Rose Geoffrey E, Sandy Charles, Hallberg Lena, Moseley Ivan
Orbital Service, Moorfields Eye Hospital, London, England.
Ophthalmology. 2003 Apr;110(4):811-8. doi: 10.1016/S0161-6420(02)01993-0.
To present the clinical and radiologic details of a series of patients with the imploding antrum, or silent sinus, syndrome, together with examples of the surgical findings and management.
Retrospective, noncomparative case series.
Fourteen patients assessed in the Orbital Service at Moorfields Eye Hospital.
Changes of clinical signs, symptoms, and radiologic signs.
Seven men and seven women, between the ages of 25 and 78 years (mean, 41.3 years), had unilateral enophthalmos, their having noted the anomaly for an average of 8 months (range, 1-36 months). All patients were nonsmokers. There was no evidence of progression of the condition in eight cases followed up for up to 63 months. On the affected side, there was 1 to 4 mm enophthalmos and up to 4 mm hypoglobus, with secondary narrowing of the vertical palpebral aperture in some cases, but no effect on visual function, and there was significant disturbance of ocular motility in only one case. The condition is characterized radiologically by a smooth inward bowing of the walls of the maxillary antrum on the affected side, with secondary enophthalmos and hypoglobus. In all 14 cases, the maxillary roof (orbital floor) was drawn downwards, and the medial and posterolateral walls of the maxilla were concave in 13 cases where it could be assessed. In one patient, there was associated inward collapse of the ipsilateral ethmoid complex. There was a patchy loss of mineral from the maxillary roof in 9 of 13 cases and, where the posterolateral maxillary wall was affected, there was a concomitant increase in the radiolucency (fat) of the pterygopalatine fossa. Some soft-tissue changes were present in the affected antrum in all 14 patients, and there was an air-fluid level in three patients. In 12 patients where septal deviation was present, this was to the affected side in 10 (83%), and an abnormally directed middle turbinate was also frequently observed (10 of 14 cases).
The silent sinus syndrome mainly presents as unilateral enophthalmos in younger people and has very characteristic clinical and radiologic signs with, in many cases, abnormal intranasal anatomic characteristics on the affected side. The condition may be exclusive to nonsmokers. The acute onset and long-term stability of the condition suggests that, although chronic and largely asymptomatic sinus disease may be the underlying cause, an acute event precipitates collapse of the orbital floor or (in fact) a widespread "implosion" of all antral walls resulting from maxillary atelectasis. Therefore, we prefer the term imploding antrum syndrome-describing the relatively acute, symptomatic, event-rather than the name silent sinus syndrome, which relates to a putative underlying mechanism.
介绍一系列患有上颌窦内陷（即静息性窦）综合征患者的临床和影像学细节，以及手术发现和处理的实例。
回顾性、非对照病例系列。
在摩尔菲尔德眼科医院眼眶科接受评估的14例患者。
临床体征、症状和影像学征象的变化。
14例患者中，7例男性，7例女性，年龄在25至78岁之间（平均41.3岁），均有单侧眼球内陷，他们注意到这种异常情况的平均时间为8个月（范围1 - 36个月）。所有患者均不吸烟。在随访长达63个月的8例患者中，没有证据表明病情进展。患侧眼球内陷1至4毫米，眼球下移达4毫米，部分病例伴有垂直睑裂孔径继发性变窄，但对视力功能无影响，仅1例患者眼球运动有明显障碍。该疾病在影像学上的特征是患侧上颌窦壁向内侧平滑凹陷，伴有继发性眼球内陷和眼球下移。14例患者中，上颌窦顶（眶底）均向下牵拉，在13例可评估的病例中，上颌骨内侧壁和后外侧壁呈凹陷状。1例患者同侧筛窦复合体伴有向内塌陷。13例中有9例上颌窦顶有散在的骨质丢失，当上颌骨后外侧壁受累时，翼腭窝的透亮度（脂肪）会相应增加。14例患者患侧上颌窦均有一些软组织改变，3例患者有气液平面。在存在鼻中隔偏曲的12例患者中，10例（83%）偏向患侧，并且经常观察到中鼻甲方向异常（14例中有10例）。
静息性窦综合征主要表现为年轻人的单侧眼球内陷，具有非常典型的临床和影像学征象，在许多情况下，患侧鼻腔解剖结构异常。该疾病可能仅见于不吸烟者。病情的急性发作和长期稳定性表明，尽管慢性且大多无症状的鼻窦疾病可能是潜在病因，但急性事件会促使眶底塌陷或（实际上）由于上颌窦肺不张导致所有窦壁广泛“内陷”。因此，我们更倾向于使用“上颌窦内陷综合征”这一术语来描述相对急性、有症状的事件，而不是“静息性窦综合征”这个与推测的潜在机制相关的名称。
