Isolated unilateral upper alveolar numbness in silent sinus syndrome

Abstract

We present a case of a 59-year-old man with left upper alveolar numbness of 2 years' duration in the absence of sinonasal symptoms. On physical examination, he demonstrated mild left facial asymmetry and diminished sensation of his left upper alveolus from the left second upper incisor to first canine. CT imaging revealed chronic sinusitis changes of the left maxillary sinus, with reduced volume and depressed anterior wall. The patient underwent functional endoscopic sinus surgery to re-establish maxillary sinus ventilation. He was noted to have some improvement of his upper alveolar paraesthesia postoperatively. Silent sinus syndrome is part of the spectrum of chronic maxillary atelectasis. In the presented case, chronic osteitic bony sclerosis, as opposed to osteopenic change of the maxillary sinus, was seen. We postulate that bony encasement of the anterior superior alveolar nerve resulted in chronic nerve compression and the patient's unusual symptom of upper alveolar paraesthesia.

Keywords: Ear, nose and throat/otolaryngology; Otolaryngology/ENT; Surgery.

Figure 1

Coronal CT images showing features of left silent sinus syndrome smooth in-bowing of anterior and lateral maxillary walls, depressed orbital floor. Left maxillary sinusitis with bony sinus wall osteitic changes is demonstrated.

Figure 2

Coronal CT images showing the left anterior superior alveolar nerve (ASAN) branching inferiorly from the infraorbital nerve. The ASAN pathway is disrupted distally within the anterior maxillary wall due to bony sclerosis.