Maxillary sinus cyst as a risk factor for osteomeatal complex block

Abstract

Introduction: Cysts of the maxillary sinuses are found in about 10% of the population. There is a necessity to clarify indications for cyst removal taking into account its size. The purpose of the study to clarify the indications for surgical treatment of maxillary sinus cysts as a risk factor for sinus drainage disorders in the development of maxillary sinusitis. Methods and materials: 57 people (92 sinuses) were examined. There were 20 patients (40 sinuses) with acute rhinosinusitis, 22 patients (22 sinuses) with post-augmentation sinusitis, and 15 (30 sinuses) almost healthy individuals among them. Prediction of the cyst size, which can lead to blockage of the maxillary sinus ostium, was performed by direct measurement on coronary sections at the ostiomeatal complex level distance from the surface of the mucoperiosteum in the area of the alveolar recessus to the lower surface of the mucosal surface in the area of the ostium. The obtained data were verified by calculation method taking into account the height of the sinus at the level of the osteomeatal complex, the magnitude of possible mucoperiosteum edema in the alveolar recessus and ostium in acute rhinosinusitis and post-augmentation sinusitis, as well as the magnitude of mucoperiosteum elevation due to sinus lift. Results: It was found that the vertical size of the cyst, which can potentially lead to blockage of the maxillary sinus ostium in acute rhinosinusitis is 21.2±0.8 mm, 14.7±1.1 mm in sinusitis after augmentation of the maxilla, and 28.5±0.7 mm in practically healthy individuals. The calculated values are 18.5 mm, 14.0 mm and 24.5 mm, respectively. In case of acute rhinosinusitis, the distance from the apex of the cyst to the surface of the mucous membrane of the ostiomeatal complex area may decrease by 12.8 mm, and in sinusitis after sinus lift it may decrease by 20.4 mm. Conclusions: To assess the potential of the ostiomeatal complex block by a cyst located in the alveolar recessus in acute rhinosinusitis, its vertical size is really important according to coronary sections of at the ostiomeatal complex level corresponding to the location of 5-6 teeth of the upper jaw. The indication for removal of the cyst of the alveolar recessus of the maxillary sinus, as a factor that may worsen the course of acute rhinosinusitis due to the anastomosis block, is its size exceeding 20 mm, and 15 mm for patients who plan to sinus lift.