Syndromic silent sinus syndrome - management and outcomes in patient suffering from skeletal dento-facial deformity 1,2

Silent sinus syndrome (SSS) is a rare entity characterized by ipsilateral chronic hypoventilation and atelectasis of the maxillary sinus, which may lead to facial or ocular asymmetry, hypoglobus, enophtalmos and diplopia. In this report, we present a case of a 21-year-old patient scheduled for an orthognathic procedure due to skeletal malocclusion. Patient complained about problems with nasal breathing. CT scans revealed an atrophic, inflamed, hypoventilated left maxillary sinus with obstruction of the left ostiomeatal complex, septal deviation and hypertrophy of the left interior turbinate. Furthermore atrophic and asymmetrical left zygomaticomaxillary complex with shifting of maxillary bite plane and left malar depression accompanied by slightly displaced inferior border of left lateral orbital wall was noted. Due to clinical symptoms of SSS, patients are often referred to the ears, nose and throat (ENT) department or to the ophthalmologist. Silent sinus syndrome diagnosis begins upon clinical examination and it is confirmed by radiological imaging (usually CT). The most characteristic radiological finding is maxillary sinus volume reduction as a result of inward retraction of the sinus walls. It is important to perform differential diagnosis, taking into consideration other conditions that present with enophtalmos. The main goal of surgical treatment is to normalize the ventilation of maxillary sinus by improving its drainage toward the nasal cavity and, in selected cases, restoration of the orbital floor.