Maxillary sinus mucocele presenting as a late complication of a maxillary advancement procedure

Occurrence of a postoperative maxillary mucocele 20 years after orbital wall reconstruction

Mucoceles of the paranasal sinus are epithelial-lined cystic structures filled with mucus and have multiple etiologies, including recurrent inflammation, trauma, or intrinsic disease. Particularly, a postoperative maxillary mucocele (POMM) is a delayed complication of radical surgery of the maxillary sinus, and most cases occur after Caldwell-Luc operations. Patients mainly complain of facial swelling, toothache, and tenderness. POMM has rarely been reported from other causes; however, there have been no reports on the occurrence of POMM following orbital wall reconstruction. Herein, we report a case of a patient with a POMM that developed 20 years after the aforementioned surgery. The patient complained of facial pain with visual disturbance, and underwent marsupialization using a combination of sublabial and endoscopic approaches, and the symptoms improved without recurrence.

Maxillary surgical ciliated cysts following advancement Le Fort I osteotomy with concomitant autogenous bone grafting: a simple coincidence or a cause-effect relationship?

Surgical ciliated cysts (SCCs) are rare benign lesions that have been described after radical maxillary sinus surgery such as a Caldwell-Luc procedure for chronic sinusitis. They usually occur several years following surgery, and they typically present as an evolving swelling in the maxillary sulcus and cheek area. The pathogenetic mechanism is related to the entrapment of respiratory epithelium from the paranasal sinuses and/or the nose within the wound created by the surgical procedures. Radiologically, SCCs manifest as a well-demarcated, unilocular or multilocular radiolucency and histologically are lined by respiratory epithelium. Enucleation remains the treatment of choice. Since the 1990s, cases of SCCs have also been described following orthognathic surgery and developing not only within the maxilla but also surprisingly within the mandible. We report here three unique cases of patients with postoperative maxillary cysts following Le Fort I advancement osteotomy with concomitant inter-positional gap autogenous bone grafting.

Bilateral Postoperative Cyst after Maxillary Sinus Surgery: Report of a Case and Systematic Review of the Literature

Purpose. We present a case of a bilateral postoperative maxillary cyst (PMC) and discuss this with a systemic review. Case Report and Literature Review. A 68-year-old female with pain and swelling on the right side of the face. MRI and CT showed a cystic tumors of the right and left maxillary sinus. Radical maxillary surgery via a Caldwell-Luc procedure had been performed 55 years ago and bilateral PMC was diagnosed. The PubMed database was searched for PMC within the last 30 years. Results. Together with the current case, we found 23 reports including 284 patients describing PMC. It was diagnosed at a mean time of 22 years after causal surgery at a mean age of 47 years. Initial symptoms were mostly pain with or without swelling. The main radiological sign was a unilocular radiolucency with a slight preference for the left side. Discussion. PMC is a long-term complication that can occur after maxillary sinus surgery and a second surgical approach is required in order to stop cystic expansion. Therefore, patients' informed consent on this complication as well as a prolonged follow-up is recommended. Simple paranasal ultrasound or paranasal sinus plain radiography may lead to an earlier detection reducing interventional morbidity.

Complicated giant mucoceles of the frontal sinus: approach to endoscopic marsupialization technique

A number of external and radical procedures have been the only surgical approaches for the treatment of frontal sinus mucoceles. However, these procedures have major complications including high surgical morbidity, esthetic concerns of postoperative scar formation, and difficulty in radiologic diagnosis of recurrence after obliteration. In this clinical report, we demonstrated an endoscopic marsupialization technique that could easily be applied to a very large mucocele that has extended to the intracranial region, without any serious complications.

The effects of sinus membrane pathology on bone augmentation and procedural outcome using minimal invasive antral membrane balloon elevation

Membrane pathology tends to complicate the postprocedural course of open sinus lift by ostio-meatal complex (OMC) obstruction and consequent acute sinusitis. The objective of this study was to evaluate the outcome of subjects with considerable sinus membrane pathology undergoing maxillary sinus floor augmentation and simultaneous implant placement using the minimal invasive antral membrane balloon elevation (MIAMBE) method. This study was a retrospective chart review of MIAMBE procedures performed in the presence of significant sinus membrane pathology. Sixteen patients with maxillary sinus membrane thickening in well-ventilated OMC as determined by dental computerized tomography underwent sinus augmentation and simultaneous implant placement using the MIAMBE technique. All 16 procedures were successfully concluded without significant procedural or postprocedural complications or implant failure. Post MIAMBE membrane pathology regressed or disappeared in 8 patients (50%) or remained unchanged in 6 patients (37.5%), while in 2 patients the sinus membrane pathology was limited to evaluation by periapical X rays. Sinus augmentation using the MIAMBE technique can be performed safely in asymptomatic patients in the presence of sinus membrane pathology if the OMC is not obstructed. In a significant proportion of these cases, complete resolution of the membrane pathology after MIAMBE is observed. When compared to open sinus lift, OMC obstruction is less likely to occur when employing the MIAMBE method.

