1/18. The spectrum of presentation of silent sinus syndrome.The general clinical, ophthalmologic, and radiologic features of three patients with silent sinus syndrome are presented. All three patients were treated surgically. The cases of these patients illustrate the spectrum of presentation of silent sinus syndrome, including enophthalmos, hypophthalmos, transient vertical diplopia, lid retraction, lagophthalmos, and blurred vision. All patients had sinus disease, and all patients improved after surgery using functional endoscopic sinus surgery techniques. The protean manifestations of silent sinus syndrome can be identified, thereby allowing appropriate management.- - - - - - - - - - ranking = 1keywords = enophthalmos (Clic here for more details about this article) |
2/18. Clinical and radiologic characteristics of the imploding antrum, or "silent sinus," syndrome.OBJECTIVES: To present the clinical and radiologic details of a series of patients with the imploding antrum, or silent sinus, syndrome, together with examples of the surgical findings and management. DESIGN: Retrospective, noncomparative case series. PARTICIPANTS: Fourteen patients assessed in the Orbital Service at Moorfields eye Hospital. MAIN OUTCOME MEASURES: Changes of clinical signs, symptoms, and radiologic signs. RESULTS: Seven men and seven women, between the ages of 25 and 78 years (mean, 41.3 years), had unilateral enophthalmos, their having noted the anomaly for an average of 8 months (range, 1-36 months). All patients were nonsmokers. There was no evidence of progression of the condition in eight cases followed up for up to 63 months. On the affected side, there was 1 to 4 mm enophthalmos and up to 4 mm hypoglobus, with secondary narrowing of the vertical palpebral aperture in some cases, but no effect on visual function, and there was significant disturbance of ocular motility in only one case. The condition is characterized radiologically by a smooth inward bowing of the walls of the maxillary antrum on the affected side, with secondary enophthalmos and hypoglobus. In all 14 cases, the maxillary roof (orbital floor) was drawn downwards, and the medial and posterolateral walls of the maxilla were concave in 13 cases where it could be assessed. In one patient, there was associated inward collapse of the ipsilateral ethmoid complex. There was a patchy loss of mineral from the maxillary roof in 9 of 13 cases and, where the posterolateral maxillary wall was affected, there was a concomitant increase in the radiolucency (fat) of the pterygopalatine fossa. Some soft-tissue changes were present in the affected antrum in all 14 patients, and there was an air-fluid level in three patients. In 12 patients where septal deviation was present, this was to the affected side in 10 (83%), and an abnormally directed middle turbinate was also frequently observed (10 of 14 cases). CONCLUSIONS: The silent sinus syndrome mainly presents as unilateral enophthalmos in younger people and has very characteristic clinical and radiologic signs with, in many cases, abnormal intranasal anatomic characteristics on the affected side. The condition may be exclusive to nonsmokers. The acute onset and long-term stability of the condition suggests that, although chronic and largely asymptomatic sinus disease may be the underlying cause, an acute event precipitates collapse of the orbital floor or (in fact) a widespread "implosion" of all antral walls resulting from maxillary atelectasis. Therefore, we prefer the term imploding antrum syndrome-describing the relatively acute, symptomatic, event-rather than the name silent sinus syndrome, which relates to a putative underlying mechanism.- - - - - - - - - - ranking = 4keywords = enophthalmos (Clic here for more details about this article) |
3/18. Clinical features and treatment of late enophthalmos after orbital decompression: a condition suggesting cause for idiopathic "imploding antrum" (silent sinus) syndrome.PURPOSE: To review the clinical and radiologic characteristics of a group of patients who experienced late enophthalmos after bone-removing orbital decompression. The surgical management of these patients is presented and a hypothesis proposed to explain the idiopathic "imploding antrum" ("silent sinus") syndrome. DESIGN: Retrospective, noncomparative case series. PARTICIPANTS: Six patients experienced relative enophthalmos, hypoglobus, and upper eyelid sulcus deformity at between 3 and 6 months after bone-removing orbital decompression for thyroid orbitopathy. Five left orbits