Silent sinus syndrome

Case contributed by Badis Al Harbawi
Diagnosis probable


Headache and mild facial asymmetry.

Patient Data

Age: 35 years
Gender: Male

The left maxillary sinus is small in volume with mucosal thickening and blocked left maxillary ostium. There is posterior bowing of anterior wall of the left maxillary sinus, in addition to lateral bowing of its medial wall and inferior bowing of left orbital floor resulting in mild orbital and facial asymmetry. Mild left enophthalmos is also seen. 

Mild mucosal thickening is seen in the ethmoid, sphenoid and right maxillary sinuses.

There is left sided deviation of the nasal septum. The turbinates are normal in size. No nasopharyngeal masses. 

Case Discussion

The silent sinus syndrome is a rare entity that is well-known to the ophthalmologist and ENT surgeons. This condition is characterized by painless enophthalmos and facial asymmetry caused by chronic maxillary sinus atelectasis.

The diagnosis is usually made clinically, however,  imaging of the sinuses can help in the diagnosis. CT scan is the imaging modality of choice and findings include:

  • Small opacified maxillary sinus.
  • Inferior bowing of the orbital floor with enophthalmos.
  • Lateral bowing of medial wall of the maxillary sinus.
  • Posterior bowing of anterior wall of the maxillary sinus and anteromedial bowing of posterolateral wall of the maxillary sinus. Blocked ostiomeatal complex.
  • Flattening of malar eminence and facial asymmetry.

Differential diagnosis include:

  • Congenital hypoplastic maxillary sinus.
  • Post-traumatic deformity of the maxillary sinus.
  • Chronic Sinusitis.

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