Mucosal cysts in the paranasal sinuses: long-term follow-up and clinical implications

Maxillary Sinus Augmentation and Implant Installation in Patients With Pseudocysts and Mucous Retention Cysts

This case study systematically assessed diverse approaches to sinus augmentation in the presence of sinus pathology. Three patients were carefully selected and categorized as pseudocyst (PsC) (type 1), mucous retention cyst (MRC) smaller than 20 mm (type 2), and MRC larger than 20 mm in size (type 3). All patients underwent sinus augmentation procedures, with each case utilizing a unique surgical approach. Spontaneous drainage was performed for the patient with PsC (type 1), followed by uncomplicated sinus augmentation. For the patient with an MRC smaller than 20 mm (type 2), aspiration of the cyst contents preceded sinus augmentation. Conversely, the patient with a larger MRC (type 3) underwent cyst enucleation followed by sinus augmentation after complete recovery of the sinus membrane. No complications were noted in any of the cases, and follow-up revealed stable implant installation at the site of sinus augmentation. Within the constraints of this study, the choice of surgical procedure, whether involving spontaneous drainage, aspiration, or enucleation, should be guided by an anticipated pathologic diagnosis and the size of the sinus cyst. This informed approach empowers clinicians to make well-informed decisions for the best possible outcomes and sustained results. Overall, this study offers valuable insights for clinicians seeking to optimize sinus augmentation procedures in the presence of sinus pathology.

Relationship between maxillary sinus mucosal cyst and sinus ostium 2D area in three-dimensional volumetric paranasal CT ımages

OBJECTIVE

To investigate the relationship between the maxillary sinus ostium 2D area (SOA) and the development of mucosal cysts of the maxillary sinus (MMC).

METHODS

Thirty patients (≥ 18 years) with unilateral MMC who underwent paranasal sinus CT (PNsCT) were included in this single-center retrospective study. Non-MMC sinus was used as the control group. Cyst and air volume of the maxillary sinuses, diameter, and 2-dimensional area of the ostium of the patients were calculated in the 3-dimensional volumetric analysis program. Both correlation and linear regression model analyses were performed for the relationship between MMC and SOA.

RESULTS

Thirty patients were included (mean age of 42.30 ± 17.62 years). A total of 15/30 (50%) were male. The mean SOA in patients with MMC (8.91 ± 1.10 mm2) was lower than in patients without MMC (12.94 ± 1.35 mm2), which was statistically significant (p < 0.001). The mean sinus ostium diameter in patients with MMC (2.12 ± 0.71 mm) was higher than in patients without MMC (1.91 ± 0.82 mm), which was statistically insignificant (p = 0.295). There was a statistically significant, good level of negative linear correlation between SOA and total cyst volume (TCV) [correlation coefficient (r) = - 0.680, p < 0.001]). As a result, the regression model consisting of "Age, Sinus air volume, and TCV" variables is a good model and has statistically significant relations with SOA.

CONCLUSION

In conclusion, small SOAs contribute to the development of MMC. There was a negative correlation between SOA and TCV. In addition, 2D area measurement may be a more accurate method instead of diameter measurement.

Evaluation of Anatomical Variations of the Maxillary Sinus in Patients With and Without Mucous Retention Cyst

Objectives: Mucous retention cyst (MRC) is a benign and self-limited lesion that can be caused by many risk factors, including anatomical variations of the sinonasal region. This study aims to investigate the relationship between anatomical variations and the presence of MRC. Materials and Methods: In total, 2109 sinonasal cone beam computed tomography images were evaluated for the presence of MRC, and the sinonasal anatomical regions such as the osteomeatal complex (OMC), infundibulum length, ostium height, the diameter of the ostium, the presence of accessory ostium, concha bullosa, and mucosal thickening of the maxillary sinuses. Shapiro-Wilk normality test, independent sample t-test, and chi-square test were used for statistical analysis, and P < .05 was considered significant. Results: The prevalence of MRC was 119 (5.6%) cases. The average diameter of the ostium in cases with and without MRC was 0.49 ± 0.41 mm and 0.99 ± 0.76 mm, respectively, which showed a significant inverse relationship(P < .001). A significant relationship was found between the septum deviation, the ostium height, the concha bullosa, and the accessory ostium with the presence of MRC (P < .001). Conclusions: Sinonasal anatomical variations such as ostium diameter, ostium height, septal deviation, the presence of accessory ostium, and concha bullosa can cause MRC development, and considering that surgery may be necessary in some cases; this could be of great importance to clinicians and surgeons for treatment and prevention of development or recurrence of these pseudocysts in patients.

