The silent sinus syndrome: A cause of spontaneous enophthalmos

Purpose: Spontaneous enophthalmos and hypoglobus, in the absence of other symptoms and unrelated to trauma or surgery, may be alarming to both physician and patient. The authors describe the clinicopathologic features of a benign syndrome ("silent sinus syndrome") with this constellation of features and discuss the possible pathophysiology. Methods: A multicenter retrospective search for similar clinical cases was performed. All clinical records, computed tomographs, and pathology reports for each case were reviewed at one center. A literature search for similar cases also was conducted. Results: Nineteen cases of a new syndrome are presented. This syndrome affects individuals at approximately the fourth decade of life (average age, 36 years; range, 29-46 years); is characterized by bone resorption and remodeling of the orbital floor due to otherwise asymptomatic maxillary sinus disease; is associated with ipsilateral maxillary sinus hypoplasia; and is not fully explained by any previously described, classic cystic lesion of the maxillary antrum. Conclusion: Enophthalmos and hypoglobus unassociated with prior trauma, surgery, or other symptoms may represent "silent sinus syndrome, " which is ipsilateral maxillary sinus hypoplasia and orbital floor resorption.