A Case of Bilateral Silent Sinus Syndrome Presenting With Chronic Ocular Surface Disease

Abstract

The silent sinus syndrome is characterized by atelectasis of the maxillary sinus in the setting of subclinical maxillary sinusitis and obstruction of the osteomeatal unit. The resultant expansion of orbital volume causes enophthalmos and hypoglobus. A review of the literature reveals only unilateral cases. The authors present a case of bilateral silent sinus syndrome presenting with chronic ocular surface disease. A 56-year-old man was referred for tarsorrhaphy to treat a chronic recurrent corneal ulcer. Exam revealed an area of corneal thinning in the left eye. The patient appeared cachectic and there was enophthalmos, hypoglobus, and lagophthalmos on both sides, left worse than right. Due to the patient's appearance and a history of sinonasal malignancy, recurrent malignancy was suspected. A systemic workup was unrevealing, and radiographic studies showed the features of silent sinus syndrome bilaterally. The patient underwent sinus surgery and placement of a left orbital floor implant.

Natural progression of bilateral maxillary silent sinus syndrome: A metachronous case report

“…Bilateral SSS is extremely rare, with only four reported cases in the literature. 5,9,19,20 Three patients were diagnosed incidentally with synchronous bilateral maxillary SSS upon initial presentation. The other case, reported by Ferri et al, 9 was that of a 27-year-old female who developed right maxillary SSS 4 months after functional endoscopic sinus surgery for the original left maxillary SSS.…”

Bilateral stage I chronic maxillary atelectasis: A case report

“…Unilateral CMA, particularly the SSS subtype, is now well documented in the literature with multiple individual and series reports. Bilateral CMA however is not, and a systematic search of PUBMED, MEDLINE and EMBASE databases revealed only six cases ( Table 2 ) [1] , [8] , [9] , [10] , [11] .…”

“…As in our case, early stage CMA is typified by sinonasal symptoms of nasal congestion, rhinorrhoea, facial pressure and pain and post-nasal drip [2] . 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] .…”

“…A deficiency in the posterior attachment of the uncinate process to the inferior turbinate and hypermobility of the medial infundibular wall have also been put forth as underlying anatomical factors promoting development of a one-way flap valve which may exacerbate ostial occlusion during times of inflammation [1] , [13] . Additionally, CMA in the context of previous chemoradiotherapy has been reported, raising the possibility of mucosal changes as long-term sequelae of adjuvant therapy being an aetiological consideration [8] . Irrespective of the aetiology, maxillary ostiomeatal obstruction and consequent sinus hypoventilation is believed to lead to sinus mucosal gas absorption and the development of a negative pressure gradient within the sinus.…”

Silent Sinus Syndrome

“…sus, nitrooční tlak a zorné pole bývají většinou v normě [14]. Silent sinus syndrom je ve většině případů jednostranný, i když v literatuře se vyskytují dva popsané případy syndromu oboustranného [9,14].…”