Bilateral stage I chronic maxillary atelectasis: A case report

• A rare case of bilateral chronic maxillary atelectasis is described.
• There is a poor correlate between symptoms and severity of chronic maxillary atelectasis.
• As seen in this case, the term ‘chronic’ maxillary atelectasis can be misleading, and rapid disease progression may occur.
• Re-ventilation of the affected sinuses alleviates symptoms, halts disease progression and facilitates antral re-expansion.

IntroductionChronic maxillary atelectasis (CMA) is a rare acquired condition of persistent and progressive reduction in maxillary sinus volume and antral wall collapse secondary to ostiomeatal obstruction and development of negative intra-sinus pressure gradients.Case presentationA 32-year old male was referred with a 6 week history of persistent and worsening sinonasal symptoms, following a significant upper respiratory tract infection. Imaging confirmed bilateral stage I CMA and successful treatment entailed bilateral endoscopic uncinectomy and maxillary antrostomy.DiscussionReview of the literature has demonstrated CMA to describe an all-encompassing disease process of ostiomeatal obstruction and atelectatic maxillary sinus remodelling that overcomes early variations in taxonomy (‘silent sinus syndrome’, ‘imploding antrum syndrome’, ‘acquired maxillary sinus hypoplasia’) and inconsistencies in reporting. Unilateral CMA is well documented, however a systematic search of the literature reveals only six bilateral cases. To the best of our knowledge, this is the first individual report of bilateral stage I CMA in which the inciting event is established and a uniquely rapid progress of disease followed.ConclusionThe present literature regarding CMA is incomplete and further investigation is required to provide greater insight into its aetiology and pathogenesis. Minimally invasive endoscopic approaches can be employed to re-establish aeration to the affected maxillary sinus for symptomatic relief, to halt disease progression and facilitate antral remodelling and sinus re-expansion.