Silent sinus syndrome

Last updated
Silent sinus syndrome
Other namesImploding antrum syndrome
Specialty ENT surgery
Symptoms facial asymmetry, vision problems, headache
Diagnostic method symptoms, CT scan
Differential diagnosis sinus atelectasis, congenital sinus hypoplasia
Treatmentsurgery (endoscopic endonasal surgery)
Frequencyrare, most common in middle age

Silent sinus syndrome is a spontaneous, asymptomatic collapse of an air sinus (usually the maxillary sinus and orbital floor) associated with negative sinus pressures. It can cause painless facial asymmetry, diplopia and enophthalmos. Diagnosis is suspected based on symptoms, and can be confirmed using a CT scan. Treatment is surgical involving making an outlet for mucous drainage from the obstructed sinus, and, in some cases, paired with reconstruction of the orbital floor. It is slightly more common in middle age.

Contents

Signs and symptoms

Silent sinus syndrome can cause facial asymmetry (usually without pain), and vision problems (such as diplopia and enophthalmos). It may also cause headaches, and a feeling of fullness in the nose. [1]

Mechanism

Silent sinus syndrome most often affects the maxillary sinus, usually with a collapse of the orbital floor. It may also affect the frontal sinus or the ethmoid sinus. When the maxillary sinus is involved, the inferior oblique muscle may be damaged. [1]

The cause of silent sinus syndrome is not well understood. Bacteria in the maxillary sinus may be involved. The connection to the nose may be blocked. [1] [2] This can create negative pressure in the sinus, as secretions are reabsorbed. [1]

Risk factors for silent sinus syndrome include any anatomic condition causing obstruction of the maxillary ostium, such as ipsilateral nasal septum deviation,ipsilateral laterally deviated middle turbinate, and narrowed infundibulum.

Diagnosis

Silent sinus syndrome is first suspected based on symptoms. A CT scan can be used to confirm a diagnosis. This can have characteristic features, including maxillary sinus outlet obstruction, sinus opacification, and sinus volume loss caused by inward retraction of the sinus walls. [1]

Differential diagnosis

Silent sinus syndrome is a subtype of stage three chronic maxillary atelectasis. The distinguishing factor is that in silent sinus syndrome, there is an absence of sinusitis symptoms. [3] [4] [5] To be clear, chronic maxillary sinusitis may be a primary causitive factor in a significant number of silent sinus syndrome cases, it just may be asymptomatic. [6] [7] [8] [9] [10] [11] Silent sinus syndrome also must be distinguished from maxillary sinus hypoplasia, which is congenital. [12] [1]

Treatment

Silent sinus syndrome is usually treated with surgery. The first stage involves restoring sinus function, most often by performing an endoscopic uncinectomy (removal of uncinate process) and maxillary antrostomy. The second stage, if needed, involves reconstruction of the orbital floor. While some clinics perform the two stages simultaneously, [13] [14] [15] most authorities recommend waiting a minimum of 6 or as many as 18 months, as spontaneous remodeling of the orbital floor after the sinus repair will occur in many if not most cases. [4] [16] [17] [18] Any prolapsed contents (such as those from the orbit) must be put back in place, though this is an rare occurrence in an already rare syndrome. [2] If the inferior oblique muscle is damaged, it may be partially removed (known as myectomy). Mucus and secretions must be drained from the sinus. [1] Earlier treatment has better outcomes.

Epidemiology

Silent sinus syndrome is fairly rare. [1] [2] It can occur at any age, but is slightly more common in middle-aged people. It occurs equally in sinuses on each side of the face. [1]

History

Silent sinus syndrome was first described in 1964. [1]

Related Research Articles

<span class="mw-page-title-main">Sinusitis</span> Inflammation of the mucous membrane that lines the sinuses resulting in symptoms

Sinusitis, also known as rhinosinusitis, is inflammation of the mucous membranes that line the sinuses resulting in symptoms that may include thick nasal mucus, a plugged nose, and facial pain. Other signs and symptoms may include fever, headaches, a poor sense of smell, sore throat, a feeling that phlegm is oozing out from the back of the nose to the throat along with a necessity to clear the throat frequently and frequent attacks of cough.

