title: Silent sinus syndrome--report of a case.
abstract: BACKGROUND
  The "silent sinus syndrome" is a rare entity that was first described in 1964 and given this name 30 years later. Although it is well described both from clinically and radiologically point of view we consider that its rarity still makes it a subject for report.
  
  
  METHODS
  A 46-year-old patient was admitted for facial asymmetry, diplopia, unilateral left enophthalmos, and inferior displacement of the eye globe, and decreased occlusal pressure in left dentate region. CT scan revealed interior bulging of all left maxillary sinus walls with osteolysis and intense opacification, enlargement of the left middle meatus especially in the posterior part and lateralization of the uncinate process. Nasal endoscopy with 00 rigid scope visualized mild deviation to the right of the nasal septum, enlargement of the left middle meatus by the lateral deviation of the left intersinusal septum and uncinate process. Surgery was scheduled and performed a left maxillary sinus antrostomy. Histopathological examination on the biopsies revealed inflammation. A complete study was performed to assess the elements of inflammation. Postoperative course was simple. Follow-up visit at three and six months, showed significant regression of diplopia and improved facial aspect.
  
  
  CONCLUSIONS
  Silent sinus syndrome is a well-defined clinical entity with characteristic imagistic findings. Surgical intervention that restores sinus drainage will interrupt the pathogenesis of the disease and lead to its progressive regression. Topographic associations and density of inflammatory elements analyzed in relation with neoforming vessels suggest their implication in reparatory angiogenesis characteristic to chronic inflammation. Modulating activity in the frame of inflammatory process, of the T-lymphocytes and especially of T-lymphocytes may represent a target for the therapeutic management. Surgery can and should be performed by an endoscopic approach.
authors.affiliation: Ist Clinic of Surgery, University of Medicine and Pharmacy of Craiova, Romania; vsurlin@gmail.com.
authors.forename: Daniela
authors.initials: D
authors.lastname: Dumitrescu
authors.forename: Bogdan
authors.initials: B
authors.lastname: FănuŢă
authors.forename: Alex Emilian
authors.initials: AE
authors.lastname: Stepan
authors.forename: Adrian Ioan
authors.initials: AI
authors.lastname: Fronie
authors.forename: Cristiana Iulia
authors.initials: CI
authors.lastname: Dumitrescu
authors.forename: Marius Cristian
authors.initials: MC
authors.lastname: MârŢu
authors.forename: Petra
authors.initials: P
authors.lastname: Şurlin
authors.forename: Valeriu
authors.initials: V
authors.lastname: Şurlin
authors.forename: Mihai
authors.initials: M
authors.lastname: Popescu
mesh_terms: D004172:Diplopia / Q000175:diagnosis; D004724:Endoscopy; D015841:Enophthalmos / Q000175:diagnosis; D005123:Eye / Q000473:pathology; D005146:Facial Asymmetry / Q000175:diagnosis; D006801:Humans; D007249:Inflammation; D007429:Intraocular Pressure; D008297:Male; D008443:Maxillary Sinus / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery*; D008875:Middle Aged; D009092:Mucous Membrane / Q000473:pathology; D009915:Orbit; D019408:Platelet Endothelial Cell Adhesion Molecule-1 / Q000378:metabolism; D013577:Syndrome; D013601:T-Lymphocytes / Q000166:cytology; D014057:Tomography, X-Ray Computed
chemical_list: D019408:Platelet Endothelial Cell Adhesion Molecule-1