A Retrospective Study on Silent Sinus Syndrome in Cone Beam-Computed Tomography Images-Author Classification Proposal

Introduction. Facial asymmetry might have many etiological factors. Most known and recognized factors are related to hemimandibular hyperplasia, elongation, condyle-related pathologies hemifacial microsomia, laterogenia, and others. In some cases, however, facial asymmetry has a different origin within the maxillary sinus (MS) bones. This rare entity as a silent sinus syndrome (SSS) causes secondary midfacial and maxillary asymmetry because of the retraction of the sinus walls. The authors present their own proposal for SSS/CMA (chronic maxillary atelectasia) classification and possible maxillary sinus disease alterations related to the scope of changes in the maxillary sinus walls, asymmetry, opacification, and related features. Material and Methods. The study consisted of 131 CBCT images which were evaluated. The authors focus on fourteen retrospective cone beam-computed tomography studies (CBCT) performed to establish and evaluate sources of facial asymmetry. Results. Neither presented maxillary and facial asymmetry cases correspond to the typical SSS/CMA findings. Asymptomatic maxillary sinusitis co-existing in maxillary asymmetry cases in patients suffering from skeletal malocclusion remains atypical for SSS pure and in-pure cases. The osteomeatal complex (OMC) patency is more common for pure forms. Conclusions. Computed tomography quite easily can identify the source of the problems in the maxillary sinus and identify SSS. Coexistent chronic rhinosinusitis might correspond with another MS pathology, CMA-chronic maxillary atelectasia. The scope and the degree of MS cause midfacial asymmetry; however, the scope of sinus opacification, osteomeatal complex drainage, and occurrence of other symptoms might be more or less present. The OMC patency is more common for pure forms.