Journal of Otology & RhinologyISSN: 2324-8785

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Case Report, J Otol Rhinol Vol: 5 Issue: 2

Facial Asymmetry as a Presentation of Silent Sinus Syndrome

Kamel UF*, Chawdhary G and Draper M
Department of ENT, Milton Keynes Hospital, Milton Keynes, England
Corresponding author : Kamel UF
Department of ENT, Milton Keynes Hospital, Milton Keynes, MK6 5LD, England
Tel: 01908 996751; Fax: 01908 996751
E-mail: [email protected]
Received: February 3, 2016 Accepted: March 21, 2016 Published: March 26, 2016
Citation: Kamel UF, Chawdhary G, Draper M (2016) Facial Asymmetry as a Presentation of Silent Sinus Syndrome. J Otol Rhinol 5:2. doi:10.4172/2324-8785.1000273

Abstract

A 43-year-old man presented with a 2 months history of sunken eye and facial asymmetry. He had no history of rhinorrhoea, hyposmia, headache, facial pains, or diplopia. There was no history of trauma or facial surgery. His clinical examination revealed enophthalmos, deepening of superior palpebral sulcus, deviation of nasal septum to right, and lateralisation of the right middle turbinate. There were no polyps or middle meatal discharge. Ophthalmological assessment showed no diplopia, normal visual acuity, normal field vision, and normal fundal examination

Keywords: sinus syndrome; right maxillary sinus; facial pains

Introduction

A 43-year-old man presented with a 2 months history of sunken eye and facial asymmetry. He had no history of rhinorrhoea, hyposmia, headache, facial pains, or diplopia. There was no history of trauma or facial surgery. His clinical examination revealed enophthalmos, deepening of superior palpebral sulcus, deviation of nasal septum to right, and lateralisation of the right middle turbinate. There were no polyps or middle meatal discharge. Ophthalmological assessment showed no diplopia, normal visual acuity, normal field vision, and normal fundal examination.
His CT scan showed recession of his right globe, atelectasis of right maxillary sinus, lateralisation of middle turbinate and uncinate process, obliteration of the middle meatus and soft tissue opacification of ethmoid and maxillary sinuses (Figure 1). A diagnosis of silent sinus syndrome of the right side was made. Under general anaesthetic, right side functional endoscopic sinus surgery was perfoemed including middle turbinate medialisation, uncinectomy, middle meatal antrostomy and anterior ethmoidectomy. Intraoperatively, it was noted that the uncinate process was lateralised and atelectatic and the maxillary sinus mucosa was healthy. The patient had uneventful recovery (Figure 2).
Figure 1: Axial CT scan showing atelectasis of the right maxillary sinus.
Figure 2: Photo showing right enophthalmos.

Discussion

Silent sinus syndrome is a rare condition of unilateral, progressive, painless enophthalmos and gradual deepening of the orbital floor in the absence of clinical sino-nasal inflammation. This condition occurs as a consequence of blockage of the osteomeatal complex [1,2]. Silent sinus syndrome may happen as a consequence of trauma [3,4]. In many cases the exact aetiology is not fully understood. In this case, there was no past history of trauma or maxillo-facial surgery. Surgical intervention in the form of Functional Endoscopic Sinus Surgery is the treatment of choice to open the sinus ostium and aims to arrest further atelectasis and deformity by re-establishing ventilation and aeration of the maxillary sinus [5]. Balloon sinoplasty had also been advocated as a successful surgical option [6]. In our case, we performed unilateral functional endoscopic sinus surgery under general anaesthesia. Orbital floor reconstruction is recommended according to severity of diplopia and facial asymmetry [3,7].
In a retrospective case series review, endoscopic sinus surgery as the only surgical intervention led to improvement of enophthalmos in fourteen out of the sixteen cases reviewed with 2.6 years’ mean follow up period [5].

Conclusion

Silent sinus syndrome is a rare condition. Awareness of aetiology, presentation, radiological features and surgical management strategies are essential to avoid progressive facial asymmetry. Re-establishing ventilation of maxillary sinus is the main option to treat and arrest progression.

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