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Let's take a look at this drawing that

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was provided to me by Azita Khorsandi, and what

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do we notice about this patient's face?

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What we see is that there's some thickening of the

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eyelid here, and the globe is a little bit lower

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on the right side compared with the left side.

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It's a little bit depressed.

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So those are some of the findings here.

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This is an example of the

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patient's faces that may be

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associated with silent sinus syndrome.

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What is silent sinus syndrome?

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Silent sinus syndrome is a complication of

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chronic sinusitis in which the maxillary sinus

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ipsilateral to the infection becomes atelectatic.

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By that we mean it actually decreases in size.

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Not on the basis of hypoplasia from birth, but

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as a complication of the low pressure within the

0:56

sinus secondary to the obstruction at the osteum.

1:01

What happens is that things kind of get sucked

1:04

inward, so you notice that there's a little bit

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more exaggeration of the inferior lateral wall of

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this maxillary sinus and some depression of the

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orbital floor compared to the

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contralateral orbital floor.

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This depression of the orbital floor leads to the

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decreased height of the globe, and sometimes there also

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is associated enophthalmos, so painless enophthalmos.

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It's actually the opposite of exophthalmos or proptosis.

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The eye is sunken inward, and this is

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associated with the chronic maxillary sinusitis.

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So what do we see here on the

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left side, we see that depression of the orbital floor.

1:47

We see the reduction in the volume of the

1:50

left maxillary sinus with chronic sinusitis changes

1:54

and you notice that the posterior wall of the maxillary

1:57

sinus on the axial scan is drawn inward by the

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low pressure effect, and you see prominence to the

2:06

peri-antral fat compared to the contralateral side.

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This kind of sucking in is what leads to

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the silent sinus syndrome associated with

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enophthalmos as well as hypoglobus, the orbit is

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actually depressed, downward in silent sinus syndrome.