Are mucous retention cysts and pseudocysts in the maxillary sinus a risk factor for dental implants? A systematic review

One-Stage Surgical Management of an Asymptomatic Maxillary Sinus Mucocele with Immediate Lateral Sinus Lift and Simultaneous Implant Placement: A Case Report

Background: The relationship between dental implants and sinus mucoceles is an area of growing interest in oral and maxillofacial surgery, as therapeutic approaches for these conditions remain controversial. This case report presents a 48-year-old male with no significant medical history who sought dental care due to recurrent abscesses on the distal abutment of a five-unit maxillary bridge. Clinical and radiographic evaluations, including Cone-Beam Computed Tomography (CBCT), revealed a pathologic lesion associated with the second molar, insufficient alveolar bone height in the posterior maxilla, and a radiopaque mass on the sinus floor. Methods: A one-stage surgical approach was planned, involving the second molar extraction, the sinus cyst removal, sinus floor elevation, and simultaneous implant placement. The prosthetic restoration was completed six months postoperatively. Results: Over an 88-month follow-up period, no prosthetic complications were observed, and the patient reported high satisfaction with the restoration's function and aesthetics. Conclusions: This case highlights a single-stage surgical strategy's feasibility and long-term success in managing asymptomatic maxillary sinus mucoceles while optimizing implant placement and rehabilitation.

Development of a machine learning-based predictive model for maxillary sinus cysts and exploration of clustering patterns

BACKGROUND AND OBJECTIVE

There are still many controversies about the factors influencing maxillary sinus cysts and their clinical management. This study aims to construct a prediction model of maxillary sinus cyst and explore its clustering pattern by cone beam computerized tomography (CBCT) technique and machine learning (ML) method to provide a theoretical basis for the prevention and clinical management of maxillary sinus cyst.

METHODS

In this study, 6000 CBCT images of maxillary sinus from 3093 patients were evaluated to document the possible influencing factors of maxillary sinus cysts, including gender, age, odontogenic factors, and anatomical factors. First, the characteristic variables were screened by multiple statistical methods, and ML methods were applied to construct a prediction model for maxillary sinus cysts. Second, the model was interpreted based on the SHapley Additive exPlanations (SHAP) values, and the risk of maxillary sinus cysts was predicted by generating a web page calculator. Finally, the K-mean clustering algorithm further identified risk factors for maxillary sinus cysts.

RESULTS

By comparing the various metrics in the training and test sets of multiple ML models, eXtreme Gradient Boosting (XGBoost) is the best model. The average area under curve (AUC) values of the XGBoost model in the training, validation, and test sets, respectively, are 0.939, 0.923, and 0.921, which indicates its excellent classification and discrimination ability. The cluster analysis model further categorized maxillary sinus cysts into high-risk and low-risk groups, with apical lesions, severe periodontitis, and age ≥ 53 as high-risk factors for maxillary sinus cysts.

CONCLUSION

These findings provide valuable insights into the etiology and risk stratification of maxillary sinus cysts, offering a theoretical basis for their prevention and clinical management. The integration of CBCT imaging and ML techniques holds the potential for prevention and personalized treatment strategies of maxillary sinus cysts.

Intraoral Approach for Dental Implant Placement in Pneumatized Maxillary Sinuses With Postoperative Maxillary Cysts: A Report of Two Cases

A postoperative maxillary cyst (POMC) is a delayed complication of the original Caldwell-Luc operation, which was once widely performed to treat chronic rhinosinusitis. Two patients who had previously undergone Caldwell-Luc operations desired dental implant treatment. In both cases, preoperative cone-beam computerized tomography (CBCT) revealed a POMC occupying the entire maxillary sinus on the side where the implants were to be placed. The residual bone height was 3-4 mm. Furthermore, the sinuses were divided into compartments by septum-like structures. An intraoral approach was applied for POMC enucleation and implant placement. The implants were placed with sinus floor penetration due to the small residual bone height. No bone substitute material was grafted in the sinus. Postoperative healing was uneventful. All implants were successfully osseointegrated and performed well (4 and 5 years for each patient). No sinonasal complications were reported. Follow-up CBCTs showed that the exposed implant parts were covered by newly formed bone. The intraoral approach is a feasible option for implant placement in a pneumatized maxillary sinus with POMC.

Collaboration between otolaryngologists and oral surgeons in maxillary sinus elevation planning

BACKGROUND

The collaboration between otolaryngologists and dental providers is crucial for the planning and execution of maxillary sinus elevation (MSE) procedures, which are integral to successful dental implant placements.

PURPOSE

This article examines the essential role of otolaryngological assessments in identifying potential sinonasal risks that could impact the outcomes of MSE.

