J Korean Assoc Oral Maxillofac Surg.  2022 Apr;48(2):101-110. 10.5125/jkaoms.2022.48.2.101.

Sinus lifts in the presence of pseudoantral and mucous retention cysts

• Choi MG
• Hong CH
• Choi EJ
• Park WJ
• Kim YG
• Gil DG

• KMID: 2529923
• DOI: http://doi.org/10.5125/jkaoms.2022.48.2.101

Abstract

Objectives
Mucous retention cysts and pseudoantral cysts are mainly located within the floor of the maxillary sinus. Most of these maxillary cysts are asymptomatic and often only require observation. However, the presence of these benign maxillary cysts may create problems when maxillary sinus all types of implants are needed. Various treatment methods have been introduced. The selected treatment option depends on the type, size, and location of the cyst and its symptoms.
Patients and Methods
The case reports of four patients with maxillary cysts were reviewed retrospectively. These patients received a sinus lift between January 2016 and October 2021 at the Wonkwang University Dental Hospital.
Results
To reduce unnecessary operations and the duration of treatment, a conservative treatment method is required. A sinus lift in the presence of maxillary cyst will not typically cause sinus problems if the lifted sinus membrane does not interfere with ventilation of the maxillary sinus.
Conclusion
When proper treatment is provided, sinus perforation during a sinus lift performed in the presence of maxillary cyst and contamination of bone graft materials by cystic fluid does not necessarily result in adverse outcomes.

Keyword

Mucous retention cyst; Pseudoantral cyst; Sinus lift

Figure

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  Fig. 1 A. Preoperative panoramic radiograph. Residual bone height was about 5 mm at the maxillary first molar and sinus radiopacity was observed in the right maxillary sinus. B. Preoperative cone-beam computed tomography (CBCT) showed a 32 mm×35 mm radiopaque, dome-shaped lesion on the right maxillary sinus and a 19 mm×12 mm radiopaque, dome-shaped lesion on the left maxillary sinus in a sagittal plane. C. Preoperative CBCT showed a 36 mm radiopaque, dome-shaped lesion on the right maxillary sinus and 22 mm radiopaque, dome-shaped lesion on the left maxillary sinus in a coronal plane. D. Intraoperative view. After elevation of the mucoperiosteal membrane, the bony window was marked with pencil on the right maxillary wall. E. Intraoperative view. Because the right maxillary first premolar did not require a sinus lift, the implant was placed first without a sinus lift, and then a round burr at a low speed was used for the creation of the bony window. F. Intraoperative view. After aspiration of the cystic fluid with a syringe a 21-gauge needle, the sinus membrane was carefully elevated. 1.0 g of ICB (Rocky Mountain Tissue Bank, USA) was used to fill the space created by elevation of the sinus membrane. And then, the implant was placed on the right maxillary first molar. G. Intraoperative view. The bony window was covered with a collagen membrane. H. Postoperative CBCT 1 day after operation showed fluid rertention on the right maxillary sinus. I. Postoperative panoramic view 1 day after operation showed two well-placed implants. J. Postoperative CBCT 4 years after operation. The cystic lesion on the right maxillary sinus disappeared completely, but the cystic lesion on the left maxillary sinus remained without any change. K. Postoperative panoramic view 5 years and 3 months after operation. The 3-bridge type dental prosthesis was well maintained.

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  Fig. 2 A. Preoperative panoramic radiograph. The residual bone height was about 4 mm at the maxillary first molar. B. Preoperative cone-beam computed tomography (CBCT) showed a 23 mm×14 mm radiopaque, dome-shaped lesion on the right maxillary sinus and a 20 mm×18 mm radiopaque, dome-shaped lesion on the left maxillary sinus in a sagittal plane. C. The preoperative CBCT showed a 10 mm radiopaque, dome-shaped lesion on the right maxillary sinus and a 24 mm radiopaque, dome-shaped lesion on the left maxillary sinus in a coronal plane. D. A panoramic view 1 day after operation showed a well-placed implant. E. A CBCT 1 day after operation showed fluid retention on the right maxillary sinus. F. Water’s view 4 months after operation showed haziness on the right maxillary sinus. G. Periapical view 6 months after operation showed a well-maintained dental prosthesis.

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  Fig. 3 A. Preoperative panoramic radiograph. The residual bone height was about 1.4 mm at the left maxillary molars are and sinus radiopacity (arrow) was observed on the left maxillary sinus. B. A preoperative cone-beam computed tomography (CBCT) showed a 15 mm×10 mm radiopaque, dome-shaped lesion in a sagittal plane on the left maxillary sinus. C. A preoperative CBCT showed a 20 mm radiopaque, dome-shaped lesion in a coronal plane on the left maxillary sinus. D. A panoramic view 1 day after operation showed an augmented left maxillary sinus (arrow). E. A CBCT 4 months after operation showed an augmented maxillary sinus without any problems.

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  Fig. 4 A. Preoperative panoramic radiograph. The residual bone height was about 3mm at the maxillary first molar and a sinus radiopacity (arrow) was observed on the maxillary sinus. B, C. Preoperative cone-beam computed tomography (CBCT). A CBCT showed multiple, dome-shaped, radiopaque lesion on the left maxillary sinus (arrow). D. Intraoperative view. After elevation of the mucoperiosteal membrane, a bony window was created. E. Intraoperative view. The cyst wall on the left maxillary sinus was torn a lot due to careless aspiration and suction. Unlike in pseudoantral cysts, an epitheilial lining existed. F. Intraoperative view. The cyst was removed conservatively. G. A CBCT 1 day after operation showed fluid retention due to sinus perforation and no problems on the right maxillary sinus. H. Histologic specimen. It was lined with a pseudostratified ciliated columnar epithelium (bottom; arrow) and was filled with mucins (top; asterisk) (Periodic-acid Schiff staining, ×200). I. Water’s view 4 months after operation showed decreased mucosal swelling on the left sinus membrane.

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  Fig. 5 Various treatment methods are illustrated. 1. Before a sinus lift, a maxillary cyst is removed. A. A large maxillary cyst (yellow color). B. Mucoperiosteal elevation. C. Removal of maxillary cyst is performed through a Caldwell-Luc operation or endoscopic sinus surgery. D. Postoperative swelling of the sinus membrane. E. After decrease of the swelling of sinus membrane, a sinus lift is later performed. 2. Doing the intraoperative management of the maxillary sinus cyst, where maxillary sinus elevation is done after cystic fluid aspiration without removal of the cyst. F. Cystic fluid is aspirated with a syringe. G. Inserting grafting material into the maxillary sinus. H. the bony window is covered with a collagen membrane. 3. Simultaneous sinus lift with the removal of cyst. I. Removal of a cyst was achieved while preserving the integrity of the periosteal layer of the Schneiderian membrane. Perforation of the periosteum (dotted part) may develop. J. When perforation of the periosteum develops, it is covered with a collagen membrane (sky blue color). Grafting material is inserted into the maxillary sinus. K. The bony window is covered with a collagen membrane. 4. Direct maxillary sinus surgery. L. A small maxillary cyst. M. Mucoperiosteal elevation. N. Elevation of the sinus membrane. O. Inserting graft material into the maxillary sinus. P. the bony window is covered with a collagen membrane.

Reference

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