Alteraciones estéticas faciales en el síndrome de seno silente / Facial aesthetic alterations in silent sinus syndrome / Alterações estéticas faciais na síndrome do seio silencioso

Introducción: el Síndrome de Seno Silente (SSS) es una entidad rara, siendo poco frecuente el hundimiento del maxilar superior como motivo de consulta. El trabajo pretende realizar una revisión de la bibliografía del SSS con el hundimiento del maxilar superior como principal manifestación. Material y método: Se realizó una revisión bibliográfica de artículos publicados desde el año 2008 a la actualidad. Se revisaron las historias clínicas de los pacientes diagnosticados con SSS, intervenidos quirúrgicamente. Como criterios diagnósticos se tuvieron en cuenta: asimetría facial, ausencia de síntomas rinosinusales, tomografía de macizo cráneo facial (TC MCF) con velamiento del seno maxilar y disminución de su volumen, y aumento del volumen orbitario. Se evaluó el seguimiento postoperatorio y sus resultados. Resultados: El SSS se debe a un proceso inflamatorio en el seno maxilar que genera aumento de las presiones negativas. Clínicamente se caracteriza por asimetría facial. El diagnóstico se confirma por tomografía, siendo lo más característico la presencia, en el plano coronal, de un seno maxilar ocupado y atelectásico y el descenso del piso orbitario con disminución del volumen del mismo y aumento del volumen de la órbita. El tratamiento quirúrgico se basa en mejorar las presiones dentro del seno maxilar, reservando el tratamiento del piso de la órbita a aquellos pacientes en los que persisten las alteraciones estéticas. Conclusiones: La asimetría facial es el principal motivo de consulta del paciente. Sin embargo el hundimiento del seno maxilar no es la causa más frecuente de asimetría.

Introduction: silent Sinus Syndrome (SSS) is a rare entity, and the subsidence of the upper jaw is rare. The paper aims to review the SSS literature with the upper jaw collapse as the main manifestation. Material and method: A bibliographic review of articles published from the year 2008 to the present time was carried out. Were viewed the medical records of patients diagnosed with SSS, whounder went surgery. As diagnostic criteria were taken into account: facial asymmetry, absence of rhinosinusal symptoms, massive facial cranial tomography with maxillary sinus veil and diminished volume, and increased orbital volume. Postoperative follow-up and results were evaluated. Results: The SSS is due to an inflammatory process in the maxillary sinus that generates an increase of the negative pressures. Clinically it is characterized by facial asymmetry. The diagnosis is confirmed by tomography being the most characteristic the presence, in the coronal plane, of a occupied maxillary sinus and atelectatic and the descent of the orbital floor with decrease of the volume of the same and increase of the volume of the orbit. The surgical treatment is based on improving the pressure inside the maxillary sinus, reserving the treatment of the floor of the orbit to those patients who persist the aesthetic alterations. Conclusions: Facial asymmetry is the main reason for patient consultation. However, sagging of the maxillary sinus is not the most frequent cause of asymmetry.

Introdução: síndrome do Sinus Silencioso (SSS) é uma entidade rara, e o maxilar inferior não é freqüente como motivo de consulta. O artigo pretende rever a literatura SSS com o colapso do maxilar superior como principal manifestação. Material e método: Foi realizada uma revisão bibliográfica de artigos publicados de 2008 para o presente. Revisamos os registros médicos de pacientes diagnosticados com SSS, que foram submetidos a cirurgia. Como critérios de diagnóstico foram tidos em conta: assimetria facial, ausência de sintomas rinossinusais, tomografia craniana facial maciça com velamento maxilar superior e volume diminuído e aumento do volume orbital. O acompanhamento pós-operatório e os resultados foram avaliados. Resultados: SSS é devido a um processo inflamató- rio no seio maxilar que gera um aumento nas pressões negativas. Clinicamente, é caracterizada por assimetria facial. O diagnóstico é confirmado pela tomografia sendo a mais característica a presença, no plano coronal, de um seio maxilar ocupado e atelectásico e a descida do piso orbital com diminuição do volume do mesmo e aumento do volume da órbita. O tratamento cirúrgico baseia-se na melhoria da pressão dentro do seio maxilar, reservando o tratamento do piso da órbita aos pacientes que persistem as alterações estéticas. Conclusões: A assimetria facial é o principal motivo para a consulta do paciente. No entanto, a flacidez do seio maxilar não é a causa mais frequente de assimetria.

Orbital Volume Change Measured by Computed Tomography in Blow Out Fracture

Enophthalmos is a common result of blow out fracture of the orbit. Prior to CT volume analysis no reliable measurement of the degree of bony and soft tissue deformity was available to identify patients who would develop enophthalmos. Evaluation of orbital volume expansion and volume expansion percentage were performed in 23 patients with blow out fracture, after 1-4 days of injury. All studies were performed on a CT (Somatom Plus, Germany, Siemens), using transaxial scan technique(140 kVp, 206 mA, 3 mm contiguous sections). The radiological boundaries of the orbit were defined anteriorly by a line mrrecting the anterior surface of the zygomaticofrontal process to the nasomaxillary suture and posteriorly to the optic foramen. The Hounsfield Unit(HU) ranges were -100 to 0 and 0 to +100. It is difficult to distinguish blood from fat in the orbital volume measurement. We used three methods to obtain more accurate orbital volume. First, The concave margin or the air meniscus surface area is blood and the convex margin area is fat. Second, It can be distingushed blood from fat by Hounsfield Unit of specific area pixel. Third, The homogenous area is blood and inhomogenous area is fat or mixture of fat and blood. The patients(> or =13% orbital volume expansion) are managed surgically. 15 patients were classified in operative group and 8 patients were in conservative treatment group. The volume expansion percentage is 12.7% to 28.8% in operative group and 4.2% to 11.2% in conservative group. There was no enophthamos in each groups after 3 months of operation and injury. CT measurements of orbital volume expansion and volume expansion percentage can predict the final degree of the late enophthalmos and may facilitate the planning of surgical intervention. To obtain more accurate prediction of enophthalmos, we consider not olny volume expansion but also volume expansion percentage, because everyone doesn't have the same normal orbital volume.

Prediction of Late Enophthalmos by Volumetric Analysis of Blowout Fractures using Orbital CT

The purpose of this study was to determine whether orbital volume assessment by CT could provide additional information for the initial evaluation of orbital blowout fractures and guide optimal treatment. The medical records of 26 patients with orbital blowout fractures, either surgically or conservatively managed, were retrospectively reviewed. Orbital volumetric analysis was then determined from digitized CT scans. Fracture-related volume expansion relative to the unaffected fellow orbit was correlated with degree of enophthalmos. Early Hertel's measurements[4 weeks] were obtained in 13 nonrepaired fractures and in 3 of 13 surgically repaired patients[late presentation;16 patients]. When seen at more than 4 weeks, 4[80%] of 5 patients with> OR =13% orbital volume expansion manifested significant enophthalmos[>2 mm] compared with 2[18.2%] of 11 patients with<13% orbital expansion[p<0.01]. CT measurements of orbital volume can predict the final degree of late enophthalmos and may facilitate the planning of surgical intervention.