Outcomes of Sinus Surgery and Orbital Reconstruction in Silent Sinus Syndrome: A Retrospective Cohort Study

This study evaluates the clinical presentation, surgical management, and outcomes of silent sinus syndrome (SSS), with emphasis on the efficacy of simultaneous sinus and orbital surgery. A retrospective review was performed of 35 patients diagnosed with SSS at a tertiary care center between January 2004 and April 2024. All patients had radiographic evidence of maxillary sinus atelectasis and orbital floor resorption. Management strategies included observation (n=12), sinus surgery alone (n=10), simultaneous endoscopic sinus surgery with orbital reconstruction (n=12), and staged procedures (n=1). The most common presenting signs were enophthalmos (48.5%), hypoglobus (37.1%), and diplopia (11.4%). Patients undergoing simultaneous repair demonstrated significant improvement in enophthalmos compared with preoperatively (from 3.2±1.1 to 0.6±0.5 mm, P =0.0002) and hypoglobus (from 2.6±1.0 to 0.1±0.5 mm, P <0.0001) and compared with those treated with sinus surgery alone (postoperative enophthalmos 2.5±0.7 mm, P =0.005). No cases of implant extrusion, infection, or vision loss were observed. Complications were limited to 1 case of transient infraorbital hypesthesia and 1 case of hyperglobus requiring revision. These findings suggest that single-stage combined sinus surgery with orbital reconstruction is safe and effective for restoring globe position in patients with SSS and clinically significant orbital displacement.