Ocular symptoms and modern approaches to the treatment of silent sinus syndrome

Grusha Y.O.; Sheptulin V.A.

doi:https://doi.org/10.17116/oftalma202414005163

Grusha Y.O.

Krasnov Research Institute of Eye Diseases;
Sechenov First Moscow State Medical University (Sechenov University)

ORCID: 0000-0002-6461-8243

Sheptulin V.A.

Krasnov Research Institute of Eye Diseases

ORCID: 0000-0002-5709-4795

Ocular symptoms and modern approaches to the treatment of silent sinus syndrome

Authors:

Grusha Y.O., Sheptulin V.A.

More about the authors

Journal: Russian Annals of Ophthalmology. 2024;140(5): 63‑69

DOI: 10.17116/oftalma202414005163

Read: 1208 times

Contact the author

Table of contents

To cite this article:

Grusha YO, Sheptulin VA. Ocular symptoms and modern approaches to the treatment of silent sinus syndrome. Russian Annals of Ophthalmology. 2024;140(5):63‑69. (In Russ.)
https://doi.org/10.17116/oftalma202414005163

Подписка 2026 Вестник офтальмологии (Russian Annals of Ophthalmology)

Использование инфографики авторами научных работ

Abstract:

Silent sinus syndrome (SSS) is a rare condition characterized by spontaneous, progressive enophthalmos and hypophthalmos due to the collapse of the maxillary sinus, often accompanied by subclinical sinusitis.

PURPOSE

This study evaluates the clinical outcomes of treating patients with silent sinus syndrome (SSS) using a two-stage treatment approach.

MATERIAL AND METHODS

The study included 22 patients (22 eyes) with SSS who were examined at the Krasnov Research Institute of Eye Diseases between 2011 and 2023. Patients presented with complaints of enophthalmos, hypophthalmos, binocular diplopia, and decreased vision. The mean age was 36 [26; 48] years, male-to-female ratio was 6:16. All patients underwent Hertel exophthalmometry, measurement of palpebral fissure, assessment of binocular status, as well as multislice computed tomography (MSCT) of the paranasal sinuses at admission, 3 months after the first stage, and during the follow-up after the second stage of treatment. The first stage involved functional endoscopic sinus surgery (FESS), and the second stage involved correction of the eyeball position.

RESULTS

The follow-up period lasted a mean of 28 [6; 120] months. After FESS, 12 patients (12 eyes) were satisfied with the cosmetic outcome, while 10 patients (10 eyes) decided to apply for a second stage of treatment. Two patients underwent nonsurgical correction of enophthalmos with intraorbital injections, and eight underwent orbital reconstruction with implant placement. Treatment outcomes showed a significant reduction in mean value of enophthalmos (from 3.5 mm to 0.5 mm), a decrease in upper eyelid excursion compared to the contralateral side (Δ changed from 4 to 1 mm), reduction of hypophthalmos (from 2 mm to 0 mm), improvements in corneal condition and ocular motility, and regression of diplopia. No complications were registered.

CONCLUSION

Diagnosis and treatment of SSS require a multidisciplinary approach. The two-stage treatment strategy for SSS provides good functional and aesthetic outcomes.

Keywords:

silent sinus syndrome

enophthalmos

hypophthalmos

orbital reconstruction

hyaluronic acid gel

Authors:

Grusha Y.O.

Krasnov Research Institute of Eye Diseases;
Sechenov First Moscow State Medical University (Sechenov University)

ORCID: 0000-0002-6461-8243

Sheptulin V.A.

Krasnov Research Institute of Eye Diseases

ORCID: 0000-0002-5709-4795

Received:

21.05.2024

Accepted:

22.08.2024

Close metadata

References:

