Postoperative Maxillary Cyst Research Articles

Silicon of the medium in the postoperative maxillary cyst

As part of a study on chronic inflammatory disease of the mucous membrane, silicon of the medium in postoperative maxillary cysts and in other cysts was measured, and following results were obtained. Silicon concentrations of the medium in the postoperative maxillary cysts and in the postoperative ethmoidal cysts were 34.5 ppm and 42.9 ppm (geometrical mean) respectively, and they were higher than in other primary cysts such as frontal cyst, nasal vestibular cyst, and dental cyst. The silicon content of the medium in the postoperative maxillary cyst varied with the water content of the medium; the lower the water content the higher was the silicon content and the relationship was expressed by the following equation. log S = 7.43 + 7.14 log d-6.14 log w, where S = Si (mcg), d = dry weight (g.) and w = wet weight (g.). The high concentration of silicon in the postoperative cyst was considered to be due to the large amount of silicon transudate from the surrounding fibrous tissue through a highly damaged or missing epithelial wall of the cyst.

顎口腔領域感染症起炎菌の検討 第３報：臨床症状と分離菌との関連について

A total 150 patients with obstructed abscesses in the oral and maxillofacial region were studied with respect to the relation between clinical symptons and the isolation of organisms.Various kinds of anaerobes were isolated from almost all patients. Mixtures of grampositive cocci and anaerobic gram-negative rods were most frequent in severe cases. Patients in whom few organisms were isolated were characterized by chronic, mild inflammation and prior chemotherapy. All patients with postoperative maxillary cysts had chronic infectionsThe results suggested that anaerobes were necessary for the occurrence of infection in the oral and maxillofacial region and that pathogenic synergy between gram positive cocci and gram negative rods contributed to increased severity of infection.

上顎洞タンポン法の有用性比較

Tampons are employed in maxillary sinus operations to prevent postoperative bleeding. In this paper, we report the effectiveness of the use of a maxillary sinus balloon (balloon) made by condoms during surgery of the maxillary sinus. We confirmed that the balloon had good tissue contact by postoperative computed tomographic scan. During the 17 years from April 1978 through March 1995, 204 patients underwent sinus operations for postoperative maxillary cyst, chronic odontogenic maxillary sinusitis, and radicular cyst or follicular cyst in the maxillary sinus at the department of dentistry and oral surgery, Asahi General Hospital. The clinical features of cases using balloon, gauze tampon, or Spongel®were reviewed and analyzed. The average duration of balloon insertion (4.4 days)was shorter than that of gauze tampon (6.0 days)(P<0.01). Postoperative spontaneous pain occurred at a rate of 33.3% with gauze tampon, 30.0% with Spongel®, and 17.3% with balloon. Among 70 cases using Spongel®, postoperative bleeding requiring hemostasis and infection occurred in 2 cases each. The balloon was easy and painless to remove. We considered balloon made by condoms to be useful as a tampon in operations of the maxillary sinus.

Endoscopic sinus surgery for postoperative maxillary cyst

Endoscopic sinus surgery for postoperative maxillary cyst

Diagnostic value of magnetic resonance imaging in postoperative maxillary cyst

Magnetic resonance imaging (MRI) is superior to conventional X-ray tomography and CT scanning in detecting postoperative maxillary cysts (POMCs). We analyzed the MRI features of 51 cases (72 sides) and compared them with the operative findings of 42 cases (52 sides) of POMC. The total number of cysts diagnosed was 121. Multiple cysts were found in 37 sides (51%) and bilateral cysts were found in 21 cases (45%). According to classification of POMC based on location in the maxilla the central cysts were found in only 38% of all cysts (peripheral ones in 62%). In the 42 patients operated on, 69 of 83 cysts which had been detected by MRI were confirmed, whereas there were two additional cysts which could not be diagnosed preoperatively. Sixty four of 71 cysts were opened to the nasal cavity under endonasal endoscopic control. The other seven cysts (five sides) were operated on via a buccogingival incision. Detailed and accurate diagnosis by MRI and development of endoscopic instruments enabled endonasal surgery in most (91%) sides of the POMC. In five cysts of the superior type which are small isolated and distant from the lateral wall of the nasal cavity, endoscopic endonasal surgery was not indicated. In conclusion, MRI for POMC was extremely helpful in selecting a surgical approach.

