![]() This process of ostium occlusion followed by negative pressure development may be analogous to what occurs in the middle ear in patients with Eustachian tube obstruction. Another case report employing the same measurement procedure documented negative pressure in the maxillary sinus of -23 mmHg (31.3 cm H2O). Results revealed subatmospheric intra-sinus pressures ranging from -13 to -6 cm H2O with a mean of −8.4 ± 2.6 cm H2O. The study utilized an 18-gauge needle placed into the sinus and attached to a pressure transducer. then investigated intra-sinus pressure measurements in 5 patients with diagnosed maxillary atelectasis and compared them to pressures of 5 healthy control patients. ![]() This phenomenon was first demonstrated experimentally in rabbits in whom experimental occlusion of maxillary ostium resulted in measured subatmospheric pressure in the sinus. Occlusion and hypoventilation of the sinus leads to negative pressure development. Obstruction of the natural sinus os may be secondary to multiple mechanisms including lateralized infundibular wall, lateralized middle turbinate, mucocele or polyp occluding the ostium, inflamed nasal mucosa, or presence of infraorbital ethmoid air cells that narrow maxillary ostium. ![]() Silent sinus syndrome occurs due to hypoventilation of the maxillary sinus after osteomeatal complex obstruction. This report thus strongly suggested that SSS occurs in patients with normal sinus size prior to disease development. documented pre-disease imaging demonstrating normal maxillary sinus anatomy several years prior to the onset of symptoms and manifestations of SSS. This association, however, was disproven after a 1999 case report by Davidson et al. When silent sinus syndrome was described in 1994 by Soparker et al., the disease process was initially thought to be related to pre-existing sinus hypoplasia. In their early reports, Montgomery named a mucocele as the cause of enophthalmos, while Wilkins and Kulwin noted a strong association with ipsilateral chronic maxillary sinus disease. These anatomical variations are hypothesized to predispose to a “flap-valve” occlusion of the natural maxillary sinus ostium, wherein the sinus becomes completely occluded allowing gas resorption and development of negative pressure in the sinus antrum. Lateral deviation of middle turbinate was found in 62% of patients in a case series of 16 people. Specifically, studies describe characteristic anatomical variations including ipsilateral nasal septum deviation, laterally deviated middle turbinate, and an otherwise narrowed infundibular passage. Underlying aberrant nasal anatomy is thought to be the largest risk factor for silent sinus syndrome. There is an equal reported incidence of right and left-sided disease. Most report an equal prevalence of SSS in men and women, although one large study of 84 patients suggests there may be a slightly higher rate in men. Silent sinus syndrome is usually diagnosed in patients in their 30s and 40s with a mean age of 39 and a range of 19 to 82. have suggested the term “imploding antrum syndrome” to clarified and described the more acute and symptomatic event of sinus implosion that happens rapidly after long periods of chronic underlying atelectasis. The tertiary stage of CMA, manifests with enophthalmos and/or hypoglobus and closely overlays the definition of SSS. While some strictly distinguish CMA and SSS as separate clinical entities by presence or absence of chronic sinusitis symptoms, others suggest that SSS is actually part of the spectrum of CMA. Additionally, CMA is divided into three stages, with stage I and II describing maxillary deformity in the absence of hypoglobus or enophthalmos. CMA, however, may be diagnosed in patients with chronic rhinosinusitis symptoms while the criteria of SSS stipulate that affected patients must have the absence of these symptoms for diagnosis. suggested the name “chronic maxillary atelectasis” (CMA), as a term describing 22 patients with similar findings. Since these first descriptions, there have been over 100 cases published in the literature. Wilkins and Kulwin followed with the report of two cases of spontaneous enophthalmos associated with chronic maxillary sinusitis in 1981. The first publication of these findings was by Montgomery in 1964, where he offered two cases of diplopia and enophthalmos associated with ipsilateral maxillary sinus opacification and collapse. This disease process, however, had been previously reported. The authors described a series of 14 patients with spontaneous, unilateral enophthalmos or hypoglobus due to collapse of orbital floor and opacification of the maxillary sinus. ![]() first applied the term “silent sinus syndrome” (SSS) in 1994.
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