Postoperative maxillary cysts: magnetic resonance imaging compared with computerized tomography

OBJECTIVES

The aim was to investigate magnetic resonance (MR) and computerized tomography (CT) images and compare MR and CT image features of postoperative maxillary cysts (POMC).

STUDY DESIGN

We retrospectively evaluated MR and CT images of 7 POMC patients. Number of the cysts, border, bone expansion, CT value, signal intensity, and contrast enhancement were observed.

RESULTS

On CT images, 15 cysts were detected. Fourteen cysts showed smooth border. Bone expansion was found in 10 cysts. Mean CT value of each cyst ranged from 23 to 50 Hounsfield units. On MR images, 18 cysts were detected. Twelve cysts showed smooth border. Bone expansion was not observed. Most cysts showed intermediate signal intensity on T1-weighted images, and high or nonhomogeneous intermediate/high signal intensity on T2-weighted images with the fat suppression technique. No cyst showed contrast enhancement in both examinations.

CONCLUSION

The CT images revealed bony information, and the MR images clearly demonstrated border of POMC. POMC should be evaluated with both CT and MR imaging.

Extensive paranasal sinus mucoceles: a 15-year review of 82 cases

PURPOSE

The aim of the study was to report the clinical characteristics, management, and outcome of patients with extensive paranasal sinus mucoceles.

MATERIALS AND METHODS

In a retrospective study, 82 patients with intracranial or intraorbital extension due to paranasal sinus mucoceles who were surgically treated between 1993 and 2007 were studied. In addition, clinical data, presenting symptoms, clinical features, management, and outcome were analyzed.

RESULTS

The study population included 42 males and 40 females, with a mean age of 52.7 years (range, 15-87 years). The most common presenting symptoms were ptosis (27/82, 32.9%) and periorbital swelling (24/82, 29.3%). The main radiologic finding on computed tomography scan was bony defect of lamina papyracea and/or medial superior orbital rim. Sixty-six patients underwent endoscopic sinus surgery; among them, 3 patients had recurrence (3/77, 3.9%) during follow-up periods.

CONCLUSION

In our study, a majority of patients with extensive paranasal sinus mucoceles exhibited ophthalmologic symptoms before treatment (81/82, 98.8%). Computed tomography scanning was a feasible tool for preoperative assessment. A satisfactory outcome can be achieved after surgical treatment of endoscopic sinus surgery.

Presentation and management of extensive fronto-orbital-ethmoid mucoceles

OBJECTIVES

The aim of the study was to report the presentation and management of extensive fronto-orbital-ethmoid (FOE) mucoceles.

METHODS

This study is a retrospective chart review of 13 consecutive patients requiring surgical intervention for extensive FOE mucoceles. Patients were treated over the period from 1999 to 2003. Variables examined include chief complaint, risk factors, location of erosion, management, and complications. Follow-up ranged from 12 to 36 months.

RESULTS

Most common chief complaint was eye proptosis, followed by forehead swelling and orbital cellulitis. Four patients had previous functional endoscopic sinus surgery (FESS) and another 4 patients had history of prior trauma and frontal sinus obliteration. Eleven patients had skull base erosion and 12 had orbital wall erosion. Four patients were managed endoscopically. Of these, 1 had previously undergone FESS, whereas the other 3 had no risk factors. All patients with prior trauma/obliteration were treated with coronal flap and frontal sinus obliteration. One patient who had undergone 2 previous FESS was successfully treated with coronal flap without obliteration. One patient treated with an osteoplastic flap had cerebrospinal fluid leak that was identified and repaired intraoperatively with a pericranial flap.

CONCLUSION

Extensive FOE mucoceles can be successfully and safely treated by endoscopic and non-endoscopic methods. The choice of surgical approach mainly depends on the anatomy of the frontal recess. Prior trauma and FESS are associated with requiring coronal flap and frontal sinus obliteration.