Surgical ciliated cyst of the maxilla: Report of two cases with striking radiological features and unusual antecedent surgical histories

Abstract

Surgical ciliated cysts of the maxilla arise from respiratory epithelium that lodges in the maxilla after radical maxillary or sinus surgery. They are common in Asia, where they are known as postoperative maxillary cysts, but are rare in Western countries. We present here two cases with striking radiologic features which distinguished them from other maxillary sinus lesions; non-radical antecedent surgery of extractions, possibly associated with maxillary trauma, and surgical and conservative endodontic treatment; and no evidence of recurrence after 14 and 31 years.

Highlights

  • Surgical ciliated cyst of the maxilla (postoperative maxillary cyst) is common in Asia and rare in Western countries.

  • Almost all published cases have resulted from radical maxillary or sinus surgery.

  • We present two cases with non-radical antecedent surgery.

  • Both had graphic radiologic features.

  • There was no recurrence for 14 and 31 years after intra-oral surgical removal.

Introduction

In 1958, Gregory and Shafer [ ] described three cases of a maxillary cyst lined by ciliated columnar epithelium. In each case there was a history of radical maxillary surgery with the potential to entrap sinus epithelium in the maxilla. It was this potential that led them to propose “surgical ciliated cyst of the maxilla” as a name for the resulting lesion. A different name, “postoperative maxillary cyst”, had been given to the lesion by surgeons in Japan [ , ] many years earlier. The lesion was common (ca. 20% of all oral cysts) in Japan during and for many years after World War II because sinusitis was treated surgically while antibiotics were in scarce supply [ , ]. It is rare in Western countries [ ], e.g., it was 0.08% of all cysts and 1.5% of non-odontogenic cysts in 40,000 surgical accessions reported by Daley et al. . In recent years occasional cases have been published under both names [ , ].

We present here two cases of surgical ciliated cyst of the maxilla ( SCCM ) with striking radiologic features that contrast sharply with those of most other cysts and tumors that involve the maxillary sinuses and in which the antecedent surgery was not “radical”.

Case reports

  • Case 1.

A man age 53 years was seen on inpatient referral to Oral Surgery with a history of “tooth removal” and his “jaw being wired closed”. He had been comfortable for a while, then for the past two weeks had “pain and infection”. Clinical examination by the Oral Surgeon revealed purulent drainage from the left anterior maxilla where the canine had been recently extracted. A dental panograph ( Fig. 1 ) showed deep caries in several anterior maxillary teeth and an apical radiolucent lesion of the left maxillary lateral incisor. In addition, there was a 2.5 × 3.5 cm dome with a thin radiopaque rim resembling an eggshell in the left maxillary sinus, associated with the older (healed) extraction sites of the premolars. The bone in the floor of the sinus was discontinuous in the base. The maxillary right canine and maxillary incisors were extracted. Two weeks later, under local anesthesia, the lesion periapical to the lateral incisor was excised, and the domed lesion was removed via an intra-oral approach.

Fig. 1
Case 1: Dental panograph showing a dome with a thin radiopaque rim (white arrows) in the left maxillary sinus where the premolars are missing. The floor of the sinus is interrupted in the base of the lesion. There is a recent extraction site of the left maxillary canine and a radiolucency at the root tip of the left lateral incisor (black arrow).

Histopathological evaluation showed that the specimen from the apical region of the lateral incisor consisted of chronically inflamed connective tissue surrounding a cavity lined with non-cornified stratified squamous epithelium (not illustrated). The diagnosis was radicular cyst. The specimen from the domed lesion ( Fig. 2 ) was a cavity lined by pseudostratified ciliated columnar epithelium surrounded by connective tissue with light to extensive chronic inflammation, all within a thin shell of bone. The diagnosis was SCCM.

Mar 21, 2021 | Posted by in Oral and Maxillofacial Surgery | Comments Off on Surgical ciliated cyst of the maxilla: Report of two cases with striking radiological features and unusual antecedent surgical histories
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