Silent Sinus Syndrome: Clinical Findings and Differential Diagnosis


The Silent Sinus Syndrome (SSS) is a rare condition that causes facial asymmetry, unilateral enophthalmos and diplopia. It is thought to be secondary to chronic maxillary sinus atelectasis (CMA) with reabsorbed bone and subsequent displacement of the orbital floor. Such anatomic modifications occur over time, and therefore it is possible to encounter different stages of the same disease with or without orbital displacement. Clinical findings can be unclear so it makes sense to recognize potentially evolving SSS while other disturbances have to be ruled out. Our purpose is to underline clinical findings for different diagnosis and proper management. We consider Functional Endoscopic Sinus Surgery (FESS) indicated in CMA and SSS to halt the progression of the disease. Nevertheless restitution treatment of enophtalmos due to orbital floor displacement involves plastic reconstruction of the floor of the orbit via transconjunctival approach. We report a case of SSS and discuss distinctive features of non-neoplastic lesions involving the maxillary sinus that should be considered for differential diagnosis.

Share and Cite:

Bossolesi, P. , Pedruzzi, B. and Emanuelli, E. (2014) Silent Sinus Syndrome: Clinical Findings and Differential Diagnosis. Case Reports in Clinical Medicine, 3, 293-303. doi: 10.4236/crcm.2014.35066.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Castelein, S., Cohen, M., Ayache, D. and Kalp, P. (2002) Atelectasis of the Maxillary Sinus: Report of a Case of Acute Onset. Revue de Laryngologie Otologie Rhinologie, 123, 99-102.
[2] Soparkar, C.N.S., Patrinely, J.R., Cuaycong, M.J., et al. (1994) The Silent Sinus Syndrome: A Rare Cause of Spontaneous Enophthalmos. Ophthalmology, 101, 772-778.
[3] Bossolesi, P., Autelitano, L., Brusati, R. and Castelnuovo, P. (2008) The Silent Sinus Syndrome: Diagnosis and Surgical Treatment. Rhinology, 46, 308-316.
[4] Monos, T., Levy, J., Lifshitz, T. and Puterman, M. (2005) The Silent Sinus Syndrome. (IMAJ) The Israel Medical Association Journal, 7, 333-335.
[5] Vander Meer, J.B., Harris, G., Toohill, R.J. and Smith, T.L. (2001) The Silent Sinus Syndrome. A Case Series and Literature Review. Laryngoscope, 111, 975-978.
[6] Hobbs, C.G.L., Saunders, W. and Potts, M.J. (2004) Spontaneous Enophthalmos: Silent Sinus Syndrome. The Journal of Laryngology & Otology, 118, 310-312.
[7] Buono, L.M. (2004) The Silent Sinus Syndrome: Maxillary Sinus Atelectasis with Enophthalmos and Hypoglobus. Current Opinion in Ophthalmology, 15, 486-489.
[8] Illner, A., Davidson, H.C., Harnsberger, H.R. and Hoffman, J. (2002) The Silent Sinus Syndrome: Clinical and Radiographic Findings. American Journal of Roentgenology, 178, 503-506.
[9] Rose, G.E., Sandy, C., Halberg, L., et al. (2003) Clinical and Radiologic Characteristics of the Imploding Antrum, or “Silent Sinus” Syndrome. Ophthalmology, 110, 811-818.
[10] Boyd, J.H., Yaffee, K. and Holds, J. (1998) Maxillary Sinus Atelectasis with Enophthalmos. Annals of Otology, Rhinology, and Laryngology, 107, 34-39.
[11] Saetti, R., Emanuelli, E., Cutrone, C., Barion, U., Rimini, A., Giusti, F., Derosas, F., Narne, S. and Staffieri, A. (1998) The Treatment of Choanal Atresia. Acta Otorhinolaryngology of Italy, 18, 307-312.
[12] Bolger, W.E., Woodruff Jr., W.W., Moreshead, J. and Parsons, D. (1990) Maxillary Sinus Hypoplasia: Classification and Description of Associated Uncinate Process Hypoplasia. Otolaryngology―Head and Neck Surgery, 103, 759-765.
[13] Ong, L.Y. and Mc Nab, A.A. (2003) The Silent Sinus Syndrome: A Case with Normal Predisease Imaging. Orbit, 22, 161-164.
[14] Hazan, A., LeRoy, A., Chevalier, E., Benzaken, J., Waisberg, A., Cymbalista, M., Adotti, E. and Peytral, C. (1998) Processus atélectasique du sinus maxillaire analyse des stades évolutifs à propos de 4 cas. Ann Otolaryngol Chir Cervicofac, 115, 367-372.
[15] Sciarretta, V., Pasquini, E., Tesei, F., Modugno, G.C. and Farneti, G. (2006) Endoscopic Sinus Surgery for the Treatment of Maxillary Sinus Atelectasis and Silent Sinus Syndrome. Journal of Otolaryngology, 35, 60-63.
[16] Facon, F., Eloy, P., Brasseur, P. and Collet, S. (2006) The Silent Sinus Syndrome. European Archives of Oto-Rhino-Laryngology, 263, 567-571.
[17] Costa, F., Emanuelli, E., Robiony, M., Zerman, N., Polini, F. and Politi, M. (2007) Endoscopic Surgical Treatment of Chronic Maxillary Sinusitis of Dental Origin. Journal of Oral and Maxillofacial Surgery, 65, 223-228.

Copyright © 2023 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.