Presentation
Left side painless unilateral enophthalmos and hypoglobus.
Patient Data
On performed orbital and paranasal sinuses non-contrast MDCT images with multiple reconstruction projections, there is remarkable thinning and inward retraction or atelectasis of left maxillary sinus walls which led to the remarkable caudal bulge of left orbit floor and downward displacement, rotation, and entrapment of left inferior rectus muscle, increased orbital cavity space and decreased left maxillary sinus antral volume. The diffusely increased mucosal thickness of the maxillary sinus and obliteration of the sinus antrum are also noted which are suggestive of chronic sinusitis.
Case Discussion
Silent sinus syndrome is a rare acquired disease and is clinically defined as progressive unilateral exophthalmos, hypoglobus, and face deformity due to asymptomatic chronic sinusitis of maxillary sinus and inward retraction of the sinus walls, especially the orbit floor downward bulge but hypoplastic maxillary sinus can also lead to the development of the syndrome.
The best imaging modality for the depiction of the syndrome findings is orbital and paranasal sinuses non-contrast MDCT which clearly defines the position and shape of maxillary sinus walls and orbital bony walls, roof, and floor, and also detects the presence of mucosal thickening and fluid within the maxillary sinus antrum. MRI of the orbit and paranasal sinuses can be also useful for further evaluation.
The treatment of the silent sinus syndrome is mainly by functional endoscopic sinus surgery and transconjunctival reconstruction of the orbital floor and/or balloon sinuplasty and careful analysis of imaging findings has a crucial role in lowering surgery complications and leads to better surgical outcomes.
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