Unusual ocular manifestations of silent sinus syndrome

Abstract

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). This in turn may cause associated ocular occurrences of enophthalmos and hypotropia. This is a report of an 8 year-old boy with silent sinus syndrome and associated ocular motility disorders. The association between silent sinus syndrome and ocular motility disturbance has been recently described in the literature. However, this is an infrequent association, mainly in childhood.

Chronic Maxillary Atelectasis and Silent Sinus Syndrom: Report of Three Cases and Literature Review

“…CMA pathophysiology is not yet fully understood. Initially, there was the hypothesis that it was linked with hypoplasia of the maxillary [8]. This theory proved to be inconsistent after several studies showed normal sinus anatomy many years before the onset of symptoms, which favors that CMA is an acquired and progressive condition [9].…”

“…Simultaneously, osteolysis of its walls occurs through bone resorption (osteopenia due to increased osteoclastic activity) in response to the lowgrade inflammatory process, making them thinner and more fragile [11]. These two conditions favor the implosion of the maxillary sinus, with retraction of its walls and the arching of the orbital floor [8]. In this stage, CMA can already be classified into stage II, as in cases 1 and 2, or stage III if facial asymmetry, as in case 3.…”

“…Computed tomography (CT) of sinuses remains the gold standard for better visualization of bone structures and also for documenting enophthalmos and increased orbital volume [10]. Other key findings include total or partial sinus opacification, loss of the maxillary roof convexity, uprising and thinning of the orbital floor, septal deviation on the affected side and lateralization of the ipsilateral middle turbinate (obstructive factors) [8].…”

“…Case 1 also had bilateral sphenoid fungal rhinosinusitis, possibly related to the patient's nasal symptoms. The treatment of these cases is basically through surgery, consisting of reopening the maxillary sinus and removing the obstructive factor to restore ventilation and intrasinusal pressure [8]. Historically, the Caldwell-Luc procedure for maxillary sinus had been used in the past, but today, with advances in functional endoscopic sinus surgery (FESS), anthrostomy with uncinectomy or total ethmoidectomy has been stated as the best treatment option [2,7].…”