Enophthalmos Due to Atelectasis of the Maxillary Sinus

Abstract

Silent sinus syndrome is a clinical entity with the constellation of progressive enophthalmos and hypoglobus due to gradual collapse of the orbital floor with opacification of the maxillary sinus, in the presence of subclinical maxillary sinusitis. It occurs secondary to maxillary sinus hypoventilation due to obstruction of the ostiomeatal unit. In this paper, a 35-year-old woman with a complaint of asymmetry in her left eye and denting of upper eyelid was reported. In the left eye, upper sulcus was deepened and there was 3-mm hypoglobus. There was no diplopia or restriction of eye movements in any gaze positions. Hertel exophthalmometry revealed a 4-mm enophthalmos on the left eye. Computed tomographic scan of the orbita and paranasal sinuses showed left maxillary sinusitis, air-fluid level, and collapse of left maxillary sinus walls. In addition, inferior bulging in the left orbital floor was also reported. The treatment was a 2-stage operation. In the first stage, she underwent endoscopic septoplasty plus left maxillary antrostomy, and in the second stage, she underwent a subciliary orbital floor repair of the iliac bone resulting in the improvement of the enophthalmos and her cosmetic appearance. Regarding this case, the literature is also reviewed in detail.

The silent sinus syndrome: protean manifestations of a rare upper respiratory disorder revisited

“…The pathophysiology of this syndrome remains unanswered in part because there is rarely a pre-symptomatic CT scan that can be used to review the stages of the process. A hypothesis for the pathophysiology is that hypoventilation of the sinus due to obstruction of the osteomeatal unit [26] creates a negative pressure [27] that leads to atelectasis [28] of the sinus with a downward displacement of the orbital floor [29]. There is disagreement over whether the obstruction of the osteomeatal unit (OMU) is caused by hypoplasia and/or if there are any cases where a normally developed sinus due to trauma, surgery, or other cause can be obstructed and consequently develop atelectasis and SSS.…”

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

“…It has been reported that some patients in the advanced stage have persistent ocular complaints after the negative pressure is removed by sinus surgery [16, 17]. This suggests that it may be necessary to remove the negative pressure while the CMA is at an early stage.…”

Clinical Evaluation of Blepharoptosis: Distinguishing Age-Related Ptosis from Masquerade Conditions

“…Enophthalmos or posterior displacement of the globe relative to the orbital rim most commonly occurs following orbital fractures, but can also be seen in silent sinus syndrome, in conditions associated with a decrease in the volume of orbital fat, and with fibrotic contracture of orbital contents such as in scirrhous breast cancer metastatic to the orbit. 4,12 Although silent sinus syndrome often presents with few clinical signs and symptoms, [13][14][15][16][17] processes that result in fibrotic contracture of orbital contents tend to be associated with restricted extraocular motility. [18][19][20][21][22][23] Hyperglobus and hypoglobus can be associated with an abnormal position of the eyelids relative to the globe and can be confused clinically as ptosis.…”