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Medica Jadertina, Vol. 52 No. Suplement 1, 2022.

Meeting abstract

The challenging Silent sinus syndrome

A. Varini orcid id orcid.org/0000-0002-6371-9261 ; ENT Department Policlinico Triestino, Via Bonaparte 4, Trieste, 34123, Italy; ENT Department Policlinico San Marco, Via Zanotto 40 Mestre (Venice), 30170, Italy
G. Del Piero ; ENT Department Policlinico Triestino, Via Bonaparte 4, Trieste, 34123, Italy
L. Papanikolla ; ENT Department Policlinico Triestino, Via Bonaparte 4, Trieste, 34123, Italy
C. Pisanti ; ENT Department Policlinico Triestino, Via Bonaparte 4, Trieste, 34123, Italy
F. Nicastro ; ENT Department Policlinico Triestino, Via Bonaparte 4, Trieste, 34123, Italy
M. Spanio ; ENT Department Policlinico Triestino, Via Bonaparte 4, Trieste, 34123, Italy
P. Tattoni ; ENT Department Policlinico San Marco, Via Zanotto 40 Mestre (Venice), 30170, Italy
F. Aielli ; ENT Department Policlinico San Marco, Via Zanotto 40 Mestre (Venice), 30170, Italy
R. Luppari ; ENT Department Policlinico San Marco, Via Zanotto 40 Mestre (Venice), 30170, Italy

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Abstract

The Silent sinus syndrome (SSS), first described in 1964 by Montgomery, is considered a relatively
rare pathological entity, but it is presumably underdiagnosed and underreported. Terms such as imploding
antrum and chronic maxillary atelectasis (CMA) have interchangeably been used to describe this syndrome,
even though CMA has been postulated to represent either a different entity or a stage of evolution of the same
disease. Bilateral involvement has been documented in a limited number of cases. Silent ethmoid sinus and
silent frontal sinus syndromes have been described. The prevalent initial presentation is facial asymmetry with
progressive “silent” painless unilateral enophthalmos and hypoglobus, and rarely diplopia. Isolated maxillary
sinus hypoplasia must be differentiated. The etiopathogenesis is poorly understood and still under debate.
According to the diagnostic criteria, SSS should spontaneously develops in absence of previous trauma or
surgery. Secondary SSS to trauma or surgery, or to other causes like inflammation or tumor, has been
documented in literature. The diagnosis relies on the CT, which typically shows unilateral hypoplastic and
opacified maxillary sinus with inward bowing and remodeling of the sinus walls and inferior displacement of
the orbital floor, an enlarged retroantral fat pad, a lateralized uncinate process, and a blocked ostiomeatal
complex. The treatment of SSS aims at restoring the eye position and orbital floor height, to prevent
progression of enophthalmos, to restore ventilation and drainage of the sinus. These objectives are achieved in
single or two-stage surgery. The timing for management of the orbital floor is still under debate.The universally
accepted treatment is surgical and usually accomplished by endoscopic sinus surgery. Associated middle
turbinate hypertrophy and septal deviation must be previously addressed. Precise and gentle endoscopic
removal of the obstruction of the ethmoid infundibulum, simply performing an inferior posteroanterior
uncinectomy, since the uncinate process has constantly been found atelectatic and adherent to the lateral nasal
wall, can reestablish the patency of the natural maxillary ostium. In our experience, following middle meatal
antrostomy, long-term observation with staged orbital surgery, if required, is recommended. In this study, we
present our cases with a focus on surgical stratagems developed in order to reduce the risk of injuring the orbit
and to achieve long-lasting results.

Keywords

Silent sinus syndrome; hypoplastic sinus, orbi

Hrčak ID:

272985

URI

https://hrcak.srce.hr/272985

Publication date:

27.2.2022.

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