MATERIALS AND METHODS

A comprehensive narrative review of existing literature was conducted.

DISCUSSION

The review underscores the importance of thorough preoperative evaluations, including patient history, computed tomography (CT) or cone-beam CT (CBCT) scans, and nasal endoscopy, to mitigate sinonasal health risks. It details various clinical scenarios and patient assessments, emphasizing a systematic approach to diagnosing and managing sinonasal conditions proactively. The discussion reveals that while some sinus conditions may not significantly affect MSE success, conditions impacting mucociliary clearance and sinus drainage are critical risk factors requiring otolaryngological intervention. Additionally, the article introduces a grading system to assist clinicians in identifying patients who would benefit from otolaryngological evaluations prior to MSE.

CONCLUSION

This review highlights the value of interdisciplinary collaboration and standardized protocols in enhancing the predictability and safety of MSE procedures, ultimately improving patient outcomes.

Croco Eye Technique: Mucous Retention Cyst Excision with Immediate Open Sinus Lift-A Retrospective Cohort Study

Objectives: A mucous retention cyst is a common, asymptomatic lesion that may cause complications during or after the sinus lift procedure. The goal of this study is to assess the effectiveness of the Croco Eye Technique (CET), which allows simultaneous excision of the cyst and sinus floor elevation. Methods: The technique was thoroughly described in two versions, and the group of 33 patients was analyzed. Patients who qualified for this procedure had insufficient alveolar ridge height, and their CBCT showed radiological images typical for retention cysts. Analyzed parameters included the version of CET, demographic data, anatomical parameters, intraoperative complications, recurrence of the cyst, success rate of the sinus lift and implants, and the follow-up period. Results: Out of the 33 cases, 9 were of the primary version (27.27%) and 24 of the final version (72.73%). The average height of a retention cyst was 24.05 mm, with the average alveolar ridge height of 1.86 mm. In three cases (9.09%), implants were placed immediately. The prevalence of uncontrolled Schneiderian membrane perforation was reduced from 55.56% to 4.17% between the primary and final versions. The cyst's recurrence rate was 3.13%. The implant survival rate was 100%. The mean follow-up period was 48.625 months (max 110 months). Conclusions: The Croco Eye Technique, despite the perforation of the Schneiderian membrane, enables successful sinus lift and implantation with a success rate of 100%. Excision of the retention cyst, which is the cause of perforation, allows for limiting the risk of the cyst's recurrence.

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.

A Clinical Approach for the Removal of a Large Antral Pseudocyst with Simultaneous Maxillary Sinus Augmentation: A Case Series

For a large benign lesion within the maxillary sinus, such as an antral pseudocyst, maxillary sinus floor augmentation is more commonly performed using a two-stage approach. This involves first removing the lesion, and then, re-entry following several months of healing. In this case series, we described the "one-bony-window" approach, which is a technical surgical modification of the previous one-stage approach, for simultaneous cyst removal and maxillary sinus floor augmentation. Four patients with large maxillary antral pseudocysts were included. The "one-bony-window" approach involves the preparation of a large window opening of approximately 15 mm × 20 mm at the lateral wall. A mesiodistally extended intentional perforation was made in the upper part of the exposed membrane to enhance the access for instrumentation. The antral pseudocyst was removed in its entirety without being deformed to prevent rupture or leakage of the cystic contents. Subsequent detachment and elevation of the Schneiderian membrane at the sinus floor significantly reduced the perforation site, and bone grafting with implant placement was performed simultaneously. This alleviated the need to surgically repair the perforation. The lateral opening was either uncovered or repositioned using bony window lids. Healing abutments were connected after six months, and the final prosthesis was placed after two months. At the 1-year follow-up, the antral pseudocysts had resolved with no specific recurrence, and the stability of the augmented sinus was maintained with excellent implant survival. Within the limitations of our findings, the "one-bony-window" technique can be suggested for the simultaneous removal of large antral pseudocysts and maxillary sinus floor augmentation with favorable clinical outcomes.

Severe facial pain and removal of maxillary sinus mucous retention cyst

Maxillary sinus retention cysts (MRCs) are typically asymptomatic and require no treatment. An early 30s man presented with a decade-long history of severe left-sided chronic facial pain (CFP). Multiple prior treatments resulted in an edentulous patient with persistent pain. Imaging revealed a dome-shaped radiopaque change in the left maxillary sinus. History and clinical examination suggested persistent idiopathic facial pain, and doubts about the outcome of a surgical intervention were explained to the patient. Surgical removal of the MRC via lateral antrotomy led to complete symptom resolution of CFP. This case substantiates the importance of considering MRCs as a possible cause of CFP. It also emphasises the need for a systematic multidisciplinary approach in cases of unexplained CFP.

