Silent Sinus Syndrome: 13-Year Experience With Endoscopic Surgery and Long-Term Patient Outcomes

Silent sinus syndrome (SSS) is a rare condition characterized by spontaneous maxillary sinus collapse with associated orbital deformity. Existing studies are limited by heterogeneous surgical approaches, small sample sizes, and short follow-up. This study aimed to evaluate long-term clinical and patient-reported outcomes after endoscopic sinus surgery for SSS and to assess the necessity and frequency of concurrent orbital floor reconstruction.

A retrospective case series was conducted at a tertiary academic center, including adults with radiologically confirmed SSS who underwent functional endoscopic sinus surgery (FESS) between 2012 and 2024. Clinical records and CT imaging were reviewed for demographics, radiologic features, ocular findings, surgical details, and postoperative course. Long-term outcomes were obtained through clinic visits and standardized telephone interviews, assessing symptom resolution, ocular changes, need for additional procedures, and quality of life (1-5 Likert scale).

Twenty-four patients met inclusion criteria (mean age 45.2 years; 54.2% male). All exhibited maxillary sinus atelectasis with orbital floor retraction. FESS was performed in all cases; one patient (4.2%) required orbital floor reconstruction. No intraoperative complications or revision surgeries occurred. After a mean follow-up of 4.71 years, all patients reported complete or near-complete resolution of sinonasal and ocular symptoms, with normalization or improvement of enophthalmos/hypoglobus. Mean quality-of-life score was 4.58/5.

Endoscopic sinus surgery provides highly effective, durable management of SSS, with no recurrences and excellent patient-reported outcomes over long-term follow-up. Routine orbital floor reconstruction is unnecessary and should be reserved for select cases with persistent diplopia or cosmetic deformity after sinus re-aeration.