in 1994 by soparkar et al. Optimal management of silent sinus syndrome requires an understanding of the underlying pathophysiology. Oct 07, 2015 this is likely due to past trauma, a congenital condition, or developmental weakness of the levator muscle support.
Silent sinus syndrome sss is known to be a rare clinical condition, characterized by spontaneous and progressive enophthalmos and hypoglobus associated with atelectasis of the maxillary sinus and alteration of the orbital floor. In most cases, it is diagnosed clinically, however, using the characteristic imaging features including maxillary sinus outlet obstruction, sinus opacification, and sinus volume loss caused by inward retraction of the sinus walls. The silent sinus syndrome sss is a rare condition that causes facial asymmetry, unilateral enophthalmos and diplopia. Following appropriate neuroimaging, we considered a diagnosis of silent sinus syndrome.
Silent sinus syndrome is an acquired condition that occurs in adults with unilateral, progressive, spontaneous enophthalmos and hypoglobus secondary to maxillary sinus hypoventilation caused by blockage of the ostiomeatal complex. Reabsorbed bone with displacement of the orbital floor is a constant finding. Silent sinus syndrome sss, is a rare disorder involving the maxillary antrum, characterized by an indolent course of subclinical maxillary sinusitis that leads to progressive contraction of the maxillary sinus. However, in a small number of patients, trauma to the lateral nasal wall and ostiomeatal complex may be the cause, e. The term silent reflects the absence of typical sinonasal symptoms, with patients instead typically having painless facial asymmetry.
A 49yearold man presented with a 1week history of right facial paraesthesia with blurred vision and diplopia. The patient often presents with a droopy eyelid and a deep superior sulcus. The right maxillary antrum is volume depleted and opacified consistent with silent sinus syndrome. The typical patient with silent sinus syndrome is an adult in the third through fifth decades of life who. Silent sinus syndrome american academy of ophthalmology. Beating the silent sinus syndrome naturally wfm health. Silent sinus syndrome as a cause of diplopia in a child. A similar process may be responsible for the appearance of the opacified hypoplastic maxillary sinus, an entity with imaging findings similar to that of the silent sinus syndrome and often used interchangeably with the silent sinus syndrome in the literature 1, 3, 12. Patency of maxillary sinus ostium was achieved with an endoscopic approach under general anaesthesia. Our patient presented with a chronic history of headaches and left facial pain, without associated ophthalmologic. An evaluation for enopthalmos from a silent sinus syndrome can only be done by examination in consultation with a qualified surgeon, and this is not possible to determine from your photo. Is this silent sinus syndrome or do i just have droopy. The silent sinus syndrome sss is a rare clinical entity characterized by painless spontaneous enophthalmos, hypoglobus, and facial deformities secondary to chronic maxillary sinus atelectasis.
Silent sinus syndrome case presentation case report introduction sss was described in literature fairly recently, the first case being reported in 1964 by montgomery1, but the name was coined 30 years later by soparker et al. These examinations will be able to reveal the condition of silent sinus syndrome to an effective extent. It is thought to be secondary to chronic maxillary sinus atelectasis cma with reabsorbed bone and subsequent displacement of the orbital floor. The silent sinus syndrome sss involves painless facial asymmetry and enophthalmos, which is the result of chronic maxillary sinus atelectasis. Silent sinus syndrome is a very rare condition that is usually caused by some type of physical trauma or one of a handful of rare u deploying diseases.
The most widely accepted theory is that an inciting event causes occlusion of the ostiomeatal complex through which the maxillary sinus drains into the middle meatus of the nasal antrum. Silent sinus syndrome an otherwise healthy 34yearold man became aware of progressive left side deepening of the superior orbital. Six months after the operation the patient is free from orbital or sinus disturbance. Silent sinus syndrome results from obstructed maxillary sinus drainage resulting in negative pressure and sinus wall collapse.
Usually the diagnosis is suspected clinically, and it can be confirmed radiologically by characteristic imaging features that include maxillary sinus outlet obstruction, sinus. There are two treatment approach of silent sinus syndrome i. The condition is quite uncommon and usually causes no pain when it occurs. It is characterized by ipsilateral enophthalmos and hypoglobus or mistakenly as an exophthalmos of the contralateral eye. Silent sinus syndrome sss is a disease in which the natural orifice of the maxillary sinus becomes obstructed and the pressure in the sinus becomes negative due to hypoventilation, causing. The problem was silent sinus syndrome, a rare condition that can become serious if left untreated. I had fess surgery and orbital reconstruction with great results. Silent sinus syndrome usually presents in the 3 rd to 5 th decade, without a gender predilection. 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 visual sign of silent sinus syndrome is the asymmetry of the face and the asymmetry of face may lead to many other problems like diplopia. A ct scan was performed which confirmed the diagnosis of silent sinus syndrome according to the patient, he experienced no ophthalmologic complaints.
This in turn may cause associated ocular occurrences of enophthalmos and hypotropia. It can cause painless facial asymmetry, diplopia and enophthalmos. Radiologic findings involving the maxillary sinus and orbit confirm the diagnosis of the silent sinus syndrome. Clinical features of silent sinus syndrome are described, including diagnosis, differential diagnosis and treatment arch soc esp oftalmol. It was clear even to me from the scans that this was the problem. Hypoplasia of maxillary sinus caused by its longterm hypoventilation due to anatomical changes in osteomeatal complex. The secret of the silence of the silent maxillary sinus syndrome dna extraction was done for the drained sinus discharge. Most of the patients with this syndrome present with ophthalmological complaints without any nasal sinus symptoms, and it typically has a painless course and slow. Jun 16, 20 br edited video showing an endoscopic management of a right side maxillary silent sinus. Silent sinus syndrome sss is known as a rare clinical condition, characterized by spontaneous and progressive enophthalmos and hypoglobus associated with atelectasis of the maxillary sinus and alteration of the orbital floor.
These days, every family outing is a photo opportunity. Usually the diagnosis is suspected clinically, and it can be confirmed radiologically by characteristic imaging features that include. There is yet another condition called the hypo plastic condition where the region becomes thicker and opaque. On physical examination, he demonstrated mild left facial asymmetry and diminished. Silent sinus syndrome sss is a rare disorder that is defined as spontaneous and gradual retraction of the maxillary sinus. Missouri womans squint turns out to be silent sinus syndrome.
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