Open Access Open Access  Restricted Access Subscription Access
Cover Image

Atelectasis of the maxillary sinus is unusual cause of retrobulbar headache. CBCT imaging and description of the case.

Marco Capelli, Patrizia Gatti


Aim: Silent Sinus Syndrome (SSS) represents a rare pathology, caracterized by atlectasis of maxillary sinus and by expansion of orbital volume because of orbital floor subsidence. Generally, clinic characteristics are enophthalmos and hypoglobus with facial asymmetry. In some rare case, SSS has been manifested with diplopia

Materials and methods: Diagnosis of SSS is always confirmed by a maxillo-facial TC. We have performed CBCT of the nose and paranasal sinus by Galileos GAX9 (Sirona Dental System GmbH Bensheim, Germany). Images were analyzed by Sidexis XG software (Sirona X-ray Imaging System Next Generation, Sirona Dental System GmbH, Bensheim, Germany). We evaluated the patient in axial, coronal and sagittal projection. We also made a 3D reconstruction of left maxillary sinu

Results: We describe a case of Silent Sinus Syndrome with atypical characteristics because it begun with retro-bulbar headache and diagnosed by Cone Beam Computed Tomography. This is the first case described with this clinic picture and studied with CBCT.

Conclusion: SSS is a rare manifestation due to atelectasis of maxillary sinus.


Silent Sinus Syndrome, CBCT, Retro-bulbar headache, Maxillary atelectasis, Enophtalmos

Full Text:



The silent sinus syndrome: protean manifestations of a rare upper respiratory disorder revisited. Guillen DE, Pinargote PM, Guarderas JC. Clin Mol Allergy. 2013 Dec 9;11(1):5.

The imploding antrum: An unusual case of nontraumatic painless enophthalmos. Sen D, Arora V, Adlakha S, Miglani H. Indian J Ophthalmol. 2016 Oct;64(10):786-788.

Silent sinus syndrome an acquired condition and the essential role of otorhinolaryngologist consultation: a retrospective study. Martínez-Capoccioni G, Varela-Martínez E, Martín-Martín C. Eur Arch Otorhinolaryngol. 2016 Oct;273(10):3183-8.

Not so silent sinus syndrome: A case report. Ferro A, Basyuni S, Santhanam V. Int J Surg Case Rep. 2016;23:1-3.

CT and MRI diagnosis of silent sinus syndrome. Gaudino S, Di Lella GM, Piludu F, Martucci M, Schiarelli C, Africa E, Salvolini L, Colosimo C. Radiol Med. 2013 Mar;118(2):265-75.

Silent sinus syndrome: CT and MRI findings. Bas A, Tutar O, Samanci C, Kepek F. BMJ Case Rep. 2012 Dec 5;2012.

Single surgical step for endoscopic surgery and orbital reconstruction of a silent sinus syndrome. Cardesín A, Escamilla Y, Romera M, Molina JA. Acta Otorrinolaringol Esp. 2013 Jul Aug;64(4):297-9.

Silent sinus syndrome: case series and literature review. Yousuf K, Velázquez-Villaseñor L, Witterick I. J Otolaryngol Head Neck Surg. 2009 Oct;38(5):E110-3.

Ethmoid Silent Sinus Syndrome Following Orbital Trauma. Brown SJ, McNab AA. Ophthal Plast Reconstr Surg. 2016 Jul 13.

Frontal silent sinus syndrome. Naik RM, Khemani S, Saleh HA. Otolaryngol Head Neck Surg. 2013 Feb;148(2):354-5.

Silent sinus syndrome in children. Rosa F, Figueirinhas R, Oliveira J, Almeida E Sousa C. Acta Otorrinolaringol Esp. 2017 Jan 19. pii: S0001-6519(16)30135-2. doi: 10.1016/j.otorri.2016.11.007

A child with silent sinus syndrome and spontaneous improvement after sinus surgery. Chang DT, Truong MT. Int J Pediatr Otorhinolaryngol. 2014 Nov;78(11):1993-5.

Bilateral stage I chronic maxillary atelectasis: A case report. Gunaratne DA, Hasan Z, Floros P, Singh N. Int J Surg Case Rep. 2016;26:53-6.

Bilateral silent sinus syndrome. Suh JD, Ramakrishnan V, Lee JY, Chiu AG. Ear Nose Throat J. 2012 Dec;91(12):E19-21.

Bilateral silent sinus syndrome: case report and surgical solution. Ferri A, Ferri T, Sesenna E. J Oral Maxillofac Surg. 2012 Jan;70(1):e103-6.

A case of bilateral silent sinus syndrome presenting with chronic ocular surface disease. Liss JA, Patel RD, Stefko ST. Ophthal Plast Reconstr Surg. 2011 Nov-Dec;27(6):e158-60.

Late enophthalmos secondary to silent sinus syndrome after orbital decompression. Chemli H, Breton P, Bouletreau P. J Fr Ophtalmol. 2013 Dec;36(10):e217-9.

Silent sinus syndrome after lateral fracture of the inferior turbinate. Jung D, Gray ST. Otolaryngol Head Neck Surg. 2012 May;146(5):863-4.

Silent sinus syndrome: a rare presentation after botulinum toxin injection. Singh KA, Barber WB 2nd, Codner MA. Aesthet Surg J. 2011 Feb;31(2):181-3.

Silent sinus syndrome secondary to a radix relicta in the antrum. Alons-ter Hoeven J, de Keizer RJ, van der Meij AG, van Merkesteyn JP. J Craniofac Surg. 2010 Mar;21(2):607-9.

Silent sinus syndrome associated with intrasinusal ossification. Khonsari RH, Sadoughi B, Rouger A, Gayet-Delacroix M, Ferron C, Corre P. Rev Stomatol Chir Maxillofac. 2010 Nov-Dec;111(56):331-3.

Diplopia: An uncommon presentation of silent sinus syndrome. Gomez J, Liu D, Palacios E, Nguyen J. Ear Nose Throat J. 2015 Jul;94(7):258-60.

Silent sinus syndrome causing cyclovertical diplopia masquerading as superior oblique paresis in the fellow eye. Zhang C, Phamonvaechavan P, Christoff A, Guyton DL. J AAPOS. 2010 Oct;14(5):450-2.

The imploding antrum syndrome: an unusual cause of double vision. Stevens K, Omer S, Toocaram B, Rich P, Almemar A. Pract Neurol. 2010 Apr;10(2):101-4.

Acute diplopia as the presenting sign of silent sinus syndrome. Saffra N, Rakhamimov A, Saint Louis LA, Wolintz RJ. Ophthal Plast Reconstr Surg. 2013 Sep-Oct;29(5):e130-1.


  • There are currently no refbacks.