Metachronous Bilateral Silent Sinus Syndrome: A Case Report

Area of Science:

• Otolaryngology
• Rhinology
• Medical Imaging

Background:

• Bilateral silent sinus syndrome (SSS) is an exceedingly rare condition.
• Most reported cases present simultaneously, with metachronous (sequential) onset being exceptionally rare.
• Understanding the pathogenetic mechanisms and evolutionary phases of SSS requires thorough radiological assessment.

Observation:

• A 45-year-old male with bilateral concha bullosa developed contralateral SSS two years after endoscopic uncinectomy and maxillary sinus re-ventilation.
• This represents the second reported case of metachronous bilateral SSS.
• Radiological follow-up demonstrated the contralateral SSS developing in a previously normal maxillary sinus.

Findings:

• Endoscopic uncinectomy and maxillary sinus re-ventilation successfully resolved symptoms and restored sinus ventilation.
• The uncinate process was implicated in the pathogenesis of SSS, as evidenced by the contralateral development.
• Complete radiological evaluation was crucial in demonstrating the disease's progression and pathogenetic factors.

Implications:

• Bilateral SSS, though rare, warrants consideration in affected patients.
• Prophylactic endoscopic uncinectomy on the contralateral side may prevent the development of SSS.
• This case underscores the importance of the uncinate process in SSS etiology and management.