title: Silent sinus syndrome: an underdiagnosed entity.
abstract: We describe a case of a 33-year-old Caucasian woman with right facial asymmetry and no sinonasal symptoms. She was referred to the ophthalmology department as having right palpebral ptosis. On physical examination, she presented painless enophthalmos and hypoglobus of the right eye. The MRI of the brain only showed sinonasal inflammatory signs of the right maxillary sinus. The CT scan revealed opacification of the right maxillary sinus, with retraction of the sinus walls. We confirmed the diagnosis of silent sinus syndrome. The patient underwent functional endoscopic sinus surgery. One year after surgery, despite clinical and aesthetic improvement, slight enophthalmos remained, but there were no other complications. In our case, the diagnosis of facial asymmetry as ptosis led to an initial imaging investigation to exclude neurological causes. Silent sinus syndrome should be included in the differential diagnosis of facial asymmetry. Despite the clinical suspicion, the diagnosis can only be confirmed by imaging studies.
authors: Department of Otorhinolaryngology, Pedro Hispano Hospital, Matosinhos, Portugal.
authors: Clara
authors: http://orcid.org/0000-0002-6279-645X
authors: C
authors: Magalhães
authors: Department of Radiology, Pedro Hispano Hospital, Matosinhos, Portugal.
authors: Miguel
authors: M
authors: Baptista
authors: Department of Otorhinolaryngology, Pedro Hispano Hospital, Matosinhos, Portugal.
authors: Gustavo
authors: G
authors: Lopes
authors: Department of Otorhinolaryngology, Pedro Hispano Hospital, Matosinhos, Portugal.
authors: Delfim
authors: D
authors: Duarte
mesh_terms: D000328:Adult; D001763:Blepharoptosis / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D001921:Brain; D003937:Diagnosis, Differential; D015841:Enophthalmos / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery; D005146:Facial Asymmetry / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery; D005147:Facial Bones / Q000473:pathology*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008443:Maxillary Sinus / Q000473:pathology* / Q000601:surgery; D009422:Nervous System Diseases / Q000175:diagnosis; D009915:Orbit / Q000473:pathology; D010254:Paranasal Sinus Diseases / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D013577:Syndrome; D014057:Tomography, X-Ray Computed