術後性上顎嚢胞の症状発現に関連する因子の臨床的検討

術後性上顎嚢胞の症状発現に関連する因子の臨床的検討

術後性上顎嚢胞に対する下鼻道対孔作成術後の経過観察

術後性上顎嚢胞に対する下鼻道対孔作成術後の経過観察

術後性上顎嚢胞に対する鼻内手術について 過去４年間の手術例の検討

Surgical treatments for postoperative maxillary cysts include the peroral method (trans-maxillary sinus method) in which the cyst wall is totally removed or conserved, and opened to the nasal cavity by incising from the gingiva, and the endonasal method in which the cyst wall is opened to the nasal cavity by the nasal approach. Recently, the endonasal method is more widely used because CT and endoscopy can be applied. Forty-two patients (56 sides) who underwent surgery for postoperative maxillary cysts in Nanyo City Hospital over the last four years were reviewed. Preoperative CT findings, surgical methods, operative findings and prognosis were analyzed. Forty-one sides were monocystic and 15 sides were multicystic. Forty-two sides were of the medial type, 4 sides were of the lateral type and 10 sides were of the mixed type. Twenty sides (35.7%), which were both monocystic and medial, were operated on by the endonasal method, while the transmaxillay sinus method was used for the remaining sicks. Though one of endonasal patients experienced a relapse of the maxillary cyst, the endonasal method was associated with less suffering and a shorter operative time than the trans-maxillary sinus method. Therefore, the endonasal method is recommended, if the postoperative maxillary cyst is both monocystic and medial.

術後性上顎嚢胞に対する内視鏡下鼻内手術

For postoperative maxillary cyst (POMC), the per-maxillary method has been performed in most cases. The endoscopic endonasal method has had only limited application, since the varied number and location make the operation difficult. Recently, we have started using the endoscopic endonasal method on all POMC cases. We discuss the indications for the use of the endoscopic endonasal method for POMC based on the results of these operations. This study comprised 55 patients (59 sides), 18 females and 37 males, who underwent the endoscopic endonasal method for POMC from January 1990 to June 1994. We followed these patients for 1-year postoperatively.We found that the wall of the cysts opened to the nasal cavity in 91.5% of cases. When there was only one cyst, the partition wall between the cyst and the nasal cavity was menbranous and/or the cyst adjoined the wall of the nasal cavity, almost all cysts opend to the nasal cavity. When the cysts had bony wall and/or were apart from the nasal cavity, it was possible for the wall opening to be blocked or restricted.Based on our results, we conclude that a minimally invasive endoscopic method should be the operation of first choice for POMC.

Proliferating cell nuclear antigen (PCNA) immunolocalization in human nasal epithelium with chronic sinusitis detected by confocal laser scanning microscopy

This study examines the immunohistological localization of proliferating cell nuclear antigen in the nasal and paranasal sinus epithelium from a group of patients undergoing sinus surgery for chronic sinusitis. PCNA immunoreactivity as determined by fluorescence intensity and the density of labeled cells as assessed by confocal laser scanning microscopy. The control group consisted of seven specimens taken from patients with post operative maxillary cyst and optic nerve canal fracture. In this group, most of the labeled cells were located on the basal cell layers with a few on the intermediate cell layers. The average labeled cell densities were 57.3 cells/mm2 on the basal cell layers and 15.9 cells/mm2 on the intermediate cell layer. The sinusitis group consisted of eleven patients. In contrast with the control group, the sinusitis epithelium displayed a significantly high proportion of goblet and intermediate cells positively stained for PCNA. The average densities were 84.9 cells/mm2 on the basal cell layers and 133.1 cells/mm2 on the intermediate cell layers in this group, the latter being nearly ten fold greater than that in the control group. Epithelial PCNA expression was correlated with the degree of inflammatory cell infiltration assessed by serial sections for each sample. A positive correlation was observed between these two factors (R = 0.63, Pearson). We believe that epithelial cell turnover is accelerated in chronic rhinosinusitis due to continuous exposure to various pathogens and host immune interventions. In those cases, goblet and intermediate cells would play the major role in enhanced epithelial proliferation.

