Post Traumatic Enophthalmos Associated to Silent Sinus Syndrome: Case Report

Introduction Silent Sinus Syndrome (SSS) is a rare but distinct clinical entity characterized by spontaneous enophthalmos and hypoglobus associated with maxillary sinus atelectasis and collapse of the orbital floor, in the absence of sinonasal symptoms [1]. The term was introduced in 1964 by Montgomery et al, then coined by Soparkar et al. in 1994 [2]. It was also named “imploding maxillary sinus” by Rose, a famous UK ophtalmologist, in 2003 [3,4]. While traditionally considered spontaneous, an increasing number of cases describe (1) post-surgical forms after functional endoscopic sinus surgery and septorhinoplasty [5], and (2) post-traumatic forms of SSS [6,7]. An orbital trauma may either unmask a previously silent condition or initiate the cascade of sinus implosion [8]. Orbital blowout fractures typically affect the orbital floor but also exacerbate pre-existing asymptomatic conditions such as atelectasia of the maxillary sinus [9]. The diagnosis is based on high-resolution CT imaging. The treatment is still debated to this date. Functional endoscopic sinus surgery via middle meatal antrostomy to restore sinus ventilation is the cornerstone of management, but the timing and necessity to perform orbital reconstruction remains controversial. This report presents the case of a post-traumatic orbital floor fracture in a patient later diagnosed with silent sinus syndrome, highlighting the importance of recognizing underlying sinus disease in facial trauma evaluation. Keywords: Atelectasia of the maxillary sinus; Silent sinus syndrome; Implosion of the maxillary sinus; Blowout fracture; Orbital floor fracture