## 4 Discussion
Those symptoms might include decreased nasal breathing, with obstruction or blockage of the nasal cavity, some scope of pain, pressure within the sinus, and disturbing smell with also the presence of atypical compression within the affected sinus, malar, and sometimes ale alveolar process of the maxilla, mimicking a tooth pain [20; 21; 22; 23; 24; 25; 26; 27; 28; 29; 30]. Since in the presented study the authors have not focused on the scope of CRS symptoms, but just mostly CT/CBCT data, the next studies therefore need to fully estimate the degree of symptoms and the potential clinical aspect of SSS/CMA. So far, a limited amount of cases reported some atypical SSS manifestations. A few cases of atypical SSS characteristics for lack of MS opacification and not disturbed OMC drainage might be also found, as reported by [PERSON] et al. [18]. Furthermore, atypical and unexplained sources of enophthalmos, hypoglobus, and maxillary atelectasia might also suggest SSS [16; 18]. Most MSs still typically lack proper ventilation and total MS volume opacification [16]. On the other hand, some cases describe posttraumatic SSS formation, which is an uncommon type of SSS, and should be described as atypical cases, related to iatrogenic or other factors, as reported by [PERSON] et al. [30]. Perhaps other extrasinus-related factors, that influence any damage to the MS, might promote the formation of SSS/CMA; however, this hypothesis needs more study. While SSS is an asymptomatic disease, some authors also report a \"not so silent sinus syndrome\", related to an incompletely opacified hypoplastic sinus and inward traction of some MS walls [31]. The \"not so silent sinus\" term suggested by some authors is also confirmed in the authors' study results. Despite the downward traction of the orbital floor, not each case results in hypoglobus and diplopia; however, enophthalmos might have various intensities [32], because each is strongly individual and might progress in time treatment remains discussable and quite individual. The treatment of SSS depends upon if it is a progressive disease or in the stable asymptomatic phase. In the authors' material, the ophthalmologic syndromes were rare and not clearly established, so none of the patients required ophthalmologic consultation or any scope of intervention. The main surgical aspect is focused on restoring proper MS ventilation by the FESS procedure and the middle meatal antrostomy procedure. At first, the OMC patency must be restored and improved, followed by sinus debridement in some cases. Endoscopic uncinctomy and antrostomy are sufficient to restore MS drainage. Some technique alternation is associated with the balloon Seldinger technique to improve MS drainage and decrease sinus-related symptoms if present [12; 13; 14; 15; 16; 17; 18; 22; 23; 24; 25; 26; 27; 28; 29; 30; 31; 32]. In rare cases of bilateral MS opacification, symptoms present should be individually evaluated [33]. Old methods might indicate the currently rarely used Caldwell-Luc procedure to remove the mucosa from the MS and then establish an additional surgical fistula (antrostomy via the medial nasal wall) under the inferior nasal conchae to improve the MS drainage. Most commonly, a Foley catheter is placed for a few days through the nose towards the MS autumn which is placed to ensure good aeration and drainage. This procedure has various limitations; therefore, it is currently rarely used. Orbital floor reconstruction can be achieved by titanium mesh or perhaps iliac bone grafting. Improving the globe's superior position is a very challenging procedure, the same as enophthalmos correction in some cases. The so-called \"sunken\" eye symptom is related to the inferior displacement of the globe, because of the negative pressure within the MS. Its correction might require not only floor reconstruction but also bone grafting. In some cases, a cosmetic approach towards the inferior orbital rim and zygomatico-malar eminence can be achieved with silicone implants, bone grafting, or orthognathic surgery.