Misdiagnosis of Silent Sinus Syndrome

Abstract

Parry-Romberg syndrome and linear scleroderma must be distinguished from silent sinus syndrome as causes of inflammatory-mediated, spontaneous enophthalmos.

Infratemporal fossa fat enlargement in chronic maxillary atelectasis

“…Burroughs et al reviewed referrals with incorrect diagnosis of silent sinus syndrome over 5 years and found 19 cases that included tumour, trauma, congenital facial asymmetry, diffuse facial lipodystrophy, Parry–Romberg syndrome and linear scleroderma 9. In the last two, fat atrophy and facial asymmetry are distinguished phenomena.…”

Enophthalmos as a Complication of Rhinoplasty

“…In their definition, they characterized silent sinus syndrome as unilateral progressive enophthalmos and hypoglobus secondary to downward bowing of the orbital floor and maxillary sinus opacification without symptoms of inflammatory sinonasal disease. This definition was paramount in differentiating silent sinus syndrome from the similar condition known as chronic maxillary sinus atelectasis, in which enophthalmos and hypoglobus are associated with obvious inflammatory sinus disease 3,4 …”

“…Various other conditions can manifest with enophthalmos and hypoglobus and mimic silent sinus syndrome. In fact, chronic sinusitis, orbital trauma, systemic inflammatory disease such as scleroderma, vasculitis such as Wagener granulomatosis, and malignant infiltration have all been cited as causative of enophthalmos and hypoglobus 3 . Burroughs et al 4 reported 18 cases misdiagnosed as silent sinus syndrome with emphasis on four cases of Parry‐Romberg syndrome (progressive hemifacial atrophy) and one case of linear scleroderma.…”

“…This definition was paramount in differentiating silent sinus syndrome from the similar condition known as chronic maxillary sinus atelectasis, in which enophthalmos and hypoglobus are associated with obvious inflammatory sinus disease. 3,4 Many explanations have been postulated to explain the pathophysiology behind this condition. Currently, the most accepted theory is hypoventilation of the maxillary sinus secondary to obstruction of the ostiomeatal complex, leading to negative sinus pressure and eventual enophthalmos and hypoglobus (Fig.…”

Imaging Rhinosinusitis

“…In this condition, the maxillary sinus volume is small, but should not be misinterpreted as maxillary sinus hypoplasia in where the molar eminence will not be pneumatised. Enophthalmos without the typical CT findings should not be misdiagnosed as silent sinusitis (Burroughs, 2003). Fig.…”