<span class="mw-page-title-main">Cholesteatoma</span> Medical condition

Cholesteatoma is a destructive and expanding growth consisting of keratinizing squamous epithelium in the middle ear and/or mastoid process. Cholesteatomas are not cancerous as the name may suggest, but can cause significant problems because of their erosive and expansile properties. This can result in the destruction of the bones of the middle ear (ossicles), as well as growth through the base of the skull into the brain. They often become infected and can result in chronically draining ears. Treatment almost always consists of surgical removal.

<span class="mw-page-title-main">Nasal polyp</span> Noncancerous growths within the nose or sinuses

Nasal polyps (NP) are noncancerous growths within the nose or sinuses. Symptoms include trouble breathing through the nose, loss of smell, decreased taste, post nasal drip, and a runny nose. The growths are sac-like, movable, and nontender, though face pain may occasionally occur. They typically occur in both nostrils in those who are affected. Complications may include sinusitis and broadening of the nose.

<span class="mw-page-title-main">Diplopia</span> Double vision

Diplopia is the simultaneous perception of two images of a single object that may be displaced horizontally or vertically in relation to each other. Also called double vision, it is a loss of visual focus under regular conditions, and is often voluntary. However, when occurring involuntarily, it results in impaired function of the extraocular muscles, where both eyes are still functional, but they cannot turn to target the desired object. Problems with these muscles may be due to mechanical problems, disorders of the neuromuscular junction, disorders of the cranial nerves that innervate the muscles, and occasionally disorders involving the supranuclear oculomotor pathways or ingestion of toxins.

<span class="mw-page-title-main">Maxillary sinus</span> Largest of the paranasal sinuses, and drains into the middle meatus of the nose

The pyramid-shaped maxillary sinus is the largest of the paranasal sinuses, located in the maxilla. It drains into the middle meatus of the nose through the semilunar hiatus. It is located to the side of the nasal cavity, and below the orbit.

Balloon sinuplasty is a procedure that ear, nose and throat surgeons may use for the treatment of blocked sinuses. Patients diagnosed with sinusitis but not responding to medications may be candidates for sinus surgery. Balloon technology was initially cleared by the U.S. Food and Drug Administration in 2005 and is an endoscopic, catheter-based system for chronic sinusitis. It uses a balloon over a wire catheter to dilate sinus passageways. The balloon is inflated with the goal of dilating the sinus openings, widening the walls of the sinus passageway and restoring normal drainage.

<span class="mw-page-title-main">Sinus lift</span>

Maxillary sinus floor augmentation is a surgical procedure which aims to increase the amount of bone in the posterior maxilla, in the area of the premolar and molar teeth, by lifting the lower Schneiderian membrane and placing a bone graft.

<span class="mw-page-title-main">Cavernous sinus thrombosis</span> Medical condition

Cavernous sinus thrombosis (CST) is the formation of a blood clot within the cavernous sinus, a cavity at the base of the brain which drains deoxygenated blood from the brain back to the heart. This is a rare disorder and can be of two types–septic cavernous thrombosis and aseptic cavernous thrombosis. The most common form is septic cavernous sinus thrombosis. The cause is usually from a spreading infection in the nose, sinuses, ears, or teeth. Staphylococcus aureus and Streptococcus are often the associated bacteria.

<span class="mw-page-title-main">Functional endoscopic sinus surgery</span> Surgery to enlarge the paranasal sinus drainage pathways

Functional endoscopic sinus surgery (FESS) is a procedure that is used to treat sinusitis and other conditions that affect the sinuses. Sinusitis is an inflammation of the sinuses that can cause symptoms such as congestion, headaches, and difficulty breathing through the nose.

