Silent sinus syndrome is a fairly rare ENT pathology. It is still not possible to explain the exact cause of this syndrome. Modern equipment and accurate diagnostics provide the opportunity to make a diagnosis and choose the right treatment and rehabilitation tactics. The authors analyzed 36 patients from 2008 to 2024 who were admitted to the ENT department with symptoms of different nature and clinical manifestations, allowing making diagnosis silent sinus syndrome, to confirm which data on the course of the disease, radiological and endoscopic characteristics of the maxillary sinus were used. For surgical access, three options for opening the maxillary sinuses were used: through the middle and lower nasal passages as well as through the canine fossa. Access through the canine fossa (micro maxillary sinusotomy) with the formation of a persistent anastomosis in the middle and lower nasal meatus turned out to be the most optimal. The choice of location for opening the sinus was determined by the degree of prolapse of the orbital contents into the lumen of the sinus and the condition of the bone walls of the orbit. The article also presents a clinical case of complete opening of the maxillary sinus, with correctly formed bone walls and normal aeration of the sinus in a patient with this syndrome, after treatment.