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.

Enoftalmia causada por uso tópico unilateral de Bimatoprost / Unilateral enophthalmos induced by the unilateral use of topical Bimatoprost

RESUMO O autor descreve o caso de uma paciente que apresenta o olho direito com o sulco palpebral profundo e enoftalmia deste lado, tratado durante uma década com Bimatoprost tópica. Concluem que os achados clínicos são provavelmente efeitos colaterais do medicamento.

ABSTRACT The author describes a case report of a patient with unilateral enophthalmia and deep palpebral sulcus probably induced by the topical use of Bimatoprost on the side of the collateral effects described.

Enoftalmos unilateral por várice orbitaria / Enophthalmos secondary to an orbital varix

El enoftalmos es un motivo de consulta poco frecuente en la práctica médica. La mayor parte de los casos se debe a un aumento de la cavidad ósea orbitaria de origen traumático. Presentamos el caso de una mujer de 63 años que consultó por enoftalmos progresivo de su ojo izquierdo, de doce años de evolución. El examen oftalmológico reveló la presencia de un marcado enoftalmos del lado izquierdo, que mejoraba notablemente con maniobras de Valsalva. Una tomografía computarizada y una resonancia magnética de la órbita permitieron diagnosticar una várice orbitaria no complicada. Las várices orbitarias son infrecuentes y por lo general se manifiestan por episodios de exoftalmos intermitente. Sin embargo, en raras ocasiones, la distensión y colapso repetidos pueden llevar a un enoftalmos progresivo por atrofia de la grasa orbitaria.

The enophthalmos is a rare cause of consultation in medical practice. The majority of cases are due to orbital space enlargement of traumatic origin.We report the case of a 63 year old patient with progressive enophthalmos of the left eye, with twelve years of evolution. Ophthalmologic examination revealed the presence of a marked enophthalmos on the left side, which improved significantly with Valsalva maneuvers. A CT scan and an MRI of the orbit allowed diagnosing uncomplicated orbital varices. Orbital varices are rare and usually manifest by episodes of intermittent exophthalmos. However, on rare occasions, repeated distension and collapse can lead to progressive enophthalmos by orbital fat atrophy.

Unusual ocular manifestations of silent sinus syndrome / Manifestações oculares incomuns na síndrome do seio silencioso

Silent sinus syndrome is an acquired condition in which there is a gradual collapse of the orbital floor and inward retraction of the maxillary sinus (atelectasis of the maxillary sinus). This in turn may cause associated ocular occurrences of enophthalmos and hypotropia. This is a report of an 8 year-old boy with silent sinus syndrome and associated ocular motility disorders. The association between silent sinus syndrome and ocular motility disturbance has been recently described in the literature. However, this is an infrequent association, mainly in childhood.

A síndrome do seio silencioso é uma afecção adquirida em que há colapso gradual do assoalho orbital e do seio maxilar (atelectasia do seio maxilar), o que pode acarretar alterações orbitárias e oculares associadas, como enoftalmia e hipotropia. Relatamos o caso de um paciente de 8 anos de idade com síndrome do seio silencioso e distúrbios da motilidade ocular. A associação entre a síndrome do seio silencioso e alterações da motilidade ocular extrínseca tem sido descrita na literatura. No entanto, esta é uma associação pouco frequente, principalmente na infância.

La diplopía que bajó de un cocotero: trauma por coco / Diplopia falling from one coconut tree: trauma by coco

Se presenta el caso clínico de un paciente a quien la caída de un coco y el consecuente traumatismo sobre su cara. produjo una fractura del piso orbitario con atrapamiento muscular, diplopía no diagnosticada y confundida con un aneurisma cerebral. Se hacen consideraciones sobre este tipo de accidentes en playas arenosas donde abundan cocoteros. La comparación de su frecuencia con ataques de tiburón y acerca de cómo un artículo médico puede ser tergiversado por el autor y convertido en noticia de prensa como para obtener el Ig Premio Nobel de Medicina con base a "una investigación que no puede o no debe ser duplicada" logros que primero hacen reir y después pensar e intertan celebrar lo inusual, imaginativo y espolear el interés por la ciencia, la medicina y la tecnología

