title: Not so silent sinus syndrome: A case report.
abstract: BACKGROUND
  Silent sinus syndrome (SSS) is a rare disorder with protean manifestations. An absence of familiarity with ambiguous and atypical presentations may complicate diagnosis and delay management.
  
  
  METHODS
  A 28year old female patient presented with a chronic history of headache, post-nasal discharge and recurrent facial pain refractory to analgesics. Enophthalmos and hypoglobus progressed over a period of 2 months, and a diagnosis of SSS was confirmed via imaging. Definitive treatment was withheld given the patient's postpartum state and improvement of symptoms.
  
  
  CONCLUSIONS
  SSS typically manifests with painless and progressive, unilateral, enophthalmos and hypoglobus. Since presentation is dominated by ophthalmologic complaints, the ordinary route by which SSS is diagnosed is through ophthalmology review. The predominant complaint in our patient was chronic headaches with facial pain, and mild enophthalmos and hypoglobus were only noted 2 months later at follow-up. This represents an atypical presentation of SSS, and exemplifies the subtle and often ambiguous presenting features of this disorder.
  
  
  CONCLUSIONS
  The protean manifestations of SSS mean that patients may initially present to specialities other than ophthalmology. To ensure rapid diagnosis and appropriate management, it is important that clinicians, particularly in ophthalmology, maxillofacial surgery, and ears, nose and throat (ENT), are familiar with this obscure condition.
authors.affiliation: Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom.
authors.forename: Ashley
authors.initials: A
authors.lastname: Ferro
authors.affiliation: Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom. Electronic address: shadi.basyuni@nhs.net.
authors.forename: Shadi
authors.initials: S
authors.lastname: Basyuni
authors.affiliation: Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom.
authors.forename: Vijay
authors.initials: V
authors.lastname: Santhanam
keywords: Chronic maxillary atelectasis; Enophthalmos; Silent sinus syndrome