A Comprehensive Clinical Review of Maxillary Sinus Floor Elevation in Patients with Well-Defined Faintly Radiopaque Lesions in the Antrum

Well-defined, faintly radiopaque lesions are occasionally observed in the antrum of the maxillary sinus in asymptomatic patients during maxillary sinus floor elevation. These lesions are treated as antral pseudocysts (AP) based on the clinical diagnosis in some cases, and maxillary sinus floor elevation is performed without enucleating these lesions. However, further surgery is required after implant placement if the lesion is a mucocele, odontogenic cyst, or tumour. This comprehensive clinical review aimed to identify an appropriate approach for maxillary sinus floor elevation in patients with well-defined, faintly radiopaque lesions in the antrum based on our clinical experience.

Longitudinal reactions of maxillary sinus in patients treated with multiple zygomatic implants: A modified radiographic evaluation with clinical follow-up

OBJECTIVES

To investigate the effects of zygomatic implant placement on the maxillary sinus using radiographic and clinical indicators.

METHODS

Patients with an atrophic maxilla who underwent zygomatic implant placement were included. The thickness and morphology of the Schneiderian membrane (SM), infundibular obstruction, and posterior bone wall of the maxillary sinus were analyzed. The generalized estimating equation and chi-square tests were performed to compare the measurements.

RESULTS

Fifty patients with 100 maxillary sinuses were included. In total, 148 zygomatic implants and 105 regular implants were placed in the maxilla. Overall, the mean pre- and postoperative SM thickness was 2.79 ± 3.26 mm and 3.97 ± 5.45 mm, respectively (p = 0.063). In sinuses with two zygomatic implants, the SM thickness increased significantly from 2.12 ± 2.14 mm preoperatively to 4.07 ± 6.14 mm postoperatively (p = 0.026). The number of sinuses with type IV morphology (fully radiopaque) increased from zero preoperatively to six (13%) postoperatively. Sinuses with a single zygomatic implant showed no difference in the pre- and postoperative SM thickness. Postoperatively, six sinuses had infundibulum obstructions. Postoperative osteitis of the bilateral sinuses was found in two patients.

CONCLUSIONS

We have proposed a new imaging evaluation method and system for evaluating the maxillary sinus response. Preoperative infundibulum obstruction combined with mucosal thickening and double zygomatic implant placement are more likely to induce postoperative maxillary sinus mucositis and osteitis.

Endodontic Surgery of the Palatal Root of a Maxillary Molar Associated with Simultaneous Management of a Maxillary Sinus Lesion

This case report describes a particular application of endodontic microsurgery with a palatal approach in the presence of a radiopaque lesion inside the maxillary sinus. The patient presented complaining of pain related to the first maxillary molar and events of nasal obstruction and facial pain in the cheek and nasal area. The endodontic orthograde treatment and retreatment were done, respectively, 7 and 4 years earlier. The cone-beam computed tomography (CBCT) scan taken before the treatment showed two separate lesions: one associated with the palatine root of the molar and another one inside the maxillary sinus. The patient agreed to solve both problems in one surgical step: endodontic surgery of the palatine root with palatal access with the simultaneous asportation of a lesion from the maxillary sinus floor. Complete bone healing of the periapical area and the maxillary sinus was visualized on intra-oral radiographs, and CBCT was taken one year after the treatment. As far as the authors know, no one in literature has ever described this approach and solved in such a conservative way both the problems at the tooth and in the maxillary sinus.

Which factors affect the risk of membrane perforation in lateral window maxillary sinus elevation? A prospective cohort study

It was the aim of this prospective cohort study to assess the various anatomical and other patient-related factors that increase membrane perforation risk. Patients underwent cone-beam computed tomography (CBCT) before surgery. The presence of septa, presence of mucous retention cyst, lateral wall thickness, membrane thickness, and residual bone height were predictive factors. Age, gender, and smoking were covariates for the study. The presence or absence of membrane perforation was the study outcome. In total, 140 subjects were studied. The hazard ratio (HR) for the presence of septa with membrane perforation was 8.07 (2.93-22.29) (p < 0.001). The HR for perforation with a single edentulous area relating to two or more teeth was 68.09 (9.52-49.16). The risk of membrane perforation in smokers was 25 times more than in non-smokers - HR 25 (7.58-82.51) (p < 0.001). The HR for membrane perforation in subjects with mucous retention cysts compared with subjects without retention cysts was 27.75 (8.73-88.23) (p < 0.001). Within the limitations of the study it seems that anatomical, habitual, and pathological factors may increase the risk of Schneiderian membrane perforation when a lateral window approach is used for sinus floor augmentation.