We present the clinical case of a patient who, after being hit the face by a falling coconut, with consequent trauma to his face, fractured his orbital floor with muscle entrapment and undiagnosed diplopia which was mistaken for a brain aneurysm. We make considerations about such accidents on sandy beaches where coconut trees abound, compare its frequency with shark attacks and discuss how a medical article can be misrepresented by its autor and become news in order to obtain the nomination for the Ig Nobel Prize for medicine based on "research that cannot or should not be duplicated; achievements that first make you laugh and then make you and try to celebrate the unusual, imaginative and spur interest in science, medicine and technology

Pulsating enophthalmos in association with an orbital varix.

We report a case of pulsating enophthalmos secondary to orbital varix associated with orbital bony defects. A 64-year-old female with pulsating enophthalmos of the right eye was found to have a right orbital mass with bony defects of the orbit. Valsalva maneuver failed to induce proptosis. The diagnosis of orbital varix was confirmed by exploratory orbitotomy. During general anesthesia for orbitotomy, proptosis of the right eye was noted. Ophthalmologists should be aware of the association between orbital varices and cranial bony defects and encephaloceles. Proptosis induced by general anesthesia and positive pressure ventilation suggests an underlying distensible venous anomaly.

Allergic fungal sinusitis

Allergic fungal sinusitis is the commonest form of fungal sinusitis which is analogous to allergic bronchopulmonary aspergillosis in many aspects. Once looked upon as a rare disease which now seems to be increasing in incidence either due to better diagnostic criteria or due to genuine increase in the number of cases. We report a case presented as allergic fungal sinusitis with infratemporal extension and expansion with bone resorption into intracranial region in an asthmatic teenager who was treated successfully with a combination of surgery and medical interventions

Síndrome do seio silencioso: relato de caso e revisão da literatura / Silent sinus syndrome: case report and literature review

O objetivo deste trabalho é relatar um caso de síndrome do seio silencioso e revisar os aspectos mais importantes para o diagnóstico e tratamento. A síndrome do seio silencioso é uma entidade clínica rara caracterizada por enoftalmia espontânea e por hipoglobus associados a atelectasia do seio maxilar, que requer tratamento cirúrgico. O diagnóstico é usualmente acidental durante a investigação radiológica de pacientes com enoftalmia. A endoscopia nasal pode apresentar um padrão característico com colapso lateral da concha média e apófise unciforme. Usualmente observa-se uma retração importante da fontanela posterior do seio maxilar comprometido. O tratamento é cirúrgico, objetivando a aeração do seio maxilar comprometido para o meato médio por meio de antrostomia. O óstio natural de drenagem do seio comprometido deve ser incluído na antrostomia, para evitar o fenômeno de recirculação de muco. O mesmo apresentou evolução favorável pós-cirúrgica com follow-up de 1 ano sem progressão da enoftalmia. Conclui-se que a síndrome do seio silencioso é uma patologia rara, que deve ser incluída no diagnóstico diferencial de enoftalmia. Os achados de imagem com envolvimento da órbita e do seio maxilar confirmam o diagnóstico, e o tratamento exige a aeração cirúrgica do seio comprometido

This paper aims to report a case of silent sinus syndrome and to review importantaspects related to the diagnosis and the treatment of this condition. The silent sinus syndrome is a rare disorder characterized by spontaneous enopthtalmos and hypoglobus associated to maxillary sinus atelectasis that requires surgical treatment. The diagnosis might be suspected during the investigation of enophtalmos. Nasal endoscopy might present a classical pattern with lateral collapse of the middle turbinate and the uncinate process. A severe retraction of the posterior fontanelle might also be noted. Treatment is surgical and aims to ventilate the maxillary sinus through the middle meatus antrostomy. The antrostomy must include the natural ostium in order to prevent mucus re-circulation phenomenon. The patient reported in this study showed 1 year post-surgery a excellent result with no progression of the enophtalmos. We conclude that the silent sinus syndromeis a rare entity that must be included in the differential diagnosis of nophtalmos. Image findings with orbital and maxillary sinus involvement confirms the diagnosis and that the treatment requires surgical ventilation of the compromised sinus

