Silent Sinus Syndrome

Abstract

Silent sinus syndrome je vzácné, pomalu se rozvíjející onemocnění spojené s asymptomatickou chronickou maxilární sinusitidou s následným vtažením spodiny očnice směrem dolů. K očním projevům patří enophtalmus, hypoglobus, pseudo-retrakce horních víček a pseudo-Graefeho příznak. Diagnosticky je nepřínosnější CT vyšetření orbity a paranasálních dutin. Léčba spočívá v provedení endoskopické antrostomie, případně v rekonstrukci dna orbity. Po operaci dochází ke znovuobnovení ventilace čelistní dutiny a k úpravě očních příznaků ad integrum. Popisujeme kazuistiku pacienta s tímto syndromem, kterého jsme léčili na našem pracovišti. Klíčová slova: silent sinus syndrom, pseudo-Graefeho příznak, pseudo-retrakce víček, maxilární sinusitis, antrostomie SUMMARY SILENT SINUS SYNDROM Silent sinus syndrom is rare and slow progressive disorder associated with asymptomatic chronic maxillary sinusitis and collapse of the orbital floor. The most common manifestations are enophtalmos, hypoglobus and pseudoretraction upper eyelid. Silent sinus syndrome is almost a unilateral condition and is usually diagnosed in patients in their 30´s and 40´s. The largest risk factors is underlaying aberrant nasal anatomy. The subsequent osteomeatal complex obstruction leads to hypoventilation of the maxillary sinus and negative pressure development. The sinus cavity is filed with a combination of mucus and acellular transudate. This proces create a chronic mucosal inflammation with demineralization and collapse of the orbital floor. CT imaging is pathognomonic and shows ipsilateral maxilar sinusitis and the orbital floor is inferiorly displaced. The differential diagnosis includes chronic sinusitis, osteomyelitis, malignat sinus infiltration and orbital trauma. The endoscopic antrostomy is the gold standard to re-establish normal sinus aeration. In this article we describe patient with silent sinus syndrome, who has been treated at our clinic and his symptoms were corrected ad integrum after the surgery.

Maxillary Sinusitis as a Complication of Zygomatic Implants Placement: A Narrative Review

“…From this review, clinical outcomes of sinusitis seemed difficult to find when compared with radiological outcomes [27], which is a critical point considering the greater evidence of radiological signs [7] that can cause silent sinusitis with otorhinolaryngological consequences, both chronically and over time [44,45]. Indeed, both symptomatic and silent sinusitis were taken into account in this review to extend the analysis to the evaluation of sinusitis diagnosis (nasal endoscopy and radiological assessment) and treatment (FESS vs. simple antibiotic vs. follow-up).…”

Chronic Maxillary Atelectasis without Obstruction of the Maxillary Ostium - A Case Report

“…[ 3 ] In previously reported CMA cases, the maxillary sinus infundibulum was shown to be obstructed on CT.[ 4 ] In addition, they were often associated with conditions likely to cause occlusion of the maxillary infundibulum, such as lateralisation of the uncinate process and middle turbinate, enlargement of the ipsilateral middle meatus and ipsilateral septal deviation to the affected sinus. [ 2 , 6 ]…”

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

“…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].…”

“…In our study, only patient 3 had mild enophthalmos. Another possible finding is retraction of the upper eyelid and Graefe's pseudo-sign, which is the illusion of the lack of convergence of the upper eyelids when looking down due to unilteral hypoglobus [9]. Stage III CMA may also have these manifestations, so as sinonasal symptoms.…”