Silent sinus syndrome: Dynamic changes in the position of the orbital floor after restoration of normal sinus pressure

Background: Silent sinus syndrome is characterised by spontaneous enophthalmos and hypoglobus, in association with chronic atelectasis of the maxillary sinus, and in the absence of signs or symptoms of intrinsic sinonasal inflammatory disease. Traditionally, correction of the enophthalmos involved reconstruction of the orbital floor, which was performed simultaneously with sinus surgery. Recently, there has been increasing evidence to support the performance of uncinectomy and antrostomy alone, then orbital floor reconstruction as a secondstage procedure if needed. Methods: We performed a retrospective review of 23 cases of chronic maxillary atelectasis managed in our unit with endoscopic uncinectomy and antrostomy alone. All patients were operated upon by the same surgeon. Results: Twenty-two of the 23 patients had either complete or partial resolution. One patient had ongoing enophthalmos, and was considered for an orbital floor reconstruction as a second-stage procedure. Conclusion: Our case series demonstrates that dynamic changes in orbital floor position can occur after sinus reventilation. These findings support the approach of delaying orbital floor reconstruction in cases of silent sinus syndrome treated with sinus re-ventilation, as such reconstruction may prove unnecessary over time.