Correction of Superior Sulcus Deformity and Enophthalmos with Porous High-density Polyethylene Sheet in Anophthalmic Patients

PURPOSE: Superior sulcus deformity is the main cosmetic problem in anophthalmic patients. Many methods of correcting enophthalmos have been reported, especially in patients with orbital wall fracture. The purpose of this study is to review the long term results of effectiveness in superior sulcus deformity correction by subperiosteal Medpor (R) sheet implantation in anophthalmic patients. METHODS: Subperiosteal Medpor (R) sheets were used in 11 eyes of 11 anophthalmic patients. To estimate the effectiveness, photographs were taken and exophthalmometric value with their own prosthesis using Hertel exophthalmometer was measured in all patients before and after surgery. RESULTS: The overall cosmetic results in superior sulcus deformity were 'excellent' in 3 (27.3%), 'good' in 6 (54.5%), 'fair' in 2 (18.2%). The overall results in enophthalmos were 'excellent' in 3 (27.2%), 'markedly improved' in 4 (36.4%), 'slightly improved' in 4 (36.4%). Most patients had a marked increase in orbital volume, except two patients. They received irradiation treatment in early childhood so showed unsatisfactory results in both superior sulcus deformity and enophthalmos. CONCLUSIONS: Subperiosteal Medpor (R) sheet implantation is considered to be a reliable and safe procedure without serious complication and with an excellent cosmetic results.

Emprego do gel de poliacrilamida no tratamento da enoftalmia em usuários de prótese ocular / Application of polyacrylamide gel in enophthalmos treatments in ocular prosthesis users

O objetivo deste estudo foi o de avaliar o efeito da injeção do gel de poliacrilamida em 21 pacientes com órbita enoftálmica e usuários de prótese ocular seguidos no Ambulatório de Cirurgia Plástica Ocular do HC-FMUSP. Foram estudadas as causas da perda ou atrofia do globo ocular, cirúrgia(s) anterior(es), tempo de uso e o volume da prótese ocular antes e após o tratamento. Foram realizadas documentação fotográfica, exoftalmometria e tomografia computadorizada para cálculo do volume orbitário antes e após a aplicação do gel. Os pacientes receberam injeção do gel de poliacrilamida no cone muscular da órbita. O volume injetado variou de 1,0 a 3,5 ml. Os defeitos órbito-palpebrais foram corrigidos em todos os casos. O gel de poliacrilamida demonstrou ser um produto seguro, econômico, de fácil obtenção e aplicabilidade / The object of this study was evaluating the effect of polyacrylamide gel injection in 21 patients presenting unilateral enophthalmic orbit with ocular prosthesis, assisted in the Oculoplastic Surgery Ambulatory of HC-FMUSP. Causes of ocular globe loss or atrophy, previous surgeries and length of use of ocular prosthesis and its volume have been evaluated. Photograph documentation, exophthalmometry and computerized tomography were studied for calculating the orbital volume before and after the application. Patients received injection of polyacrylamide gel in the muscular cone of the orbit. Volume injected varied from 1,0 ml to 3,5 ml. Orbito-palpebral defects have been corrected in all cases. The use of polyacrylamide gel has shown that it is a product which is safe, cost-effective, easy to obtain and to apply...

Correction of severe enophthalmos with titanium mesh.

The aim of this study was to analyse the types of facial fractures that caused severe enophthalmos and the outcome after repair of the medial wall and the floor of the orbit with titanium mesh. Eighteen cases with severe enophthalmos were repaired with titanium mesh in Siriraj Hospital between January 1992 and December 1999. We recorded the types of facial fractures of the patients, the results after operations and the complications. All cases were followed-up for at least 6 months. Le Fort fracture was the most common cause of severe enophthalmos from orbital fracture. The results after operations were satisfactory in 17 cases. Only one case still had enophthalmos after the first correction with titanium mesh and needed further repair with bone graft. Few complications happened post-operatively. They were 4 cases of chemosis and 4 cases of temporary diplopia. All subsided spontaneously. The author concludes that titanium mesh can be used to repair the medial wall and the floor of the orbit with good results.