Surgical repair of the silent sinus syndrome

Spontaneous enophthalamos and hypoglobus associated with the silent sinus syndrome are disfiguring for the patient and create functional problems, such as lagophthalmos and audible clicking while blinking. We describe a surgical technique that was used to successfully treat two patients with this disorder of maxillary sinus hypoplasia and orbital floor resorption. Two patients underwent transconjunctival exploration of the involved orbital floor with simultaneous Caldwell-Luc procedure. The floor was elevated by packing the maxillary sinus, and the remainder of the orbital soft-tissue volume disparity was filled with either autogenous nasal septal cartilage or banked irradiated costochondral cartilage. Both patients had uncomplicated, complete resolution of their functional problems and cosmetic disfigurement. These patients remained clinically stable for a 1-year follow-up period. This technique appears to be a safe and effective means to correct the functional and cosmetic abnormalities associated with the silent sinus syndrome.