<span class="mw-page-title-main">Orbital blowout fracture</span> Medical condition

An orbital blowout fracture is a traumatic deformity of the orbital floor or medial wall that typically results from the impact of a blunt object larger than the orbital aperture, or eye socket. Most commonly this results in a herniation of orbital contents through the orbital fractures. The proximity of maxillary and ethmoidal sinus increases the susceptibility of the floor and medial wall for the orbital blowout fracture in these anatomical sites. Most commonly, the inferior orbital wall, or the floor, is likely to collapse, because the bones of the roof and lateral walls are robust. Although the bone forming the medial wall is the thinnest, it is buttressed by the bone separating the ethmoidal air cells. The comparatively thin bone of the floor of the orbit and roof of the maxillary sinus has no support and so the inferior wall collapses mostly. Therefore, medial wall blowout fractures are the second-most common, and superior wall, or roof and lateral wall, blowout fractures are uncommon and rare, respectively. They are characterized by double vision, sunken ocular globes, and loss of sensation of the cheek and upper gums from infraorbital nerve injury.

<span class="mw-page-title-main">Odontogenic infection</span> Infection originating in a tooth

An odontogenic infection is an infection that originates within a tooth or in the closely surrounding tissues. The term is derived from odonto- and -genic. The most common causes for odontogenic infection to be established are dental caries, deep fillings, failed root canal treatments, periodontal disease, and pericoronitis. Odontogenic infection starts as localised infection and may remain localised to the region where it started, or spread into adjacent or distant areas.

<span class="mw-page-title-main">Sinus implant</span>

A Sinus implant is a medical device that is inserted into the sinus cavity. Implants can be in conjunction with sinus surgery to treat chronic sinusitis and also in sinus augmentation to increase bone structure for placement of dental implants.

Endoscopic ear surgery (EES) is a minimally invasive alternative to traditional ear surgery and is defined as the use of the rigid endoscope, as opposed to a surgical microscope, to visualize the middle and inner ear during otologic surgery. During endoscopic ear surgery the surgeon holds the endoscope in one hand while working in the ear with the other. To allow this kind of single-handed surgery, different surgical instruments have to be used. Endoscopic visualization has improved due to high-definition video imaging and wide-field endoscopy, and being less invasive, EES is gaining importance as an adjunct to microscopic ear surgery.

Antral lavage is a largely obsolete surgical procedure in which a cannula is inserted into the maxillary sinus via the inferior meatus to allow irrigation and drainage of the sinus. It is also called proof puncture, as the presence of an infection can be proven during the procedure. Upon presence of infection, it can be considered as therapeutic puncture. Often, multiple repeated lavages are subsequently required to allow for full washout of infection.

Caldwell-Luc surgery, Caldwell-Luc operation, also known as Caldwell-Luc antrostomy, and Radical antrostomy, is an operation to remove irreversibly damaged mucosa of the maxillary sinus. It is done when maxillary sinusitis is not cured by medication or other non-invasive technique. The approach is mainly from the anterior wall of the maxilla bone. It was introduced by George Caldwell (1893)and Henry Luc (1897). The maxillary sinus is entered from two separate openings, one in the canine fossa to gain access to the antrum and other in the naso antral wall for drainage.

<span class="mw-page-title-main">Oroantral fistula</span> Medical condition

Oroantral fistula (OAF) is an epithelialised oroantral communication (OAC). OAC refers to an abnormal connection between the oral cavity and antrum. The creation of an OAC is most commonly due to the extraction of a maxillary (upper) tooth closely related to the antral floor. A small OAC may heal spontaneously but a larger OAC would require surgical closure to prevent the development of persistent OAF and chronic sinusitis.

Eustachian tube dysfunction (ETD) is a disorder where pressure abnormalities in the middle ear result in symptoms.

