What Is the Surgical Ciliated Cyst of Maxilla?
The surgical ciliated cyst of the maxilla is a specific cyst occurring in the maxillary region (upper jaw). It is a true cyst because it is lined by an epithelium (a covering). It originates in the maxilla from the sinus mucosa or the nasal glands. Iatrogenic injury or operator-induced trauma to the maxillary sinus membrane during dental operations can create postoperative trauma in this region resulting in cyst formation. Also, when the maxillary sinus undergoes severe pressure after surgical procedures that involve the maxillary sinus or its membrane, it can result in the formation of this cyst. Although this cyst is an aggressive lesion, patients present with fewer uncomfortable symptoms that push them to seek medical attention. It is because the cyst is mostly an incidental finding during a routine follow-up after the surgery.
What Is the Theory Behind a Surgical Ciliated Cyst Formation?
The description of the surgical ciliated cyst was first given by Kubo in 1927. It is one of the earliest dental cysts known in the literature.
By theory, after the operator completes a surgical procedure in a part of the maxillary sinus, the membrane gets entrapped while closing the wound. It is the most accepted theory behind the formation of this cyst. However, it can also occur when the maxillary posterior (back) teeth are extracted with trauma or with incorrect technique. Also, pressure in this region or entrapping part of the ciliary sinus membrane can form this cyst.
The procedures given below are known to cause a surgical ciliated cyst of the maxilla.
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Traumatic tooth extractions of the upper jaw.
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Trauma to the face.
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Surgery in the maxillary sinus segment or region (orthognathic surgeries, sinus floor augmentation surgery, and maxillary sinus lift).
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Caldwell-Luc procedure or radicular antrostomy.
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Maxillary osteotomy.
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Odontogenic (originating from the teeth) cysts in that region of the maxilla.
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Possible fractures in the maxillary segment.
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Maxillary angiofibroma (a tumor made of blood vessels and connective tissue).
What Is the Incidence of the Surgical Ciliated Cyst of the Maxilla?
According to case reports, the SCMM incidence varies from 0.1 to 20 percent among all the commonly occurring jaw cysts. Development of SCCM also is a known complication that occurs only post-surgery and is either classified as an acute or a delayed onset complication. When the dentist elicits the patient's medical history, the time can be assessed between the event or trauma till formation. The time for these cysts is sometimes unpredictable. However, studies suggest that they may appear anywhere from six months to twenty years following an initial surgery in the affected region of the maxilla. The age at which SCMM can occur ranges from the second to the seventh decade of life.
What Are the Clinical Characteristics of the Surgical Ciliated Cyst of the Maxilla?
In the initial stages, the cyst may just remain asymptomatic for years. Still, a patient may complain of the following:
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Swelling in the buccal posterior tooth region.
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Pain in the cheek region.
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Oral discomfort in the maxilla or upper jaw involving one or more maxillary teeth.
How to Prevent Surgical Ciliated Cyst of the Maxilla?
The SCCM is a locally aggressive lesion. It is not possible that this cyst is acute (short-lived) in nature. It is because sometimes it may develop several years later. Hence, the dentist can diagnose it only by eliciting dental history.
To prevent such postoperative complications, it is advocated that dentists should not use the same surgical instruments during sinus lift, extraction, or other surgical procedure for both the maxilla and the mandible. Using the same instruments can lead to the potential trapping of the sinus epithelium potentiating cyst formation. The surgical ciliated cyst is more common in the maxilla and rare in the mandible.
What Is the Differential Diagnosis of Surgical Ciliated Cyst of the Maxilla?
The differential diagnoses of SCCM are those lesions that have similar clinical features such as oral swelling, pain, and discomfort in the maxillary region. SCMM is differentiated from similar lesions by the dental surgeon for obtaining a confirmative diagnosis. These are:
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Odontogenic Keratocyst (OKC)- Odontogenic keratocyst can have ciliated epithelium, but SCCM does not have a keratinizing tendency (keratin formation).
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Incisive Canal Cyst (ICC)- The location of the ICC is midline and behind the maxillary incisors.
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Antral Mucosal Cyst-The mucosal cyst of the antrum consists of a lining of the seromucous gland lining. SCCM does not contain the same lining.
What Are the Management Strategies of the Surgical Ciliated Cyst?
The surgical treatment for eliminating these cysts is done by the oral and maxillofacial surgeon. The oral surgeon performs an enucleation (removal of the cystic lining) procedure in most cases due to its benign (non-cancerous) nature. Hence, the treatment of choice is enucleation according to site and size.
But, when the SCMM is extensive, marsupialization (cutting a slit into the cyst and suturing the edges) can be done. Recently, the technique of intranasal surgery and endoscopic treatment has been recommended for draining the cyst. However, the endoscopic technique of treating post-operative maxillary cysts may not be considered effective by some oral surgeons because of the high recurrence rate in case of incomplete drainage.
Conclusion
To conclude, the maxillary surgical ciliated cyst is a rare but potential postoperative complication that can occur after maxillary jaw surgery. Hence, it needs timely management to prevent oral discomfort, swelling, and pain in affected patients. Also, the surgical ciliated cyst can vary from case to case in terms of duration, pathogenesis, and etiology.
