It is relatively uncommon to come across a case of silent sinus syndrome (SSS), but not as rare as the prevalence in the literature might suggest – the authors of this study note that only 100 cases are reported in the medical literature. They looked at 891 CT head scans done for a variety of reasons and had two radiologists assess them for the presence of SSS or maxillary sinus hypoplasia (MSH), with a third radiologist to solve any disputes. The results are fascinating, in that five of the 891 patients had evidence of MSH with enophthalmos and hypoglobus - pathognomic of SSS - a prevalence of 0.56%. They also found the rate of MSH to be 6.17%, which is in keeping with the literature, but that in only one of these 55 cases was it identified on the CT report. This suggests that it is a relatively unrecognised anomaly, and highlights how essential it is for a surgeon to review the CT scan images in detail before embarking on a surgical intervention, and to never rely on the report alone.