and one right orbit were affected. INTERVENTION: All patients underwent middle meatal antrostomy, together with mobilization and elevation of the collapsed orbital contents by firm packing of the affected maxillary antrum through a buccal antrostomy, the pack being removed about 3 weeks after placement. MAIN OUTCOME MEASURES: Symptomatic improvement and reduction in the degree of relative enophthalmos, hypoglobus, and upper eyelid sulcus deformity. RESULTS: Late-onset enophthalmos after orbital decompression was associated with clinical and radiologic features that resemble the idiopathic imploding antrum syndrome. In all patients, the ethmoidal infundibulum was obstructed by prolapsed orbital fat with secondary antral consolidation, and inward bowing of the maxillary walls was present in five of six patients. After antral drainage and packing, there was an improvement in enophthalmos (mean, 2.7 mm; range, 0-4 mm) and all but one globe returned to within 2 mm of exophthalmometry of the contralateral eye. For recurrent enophthalmos in two patients (minor in one patient and marked in the other), later repair of the orbital floor was undertaken through a lower eyelid swinging flap, using porous polythene sheet, with good cosmetic outcome. CONCLUSIONS: Late-onset enophthalmos after bone-removing orbital decompression seems to be the result of obstruction of maxillary antral aeration, with secondary fluid retention and a subatmospheric pressure in the sinus. This iatrogenic condition, associated in most cases with inward collapse of the maxillary walls, provides a guide to a hypothetical mechanism for the idiopathic imploding antrum (silent sinus) syndrome.- - - - - - - - - - ranking = 11keywords = enophthalmos (Clic here for more details about this article) |
4/18. Conservative treatment of vertical diplopia in a patient with silent sinus syndrome.Silent sinus syndrome is a rare disease of the maxillary sinus characterized by bony absorption processes leading to progressive sinus wall thinning with consecutive enophthalmos and hypoglobus. It represents a benign cause of acquired enophthalmos and is often accompanied by painless vertical diplopia, the latter treated surgically in all cases published to date. We report a 56-year-old patient with silent sinus syndrome in whom vertical diplopia was treated with prisms showing that conservative treatment alone may, in mild cases, be an effective alternative to reconstructive surgery.- - - - - - - - - - ranking = 2keywords = enophthalmos (Clic here for more details about this article) |
5/18. Misdiagnosis of silent sinus syndrome.PURPOSE: To review cases of spontaneous enophthalmos erroneously diagnosed as silent sinus syndrome to identify other inflammatory disorders with a similar clinical presentation. methods: Retrospective observational case series. Chart reviews were performed covering encounters over a 5-year period, searching for patients referred to two physicians with an incorrect diagnosis of silent sinus syndrome. Only cases of acquired enophthalmos of reported nontraumatic or nonneoplastic cause were included. Particular attention was directed toward noting clinical features of upper eyelid position and periocular atrophy. RESULTS: Nineteen cases of erroneous referral for silent sinus syndrome were identified. Fourteen of these cases were due to tumor, trauma, congenital facial asymmetry, or diffuse facial lipodystrophy. Among the remaining cases, four were diagnosed as Parry-Romberg syndrome and one as linear scleroderma. CONCLUSIONS: Parry-Romberg syndrome and linear scleroderma must be distinguished from silent sinus syndrome as causes of inflammatory-mediated, spontaneous enophthalmos.- - - - - - - - - - ranking = 3keywords = enophthalmos (Clic here for more details about this article) |
6/18. Spontaneous enophthalmos: silent sinus syndrome.Spontaneous enophthalmos unrelated to trauma or surgery is rare. The term 'silent sinus syndrome' has been used to describe this process where, in particular, there is an absence of any sino-nasal symptoms. The enophthalmos and hypoglobus that occurs in these subjects is caused by atelectasis of the maxillary antrum, which itself appears to be due to chronic maxillary hypoventilation. We report a case of silent sinus syndrome that arose following insertion of a nasogastric tube. Whilst acute paranasal sinusitis is a well-described sequela of nasal intubation, this association with a rare, and as yet unexplained, phenomenon may go some way to explain its aetiology.- - - - - - - - - - ranking = 6keywords = enophthalmos (Clic here for more details about this article) |
