Stage II Chronic Maxillary Atelectasis Associated with Subclinical Visual Field Defect

Abstract

Introduction Chronic maxillary atelectasis (CMA) is characterized by a persistent decrease in the maxillary sinus volume due to inward bowing of its walls. According to its severity, it may be classified into three clinical-radiological stages. Objective To report a case of stage II CMA associated with subclinical visual field defect. Case Report A 34-year-old woman presented with a 15-year history of recurrent episodes of sinusitis and intermittent right facial discomfort for the past 5 years. She denied visual complaints, and no facial deformities were observed on physical examination. Paranasal sinus computed tomography (CT) demonstrated a completely opacified right maxillary sinus with inward bowing of its walls, suggesting the diagnosis of stage II CMA. A computerized campimetry (CC) disclosed a scotoma adjacent to the blind spot of the right eye, indicating a possible damage to the optic nerve. The patient was submitted to functional endoscopic sinus surgery, with drainage of a thick mucous fluid from the sinus. She did well after surgery and has been asymptomatic since then. Postoperative CT was satisfactory and CC was normal. Discussion CMA occurs because of a persistent ostiomeatal obstruction, which creates negative pressure inside the sinus. It is associated with nasosinusal symptoms but had never been described in association with any visual field defect. It can be divided into stage I (membranous deformity), stage II (bony deformity), and stage III (clinical deformity). The silent sinus syndrome is a special form of CMA. This term should only be used to describe those cases with spontaneous enophthalmos, hypoglobus, and/or midfacial deformity in the absence of nasosinusal symptoms.

Bilateral stage I chronic maxillary atelectasis: A case report

“…It is distinguished from CMA by its ‘silent’ progression with absence of significant sinonasal symptoms. Although presented initially as distinct clinical entities, subsequent evaluation has demonstrated SSS and CMA to be of the same disease spectrum, with incorporation of SSS into the CMA staging classification [2] , [7] . Unilateral CMA, particularly the SSS subtype, is now well documented in the literature with multiple individual and series reports.…”

“…As sinus atelectasis advances, diplopia, enophthalmos, lagophthalmos, hypoglobus and mid-face asymmetry become apparent [8] , [9] , however gradual alterations, particularly if bilateral, may go unnoticed by patients, with detection only occurring when imaging is performed for unrelated reasons [10] . Characteristic CT findings include near or total opacification of the affected sinus, ostiomeatal obstruction and inward bowing of antral walls, including orbital floor displacement [7] . Our patient experienced severe symptoms and rapid disease progression and stage I CMA was diagnosed within 6 weeks of initial symptom onset.…”

“…Manometric studies have recorded this at −8.4 ± 2.6 cm H 2 O on average, however this gradient may decrease to approach atmospheric pressures with advancing disease and greater opacification [14] . Thereafter, chronic inflammation and mucous retention is thought to be responsible for atelectatic remodelling with inward displacement and demineralisation of the affected antral walls [7] . It has been demonstrated that concurrent expansion occurs in the infratemporal, nasal and orbital compartments and this is postulated to be a compensatory mechanism to redistribute volume in the mid-face and prevent clinical asymmetry [15] .…”

“…Thereafter, deliberation amongst authors regarding CMA, SSS and other hypoplastic disease processes of the maxillary sinuses led to inconsistencies in reporting and the emergence of additional nomenclature including ‘acquired maxillary sinus hypoplasia’ (MSH) and ‘imploding antrum syndrome’ [2] , [6] . CMA has since been classified into three distinct, but progressive stages ( Table 1 ) [1] , and based on a systematic review of all reported cases, SSS was demonstrated to be equivalent to, or a subtype of stage III CMA [2] , [7] . Furthermore, through careful clinical and radiological evaluation, CMA should be distinguished from congenital MSH which reflects a developmental anomaly and not the acquired defect of CMA.…”

Repetitive Sinus-Related Symptoms May Accelerate the Progression of Chronic Maxillary Atelectasis

“…CMA is categorized into three stages on the basis of the degree of sinus wall deformation. Stage I is characterized by a lateralized maxillary fontanel (membranous deformity); stage II is defined as inward bowing of one or more of the osseous walls (bone deformity); and stage III is characterized by enophthalmos, hypoglobus, and/or midfacial deformity (clinical deformity) [1, 5]. Although several authors have previously reported cases of patients with CMA [2, 6–9], they only described the condition at one time point.…”