The Silent Sinus Syndrome: A Cause of Spontaneous Enophthalmos

doi:10.1016/S0161-6420(94)31267-X

Ophthalmology

Volume 101, Issue 4, April 1994, Pages 772-778

https://doi.org/10.1016/S0161-6420(94)31267-X Get rights and content

Purpose: Spontaneous enophthalmos and hypoglobus, in the absence of other symptoms and unrelated to trauma or surgery, may be alarming to both physician and patient. The authors describe the clinicopathologic features of a benign syndrome (“silent sinus syndrome”) with this constellation of features and discuss the possible pathophysiology.

Methods: A multicenter retrospective search for similar clinical cases was performed. All clinical records, computed tomographs, and pathology reports for each case were reviewed at one center. A literature search for similar cases also was conducted.

Results: Nineteen cases of a new syndrome are presented. This syndrome affects individuals at approximately the fourth decade of life (average age, 36 years; range, 29–46 years); is characterized by bone resorption and remodeling of the orbital floor due to otherwise asymptomatic maxillary sinus disease; is associated with ipsilateral maxillary sinus hypoplasia; and is not fully explained by any previously described, classic cystic lesion of the maxillary antrum.

Conclusion: Enophthalmos and hypoglobus unassociated with prior trauma, surgery, or other symptoms may represent “silent sinus syndrome,” which is ipsilateral maxillary sinus hypoplasia and orbital floor resorption.

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Cited by (224)