Muaaz Tarabichi is a Syrian otolaryngologist, lecturer, researcher, and author. He is recognized around the world as the father of endoscopic ear surgery. He is the co-founder of Tarabichi Stammberger Ear and Sinus Institute. He was elected as the chairman of the International Advisory Board of the American Academy of Otolaryngology–Head and Neck Surgery.

<span class="mw-page-title-main">Orbital emphysema</span> Medical condition

Orbital emphysema is a medical condition that refers to the trapping of air within the loose subcutaneous around the orbit that is generally characterized by sudden onset swelling and bruising at the impacted eye, with or without deterioration of vision, which the severity depends on the density of air trapped under the orbital soft tissue spaces.

Odontogenic sinusitis is a type of sinusitis, specifically caused by dental infections or procedures. Comprising approximately 10-12% of all chronic sinusitis cases, this condition primarily affects the maxillary sinus, which is in close proximity to the upper teeth.

References

  1. 1 2 3 4 5 6 7 8 9 10 Stryjewska-Makuch, Grażyna; Goroszkiewicz, Karolina; Szymocha, Jerzy; Lisowska, Grażyna; Misiołek, Maciej (3 September 2021). "Etiology, Early Diagnosis and Proper Treatment of Silent Sinus Syndrome Based on Review of the Literature and Own Experience". Journal of Oral and Maxillofacial Surgery . 80 (1): 113.e1–113.e8. doi: 10.1016/j.joms.2021.08.166 . ISSN   0278-2391. PMID   34597532. S2CID   238249024.
  2. 1 2 3 Annino, Donald J. Jr; Goguen, Laura A. (February 2008). "Silent sinus syndrome". Current Opinion in Otolaryngology & Head and Neck Surgery. 16 (1): 22–25. doi:10.1097/MOO.0b013e3282f2c9aa. ISSN   1068-9508. PMID   18197017. S2CID   35744217.
  3. ↑ Sivrice, M.; Yasan, H.; Okur, N.; Okur, E.; Buyukcelik, B.; Kumbul, Y. (10 Jan 2022). "Prevalence of chronic maxillary atelectasis: A radiological study". Journal of Laryngology & Otology. 136 (12): 1240–1244. doi: 10.1017/S0022215122000056 . PMID   35000660. S2CID   253512002 . Retrieved 20 Apr 2022.
  4. 1 2 Ho, J.; Wong, E.; Gunaratne, D.; Singh, N. (18 Feb 2019). "Chronic maxillary atelectasis (including silent sinus syndrome) can present bilaterally". Journal of Laryngology & Otology. 133 (3): 251–255. doi:10.1017/S0022215119000252. PMID   30773158. S2CID   73497631 . Retrieved 20 Apr 2022.
  5. ↑ de Dorlodot, C.; Collet, S.; Rombaux, P.; Horoi, M.; Hassid, S.; Eloy, P. (2017). "Chronic maxillary atelectasis and silent sinus syndrome: two faces of the same clinical entity". Eur Arch Otorhinolaryngol. 274 (9): 3367–73. doi:10.1007/s00405-017-4622-8. PMID   28573375. S2CID   7917436.
  6. ↑ Albadr, Fahad B. (2020). "Silent Sinus Syndrome: Interesting Computed Tomography and Magnetic Resonance Imaging Findings". Journal of Clinical Imaging Science. 10: 38. doi:10.25259/JCIS_62_2020. PMC   7332466 . PMID   32637229.
  7. ↑ Hlaváčová, Radka; Kuběna, Tomáš; Černošek, Pavel (2019). "Silent sinus syndrome". Czech and Slovak Ophthalmology. 74 (6): 245–248. doi: 10.31348/2018/6/5 . PMID   31238693. S2CID   192493349.