The Relationship Between Degree of Nasal Septum Deviation With Sinonasal Structures and Variations

ABSTRACT

We aimed to evaluate whether the nasal septum deviation affects the development of sinonasal structures. Patients who had undergone paranasal sinus computed tomography (PNS-CT) imaging due to nasal obstruction were divided into 3 groups according to the septal deviation angle; group I: 0° to 9°, group II: 10° to 15°, and group III: >15°. The features of sinonasal structures were recorded when evaluating PNS-CT. There were totally 234 patients, 119 patients in group I, 68 in group II, and 47 in group III. On the opposite side of the deviation, keros 3 was significantly more in group III (P < 0.001). Although the incidence of concha bullosa and agger nasi cell were not affected by the degree of deviation (P > 0.05), the incidence of Haller and Onodi cells were significantly higher in group III (P < 0.001). In addition, all cells were observed more in the opposite side of the deviation in each group (P < 0.001). Maxillary sinus retention cysts and hypoplasia of maxillary and frontal sinuses, as an indicator of the low pneumatization of the sinuses, are seen more on the same side of nasal septum deviation, increasing with the degree of deviation increases (P < 0.001). Nasal septum deviation affects the development of sinonasal structures by affecting the pneumatization. Preoperative PNS-CT evaluation is important in order to be aware of the situations that we may encounter during surgery and to provide adequate treatment.

[Retention cysts: a new approach to treatment]

In 2017-2018, the authors examined and operated on 35 patients aged 20 to 39 years (19 women, 16 men) with cystic maxillary sinusitis. The study included patients who were diagnosed with retention cyst of the maxillary sinus, located on the lower walls of the maxillary sinus and dealing with no more than ²/₃ of the maxillary sinus volume, according to CT of the paranasal sinuses. The operation was performed using the following method: two punctures of the sinus were performed simultaneously in a typical place in the lower nasal passage - using a Kulikovsky needle and using a 2.8 mm trocar. The fiber of the Ho-laser was inserted into the Kulikovsky needle, and an endoscope was inserted into the trocar in parallel with the 0, 30 or 45°. Then, under the control of the endoscope, the fiber was inserted into the cyst and given a series of impulses before its 'explosion'. The parameters Ho:YAG-radiation had the following values: power - 14.4 W, pulse energy - 1.2 Jol, pulse frequency - 12.0 Hz. All patients were discharged from the hospital on the 2^nd day. In the long-term period (up to 14 months), according to the endoscopic examination, an objective examination and CT of the paranasal sinuses showed no recurrence of the cyst in any patient, no pathological changes were recorded in the area of the lower nasal passage.

Paranasal Sinus Anatomic Variations Accompanying Maxillary Sinus Retention Cysts: A Radiological Analysis

Objective

The risk factors for the development of retention cysts of the maxillary sinuses (RCMs) are not clear, although RCMs are common findings on radiographic images. This study was conducted to evaluate the correlation between RCMs and other nasal-paranasal anomalies and to demonstrate the possible effects of these anomalies on the development of RCMs.

Methods

In the study, paranasal sinus computerized tomography (PNsCT) images from 5166 patients were retrospectively reviewed. Correlations between RCMs and osteomeatal complex obstruction, accessory ostium presence, abnormalities of the middle turbinate, and nasal septal deviation were analyzed in the PNsCT images. The paranasal sinus anomalies on the side of the RCMs were compared to the contralateral side.

Results

A total of 1880 RCMs were detected in 1429 (27.6%) of 5166 patients. At least one nasal-paranasal sinus anomaly was associated with 88.7% of the RCMs. In the descending order, accessory ostium presence, accessory ostium, middle turbinate anomalies, and nasal septal deviation are pathologies that accompany RCMs. When unilateral RCMs were compared with the normal side, significant correlations were observed between RCMs and osteomeatal complex obstruction, accessory ostium, and middle turbinate anomalies (p=0.001, p=0.016, and p=0.03, respectively). RCMs were commonly found on the same side as osteomeatal complex obstruction (p=0.001), middle turbinate anomalies (p=0.001), and accessory ostium (p=0.052).

Conclusions

In this study, the coexistence of osteomeatal complex obstruction, accessory ostium, middle turbinate anomalies, and nasal septum deviation with RCMs was analyzed by investigating PNsCT findings in 5166 patients. The results show that RCMs are associated with pathologies that increase paranasal inflammation, such as osteomeatal complex obstruction, and are good markers for nasal-paranasal sinus anomalies. The presence of incidental RCMs should be a warning sign of nasal-paranasal sinus anomalies.

Cyst decreased in size post maxillary sinus floor augmentation surgery in diabetic patient: A case report

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2.37 mm from the ridge to sinus floor with cyst (18.72 mm × 24.61 mm) firmly attached to the wall.

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Lateral approach to elevate the sinus floor with cyst simultaneously in diabetic patient.

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Osseointegration was achieved and the cyst decreased in size 6 months later.

