This Article  • Extract  • PDF  • Reply to article  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citing articles on HighWire  • Citing articles on ISI (36)  • Contact me when this article is cited  Related Content  • Similar articles in this journal

Arch Ophthalmol. 1999;117:1653-1654.

We present the first case of silent sinus syndrome with both normal predisease imaging findings and documented negative maxillary sinus pressure, demonstrating unequivocally the acquired nature and possible etiologic association with negative maxillary sinus pressure in at least some cases of silent sinus syndrome.

Report of a Case
A 27-year-old woman with painless, progressive sinking of her right eye over a 3-month period demonstrated 8 mm of enophthalmos and 4 mm of hypoglobus. Computed tomography showed a small, opacified right maxillary sinus with a depressed orbital floor (Figure 1), a new finding, as a magnetic resonance imaging study performed 3 years earlier (for new-onset seizures) was normal (Figure 2).

View larger version (36K): [in this window] [in a new window] Figure 1. Computed tomographic scan (axial [left] and coronal [right]) at time of presentation shows marked depression of the right orbital floor with opacification of the right maxillary sinus.

View larger version (36K): [in this window] [in a new window] Figure 2. Magnetic resonance imaging study 3 years before presentation shows normal orbits and maxillary sinuses bilaterally (left, anterior; right, posterior).

The patient underwent right orbital floor reconstruction with maxillary antrostomy. Before surgical manipulation, the maxillary os was found to be occluded, and an 18-gauge needle attached to a pressure transducer (model 90602A; SpaceLabs Inc, Redmond, Wash) was inserted into the sinus. A pressure of -23 mm Hg was recorded.

Comment
Silent sinus syndrome is spontaneous enophthalmos and hypoglobus associated with a small, ipsilateral maxillary sinus.¹ It develops over a course of days to years and is not associated with trauma. At presentation, the maxillary os may be patent or occluded, and the sinus may be partially or completely opacified.

One theory for the development of silent sinus syndrome is as follows. Occlusion of the maxillary sinus os forms an enclosed mucosal space where resorption of air creates negative pressure. Such negative pressure has been recorded in occluded rabbit maxillary sinuses² and in humans.³ Negative sinus pressure may cause thinning and inward bowing of the sinus walls, including the orbital floor, resulting in hypoglobus. If the maxillary os reopens, the sinus fluid, which initially may have provided some support for the thin orbital floor, may drain, allowing further depression of the orbital floor and globe. This may account for the rapid presentation of some patients, the variable patency of the os, and the variability of sinus fluid.

In the more than 25 cases in our experience, and a nearly equal number in the literature, we are aware of only one case of silent sinus syndrome with normal predisease neuroimaging findings⁴ and only one report of documented negative sinus pressure.³ Our patient represents the first case of silent sinus syndrome with both normal predisease imaging and documented negative maxillary sinus pressure, demonstrating unequivocally the acquired nature as well as likely etiologic association with negative maxillary sinus pressure in at least some cases of silent sinus syndrome.

AUTHOR INFORMATION

Joseph K. Davidson, MD; Charles N. S. Soparkar, MD, PhD; Jack B. Williams, MD; James R. Patrinely, MD
Houston, Tex

Corresponding author: Joseph Davidson, MD, 360 S Mt Auburn Rd, Cape Girardeau, MO 63702-2018 (e-mail: idoctor{at}iname.com).

REFERENCES
1. Soparkar CNS, Patrinely JR, Cuaycong MJ, et al. The silent sinus syndrome. Ophthalmology. 1994;101:772-778. ISI | PUBMED 2. Scharf KE, Lawson W, Shapiro JM, Gannon PJ. Pressure measurements in the normal and occluded rabbit maxillary sinus. Laryngoscope. 1995;105:570-574. ISI | PUBMED 3. Kass ES, Salman S, Montgomery WW. Manometric study of complete ostial occlusion in chronic maxillary atelectasis. Laryngoscope. 1996;106:1255-1258. PUBMED 4. Eto RT, House JM. Enophthalmos: a sequela of maxillary sinusitis. AJNR Am J Neuroradiol. 1995;16:939-941. ABSTRACT

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

"Imploding antrum" or silent sinus syndrome following naso-tracheal intubation
Hobbs et al.
Br. J. Ophthalmol. 2004;88:974-975.
FULL TEXT  

A case of unilateral enophthalmos
Roach et al.
Br. J. Radiol. 2003;76:577-578.
FULL TEXT  

The Silent Sinus Syndrome: Clinical and Radiographic Findings
Illner et al.
Am. J. Roentgenol. 2002;178:503-506.
ABSTRACT | FULL TEXT