Casos clínicos

Caso 3

Introducción
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Discusión y conclusión

3) Ugrin MC, Heidenreich AM; Weil D, Armesto A. J AAPOS 2004 Feb; 8(1):100
Asymptomatic, acquired, spontaneus and progressive enophthalmos: The silent sinus syndrome.
Purpose: To describe clinical and tomographic features of an unusual cause of acquired, spontaneus and progresive enophthalmos. Patients and methods: Three patients with unilateral superior eyelid ptosis, spontaneous and progressive enophthalmos, palpebral and ocular motility disorders, and their tomographic findings are presented. Results: All patients showed unilateral enophthalmos, superior eyelid ptosis, lid lag and elevation deficiency with diplopia in upgaze.Tomographic findings in all patients included decrease in maxillary sinus volume, inward bowing of one or more antral walls, complete or incomplete antral opacification and enhancement of the orbital volume due to depression of the orbital floor. Conclusion: Clinical findings in silent sinus syndrome are due to dislocation of the eyeball caused by the deformities of maxillary and orbital architecture previously described. References: Soparkar CNS, Patrinely JR, Cuaycong MJ, et al. The silent sinus syndrome: a cause of spontaneous enophthalmos. Ophthalmology. 1994;101:772-778. Wan MK, Prancis IC, Carter PR, et al. The spectrum of presentation of silent sinus syndrome. J Neuro-Ophthalmol 2000;20:207-212. Gillman GS, Schaitkin BM, May M. Asymptomatic enophthalmos: the silent sinus syndrome. Ain J Rhinol. 1999;13:459-462.


4) Burroughs JR, Hernandez Cospin JR, Soparkar CN, Patrinely JR.Ophthal Plast Reconstr Surg. 2003 Nov;19(6):449-54.
Misdiagnosis of silent sinus syndrome.

PURPOSE: To review cases of spontaneous enophthalmos erroneously diagnosed as
silent sinus syndrome to identify other inflammatory disorders with a similar
clinical presentation. METHODS: Retrospective observational case series. Chart
reviews were performed covering encounters over a 5-year period, searching for
patients referred to two physicians with an incorrect diagnosis of silent sinus
syndrome. Only cases of acquired enophthalmos of reported nontraumatic or
nonneoplastic cause were included. Particular attention was directed toward
noting clinical features of upper eyelid position and periocular atrophy.
RESULTS: Nineteen cases of erroneous referral for silent sinus syndrome were
identified. Fourteen of these cases were due to tumor, trauma, congenital facial
asymmetry, or diffuse facial lipodystrophy. Among the remaining cases, four were
diagnosed as Parry-Romberg syndrome and one as linear scleroderma. CONCLUSIONS:
Parry-Romberg syndrome and linear scleroderma must be distinguished from silent
sinus syndrome as causes of inflammatory-mediated, spontaneous enophthalmos.


5) Yip CC, [et al.]. J Pediatr Ophthalmol Strabismus. 2003 Sep-Oct;40(5):309-11.
Silent sinus syndrome as a cause of diplopia in a child.


6) Ong L, McNab A.Orbit. 2003 Sep;22(3):161-4.
The silent sinus syndrome: a case with normal predisease imaging.

The silent sinus syndrome is a cause of spontaneous enophthalmos associated with
unilateral chronic maxillary atelectasis. It remains an under-recognised
condition in both the ophthalmological and otolaryngological community. We
present a case of a 46-year-old lady with a six-month history of enophthalmos to
illustrate the clinical features and radiological findings of this condition.
Four years prior to presentation, she had normal maxillary sinuses on magnetic
resonance imaging.

7) Iseli HP, Hafezi F, Mojon DS. Ophthalmologica 2003 Jul-Aug;217(4):308-9.
Conservative treatment of vertical diplopia in a patient with silent sinus
syndrome.

Silent sinus syndrome is a rare disease of the maxillary sinus characterized by
bony absorption processes leading to progressive sinus wall thinning with
consecutive enophthalmos and hypoglobus. It represents a benign cause of
acquired enophthalmos and is often accompanied by painless vertical diplopia,
the latter treated surgically in all cases published to date. We report a
56-year-old patient with silent sinus syndrome in whom vertical diplopia was
treated with prisms showing that conservative treatment alone may, in mild
cases, be an effective alternative to reconstructive surgery.


8) Thomas RD, [et al]. Am J Rhinol. 2003 Mar-Apr;17(2):97-100.
Management of the orbital floor in silent sinus syndrome.

