Journal of Oral and Maxillofacial Pathology

CASE REPORT
Year
: 2003  |  Volume : 7  |  Issue : 1  |  Page : 8--10

Surgical ciliated cyst of maxilla - report of a case


K Rajkumar1, SS Sharma2, G Anuradha2, Prasanna Lakshmi2,  
1 Dept. of Oral Pathology, S.R.M. Dental College and Hospital, Ramapuram, Chennai 600 089, India
2 Dept. of Oral & Maxillofacial Surgery, S.R.M. Dental College and Hospital, Ramapuram, Chennai 600 089, India

Correspondence Address:
K Rajkumar
Dept. of Oral Pathology, S.R.M. Dental College and Hospital, Ramapuram, Chennai 600 089
India

Abstract

The surgical ciliated cyst is a very rare cyst of the maxillary antrum and accounts for about 1.5% of all the oral cysts. This cyst occurs as a delayed complication after radical surgical intervention in the maxillary sinus. Many authors have suggested that this cyst occurs mainly in middle decades and presents as a nonspecific, poorly localized pain occurring in the maxilla. The treatment of choice is enucleation. Here we report a case of surgical ciliated cyst in a 27 yrs old female patient, in which the etiology is proposed to be traumatic extraction, which is quiet rare.



How to cite this article:
Rajkumar K, Sharma S S, Anuradha G, Lakshmi P. Surgical ciliated cyst of maxilla - report of a case.J Oral Maxillofac Pathol 2003;7:8-10


How to cite this URL:
Rajkumar K, Sharma S S, Anuradha G, Lakshmi P. Surgical ciliated cyst of maxilla - report of a case. J Oral Maxillofac Pathol [serial online] 2003 [cited 2019 Nov 13 ];7:8-10
Available from: http://www.jomfp.in/text.asp?2003/7/1/8/40998


Full Text

 Introduction



The surgical ciliated cyst (SCC) was originally described by Kubo in 1927. It has been reported frequently in Japanese literature since then. This cyst is known as 'postoperative maxillary cyst or post operative paranasal cyst[7] . According to Basil et al in 1988 surgical ciliated cyst accounts for about 15% of all the oral cysts.

This is thought to be a delayed complication occurring years after surgical intervention into the maxillary sinus[7] . The most common symptom at the initial examination is swelling or pain of the check or muco-gingival fold. These cysts have also been reported to occur after Le Fort I, II, III and midface osteotomies'.

Gregory and Shafer described the lesion as surgical ciliated cyst (SCC) of maxilla because they were all found in maxilla and patients Whose maxillary sinus had been opened surgically and title describes the histological appearance.

The cyst has been suggested to result from mucosa of the maxillary sinus being entrapped in the wound during closure. The histologic similarity of the epithelial lining of the cyst to that of the maxillary sinus supports this theory.

Here we report a case of SCC in a 27 yrs old female patient.

 Case Report



In September 2000, a 27-year-old female patient was seen in our dental out patient department with a chief complaint of a painless diffuse swelling in the left maxilla posteriorly of 10 days duration [Figure 1]. History revealed that she underwent extraction of her left upper I" molar, 5 years back, which was alleged to be traumatic with possible involvement of the maxillary antrum.

On extra-oral examination there was a diffuse non-tender swelling with obliteration of nasolabial fold. Intra-oral examination revealed the margins of the swelling were well defined, measuring 1.5 X 1.5 cms 2 with obliteration of buccal vestibule. On palpation the swelling was firm in consistency and non-tender. This swelling was provisionally diagnosed as residual cyst of left maxilla iii relation to 26 region.

Panoramic radiograph showed radiolucent area in 25, 26 region with well defined radiopaque borders clearly demarcating from the floor of the sinus. The occlusal view also showed radiolucent area with expansion of cortical plates. [Figure 2],[Figure 3] Aspiration was done and it yielded thick viscous straw colored fluid.

