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Int Arch Otorhinolaryngol 2013; 17(04): 409-412
DOI: 10.1055/s-0033-1351679
Case Report
Thieme Publicações Ltda Rio de Janeiro, Brazil

Stage II Chronic Maxillary Atelectasis Associated with Subclinical Visual Field Defect

João Mangussi-Gomes
1   Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital of Brasília, University of Brasília, Brasília/DF, Brazil
,
Márcio Nakanishi
1   Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital of Brasília, University of Brasília, Brasília/DF, Brazil
,
Maria Regina Chalita
2   Department of Ophthalmology, University Hospital of Brasília, University of Brasília, Brasília/DF, Brazil
,
Fabiana Damasco
1   Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital of Brasília, University of Brasília, Brasília/DF, Brazil
,
Carlos Augusto Costa Pires De Oliveira
1   Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital of Brasília, University of Brasília, Brasília/DF, Brazil
› Author Affiliations
Further Information

Publication History

25 November 2012

29 April 2013

Publication Date:
13 September 2013 (online)

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Abstract

Introduction Chronic maxillary atelectasis (CMA) is characterized by a persistent decrease in the maxillary sinus volume due to inward bowing of its walls. According to its severity, it may be classified into three clinical-radiological stages.

Objective To report a case of stage II CMA associated with subclinical visual field defect.

Case Report A 34-year-old woman presented with a 15-year history of recurrent episodes of sinusitis and intermittent right facial discomfort for the past 5 years. She denied visual complaints, and no facial deformities were observed on physical examination. Paranasal sinus computed tomography (CT) demonstrated a completely opacified right maxillary sinus with inward bowing of its walls, suggesting the diagnosis of stage II CMA. A computerized campimetry (CC) disclosed a scotoma adjacent to the blind spot of the right eye, indicating a possible damage to the optic nerve. The patient was submitted to functional endoscopic sinus surgery, with drainage of a thick mucous fluid from the sinus. She did well after surgery and has been asymptomatic since then. Postoperative CT was satisfactory and CC was normal.

Discussion CMA occurs because of a persistent ostiomeatal obstruction, which creates negative pressure inside the sinus. It is associated with nasosinusal symptoms but had never been described in association with any visual field defect. It can be divided into stage I (membranous deformity), stage II (bony deformity), and stage III (clinical deformity). The silent sinus syndrome is a special form of CMA. This term should only be used to describe those cases with spontaneous enophthalmos, hypoglobus, and/or midfacial deformity in the absence of nasosinusal symptoms.

Keywords

paranasal sinus diseases - maxillary sinus - visual fields - maxillary diseases
 

  • References

  • 1 Kass ES, Salman S, Rubin PA, Weber AL, Montgomery WW. Chronic maxillary atelectasis. Ann Otol Rhinol Laryngol 1997; 106: 109-116
    Google Scholar
  • 2 Brandt MG, Wright ED. The silent sinus syndrome is a form of chronic maxillary atelectasis: a systematic review of all reported cases. Am J Rhinol 2008; 22: 68-73
    CrossrefGoogle Scholar
  • 3 Hunt SM, Tami TA. Sinusitis-induced enophthalmos: the silent sinus syndrome. Ear Nose Throat J 2000; 79: 576 , 579–581, 584
    Google Scholar
  • 4 Annino Jr DJ, Goguen LA. Silent sinus syndrome. Curr Opin Otolaryngol Head Neck Surg 2008; 16: 22-25
    CrossrefGoogle Scholar
  • 5 Ende K, Mah L, Kass ES. Progression of late-stage chronic maxillary atelectasis. Ann Otol Rhinol Laryngol 2002; 111: 759-762
    Google Scholar
  • 6 Davidson JK, Soparkar CN, Williams JB, Patrinely JR. Negative sinus pressure and normal predisease imaging in silent sinus syndrome. Arch Ophthalmol 1999; 117: 1653-1654
    Google Scholar
  • 7 Kass ES, Salman S, Montgomery WW. Manometric study of complete ostial occlusion in chronic maxillary atelectasis. Laryngoscope 1996; 106: 1255-1258
    CrossrefGoogle Scholar
  • 8 Numa WA, Desai U, Gold DR, Heher KL, Annino DJ. Silent sinus syndrome: a case presentation and comprehensive review of all 84 reported cases. Ann Otol Rhinol Laryngol 2005; 114: 688-694
    CrossrefGoogle Scholar
  • 9 Gaudino S, Di Lella GM, Piludu F , et al. CT and MRI diagnosis of silent sinus syndrome. Radiol Med (Torino) 2013; 118: 265-275
    CrossrefGoogle Scholar
  • 10 Illner A, Davidson HC, Harnsberger HR, Hoffman J. The silent sinus syndrome: clinical and radiographic findings. AJR Am J Roentgenol 2002; 178: 503-506
    CrossrefGoogle Scholar
  • 11 Wise SK, Wojno TH, DelGaudio JM. Silent sinus syndrome: lack of orbital findings in early presentation. Am J Rhinol 2007; 21: 489-494
    CrossrefGoogle Scholar
  • 12 Borin A, Cruz OLM, Figueiredo CR. [Síndrome do seio silencioso, uma entidade pouco conhecida: relato de dois casos clínicos e revisão de literatura]. Braz J Otorhinolaryngol 2005; 71: 26-31
    Google Scholar
  • 13 Soparkar CN, Patrinely JR, Cuaycong MJ , et al. The silent sinus syndrome. A cause of spontaneous enophthalmos. Ophthalmology 1994; 101: 772-778
    CrossrefGoogle Scholar
  • 14 Thawley SE. The otolaryngologist-ophthalmologist relationship: an historic perspective. Otolaryngol Clin North Am 2006; 39: 845-853
    CrossrefGoogle Scholar
  • 15 Sivasubramaniam R, Sacks R, Thornton M. Silent sinus syndrome: dynamic changes in the position of the orbital floor after restoration of normal sinus pressure. J Laryngol Otol 2011; 125: 1239-1243
    CrossrefGoogle Scholar