Silent sinus syndrome: systematic review and proposal of definition, diagnosis and management

Abstract

SUMMARY Silent sinus syndrome (SSS) is a rare disease consisting of a collapse of maxillary sinus walls with concomitant orbital floor descent. Due to its rareness, the literature highlights some confusion on its definition, diagnosis and management. A PRISMA-compliant systematic review was performed on SSS with focus on definition, diagnosis and therapeutic management. Twenty-eight studies were selected, with 276 patients evaluated. The analysis revealed that the leading definition of SSS includes evidence of both enophtalmos and maxillary atelectasia. Although the definition of SSS accepts only spontaneous sinus collapse, the presence of sinonasal diseases and history of facial trauma are starting to be included in the criteria. Most studies (n = 21) considered CT scans satisfactory for diagnosis of SSS, while 7 also performed MR. The majority of SSS were successfully treated with isolated functional endoscopic sinus surgery (n = 17), sparing orbital reconstruction as a rescue procedure in case of non-satisfactory long-term resolution of signs. Although the literature is starting to coordinate on diagnosis of SSS, our review revealed the necessity of consensus on its definition and management.

Silent Sinus Syndrome: A Case of Orbital Reconstruction With Patient-specific Implant and Intraoperative Navigation System and Computed Tomography Scan

“…13 Currently, the procedure of choice to restore aeration of the maxillary sinus is FESS. 2 In our case, since we did not have an endoscope available in our department, sinus repermeabilization was performed using the Caldwell-Luc technique, a procedure traditionally performed in literature and which we have experience with. Sinus drainage and aeration was successfully achieved.…”

“…7,13,17 Accordingly, some of the cases reported in the literature waited between two and six months after sinus repermeabilization for orbital reconstruction. 2,6,17 This argument is especially relevant in children. 14 Moreover, the avoidance of orbital infections associated with the one-stage procedure has also been argued.…”

“…Silent Sinus Syndrome (SSS), also called imploding antrum syndrome or chronic maxillary atelectasis, is a very rare condition, typically consisting of asymptomatic and spontaneous collapse of the maxillary antrum walls and orbital floor. 1,2 First described by Montgomery in 1964, the term was coined by Soparkar three decades later. 1,3 Due to its singularity, the literature has often emphasized the confusion around its definition, diagnosis and optimal management.…”

“…Historically, surgical treatment consisted in Caldwell-Luc sinus surgery with inferior meatotomy and concurrent repair of the orbital floor. 2 Blackwell and colleagues described in the early nineties treating successfully SSS with endoscopic maxillary antrostomy combined with a transconjunctival orbital floor repair. 11 Currently, in order to restore the natural ventilation of the maxillary sinus, the SSS treatment of choice appears to be endoscopic maxillary antrostomy, commonly referred as functional endoscopic sinus surgery (FESS).…”

“…13,14 The proposed timespan for a potential postponed orbital reconstruction, according to the literature, is six months. 2 On the other hand, orbital volume should accurately be restored in order to avoid undesirable aesthetical consequences for the patient. In this regard, an assortment of alloplastic and autogenous options are currently available for reconstruction, being titanium plates, nylon sheets, and Medpor implants the most popular.…”