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Orbital Asymmetry
This case features a patient presenting with orbital asymmetry, ultimately diagnosed with silent sinus syndrome.
Imaging overview:
Prior coronal CT sinus demonstrates normal bilateral maxillary sinuses and orbital volumes. Current coronal CT sinus shows interval development of right maxillary sinus atelectasis with downward bowing of the right orbital floor, resulting in increased right orbital volume. Current axial CT sinus confirms posterior displacement of the right globe consistent with enophthalmos, demonstrated by asymmetric globe position relative to the orbital rims.
Clinical insight:
Silent sinus syndrome is a slowly progressive condition caused by chronic obstruction of the maxillary sinus ostium, leading to negative pressure within the sinus and gradual inward retraction of the sinus walls. The resulting downward bowing of the orbital floor increases orbital volume, causing enophthalmos and hypoglobus. The condition is characteristically asymptomatic or minimally symptomatic, hence the term “silent,” and is often discovered incidentally as orbital asymmetry. Extraocular movements are typically preserved, though diplopia can occur with significant orbital floor deformity. Comparison with prior imaging is invaluable for demonstrating the interval development of maxillary sinus atelectasis and orbital floor depression.
Case courtesy of Jocelyn Chen, BS, and Daniel Warren, MD, Carle Illinois College of Medicine, Carle Foundation Hospital.