Silent sinus syndrome: which approach offers the best outcome?
Reviewed by Sangeeta Maini and Bhaskar Ram

Silent sinus syndrome (SSS) is a rare condition with patients presenting as spontaneous, painless enophthalmos, hypoglobus, orbital asymmetry, and maxillary sinus collapse on the ipsilateral side. The orbital resorption occurs secondary to negative pressure created in the maxillary sinus by occlusion of the infundibulum. Radiology findings include inferior displacement of orbital floor, collapsed maxillary sinus, and uncinate process lateralisation. The primary goals of the SSS treatment are the restoration of maxillary sinus drainage and improvement of orbital floor anatomy using the following three options including single-stage operation with endoscopic sinus surgery (ESS), two-stage treatment with reconstruction delayed two-to-six months after ESS, and ESS with no orbital reconstruction. It is as yet not clear from the available literature which approach gives the best outcome. The author in their series of 15 cases highlights the advantages, benefits and reasoning behind single stage orbital reconstruction along with ESS. They recommend a team approach, use of objective measurements such as CT to calculate facial and orbital asymmetry, and MEDPOR titan orbital floor implant for orbital reconstruction. They report that the single stage reconstruction offers the best solution in restoring the orbital and facial asymmetry and optimal sinus drainage/ventilation. They report no major complications in their series and good objective outcome at one-month post-surgery. Longer term results would have been preferable. We personally liked the idea of single stage reconstruction and the logic behind this.

Silent sinus syndrome: Combined sinus surgery and orbital reconstruction – report of 15 cases.
Clarós P, Sobolewska AZ, Cardesa A, et al.
ACTA OTO-LARYNGOLOGICA
2019;139(1)64-9.