7/18. Silent sinus syndrome.BACKGROUND: Silent sinus syndrome (SSS) is similar to and a subset of chronic maxillary atelectasis (CMA), which refers to a persistent decrease in sinus maxillary volume due to inward retraction of the maxillary sinus walls secondary to obstruction of the osteomeatal complex. It differs from CMA, however, in that there is no pain or maxillary sinus congestion. patients with SSS usually manifest spontaneous unilateral enophthalmos and hypoglobus, with no history of facial trauma or surgery. They also do not have any nasal symptoms, sinusitis, or pain. CASE REPORT: A 28-year-old woman with asymptomatic enophthalmos and hypoglobus is described. The presentaton, diagnosis, and treatment of silent sinus syndrome are discussed. CONCLUSIONS: Silent sinus syndrome should be included in the differential diagnosis of enophthalmos and hypoglobus in the absence of trauma, surgery, and nasal symptoms. In addition to a thorough eye examination, axial and coronal computerized tomography of the sinus and orbits should be obtained to confirm the diagnosis.- - - - - - - - - - ranking = 3keywords = enophthalmos (Clic here for more details about this article) |
8/18. Management of enophthalmos and superior sulcus deformity induced by the silent sinus syndrome.BACKGROUND: Silent sinus syndrome is a dysfunction of the maxillary sinus that induces a progressive and asymptomatic enophthalmos with prominent deep superior sulcus deformity. methods: Two cases of silent sinus syndrome are reported, and the simultaneous management of both enophthalmos and superior sulcus deformity caused by this syndrome is discussed. RESULTS: The patients underwent surgical endoscopic maxillary meatotomy and transconjunctival subperiosteal implantation of porous polyethylene sheets. The treatment successfully corrected both the enophthalmos and the upper eyelid sulcus deformity. However, small degrees of vertical eye dystopia were observed. CONCLUSIONS: Silent sinus syndrome is a rare cause of enophthalmos and superior sulcus deformity. Orbital floor implants can be used to increase the volume of the orbital contents, but vertical eye dystopia is likely to be induced if this method of treatment is the only option chosen.- - - - - - - - - - ranking = 8keywords = enophthalmos (Clic here for more details about this article) |
9/18. Ethmoidal involvement in "imploding" (silent) sinus syndrome.A 32-year-old woman presented with mild enophthalmos of her right eye of recent onset. A CT scan revealed characteristic findings of silent sinus syndrome, involving not just the maxillary but the less frequently reported ethmoid sinus as well. A clinically and radiologically noted shrunken and lateralized middle turbinate was a strong pointer to the suspected cause. The symptoms resolved with endoscopic sinus drainage.- - - - - - - - - - ranking = 1keywords = enophthalmos (Clic here for more details about this article) |
10/18. Management of spontaneous enophthalmos due to silent sinus syndrome: a case report.Silent sinus syndrome (SSS) is a rare disease exhibiting unilateral enophthalmos and hypoglobus. A 26-year-old white female presented with right side enophthalmos and hypoglobus. There was no history of previous trauma or maxillary sinus diseases. A CT scan showed an opacified right maxillary antrum with decreased volume and downward bowing of the right orbital floor. From clinical and radiological findings the diagnosis SSS was made. Biopsies were collected from the maxillary sinus for the exclusion of malignancy. Two months later orbital floor reconstruction was carried out. Before antrostomy of the affected maxillary sinus, a relative enophthalmos of 4mm was determined. Five days after antrostomy the value reduced to 2.3mm. During the following 2 months the enophthalmos remained constant. At the end of the operation for orbital floor reconstruction it was 0.1mm. Five days after surgery the relative enophthalmos increased to 0.8mm. The value remained constant during the following 3 months. Initial antrostomy of the affected maxillary sinus may lead to a relevant, spontaneous reduction of enophthalmos. After a minimum period of 2 months a re-evaluation should be made, if a reconstruction of the orbital floor is still necessary for the correction of the globe position.- - - - - - - - - - ranking = 10keywords = enophthalmos (Clic here for more details about this article) |
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