## 4 Discussion  
The pathology of SSS is widely discussed and not yet fully clear. Its relationship with the occlusion of the MS ostium resulting in gradual air resorption and the presence of negative pressure within the MS is considered the most possible one. During the time when OMC is closed or impatient, the inward bowing of all four maxillary walls is present gradually in time with various stages of intensity. The progression of MS atelectasis and osteomalacia is not possible to estimate. During time asymmetry, the maxilla-malar area might be present along with the occurrence of enophthalmos. Some other theories are known, including the presence of chronic obstructive sinusitis, inflammatory wall erosion, lateralization of the uncinated process, and others [12; 13; 14; 15; 16; 17; 18; 19; 20]. A differential diagnosis should include other MS-related pathologies such as paranasal sinuses hypo-/hyperventilation cases, MS hypoplasia (MSH), facial deformities, trauma-related cases, surgically related (orbital decompression) cases, mucoele, chronic rhinos-nusitis, cancer-related factors, linear scleroderma, hemifacial microsomia, Parry-Romberg syndrome, and others [8; 9; 10; 11; 12; 13; 14; 15; 16; 17; 18; 19; 20; 21]. SSS might have some characteristic radiological and clinical features. Most of the features are found accidentally on routine CT/CBCT evaluation (Table 1). In some situations, as reported by [PERSON] and other authors, magnetic resonance imaging (MRI) might establish some additional features, such as the presence of an opacified sinus with mixed-signal contents and diminished volume, the prominence of orbital fat, and widen  
Figure 12: Intraoperative view from SARME procedure (surgically assisted rapid maxillary expansion) on Hyrax device, during orthognathic surgery. The right maxillary sinus is smaller than the left one. The presented herein atypical SSS was symptomless, and after laryngologist consultation and good endoscopic and CT evaluation, there was no functional endoscopic sinus surgery—FESS procedure was scheduled before SARME. Abbreviations: CT—computed tomography, SSS—silent sinus syndrome, CMA—chronic maxillary atelectasia, MS—maxillary sinus, OMC—osteomeatal complex; All intraoperative photographs presented in the study are from the authors’ own dataset collection. ing of the retroantral fat pad, along with the extraocular muscle (inferior rectus muscle), which may descend along with the globe downwards [11; 12; 13; 14; 15; 16; 17; 18; 19]. Based on the following occurrence of enophthalmos, maxillary opacification with maxillary atelectasia are a basic characteristic feature of SSS. The presented symptoms confirm the final diagnosis in the typical asymptomatic idiopathic form [18; 19; 20; 21; 22]. SSS in MS is a rare asymptomatic finding. The changes within the MS bony walls and their inward retraction causing asymmetrical sinus volume reduction compared to the opposite healthy side is always present. The opacification, OMC drainage, and sinus floor downward position may have different intensities [15; 16; 17; 18; 19; 20]. Many other pathologies present in MS do not have this full scope of symptoms as this disease. As presented in the authors' study, clear SSS/CMA can be also divided into in-pure forms with lesser radiological symptoms present, which should be important form clinical point of view, because this fact would impact any additional procedures which could be done if necessary. The occurrence of CRS might improve that diagnosis and indicate CMA, which is mostly a symptomatic disease. When present, each clinician should be aware of its presence and symptoms which require conservative or surgical approaches to treat it. Then, either a detailed pharmacological or surgical approach such as FESS/ESS should be scheduled. Each treatment should be focused on restoring the proper sinus aeration and controlling any sino-nasal and ophthalmic syndromes. Because each symptom could have a different manifestation rate, an adequate clinical and radiological evaluation is essential.