Volume 3, Issue 2 , Pages 75-77, March 2008
Silent sinus syndrome associated with nasal foreign body
Article Outline
Abstract
Silent sinus syndrome is characterized by enophtalmus and hypoglobus caused by the maxillary atelectasis. Approximately 160 cases have been published in the literature but none of them due to a nasal foreign body. A case with silent sinus syndrome related to a foreign body has been presented in this article. Utmost attention should be paid management of the nasal foreign body because it may be the reason for silent sinus syndrome.
Keywords: Nasal foreign body, Silent sinus syndrome
Silent sinus syndrome is a rare condition which is characterized by enophtalmos and hypoglobus caused by the maxillary atelectasis [1]. There is an orbital displacement inferiorly compared to the other side. Montgomery described it as a silent sinus syndrome, but recently it has been described as an imploding antrum [2]. Approximately 160 cases have been published in the literature but none of them due to a nasal foreign body [3]. In this article, a case with silent sinus syndrome related to a foreign body has been presented.
1. Case report
A 17-year-old, mentally retarded girl was admitted to the ear nose and throat (ENT) outpatient clinic with purulent nasal secretion from the right nasal passage for one year. During nasal endoscopy, a mass was seen between the inferior turbinate and the septum. In addition, her right eye globe was lower than the left one. The right malar eminence was depressed. She had no ophthalmic complaints. She denied any history of facial trauma, sinonasal tumor, or sinus and/or facial surgery. In the light of previous hospital records of the patient, the findings of pneumatised Waters graphy, which was obtained when she was 12 years old, were normal (Fig. 1).
Fig. 1.
The normally pneumatised Waters graphy of patient when she was 12 years old.
Ophtalmologic examination revealed normal visual acuity and extraocular movements but 2.5
mm of enophthalmos and 1.5mm of hypoglobus.
In the ENT examination, depression in the right eye and folded foreign body in the right nasal cavity were detected. Computerized tomography showed pneumatisation in the middle turbinate and marked reduction and opacification in the maxillary sinus (Fig. 2). The other components were normal.
Fig. 2.
There is a folded foreign body in the right nasal cavity, pneumatisation in the middle turbinate and marked reduction and opacification in the maxillary sinus volume in coronal computed tomography.
Uncinectomy and antrostomy were performed. The foreign body, which was a plastic component of a cola cap, was removed. Bacterial and fungal cultures were negative and polypoid fibrinous material was excised from the maxillary sinus. During the follow-up, hypoglobus in the left eye had reduced and an improvement in the left nasal airway and resolution of facial pressure were noted. Orbital floor reconstruction was not required.
2. Comment
Silent sinus syndrome is a clinical entity, occurs in the third to fifth decade, shows equal sex distribution, and is caused by negative sinus pressure from acquired obstruction of the maxillary sinus ostium leading to enophthalmos and hypoglobus. Vertical diploplia, upper lid retraction, lagophthalmos, malar depression, and facial pressure [3] can be the other symptoms.
Mental retardation is characterized by reduced intellectual capacity such as limited communication and self-care, and difficulty in other skills. Mentally retarded individuals may insert foreign bodies in the ear, nose, etc. In addition, they may not be aware of such actions and complain about them, as was in our case. Our patient is the first case of prolonged nasal foreign body, which led to maxillary sinus hypoplasia in a mentally retarded person.
The most accepted theory of pathogenesis is that ostiomeatal obstruction results in reduced aeration of the antrum, causing negative maxillary sinus pressure and atelectasis [4], [5], [6]. According to Baujat et al., some “silent sinus syndrome” might be caused by an aspiration phenomenon resulting from masticatory muscle movements [7]. Along with the orbital floor being drawn downwards, there were abnormal concavities in the medial and posterolateral walls of all the maxilla that could be assessed on CT scanning [2]. They also describe an iatrogenic version of the disease occurring after orbital decompression [8]. These relatively acute changes have led them to use the term “imploding antrum syndrome” [2]. In our patient, the nasal foreign body might have occluded the ostiomeatal complex and thus created the conditions necessary for development of the syndrome. This supports the hypoventilation theory.
In conclusion, utmost attention should be paid in management of the nasal foreign body because it may be the reason for silent sinus syndrome.
References
- . The silent sinus syndrome: maxillary sinus atelectasis with enophthalmos and hypoglobus. Curr Opin Ophthalmol. 2004;15:486–489
- Clinical and radiologic characteristics of the imploding antrum, or “silent sinus, ” syndrome. Ophthalmology. 2003;110:811–818
- Silent sinus syndrome: a case presentation and comprehensive review of all 84 reported cases. Ann Otol Rhinol Laryngol. 2005;114:688–694
- . Asymptomatic enophthalmos: the silent sinus syndrome. Am J Rhinol. 1999;13:459–462
- Negative sinus pressure and normal predisease imaging in silent sinus syndrome. Arch Ophthalmol. 1999;117:1653–1654
- Silent sinus syndrome, a case presentation. Rhinology. 2005;43:313–315
- Silent sinus syndrome: a mechanical theory. Orbit. 2006;25:145–148
- Enophthalmos as a complication of rhinoplasty. Laryngoscope. 2006;116:1035–1038
PII: S1871-4048(07)00088-3
doi:10.1016/j.pedex.2007.10.007
© 2007 Elsevier Ireland Ltd. All rights reserved.
Volume 3, Issue 2 , Pages 75-77, March 2008
