Background: Silent sinus syndrome (SSS) is a rare clinical entity of maxillary antral collapse secondary to hypoventilation leading to orbital deformation and enopthalmos.

Objectives: To present the variety in presentation and discuss the theories regarding etiopathogenesis and current management strategies.

Results: Nine patients were diagnosed between 2006 and 2013. Six males and three females between the ages of 9 and 79 years. Aetiology varied in the cohort, six idiopathic and three had a preceding history of trauma, rhinoplasty or orbital decompression. All had deformation of one or more of the maxillary antral walls with varying severity with the orbital floor being the commonest. One patient had lateral nasal wall involved mainly with no orbital floor involvement and another had involvement of orbital floor, roof and medial wall. Three patients were managed with concurrent endoscopic sinus surgery (ESS) and orbital floor reconstruction with alloplastic implant, a further three received both in a staged manner, one patient received ESS only and two patients are under close observation.

Conclusions: This series highlights the variety in the clinical and radiological presentation of SSS. Restoration of sinus ventilation with ESS and concurrent enopthalmos correction is recommended.

Key words: silent sinus syndrome; orbital reconstruction; endoscopic sinus surgery