Enophthalmos in a patient with an opacified hypoplastic maxillary
sinus, without sinus symptomatology, describes the silent sinus syndrome. A
current trend is to perform endoscopic maxillary antrostomy and orbital floor
reconstruction as a single-staged operation. A two-staged approach is performed
at our institution to avoid placement of an orbital floor implant in the midst
of potential infection and allow for the possibility that enophthalmos and
global ptosis may resolve with endoscopic antrostomy alone, obviating the need
for orbital floor reconstruction. METHODS: A retrospective review identified
four patients with silent sinus syndrome evaluated between June 1999 and August
2001. Patients presented to our ophthalmology department with ocular asymmetry,
and computerized tomography (CT) scanning confirmed the diagnosis in each case.
RESULTS: There were three men and one woman, with ages ranging from 27 to 40
years. All patients underwent endoscopic maxillary antrostomy. Preoperative
enophthalmos determined by Hertel's measurements ranged from 3 to 4 mm. After
endoscopic maxillary antrostomy, the range of reduction in enophthalmos was 1-2
mm. Case 2 had a preoperative CT scan and a CT scan 9 months after left
endoscopic maxillary antrostomy. Volumetric analysis of the left maxillary sinus
revealed a preoperative volume of 16.85 +/- 0.06 cm3 and a postoperative volume
of 19.56 +/- 0.07 cm3. This represented a 16% increase in maxillary sinus volume
postoperatively. Orbital floor augmentation was avoided in two patients because
of satisfactory improvement in enophthalmos. In the other two patients, orbital
reconstruction was performed as a second-stage procedure. There were no
complications. CONCLUSION: Orbital floor augmentation can be offered as a
second-stage procedure for patients with silent sinus syndrome. Some patients'
enophthalmos may improve with endoscopic antrostomy alone.

9) Rose GE, Lund VJ. Ophthalmology 2003 Apr;110(4):819-26.
Clinical features and treatment of late enophthalmos after orbital
decompression: a condition suggesting cause for idiopathic "imploding antrum"
(silent sinus) syndrome.

PURPOSE: To review the clinical and radiologic characteristics of a group of
patients who experienced late enophthalmos after bone-removing orbital
decompression. The surgical management of these patients is presented and a
hypothesis proposed to explain the idiopathic "imploding antrum" ("silent
sinus") syndrome. DESIGN: Retrospective, noncomparative case series.
PARTICIPANTS: Six patients experienced relative enophthalmos, hypoglobus, and
upper eyelid sulcus deformity at between 3 and 6 months after bone-removing
orbital decompression for thyroid orbitopathy. Five left orbits and one right
orbit were affected. INTERVENTION: All patients underwent middle meatal
antrostomy, together with mobilization and elevation of the collapsed orbital
contents by firm packing of the affected maxillary antrum through a buccal
antrostomy, the pack being removed about 3 weeks after placement. MAIN OUTCOME
MEASURES: Symptomatic improvement and reduction in the degree of relative
enophthalmos, hypoglobus, and upper eyelid sulcus deformity. RESULTS: Late-onset
enophthalmos after orbital decompression was associated with clinical and
radiologic features that resemble the idiopathic imploding antrum syndrome. In
all patients, the ethmoidal infundibulum was obstructed by prolapsed orbital fat
with secondary antral consolidation, and inward bowing of the maxillary walls
was present in five of six patients. After antral drainage and packing, there
was an improvement in enophthalmos (mean, 2.7 mm; range, 0-4 mm) and all but one
globe returned to within 2 mm of exophthalmometry of the contralateral eye. For
recurrent enophthalmos in two patients (minor in one patient and marked in the
other), later repair of the orbital floor was undertaken through a lower eyelid
swinging flap, using porous polythene sheet, with good cosmetic outcome.
CONCLUSIONS: Late-onset enophthalmos after bone-removing orbital decompression
seems to be the result of obstruction of maxillary antral aeration, with
secondary fluid retention and a subatmospheric pressure in the sinus. This
iatrogenic condition, associated in most cases with inward collapse of the
maxillary walls, provides a guide to a hypothetical mechanism for the idiopathic
imploding antrum (silent sinus) syndrome.

10) Illner A,[et al.]. AJR Am J Roentgenol. 2002 Feb;178(2):503-6.
The silent sinus syndrome: clinical and radiographic findings.
Disponible en texto completo en: http://www.ajronline.org/cgi/content/full/178/2/503

11) Vander Meer JB, Harris G, Toohill RJ, Smith TL. Laryngoscope. 2001 Jun;111(6):975-8.
The silent sinus syndrome: a case series and literature review.

12) Wan MK, [et al.]. J Neuroophthalmol. 2000 Sep;20(3):207-12.
The spectrum of presentation of silent sinus syndrome.

13) Davidson JK, Soparkar CN, Williams JB, Patrinely JR. Arch Ophthalmol. 1999 Dec;117(12):1653-4.
Negative sinus pressure and normal predisease imaging in silent sinus syndrome.
Disponible en texto completo en: http://archopht.ama-assn.org/cgi/content/full/117/12/1653?ijkey=6e11abb7fc478593f2a71805faa196c9afe3f5f5&keytype2=tf_ipsecsha

14) Dailey RA, Cohen JI. Ophthal Plast Reconstr Surg. 1995 Dec;11(4):261-8.
Surgical repair of the silent sinus syndrome.

15) Soparkar CN, et al. Ophthalmology. 1994 Apr;101(4):772-8.
The silent sinus syndrome. A cause of spontaneous enophthalmos.

16) Devoto MH, Estrin E, Valenzuela J. Arch Oftalmol B Aires 1999 Abr-Jun; 74:120-122
Enoftalmos no traumatico progresivo
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