Abstract
Cholesterol granuloma (CG) is a tissue reaction in response to the accumulation of cholesterol crystals rarely found in the maxillary sinus. The etiopathogenesis of maxillary sinus CG remains unclear. We reviewed the literature and added two new reports of cholesterol granuloma in maxillary sinus related to endodontically treated maxillary posterior teeth. The first report refers to a 45-year-old woman diagnosed with rhinitis, who was submitted to endodontic retreatment of maxillary molar, and subsequently showed maxillary sinus opacity with cystic appearance. The second case describes a young adult woman, who presented a cystic mass in maxillary sinus after endodontic treatment, in close association with the apex of the maxillary right second premolar. Both patients were treated by a classic Caldwell-Luc surgery and the microscopic analyses revealed maxillary sinus CG. In the following, the authors discuss the probable involvement of endodontically treated maxillary posterior teeth in the etiopathogenesis of maxillary sinus CG.
Highlights
Cholesterol granuloma (CG) is considered rare in maxillary sinus and approximately 50 cases were reported in English literature, with 12 of them being described from 2005 to 2016 [1,2,3,4,5,6,7,8,9,10]
The clinical features of CG in the maxillary sinus are nonspecific mimicking other cystic or inflammatory diseases [3]. It is often associated with a history of rhinitis, sinusitis, trauma, and paranasal sinus surgery [6, 9, 10] and can be accompanied by symptoms, such as facial pain, headache, otalgia, rhinorrhea, and nasal obstruction, commonly showing a cystic appearance and sinus opacification in radiological examinations [2, 3]
Diagnosis of maxillary sinus CG is based on microscopic analysis of a foreign body reaction characterized by foreign body giant cells and longitudinal cholesterol clefts, granulocytes, foam cells, and macrophages filled with hemosiderin [2, 3]
Summary
Cholesterol granuloma (CG) is considered rare in maxillary sinus and approximately 50 cases were reported in English literature, with 12 of them being described from 2005 to 2016 [1,2,3,4,5,6,7,8,9,10]. The clinical features of CG in the maxillary sinus are nonspecific mimicking other cystic or inflammatory diseases [3]. It is often associated with a history of rhinitis, sinusitis, trauma, and paranasal sinus surgery [6, 9, 10] and can be accompanied by symptoms, such as facial pain, headache, otalgia, rhinorrhea, and nasal obstruction, commonly showing a cystic appearance and sinus opacification in radiological examinations [2, 3]. We intend to report two cases of cholesterol granuloma in the maxillary sinus and to discuss the involvement of endodontically treated maxillary posterior teeth in their probable pathogenesis
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