Cyst of the maxillary sinus

Why do cysts form?

There are 7 sinuses in the facial part of the skull: 3 paired and 1 unpaired. The paired ones are the frontal, maxillary (or maxillary) sinuses and the ethmoidal labyrinths (consisting of several fused cells of the ethmoid bone). Unpaired - wedge-shaped in the body of the bone of the same name. The paranasal sinuses are connected to the nose by narrow canals or anastomoses. Thanks to them, the facial part of the skull is filled with air. The sinuses are located inside the cranial bones, their size is constant. The inside of the sinus cavities are lined with ciliated epithelium or special cells - cilia. These cells are covered with mucus, which flows down with constant rhythmic movements of the epithelial “cilia” into the nose, carrying with it particles of airborne dust.

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• Repeated consultation – 2,000

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Each gland that produces mucus ends in an excretory duct. Sometimes - most often during the process of inflammation - the duct closes, and the gland continues to work for some time. The mucus accumulates, the tissues move apart - this is how cysts are formed, enclosed in a membrane. Such cysts are called true or mucoceles. There are other types of cysts:

• congenital (developmental defects) - often are incidental findings during studies for another reason;
• false - without a membrane, formed in the thickness of the mucous membrane, can empty themselves, develop with chronic runny nose or allergies;
• cavities located at the roots of the teeth of the upper jaw (odontogenic cysts), formed as a result of treatment errors or in the place of underdeveloped tooth germs.

Odontogenic cysts rarely occur on healthy soil. Typically, people who experience this complication have a congenital defect - a low bottom of the maxillary sinus. Sometimes the filling material comes out of the nerve canal, which can cause inflammation and cyst formation.

Mucocele

Mucocele is a complete decrease in the airiness of one or more paranasal sinuses due to the accumulation of mucus in them, often combined with bone expansion as a result of impaired sinus drainage.

Clinical picture

The clinical picture depends on two factors

1. localization and directions of expansion
2. presence of associated infection

Mucocele disrupts local anatomy and, as it enlarges, puts pressure on adjacent structures, for example:

• mucocele of the frontal sinus extends into the anterior part of the orbit in the form of a mass
• mucocele of the posterior ethmoidal labyrinth compresses the apex of the orbit
• Mucocele of the sphenoid sinus extends posteriorly towards the pituitary gland and brainstem
• mucocele of the maxillary sinus can elevate the inferior wall of the orbit causing ptosis

when an infection occurs, the clinical picture is similar to acute sinusitis, with the potential spread of infection into adjacent spaces:

• intracranial: subdural empyema, meningitis, brain abscess
• orbit: subperiosteal abscess
• subcutaneously

Pathology

More likely, a mucocele is the result of obstruction of the sinus ostium due to inflammation, trauma, mass lesion, etc., with subsequent mucus accumulation and eventual sinus expansion. Some authors (a minority) believe that a mucocele is a mucous retention cyst that gradually enlarges, eventually occupying the entire sinus [3]. Chronic non-invasive fungal sinusitis also occurs as an etiogenic factor of mucocele [3-4]. From the radiologist's point of view, it does not matter which of these theories is correct. The content of a mucocele is variable, and its composition influences the imaging appearance.

Localization

Up to 2/3 of the mucocele is formed in the frontal sinuses, the ethmoidal labyrinth is in second place, the maxillary and main sinuses are rarely affected [3].

Combined pathology

• cystic fibrosis

Diagnostics

Radiography

X-ray of the skull does not play a significant role in the diagnosis of mucocele and can only reveal darkening of the affected sinus.

CT scan

The affected sinus is airless, and the walls are thinned and moved apart. Zones of complete resorption of bone walls can be visualized, forming bone defects and allowing the “formation” to prolapse into adjacent tissues [3-4]. Sometimes calcifications are found along the periphery [3]. After administration of a contrast agent, its accumulation along the periphery is sometimes noted. Sinus content is variable depending on water content, varying in density from fluid content to hyperdense [4].

Magnetic resonance imaging

The intensity of the MR signal depends on the ratio of the amount of water, mucus and proteins [2-4]:

• T1 high water content: low signal intensity (most common)
• high protein content: high signal intensity

NB: the addition of a fungal infection leads to a decrease in the signal on T1 and T2 weighted images, simulating normally aerated sinuses [4].

Differential diagnosis

• tumors, e.g. inverted papilloma or cancer more pronounced degree of contrast enhancement

Signs

Quite often, cysts of the paranasal sinuses do not manifest themselves for a very long time, until they reach gigantic sizes, occupying all the free space. A person may be bothered by:

• headache for no apparent reason, has no pattern and cannot be treated with painkillers;
• a feeling of pressure on the eyes, strange discomfort in the upper jaw;
• an unpleasant feeling of mucus running down the throat (mucus flows down the back of the throat);
• smell disorders - occur with a cyst of the sphenoid sinus,
• the release of a clear, light-colored liquid without any admixture of pus or blood during spontaneous rupture and emptying of the cyst.

When a cyst occurs, the emptying of the sinuses may be disrupted, reducing their natural cleansing ability. Then inflammation occurs, which is manifested by constant nasal discharge, increased headaches, the appearance of an unpleasant odor, increased body temperature, and the development of chronic sinusitis.

In the presence of a cyst, allergic manifestations are more severe, losing their seasonality and turning into a permanent problem.

Nasal breathing is rarely difficult, only when the cyst enters the nasal cavity or is inflamed.

Computed tomography of the sinuses

• Cost: 5,000 rub.