A Combination of Platelet-Rich Fibrin and Collagen Membranes for Sinus Membrane Repair: A Case Report (Repair of Sinus Membrane Perforation)

Maxillary sinus lift surgery is applied to compensate for the reduced vertical height in the posterior maxilla to facilitate placing a dental implant of a suitable length. Pathological conditions may be accidentally discovered, which necessitate careful assessment and management to prevent the infection of the maxillofacial complex and eventually bone grafting and dental implant failure. This case report describes an approach for the management of Schneiderian membrane perforation associated with the removal of an antral pseudocyst for successful dental implant therapy. A 70-year-old healthy Caucasian male presented for implant therapy to replace a non-restorable maxillary molar. Initial examination revealed the need for a sinus lift procedure to prepare the site for implant placement. A 3D CBCT evaluation before surgery revealed an incidental finding of a pathological lesion at the surgical site. The histological analysis of a biopsy specimen retrieved during implant site preparation showed findings consistent with antral pseudocyst. The resulting perforation of the sinus membrane was treated, and an adequate period of healing was given. A thickened sinus membrane was detected upon surgical exposure for implant placement. The novel technique illustrated could result in a fibrotic repaired sinus membrane and help shorten the time required for dental implant treatment.

Maxillary Antral Pseudocyst Drift after Osteotome Sinus Floor Elevation with Simultaneous Implant Placement: A Case Report and Literature Review

This report describes maxillary antral pseudocyst drift after maxillary sinus floor augmentation through osteotome sinus floor elevation with simultaneous implant placement. 3D Slicer was used to measure the pseudocyst and maxilla for the placement of the implants; follow-up visits were scheduled at 6, 12, and 22 months. No adverse effects were observed during or after surgery, and all implants exhibited osseointegration without mobility. At 6 months after surgery, the pseudocyst had moved posterolaterally from the preoperative position near the anterior medial maxillary sinus, then returned to its original position at 12 months. However, it had remigrated to the posterolateral position at 22 months. The preoperative volume of the pseudocyst was 3.795 mm³; it was 2.370, 3.439, and 2.930 mm³ at 6, 12, and 22 months after surgery, respectively. The changes in pseudocyst drift and volume did not have a substantial negative influence on the implants, presumably because of cystic attachment and the recurrence of multiple pseudocysts at different locations. The risks associated with changes in a pseudocyst can be avoided, if an appropriate treatment plan is selected.

MORPHOLOGICAL FEATURES OF MAXILLARY SINUS CYSTS BASED ON THE STUDY OF PARTICULAR HISTOCHEMICAL AND IMMUNOHISTOCHEMICAL FACTORS OF INFLAMMATION

OBJECTIVE

The aim: To study the morphological structure and immunohistochemical markers of inflammatory cells in the maxillary sinus cyst wall.

PATIENTS AND METHODS

Materials and methods: Biopsy samples of maxillary sinus cysts of 92 operated patients aged 18 to 74 years were studied. We used standard staining with hematoxylin and eosin, PAS reaction, and immunohistochemical analysis with monoclonal antibodies to CD68 (macrophages) and CD3 (T- lymphocytes) to determine morphological features and severity of inflammation and PanCK AE1/AE2 antibodies to identify epithelium state.

RESULTS

Results: All patients were divided into 2 groups: 29 patients with retention cysts and 63 with lymphagiotatic cysts (pseudocysts), depending on the unilateral or bilateral epithelial lining of the cyst wall. Retention cysts had the bilateral epithelial lining with a saving its function and structure. The thinned connective tissue layer was filled with separate clusters of lymphocytes and macrophages. Lymphagiotatic cysts were characterized by the unilateral epithelium lining of the wall with signs of degeneration, desquamation, and loss of the mucus-forming function. Dense infiltration of the connective tissue layer by inflammatory cells with pronounced expression is observed.

CONCLUSION

Conclusions: Immunohistochemical analysis with monoclonal antibodies to CD3 and CD68 demonstrated that the inflammatory infiltrate of pseudocysts is represented by T-lymphocytes and different sizes of macrophages. The inflammatory infiltration of the pseudocyst wall was significantly severe compared to retention cysts.

Maxillary sinus floor augmentation comparing removing versus retaining antral pseudocyst: A retrospective cohort study

OBJECTIVES

To retrospectively compare multilevel volumetric changes in both hard and soft tissues between antral pseudocyst (AP) removal and retainment before maxillary sinus floor augmentation (MSFA) and immediate implant placement.