  8. ↑ Kikuta, Shu; Horikiri, Kyohei; Kanaya, Kaori; Kagoya, Ryoji; Kondo, Kenji; Yamasoba, Tatsuya (2017). "Repetitive Sinus-Related Symptoms May Accelerate the Progression of Chronic Maxillary Atelectasis". Case Reports in Otolaryngology. 2017: 1–5. doi: 10.1155/2017/4296195 . PMC   5512096 . PMID   28758040.
  9. ↑ Mangussi-Gomes, João; Nakanishi, Márcio; Chalita, Maria Regina; Damasco, Fabiana; Oliveira, Carlos Augusto Costa Pires (2013). "Stage II Chronic Maxillary Atelectasis Associated with Subclinical Visual Field Defect". International Archives of Otorhinolaryngology. 17 (4): 409–412. doi:10.1055/s-0033-1351679. PMC   4399176 . PMID   25992047.
  10. ↑ George, Jonathan; Durr, Megan; Pletcher, Steven (2011). "Endoscopic Treatment of Silent Sinus Syndrome with Dramatic Resolution". The Laryngoscope. 121: S230. doi:10.1002/lary.22116. S2CID   71631041.
  11. ↑ Hunt, Scott M; Tami, Thomas A (August 2000). "Sinusitis-induced enophthalmos: The sllent sinus syndrome". Ear, Nose & Throat Journal. 79 (8): 576–584. doi: 10.1177/014556130007900810 . S2CID   44310054.
  12. ↑ Gunaratne, Dakshika A.; Hasan, Zubair; Floros, Peter; Singh, Narinder (2016). "Bilateral stage I chronic maxillary atelectasis: a case report". Int J Surg Case Rep. 26: 53–6. doi:10.1016/j.ijscr.2016.07.014. PMC   4961494 . PMID   27451129.
  13. ↑ Arnon, R; Gluck, O; Winter, H; Pikkel, J; Rubinov, A (2019). "Combined Single-Step Procedure for Correction of Silent Sinus Syndrome". Case Rep Ophthalmol. 10 (1): 95–100. doi:10.1159/000498964. PMC   6489024 . PMID   31097950.
  14. ↑ Cardesín, Alda; Escamilla, Yolanda; Romera, Manuel; Molina, Juan Antonio (2013). "Single Surgical Step for Endoscopic Surgery and Orbital Reconstruction of a Silent Sinus Syndrome". Acta Otorrinolaringologica (English Edition). 64 (4): 297–299. doi:10.1016/j.otoeng.2013.08.010. ISSN   2173-5735. PMID   22421390.
  15. ↑ Sesenna, Enrico; Oretti, Gabriele; Anghinoni, Marilena Laura; Ferri, Andrea (2010). "Simultaneous management of the enophthalmos and sinus pathology in silent sinus syndrome: A report of three cases". Journal of Cranio-Maxillofacial Surgery. 38 (6): 469–472. doi:10.1016/j.jcms.2009.12.003. PMID   20096597.
  16. ↑ Sivasubramaniam, R; Sacks, R; Thornton, M (2011). "Silent sinus syndrome: dynamic changes in the position of the orbital floor after restoration of normal sinus pressure". Journal of Laryngology & Otology. 125 (12): 1239–1243. doi: 10.1017/S0022215111001952 . PMID   21835074. S2CID   23539528.
  17. ↑ Babar-Craigh, H.; Kayhanian, H.; De Silva D.J.; Rose, G.E.; Lund, V.J. (2011). "Spontaneous silent sinus syndrome (imploding antrum syndrome): Case series of 16 patients". Rhinology. 49 (3): 315–317. doi: 10.4193/Rhino10.103 . PMID   21858262.
  18. ↑ Thomas, Robert; Graham, Scott; Carter, Keith; Nerad, Jeffrey (Mar 2003). "Management of the Orbital Floor in Silent Sinus Syndrome". American Journal of Rhinology. 17 (2): 97–100. doi:10.1177/194589240301700206. PMID   12751704. S2CID   24006400.

Bibliography

This page is based on this Wikipedia article
Text is available under the CC BY-SA 4.0 license; additional terms may apply.
Images, videos and audio are available under their respective licenses.