Archive | 2021
Chronic Maxillary Atelectasis and Silent Sinus Syndrom: Report of Three Cases and Literature Review
Abstract
1. Abstract Chronic Maxillary Atelectasis (CMA) and Silent Sinus Syndrome (SSS) are conditions that may lie on the same clinical spectrum, since both have similarities in pathophysiology, clinical findings and treatment, although the absence of sinonasal symptoms is the main difference between them. In this study we present three different cases of CMA that were submitted to functional endoscopic sinus surgery to exemplify this condition and we made a literature review about both CMA and SSS for the most relevant and recent data about the subject. Most studies show that a negative pressure gradient may be the cause for the maxillary antral collapse and that best treatment is the endoscopic approach to reopen the sinus and restore its ventilation, orbital floor reconstruction is still debatable though. In conclusion, the understanding about both CMA and SSS seem to be increasing in the last years and that allows a better treatment and classification of the these conditions. 2. Introduction Chronic maxillary atelectasis (CMA) and silente sinus syndrom (SSS) are two unusal clinical conditions whose denominations were coined at the end of the 20th century. Event though their names and even symptoms are different, recent studies have shown more and more that both situations seem to be in the same clinical spectrum [1, 2]. The main difference consists basically in the presence or abscence of sinonasal symptoms, which must be absent in the classic SSS [3]. Thus, isolated cases of SSS are tipically reported in the ophtalmological literature, while CMA, whose patients have similar complaints to chronic rhinosinusitis, is traditionally cited in otorhinolaryngological journals [1]. To demonstrate that situation, we reported three diferente cases of patients with CMA who were treated at an otolaryngology service and we made a literature review on both CMA and SSS to better caracterize these conditions and to show their proximity. 3. Case Report 3.1. Case 1 A 68-year-old female patient, hypertensive and dyslipidemic, referred hyposmia and hypogeusia that started two years before. She also mentioned itchy nose and sneezing when in contact with dust or smoke, but she denied rhinorrea, nasal obstruction, headache or facial pain. Treatment with topical corticosteroids and nasal irrigation with saline was given. There was no improvement after three months and then a fibronasolaringoscopy and a computed tomography (CT) of the sinuses were requested. In the endoscopy, there was only signs of nonspecific rhinitis and pharyngolaryngeal reflux. While CT showed opacification and volume reduction of the right maxillary sinus, as well as a content with soft tissue density in sphenoid sinuses bilaterally with bone sclerosis and erosion of its walls (Figure 1).