More details

Odontogenic cysts have unpleasant manifestations. There is lacrimation, swelling, and acute pain similar to neuralgia. If the cyst suppurates, signs of general intoxication appear: fever, severe headache, nausea or vomiting, loss of appetite, weakness.

Diagnosis of a cyst

A simple examination cannot detect a cyst. Based on a combination of complaints and other data, an ENT doctor may suspect that a person has a cyst in the paranasal sinuses. To clarify the diagnosis, instrumental diagnostics are needed, which allows one to identify the cyst.

The first step is an x-ray or computed tomography, which allows you to determine the relative position of the bones of the skull and nasal sinuses, their size and structure. Computed tomography provides a 3-dimensional image.

In unclear cases, especially during initial treatment, probing or puncture of the maxillary sinuses is performed. The goal is to obtain the contents and examine them in a laboratory setting. The punctate examines the presence of cells and their characteristics, the biochemical composition of the liquid, and the presence of bacteria.

After all the research has been carried out and the diagnosis has been clarified, treatment must be started.

Removal of a maxillary sinus cyst at the ENT clinic of Dr. Korenchenko

See also Treatment of ENT diseases Cyst in the maxillary sinus Treatment of a cyst in the maxillary sinus Surgery to remove a cyst in the maxillary sinus

Endoscopic ENT surgeries are not performed in all clinics. After all, they require modern equipment, the doctor having the appropriate skills and certificates. Dr. Korenchenko’s ENT clinic is a modern, specialized and well-equipped medical center. Our specialists are highly qualified and have rich clinical experience, all the necessary certificates and skills. When treating patients, we use only modern, clinically proven and highly effective techniques.

Endoscopy at Dr. Korenchenko’s Clinic is an important and widely used therapeutic and diagnostic procedure. It is included in the basic examination of all patients who apply and are observed, which allows doctors to receive reliable and accurate information about the current condition of the ENT organs. Our specialists also perform removal of maxillary cysts and most other operations endoscopically, with high results and without long-term rehabilitation of patients.

Treatment at Dr. Korenchenko’s ENT clinic is a modern and competent approach, using effective technologies and effective therapeutic regimens.

Treatment methods for sinus cysts

Treatment for cysts is not always surgical. Conservative methods are effective for small cysts. Surgery can be started only after acute inflammation has resolved. Therefore, the ENT doctor first prescribes conservative treatment. Whether surgery is necessary or not is decided solely by the attending ENT doctor. In some cases, a fairly long-term observation of the growth of the cyst and its “behavior” is required, which reveals all the nuances of formation in a particular person.

The patency of all anastomoses through which the sinuses communicate with the nose requires attention. Odontogenic cysts require the participation of a dentist; without him, treatment is not carried out.

Endonasal maxillary sinusotomy

• Cost: 40,000 - 75,000 rubles.
• Duration: 20-40 minutes
• Hospitalization: 1-2 days in hospital

More details

Surgical removal of paranasal sinus cysts is performed at CELT using the endoscopic method, which is the most gentle method. A small probe with a video camera and special instruments is used. The instrument is inserted into the nose - after anesthesia, of course. No incisions are made on the face or anywhere else. Thanks to a video camera, the surgeon sees everything that is happening on a large screen, where all the details are clearly visible. The cyst is first emptied, then its membrane, if any, is removed.

If the contents are purulent, additional rinsing with antibiotics is performed. The final stage of the operation is the formation of a full-fledged anastomosis between the sinus and nose, which prevents relapses. Of course, in the postoperative period, supervision by an ENT doctor is required.

It is also important to examine and treat children and adolescents. Often cysts first appear between the ages of 10 and 13 years, when they form on tooth germs that are displaced from their physiological place or impacted. Baby teeth can also become inflamed and give rise to the formation of a cyst. Treatment of children is carried out in a day surgical hospital for maximum comfort.

The CELT Clinic has accumulated a wealth of experience in the treatment of ENT pathologies, including cysts. By contacting otolaryngologists at CELT, you can be confident in a competent examination and treatment by experienced specialists.

How is surgery to remove a cyst in the nose performed?

For a long time, surgery to remove a sinus cyst was carried out only by opening the wall of the maxillary sinus through the oral cavity or through the cheek. This manipulation is called maxillary sinusotomy; it is quite traumatic and requires a long recovery period.

Currently, classical surgery is rarely performed, with preference given to minimally invasive interventions. But for extensive purulent cases, just such a radical intervention is used. The dangerous formation is completely removed, the sinus is washed with an antiseptic and drained.

In other cases, surgery on the maxillary cyst is performed endoscopically, with minimal disruption of the integrity of the sinus walls.

If necessary, additional plastic surgery of the anastomosis is performed and adjacent polypous growths are removed.

Endoscopic surgery to remove a maxillary sinus cyst is performed on an outpatient basis and usually lasts 20–40 minutes. After its completion, the patient remains in the clinic for 1–2 hours under the supervision of a doctor, then returns to his normal life.

Using an endoscope allows you to remove the maxillary cyst in a gentle way. This operation does not disrupt the drainage and ventilation of the sinuses, reduces the risk of chronic rhinosinusitis and does not require long-term recovery for the patient.

Our services in otorhinolaryngology

The administration of CELT JSC regularly updates the price list posted on the clinic’s website. However, in order to avoid possible misunderstandings, we ask you to clarify the cost of services by phone: +7

All services

Make an appointment through the application or by calling +7 +7 We work every day:

• Monday—Friday: 8.00—20.00
• Saturday: 8.00–18.00
• Sunday is a day off

The nearest metro and MCC stations to the clinic:

• Highway of Enthusiasts or Perovo
• Partisan
• Enthusiast Highway

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