Silent sinus syndrome: potentially misleading features that should be recognized
2023, Canadian Journal of Ophthalmology
Silent sinus syndrome (SSS) usually manifests clinically as hypoglobus and enophthalmos. Patients may experience different symptoms and may present to an assortment of specialties and delay diagnosis and management. The objective of this article was to describe the different and sometimes misleading signs and symptoms of SSS to improve the level of suspicion and reduce time to diagnosis.
A retrospective consecutive audit of the records of all patients diagnosed with SSS between 2015 and 2019 in the Oxford Eye Hospital, Oxford University Hospitals NHS Foundation Trust. Demographic and clinical data including presentation, diagnosis, and symptoms were obtained from the patients’ medical files.
Ten patients were included; mean age was 42.5 ± 11.5 years (range, 16–56 years). Four patients were initially referred to an ophthalmologist with globe asymmetry, diplopia, eyelid asymmetry, or retraction. Three patients were initially referred to an ear, nose, and throat specialist with facial asymmetry or infraorbital paraesthesia. Two patients were referred from the maxillofacial department with an incidental finding, and the last patient was seen initially by the neurology team with headaches.
SSS has a variable presentation. Patients may have common or misleading signs. Patients may attend different clinics and subspecialties, and physicians should be aware of the broad range of presenting signs in this condition to prevent delay in diagnosis and further morbidity.
Du point de vue clinique, le syndrome du sinus silencieux (SSS) prend habituellement la forme d'un hypoglobe et d'une énophtalmie. Cela dit, les patients peuvent présenter tout un éventail de symptômes et consulter divers spécialistes, ce qui retarde le diagnostic et le traitement. Le présent article vise à décrire les différents signes et symptômes, parfois trompeurs, du SSS pour accroître la vigilance des médecins de façon à raccourcir le délai avant l’établissement du diagnostic.
Nous avons procédé à une vérification rétrospective des dossiers médicaux de tous les patients consécutifs qui ont reçu un diagnostic de SSS entre 2015 et 2019 à l'Oxford Eye Hospital. Les données démographiques et cliniques – résultats de l'examen initial, diagnostic et symptômes – ont été tirées des dossiers médicaux des patients.
Dix patients ont été inclus; leur âge moyen s’élevait à 42,5 ± 11,5 ans (fourchette : 16–56 ans). De ce nombre, 4 patients avaient d'abord été adressés à un ophtalmologiste en raison d'une asymétrie des globes oculaires, d'une diplopie ou encore d'une asymétrie ou d'une rétraction des paupières. Trois autres patients avaient d'abord été adressés à un otorhinolaryngologiste en raison d'une asymétrie du visage ou d'une paresthésie infra-orbitaire. Deux patients avaient d'abord consulté un spécialiste maxillofacial pour ensuite nous être adressés en raison d'une découverte fortuite. Enfin, le dernier patient a d'abord consulté un neurologue pour cause de céphalées.
Le SSS peut prendre plusieurs formes, dont les signes et les symptômes se chevauchent et peuvent être trompeurs. Voilà qui peut amener les patients à consulter plusieurs spécialistes dans diverses cliniques. Les médecins doivent donc être au courant de la variété des signes qui peuvent annoncer le SSS, afin d’éviter les délais en matière de diagnostic et les risques de morbidité supplémentaire.
Silent sinus syndrome: Reduction of surgical invasiveness in an underdiagnosed clinical entity
2022, American Journal of Otolaryngology - Head and Neck Medicine and Surgery
The aim of this study was to investigate our experience in the management of silent sinus syndrome.
The records of all patients treated for silent sinus syndrome between 2011 and 2021 were evaluated retrospectively. Data were collected on epidemiological parameters (age, gender), referral specialty, imaging findings, surgical approach, and management.
In total, nine cases made up our final study sample (5 men, 4 women; male-female ratio 1:0.8). Their mean age was 39 years (range: 19–71 years). Besides the typical imaging findings (orbital floor depression, maxillary sinus atelectasis with ostium occlusion), lateralization of the uncinate process could be seen in seven cases (77.8 %) and ipsilateral septal deviation in six cases (66.6 %). Four cases were managed by means of middle meatal antrostomy and five with additional reconstruction of the orbital floor (transconjuctival approach in two cases, endonasal endoscopic approach in three cases). Enopthalmus recovered in all cases; diplopia (3 cases) recovered completely in two cases and partly in one case.
Reduced surgical invasiveness in silent sinus syndrome, with management of the cause (maxillary sinus hypoventilation) and the sequel (orbital floor depression) using the same endoscopic approach, is associated with an acceptable clinical outcome.
Etiology, Early Diagnosis and Proper Treatment of Silent Sinus Syndrome Based on Review of the Literature and Own Experience
2022, Journal of Oral and Maxillofacial Surgery
The authors’ aim was to review the literature in terms of the etiology of the syndrome, the frequency of Silent Sinus Syndrome (SSS) and surgical procedure, as well as to present their own experience.
The authors used PubMed, Medline, and Science Direct websites to find and review the most significant papers related to SSS. The case reports of SSS published between 2010 and 2020 were reviewed. A retrospective case review of 8 patients with SSS treated at the authors’ departments was done.
The silent sinus syndrome has been reported in both children and adults. It is relatively rare and should be differentiated from congenital sinus hypoplasia or atelectasis. It most often affects the maxillary sinus. SSS is usually diagnosed when facial asymmetry or vision problems occur. Late diagnosis requires endoscopic sinus surgery, involving orbital wall reconstruction. The etiology of the syndrome, including the role of bacterial flora found in the sinuses, is unclear.
Early diagnosis of SSS enables avoiding orbital complications and limits surgical intervention to endoscopic surgery. Further research into bacteriology may help to understand the pathophysiology of the silent sinus syndrome.
Prevalence of chronic maxillary atelectasis: a radiological study
2022, Journal of Laryngology and Otology
Complications of combination intranasal corticosteroids and anti-retroviral therapy
2021, Journal of Laryngology and Otology
Delayed onset enophthalmos and hypoglobus mimicking silent sinus syndrome following midface trauma
2024, BMJ Case Reports

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: Supported in part by an unrestricted grant to the Department of Ophthalmology, Baylor College of Medicine, from Research to Prevent Blindness Inc, New York, New York.

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The Silent Sinus Syndrome: A Cause of Spontaneous Enophthalmos

Am J Ophthalmol

Ophthalmology

J Am Dent Assoc

Oral Surg Oral Med Oral Pathol

Oral Surg Oral Med Oral Pathol

Otolaryngol Clin North Am

Ophthalmology

Oral Surg Oral Med Oral Pathol

Chronic sinus disease: a rare cause of enophthalmos

Ann Otol Rhinol Laryngol

Mucocele of the maxillary sinus causing enophthalmos

Eye Ear Nose Throat Mon