Facial asymmetry: silent sinus syndrome.

To cite: Eisa N, Alraiyes AH, Alraies MC. BMJ Case Rep Published online: [please include Day Month Year] doi:10.1136/ bcr-2013-010377 DESCRIPTION A 23-year-old woman presented to the primary care clinic with a 10-month history of progressive left facial asymmetry, sinking of left eye and deepening of the superior palpebral sulcus. She denied headache, periocular pain, double vision, scalp or face tenderness. Her medical history was negative for sinus tumours, trauma, surgery or allergic rhinosinusitis. Physical examination showed leftsided enophthalmos with hypoglobus, sunken sulcus appearance to the left upper lid and leftsided deviation of the nasal septum with no obvious infection, the rest of ophthalmic examination was intact. CT of the orbits and sinuses (figure 1) revealed left enophthalmos, downward retraction of the orbital floor, total mucosal opacification and reduced volume of the left maxillary sinus. Diagnosis of silent sinus syndrome was made. The patient was managed with endoscopic sinus surgery to drain and aerate the left maxillary sinus, to repair the left orbital floor and to correct the hypoglobus and enophalmos. Microscopic examination of the antral mucosal specimen showed mild chronic inflammatory changes with no bacterial growth. Her postoperative recovery was uneventful, on 3-months follow-up; she reported complete resolution of symptoms with no recurrence.