Soparkar CN, Patrinely JR, Cuaycong MJ, et al. The silent sinus syndrome: a cause of spontaneous enophthalmos. Ophthalmology. 1994;101:772-778. https://doi.org/10.1016/s0161-6420(94)31267-x
Montgomery WW. Mucocele of the maxillary sinus causing enophthalmos. Eye Ear Nose Throat Mon. 1964;43:41-44.
Cobb A, Murthy R, Cousin G. Silent sinus syndrome. Br J Oral Maxillofac Surg. 2012;50:1045-1048. https://doi.org/10.1016/j.bjoms.2011.10.001
Michelle L, Du AT, Abiri A, Kuan EC. Clinical manifestations, management, and outcomes of primary silent sinus syndrome: a systematic review. Rhinology. 2023 Aug 1;61(4):297-311. https://doi.org/10.4193/Rhin23.028
Eyigor H, Cekic B, Turgut C, Toban D, et al. Is there a correlation between the clinical findings and the radiological findings in chronic maxillary sinus atelectasis? J Cranio-Maxillofacial Surg. 2016;44:820-826. https://doi.org/10.1016/j.jcms.2016.04.004
Rose GE, Sandy C, Hallberg L, et al. Clinical and radiologic characteristics of the imploding antrum, or “silent sinus,” syndrome. Ophthalmology. 2003; 110:811-818. https://doi.org/10.1016/S0161-6420(02)01993-0
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;110:819-826. https://doi.org/10.1016/S0161-6420(02)01994-2
Gaudino S, Di Lella GM, Piludu F, et al. CT and MRI diagnosis of silent sinus syndrome. Radiol Med. 2013;118:265-275. https://doi.org/10.1007/s11547-012-0822-x
Pula JH, Mehta M. Silent sinus syndrome. Otolaryngol Tokyo. 2012;55:38-39. https://doi.org/10.1097/ICU.0000000000000106
Tieghi R, Malagutti N, Valente L, et al. Combined Endoscopic and Trans Palpebral Orbital Reconstruction for Silent Sinus Syndrome. J Craniofac Surg. 2017 Jun;28(4):955-958. https://doi.org/10.1097/SCS.0000000000003421
Feldman I, Sheptulin V, Grusha Y, Malhotra R. Deep Orbital Sub-Q Hyaluronic Acid Filler Injection for Enophthalmic Sighted Eyes in Parry-Romberg Syndrome. Multicenter Study. Ophthalmic Plast Reconstr Surg. 2018 Sep/Oct;34(5):449-451. https://doi.org/10.1097/IOP.0000000000001050
Grusha YO, Sheptulin VA, Prause JU, Danilov SS. Hyaluronic acid gel implants for correction of pathological conditions of the orbit and eyelids. Russian Annals of Ophthalmology = Vestnik oftal’mologii. 2018;134(5):61-71 (In Russ.). https://doi.org/10.17116/oftalma201813405161
Grusha YO, Sheptulin VA, Fedorov AA. Injectable hyaluronic acid gel implants for correction of pathological conditions of the orbit and eyelids. M.: GEOTAR-Media; 2017 (In Russ.).
Savvateeva DM, Svistushkin VM, Averbukh VM, Dzhafarova MZ. The silent sinus syndrome in the patients presenting with the uncinate process apposed to the orbital wall. Russian Bulletin of Otorhinolaryngology. 2015; 80(6):10-13 (In Russ.). https://doi.org/10.17116/otorino201580610-13
Charf KE, Lawson W, Shapiro JM, Gannon PJ. Pressure measurements in the normal and occluded rabbit maxillary sinus. Laryngoscope. 1995 Jun; 105(6):570-574. https://doi.org/10.1288/00005537-199506000-00002
Wan MK, Francis IC, Carter PR, Griffits R, van Rooijen ML, Coroneo MT. The spectrum of presentation of silent sinus syndrome. J Neuroophthalmol. 2000;20(3):207-212. https://doi.org/0.1097/00041327-200020030-00010
Annino DJ Jr, Goguen LA. Silent sinus syndrome. Curr Opin Otolaryngol Head Neck Surg. 2008 Feb;16(1):22-25. https://doi.org/10.1097/MOO.0b013e3282f2c9aa
Kim S-H. Successful treatment of silent sinus syndrome with combined endoscopic sinus surgery and blepharoplasty without orbital floor reconstruction. J Craniofac Surg. 2016;27:e586-e588. https://doi.org/10.1097/SCS.0000000000002998.
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;125:1239-1243. https://doi.org/10.1017/S0022215111001952
Amin D, Chitguppi C, Xu V, Haghshenas C, Gorniak R, Rabinowitz M, Toskala E, Rosen M, Nyquist G. Volumetric Analysis of the Sinus and Orbit in Silent Sinus Syndrome After Endoscopic Sinus Surgery. Otolaryngol Head Neck Surg. 2023 Jul;169(1):151-156. https://doi.org/10.1002/ohn.259
Cardesín A, Escamilla Y, Romera M, Molina JA. Single surgical step for endoscopic surgery and orbital reconstruction of a silent sinus syndrome. Acta Otorrinolaringol Esp. 2013 Jul-Aug;64(4):297-299. (In English, Spanish). https://doi.org/10.1016/j.otorri.2011.12.004
Allakhverdiev SA, Lopatin AS, Kochetkov PA. The “silent” sinus syndrome: review of the literature and the description of two clinical observations. Russian Bulletin of Otorhinolaryngology. 2010;(6):81-84 (In Russ.). https://doi.org/10.17116/otorino201580610
Grusha YaO. Modern aspects of reconstructive surgery for orbital trauma. Russian Annals of Ophthalmology = Vestnik oftal’mologii. 2014;130(6):50-55 (In Russ.).