SIG: Silent Sinus Syndrome

By: Emily Millet, Heygaan Rajakumar, Jesse Lamb, Brad Trent, Akshata Gailot, Tiffany Golek

A 51-year-old female presented with sinus pain to her dentist, who incidentally found the patient had a left-sided blocked maxillary sinus via a computed tomography scan. She was referred to an otolaryngologist.  Patient had a chief concern of pressure and discomfort in the left cheek.  Patient reported the duration of this discomfort as approximately 1 year with no additional complaints nor changes in smell or rhinorrhea.  Upon examination, the physician noted a change in eye position.  Physical exam revealed enophthalmos of the left eye with normal extraocular movements.  Additionally, the orbital floor was lower on the right side and radiological imaging showed a completely opacified left maxillary sinus.  These findings are consistent with a diagnosis of Silent Sinus Syndrome.

A left maxillary antrostomy was performed as well as a left inferior turbinate reduction to relieve the sinus blockage.  Evacuation and irrigation of the maxillary sinus was completed.  The surgery appeared to be successful and follow up was performed.  Increased rhinorrhea was noted initially, which is an unremarkable post-op finding.

Silent sinus syndrome is diagnosed when a patient has a maxillary sinus that is occluded.  The maxillary sinus becomes occluded due to negative pressure when it is blocked as a result of trauma or infection.  Chronic Silent Sinus Syndrome causes prolonged discomfort for patients with this condition.  If undetected patients can experience issues with facial deformity through the slow decay of the orbital floor – irreversibly displacing the eye. This irreparably affects vision, comfort, and decreases quality of life.  Although it is a rare disease—estimated to be less than 1 in 1,000,000— Silent Sinus Syndrome should be considered, alongside diseases such as Horner Syndrome and Myasthenia Gravis, during differential diagnoses when ptosis or enophthalmos are present as early detection is crucial to minimizing permanent eye displacement.

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