Clin Exp Otorhinolaryngol.  2019 Feb;12(1):79-85. 10.21053/ceo.2018.00528.

Principal Clinical Factors Predicting Therapeutic Outcomes After Surgical Drainage of Postoperative Cheek Cysts: Experience From a Single Center

• Cho SW
• Lim HJ
• Song Y
• Kang Y
• Lim JH
• Jeon YJ
• Han DH
• Won TB
• Kim DY
• Kim HJ

• KMID: 2437495
• DOI: http://doi.org/10.21053/ceo.2018.00528

Abstract

OBJECTIVES
Postoperative cheek cyst (POCC) is a late postoperative complication of radical maxillary sinus surgery including the Caldwell-Luc (C-L) operation. The present study aimed to evaluate the therapeutic outcomes of surgical treatment for POCC and to assess the clinical factors correlated to these outcomes.
METHODS
This study included 57 patients (67 nostrils) diagnosed with POCC who underwent surgical drainage. The medical records of the patients were retrospectively reviewed for radiological findings, treatment modalities, residual symptoms, and recurrences.
RESULTS
In total, 30 patients were male and 27 patients were female with a mean age of 55 years, and the patients were usually diagnosed with POCC 28.2 years after radical surgery. Endonasal endoscopic marsupialization was performed via inferior meatal antrostomy, and if possible, middle meatal antrostomy was performed at the same time. In patients with cysts that were difficult to reach using an endonasal endoscopic approach, additional open C-L approaches were performed. The median follow-up period was 19.4 months. Overall, adequate drainage and symptomatic relief were achieved in 91% (61/67) of the patients. The recurrence rate was significantly higher in patients who had anterolateral POCC. Failure to achieve symptomatic relief was correlated to a smaller cyst and the use of the open C-L approach for drainage.
CONCLUSION
The location and size of the cyst as well as the use of the open surgical approach were important factors in predicting the therapeutic outcome of POCC. The time point of treatment and surgical approaches should be based on the above-mentioned findings.

Keyword

Maxillary Sinus; Mucocele; Drainage; Treatment Outcome

MeSH Terms

Cheek*
Drainage*
Female
Follow-Up Studies
Humans
Male
Maxillary Sinus
Medical Records
Mucocele
Postoperative Complications
Recurrence
Retrospective Studies
Treatment Outcome

Figure

• 

  Fig. 1. Classification of postoperative cheek cysts. In the conventional system, a line is drawn between the anterior end of the inferior turbinate and base of the lateral pterygoid process (red lines). A medial cyst (A) extends toward the midline across this imaginary line, and a lateral cyst is classified as anterolateral (B) or posterolateral (C) based on the position of the center of the cyst with reference to another line (red dotted lines) that lies vertically to the initial line.

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  Fig. 2. Modified classification of postoperative cheek cysts. Line is drawn between the anterior end of the inferior turbinate and base of the lateral pterygoid process (red line). We modified the system such that an anterior cyst was defined as the posterior end of the cyst wall is located anterior to the midline (red dotted line). In cases where the posterior wall of the cyst is posterior to the midline, the cyst is classified as non-anterolateral.

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  Fig. 3. Case of multiple cysts. Cysts separated by bony or membranous septations (black arrows) were considered as multiple cysts.

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  Fig. 4. Initial presenting symptoms of postoperative cheek cysts. Cheek pain and swelling were the primary symptoms, followed by dental symptoms, orbital pain, nasal obstruction, and headache. The categories herein are not mutually exclusive.

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  Fig. 5. Kaplan-Meier probability curves for the risk of cyst recurrence. According to the location of the cyst, the recurrence rates were significantly different (log-rank test, P-value<0.001).

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