MATERIAL AND METHODS

Twenty-six patients with thirty-eight implants placed from 2016 to 2021 were included and divided according to a cohort design as follows: 13 removing the cyst (RC group) and 13 "leaving alone" the cyst (LC group). 3D radiographic parameters (primary outcome), 2D parameters and clinical records (secondary outcome) involving both hard and soft tissues were evaluated for 4 periods (T1: immediate postoperative, T2: 6-month, T3: 12-month, and T4: 2- to 5- year follow-up). Possible confounding factors, including sinus anatomical features and implant distribution, were also analyzed to eliminate their disturbance.

RESULTS

The 3D volumetric change rate of bone grafts in the RC group (-9.32 ± 10.01%) from T2 to T3 was significantly lower than that in the LC group (-19.8 ± 10.59%) (p < .05). The change rate of apical bone height (ABH), endo-sinus bone gain (ESBG) and other 2D parameters were not significantly different between the two groups. 5.3% implants in RC group and 9.1% implants failed during follow-ups. 0% postoperative complications were observed in RC group. The Schneiderian membrane of RC group was significantly thinner than that of LC group at two measuring points in sinus.

CONCLUSION

The present study demonstrated that compared to AP retainment, AP removal before MSFA and immediate implant placement can obtain higher bone graft volumetric stability and favorable prognosis. The study protocol was approved by the Medical Ethics Committee of the Affiliated Hospital of Stomatology, School of medicine, Zhejiang University, China (Acceptance number: 2021-117(R)).

Evaluation of Mucous Retention Cyst Prevalence on Digital Panoramic Radiographs in the Local Population of Iran

Introduction. Inflammatory diseases and cysts such as mucous retention cysts (MRCs) and benign tumors include a large proportion of lesions of the mouth, teeth, and jaw. The most common complication of this lesion is sinusitis. Due to the high frequency of these cysts in panoramic radiography of patients referred to dentistry, this study aimed to evaluate the frequency of mucous retention cysts in the maxillary sinus on panoramic images of the local population in Birjand in the year 2020. Methods. In this descriptive research design study, 1624 digital panoramic radiographs of patients referred to the oral and maxillofacial radiology department of Birjand Dental School were selected randomly. Cases were evaluated in terms of MRC appearance by two oral and maxillofacial radiology specialists. Then, based on sex, location, and size of the cysts, the images were assessed. In the predesigned checklists, data were recorded. The MRC diagnosis was confirmed by observation of a dome-shaped radiopaque view on the floor or sinus walls with a smooth surface with no cortical margin. MRCs were categorized into one of three groups by size: 1- less than 10 mm, 2- between 10 and 20 mm, and 3- more than 20 mm. Bilateral or unilateral involvement of lesions was noted. Seasons of the year ( $P<0.05$ ). There was no significant relationship between the month of the year and the prevalence of cysts ( $P>0.05$ ). Results. MRCs were detected in 80 panoramic images of 1624 (9/4), of which 54 patients (67.5%) were male and 26 patients (32.5%) were female. Of those 34 (42.5%), the total cases were between 30 and 40 years old. Most cysts (58.8%) were in the right sinus, and their size was 10–20 mm mainly (43.4%). Based on the results, there was a significant relationship between the prevalence of MRCs with age and sex. Conclusions. Panoramic images are so helpful in MRC detection. In this study, the frequency of MRCs is the highest in males between 30 and 40 years old. These lesions are reported mainly as unilateral and solitary in spring.

Proposal for a Paradigm Shift in Personalized Medicine for Patients with a Maxillary Edentulous Jaw by ENT Specialist and Dentist Cooperation

With the spread of oral implant therapy, serious medical complications related to implant surgery are becoming a social problem. Although the number of complications after implant surgery in the edentulous jaw is decreasing in Japan, maxillary-sinus-related complications (MSRCs) have reached the highest number since 2012. It is essential to identify and eliminate possible predisposing risk factors for MSRCs at an early stage to prevent MSRCs. In this review article, we highlight the causal factors of postoperative complications with or without sinus augmentation for the maxillary molar region to achieve optimal treatment outcomes and reduce complications. In particular, we focus on anatomical variations that can cause the impairment of maxillary sinus drainage. Furthermore, we emphasize that the paradigm for personalized medicine for patients with a maxillary edentulous jaw by ENT specialist and dentist cooperation is shifting from the traditional assessment of maxillary sinus pathologies alone to the new assessment of anatomic variations that can cause the impairment of maxillary sinus drainage in addition to maxillary sinus pathologies.

Sinus lifts in the presence of pseudoantral and mucous retention cysts

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.