Based on the above findings it was decided to treat the cyst by enucleation [Figure 4]. Under local anaesthesia a trapezoidal mucoperiosteal flap was raised and cyst was enucleated and wound primarily closed with sutures. Specimen was submitted for histopathological examination [Figure 5].

 Histology



The histology revealed a cyst lined by a thin epithelium made up of pseudostratified ciliated columnar cells[Figure 6]. Under higher magnification the pseudostratified ciliated columner epithelium cells are clearly seen with prominent cilia [Figure 7]. The cyst wall was fibrous with few inflammatory cells. So with the clinical, radiographic and histopathology grounds the diagnosis of cyst was confirmed as surgical ciliated cyst of maxilla.

The patient recovered uneventfully and is being followed up regularly with no evidence of recurrence.

 Discussion



The clinician may always be concerned with radiolucent lesions involving the jaw, obviously some cases represent developmental disturbances, other reactive or inflammatory processes and still others are benign or malignant neoplasm. Whatever the source or cause of radiolucent lesions, it must he investigated and actively pursued in order to treat them appropriately. There are very few reports of postoperative maxillary cysts in the English literature. This cyst is very common in Japanese literature. According to Kaneshiro et al (1981) [7] the high incidence in Japan could be explained by the prevalence of chronic maxillary sinusitis amongst Japanese children until 1970, particularly during war years of 1939 until 1945. Moreover surgery was widely adopted method of treatment for paranasal sinusitis in Japan before antibiotics became freely available. It is believed that SCC can develop after midface osteotomies, traumatic extraction, maxillary fracture, or a complication of Cald-Well Luc procedures.

The SCC has been found to occur in only about 3-20% of patient who have undergone a radical surgery involving maxillary sinus. Specifically according to Kubo (1927 & 1933) [8] it is an implantation phenomenon in which the epithelium of maxillary sinus becomes entrapped along the line of surgical intervention into the antrum and proliferates to form a cystic cavity separate from maxillary sinus.

The duration from the initial surgical onslaught until cyst development ranges from 6 months to 50 years with a mean period of 18.3 years. In those cases where the cyst has occurred in a much shorter time, infection is one of the precipitating factors.

Clinically the SCC of maxilla is generally seen in middle-aged patients with molars being affected more commonly. The usual complaints are of swelling, tenderness, pain or discomfort involving the maxilla. Radiographically a well­ defined radiolucent area, anatomically separate from maxillary sinus is observed. The cyst can either be unilocular or multilocular and bony perforations can be present. The cysts are usually lined by a pseudo stratified ciliated columnar epithelium of respiratory type but this may be focally or totally replaced by squamous cuboidal or columnar epithelium'. There are also reports of' sub-epithelial hyalinization and foci of squamous metaplasia of the luminal epithelium in areas of inflammation. The wall of the cyst is composed of fibrous connective tissue with or without inflammatory cell infiltration.

The SCC of maxilla should not be confused with mucosal cyst of antrum [3],[4] . The mucosal cyst of antrum is lined by antral mucosa, which consists of sero-mucinous glands, which stains positive with alcian blue at PH 0.5. Sero­mucinous ,glands are not observed in SCC of maxilla.

Yashikawa et al (1992) [13] have discussed the management of such cysts. Four different methods have been adopted, Cald-Well Luc operation, enucleation with primary closure, pack open and marsupialization. In most cases enucleation through an approach appropriate to the site will be the treatment of choice. But in those cases of large cyst with thin wall and extensive bony perforation, marsupialization is proposed.

Recurrence is not common, [10] and is seen only in cases with infection, thin walled cyst, and perforation of bone.

It is of interest in the case report here that there had been a difficult extraction 5 years back. This lesion probably developed as a result of implantation of respiratory epithelium of sinus origin at the surgical site.

 Summary & Conclusion



A rare case report of surgical ciliated cyst of maxilla has been presented. Clinical, radiological and histological evidence along with surgical history of previous tooth extraction should be considered collectively in establishing the diagnosis.

References

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