Introduction

Whether mucosal cyst of maxillary sinus is contraindication for sinus floor augmentation surgery has been a controversial hot spot for years.

Presentation of case

This case aims to present the surgical procedure of sinus floor augmentation surgery with cyst (18.72 mm × 24.61 mm) in diabetic patient. And 6 months later, the cyst decreased in size. The authors elevated the sinus floor and cyst simultaneously. The surgery was carried out successfully without sinus membrane perforation and the alveolar ridge gained about 8 mm height. Six months later, the cyst decreased in size and osseointegration was observed.

Discussion

Interdisciplinary cooperation is encouraged to diagnose benign mucosal cyst. The isolation between sinus lumen and the grafted sub-sinus space is important. Graft contamination or dispersion into the sinus lumen should be avoided. The integrity of the sinus membrane and use of antibiotics are very important to prevent the occurrence of postoperative sinus infection

Conclusion

The authors conclude that sinus augmentation surgery could be done with mucosal cyst in diabetic patient.

Sinus grafting and simultaneous removal of large antral pseudocysts of the maxillary sinus with a micro-invasive intraoral access

Large antral pseudocysts of the maxillary sinus (APCs) may hamper the elevation of the Schneiderian membrane during sinus grafting and may impair osteo-meatal complex patency after sinus augmentation. Therefore, these should be removed prior to or at the time of sinus grafting. This study presents a new technique that combines enucleation of large APCs during sinus grafting via a lateral approach with preservation of the Schneiderian membrane periosteal layer. Twelve patients underwent a sinus graft via lateral approach during the years 2004-2012. Simultaneous APC removal was achieved through a small additional bony access, preserving the integrity of the periosteal layer of the Schneiderian membrane. Nineteen implants were inserted at the time of sinus augmentation or during a second stage. Prosthetic rehabilitation was started at 4-6 months after implant placement. No patient developed surgical complications or APC recurrence. The survival rate of implants and related prostheses was 100% over a mean follow-up of 50 months (range 12-96 months) after completion of the prosthetic restorations. This technique may represent an effective procedure to achieve APC removal at the time of sinus grafting, preserving the integrity of the Schneiderian membrane periosteal layer.

Maxillary sinus retention cysts protruding into the inferior meatus

Although most of the maxillary sinus retention cysts are asymptomatic, a few of them increase in size and cause symptoms. However, they rarely erode bony walls nor protrude into the inferior meatus. I present 2 cases with maxillary sinus retention cysts protruding into the inferior meatus by making a large defect on the medial wall of the maxillary sinus.

Cysts of the maxillary sinus: a literature review

BACKGROUND

Patients with isolated mucosal cysts of the maxillary sinus (MMC) often undergo surgical treatment despite the absence of relevant symptoms. Some physicians believe that MMC might increase in size and cause complications in the future. The anticipated value of this study is to consolidate and improve the understanding of MMC based on published data and to contribute to avoiding unnecessary interventions.

METHODS

We performed a comprehensive review of the literature regarding definition, etiology, epidemiology, natural course, and best treatment of MMC.

RESULTS

Among the 988 papers found in the literature search, 33 studies were selected to be relevant. Among those studies, there are only a few prospective controlled studies. Their prevalence rates range broadly from 3.6% to 35.6% according to different diagnostic methods as well as different indications for imaging. Recent prospective studies showed no correlation of MMC with sinonasal complaints or Lund-Mackay computed tomography (CT) score. The natural course is characterized by a decrease in size of MMC in 30% of the cases, an unchanged status in 50% to 60%, and an increase in 8% to 20% of the cases.

CONCLUSION

MMC are harmless, mostly asymptomatic lesions that usually do not need surgical treatment. If surgery is indicated, endonasal endoscopic techniques should be the gold-standard approach.

Mucosal maxillary cysts: long-term subjective outcomes after surgical treatment

Mucosal maxillary cysts (MMCs) are usually asymptomatic and are often diagnosed as an incidental finding. The aim of this study is to assess clinical significance of MMCs and the long-term effect of surgical treatment on the symptoms initially addressed to MMCs. The study included a retrospective analysis of 64 patients who had undergone surgery for MMC using a questionnaire focused mainly on the effect surgery had on symptoms. Mean time of follow-up was 79 months. Patients were also divided and compared according to the presence of rhinitic symptoms. Twenty-six patients (63.4%) reported complete disappearance of symptoms, 8 (19.5%) reported improvement, 4 (9.7%) reported no change in symptoms following surgery and 3 (7.3%) reported that symptoms reappeared. Significantly (p = 0.0365) better results were achieved in patients without preexisting rhinitic symptoms. This study supports the opinion that in some cases, MMCs are involved in the development of sinonasal symptoms. Surgical treatment leads, in most patients, to disappearance or improvement of symptoms and the effect is better in patients without rhinitic symptoms.