Silent sinus syndrome: surgical outcomes and a proposed algorithm for orbital reconstruction
DOI:
https://doi.org/10.51987/Rev.Hosp.Ital.B.Aires.v46i3.1342Keywords:
silent sinus syndrome, chronic maxillary atelectasis, enophthalmos, orbit, endoscopic sinus surgeryAbstract
Introduction: silent sinus syndrome (SSS) is an uncommon entity characterized by progressive maxillary atelectasis associated with inferior displacement of the orbital floor, resulting in enophthalmos and hypoglobus in the absence of significant sinonasal symptoms. Although endoscopic maxillary sinus ventilation is considered the treatment of choice, the indication for simultaneous orbital floor reconstruction remains controversial.
Objective: to describe the surgical outcomes of patients with silent sinus syndrome and to propose a therapeutic algorithm for orbital floor reconstruction.
Methods: A retrospective descriptive study was conducted including patients diagnosed with SSS who underwent surgical treatment between March 2018 and October 2025.
Results: five patients were treated; all presented with enophthalmos and one also had diplopia. All patients underwent endoscopic endonasal surgery with middle meatal antrostomy to restore maxillary sinus ventilation. Simultaneous orbital floor reconstruction was performed in two patients with severe enophthalmos and associated diplopia. During follow-up, all maxillary antrostomies remained patent. Improvement of enophthalmos was observed in all patients, and resolution of diplopia was achieved in the affected patient.
Conclusions: our findings suggest that endoscopic maxillary sinus surgery alone may be sufficient in mild cases of SSS, whereas patients with severe orbital deformity or visual symptoms may benefit from simultaneous orbital floor reconstruction.
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de Dorlodot C, Collet S, Rombaux P, et al. Chronic maxillary atelectasis and silent sinus syndrome: two faces of the same clinical entity. Eur Arch Otorhinolaryngol. 2017;274(9):3367-3373. DOI: https://doi.org/10.1007/s00405-017-4622-8
Rullan-Oliver B, del Toro-Diez E, Portela-Arraiza JC. Natural progression of bilateral maxillary silent sinus syndrome: a metachronous case report. SAGE Open Med Case Rep. 2020;8:2050313X20902339. DOI: https://doi.org/10.1177/2050313X20902339
Brandt MG, Wright ED. The silent sinus syndrome is a form of chronic maxillary atelectasis: a systematic review of all reported cases. Am J Rhinol. 2008;22(1):68-73. DOI: https://doi.org/10.2500/ajr.2008.22.3118
Soparkar CN, Patrinely JR, Cuaycong MJ, et al. The silent sinus syndrome. A cause of spontaneous enophthalmos. Ophthalmology. 1994;101(4):772-778. DOI: https://doi.org/10.1016/S0161-6420(94)31267-X
Cobb AR, Murthy R, Cousin GC, et al. Silent sinus syndrome. Br J Oral Maxillofac Surg. 2012;50(6):e81-e85. DOI: https://doi.org/10.1016/j.bjoms.2011.10.001
Rose GE, Lund VJ. Clinical features and treatment of late enophthalmos after orbital decompression: a condition suggesting cause for idiopathic "imploding antrum" (silent sinus) syndrome. Ophthalmology. 2003;110(4):819-826. DOI: https://doi.org/10.1016/S0161-6420(02)01994-2
Strabbing EM, Engin O, Telleman MAJ, et al. Post-traumatic and iatrogenic silent sinus syndrome: a case series. Oral Maxillofac Surg. 2025;29(1):106. DOI: https://doi.org/10.1007/s10006-025-01391-x
Shoji MK, Al-Sharif E, Dib El Jalbout N, et al. Orbital causes of ostiomeatal complex occlusion. Ophthalmic Plast Reconstr Surg. 2026;42(1):28-34. DOI: https://doi.org/10.1097/IOP.0000000000002965
Eloy JA, Jacobson AS, Elahi E, et al. Enophthalmos as a complication of rhinoplasty. Laryngoscope. 2006;116(6):1035-1038. DOI: https://doi.org/10.1097/01.mlg.0000217254.22699.09
Bossolesi P, Autelitano L, Brusati R, et al. The silent sinus syndrome: diagnosis and surgical treatment. Rhinology. 2008;46(4):308-316.
11.Tousidonis M, Alvarez-Mokthari S, Khayat S, et al. Contemporary treatment of silent sinus syndrome: a case report and literature review. Cureus. 2024;16(4):e57577. DOI: https://doi.org/10.7759/cureus.57577
Amin D, Chitguppi C, Xu V, et al. Volumetric analysis of the sinus and orbit in silent sinus syndrome after endoscopic sinus surgery. Otolaryngol Head Neck Surg. 2023;169(1):151-156. DOI: https://doi.org/10.1002/ohn.259
Rosso C, Saibene AM, Felisati G, et al. Silent sinus syndrome: systematic review and proposal of definition, diagnosis and management. Acta Otorhinolaryngol Ital. 2022;42(4):305-316. DOI: https://doi.org/10.14639/0392-100X-N1598
Sivasubramaniam R, Sacks R, Thornton M. Silent sinus syndrome: dynamic changes in the position of the orbital floor after restoration of normal sinus pressure. J Laryngol Otol. 2011;125(12):1239-1243. DOI: https://doi.org/10.1017/S0022215111001952
Babar-Craig H, Kayhanian H, De Silva DJ, et al. Spontaneous silent sinus syndrome (imploding antrum syndrome): case series of 16 patients. Rhinology. 2011;49(3):315-317. DOI: https://doi.org/10.4193/Rhino10.103
Sesenna E, Oretti G, Anghinoni ML, et al. Simultaneous management of the enophthalmos and sinus pathology in silent sinus syndrome: a report of three cases. J Craniomaxillofac Surg. 2010;38(6):469-472. DOI: https://doi.org/10.1016/j.jcms.2009.12.003
Arnon R, Gluck O, Winter H, et al. Combined single-step procedure for correction of silent sinus syndrome. Case Rep Ophthalmol. 2019;10(1):95-100. DOI: https://doi.org/10.1159/000498964
Clarós P, Sobolewska AZ, Cardesa A, et al. Silent sinus syndrome: combined sinus surgery and orbital reconstruction - report of 15 cases. Acta Otolaryngol. 2019;139(1):64-69. DOI: https://doi.org/10.1080/00016489.2018.1542161
Shoji MK, Legala AR, Al-Sharif E, et al. Outcomes of sinus surgery and orbital reconstruction in silent sinus syndrome: a retrospective cohort study. J Craniofac Surg. 2025;36(8):e1247-e1251. DOI: https://doi.org/10.1097/SCS.0000000000011897
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