Ｌｅｖｏｆｌｏｘａｃｉｎ（ＬＶＦＸ）の口腔外科領域感染症に対する抗菌力，および薬動力学的動態に関する検討

The antibacterial activity, tissue concentration, and pharmacokinetics of levofloxacin (LVFX) were investigated in patients with infections in the fields of dentistry and oral-maxillofacial surgery. The patients included 20 with subperiosteal abscesses, 12 with intraoral buccal abscesses, 12 with postoperative maxillary cysts, 4 with radicular cysts, 8 with maxillary siunsitis, 6 with maxillary or mandibular cysts, 4 with osteomyelitis, 5 with facial abscesses, and 3 with neck abscesses. The drug was administered at a dose of 100mg orally before maxillofacial surgery to 16 patients, and the concentrations in the blood (n=16), oral mucosa (n=16), and maxilla or mandible (n=13) were measured by bioassay 0.5, 1, 2, and 3 hours after administration. A pharmacokinetic study was also performed using a one-compartment model.(1) Of the 74 patients, bacteria were isolated from 69 (93.2%). A total of 184 isolates were obtained, including 86 (46.7%) aerobes and 98 (53.3%) anaerobes. The bacteria isolated most frequently were Streptococcus and Peptostreptococcus. Streptococcus showed an MIC range of 0.2 to 0.78μg/ml, and Peptostreptococcus showed a range of 0.1 to 0.78μg/ml. The mean 90% minimum inhibitory concentration was 0.78μg/ml, and the MIC50 was 0.39μg/ml. LVFX showed good antibacterial activity against these organisms.(2) The blood concentration (n=16) was 0.95±0.1μg/ml (0.5h), 1.29±0.1μg/ml (1h), 0.88±0.1μg/ml (2h), and 0.63±0.1μg/ml (3h). The pharmacokinetic parameters determined by the one-compartment model were as follows: maximum blood concentration Cmax, 1.18μg/ml; half life, 1.37h; area under the concentration-time curve (AUC), above 0.78: 0.53μg·h/ml; and effective time above MIC90: 2.09h.(3) When the drug was administered preoperatively at a dose of 100mg to 13 maxillofacial patients, the oral mucosal concentration was 0.79±0.1μg/g, and the maxillary or mandibular concentration was 0.35±0.1μg/g. Therefore, LVFX produced similar levels in the oral mucosa and serum, but yielded bone concentrations below the MIC.We conclude that LVFX is well absorbed and attains a serum concentration sufficient for a favorable therapeutic effect.

Improvement in Endonasal Maxillary Sinus Surgery

From 1985 endonasal sinus surgery characterized by middle meatal antrostomy and subsequent ethmoidectomy and sphenoidectomy after temporarily reflecting the mucosa of the inferior turbinate was performed. When antrostomy enlargement is required, in cases of benign tumor, antral polyp, severe sinusitis and postoperative maxillary cyst, make an opening in the inferior meatus and enlarge upward into the middle meatal antrostomy till removal of the entire medial wall of the antrum. This method is easily performed without a danger of injuring the nasolacrimal duct. A wide surgical field with good orientation of the antrum was gained. This antrostomy enlargement was performed on 14 patients with ages ranging between 12-69 years without surgical complications. All of the antrostomies were patent and functional. Postoperatively nasal symptoms and findings were improved in 12 patients.

術後性頬部嚢胞の鼻内手術適応と限界

Recently, endoscopic endonasal surgery has been widely used in the treatment of chronic sinusitis, with good results reported by many investigators. Endoscopic endonasal surgery is a technique available not only for chronic sinusitis but also for post-operative maxillary cysts. In this report, the indications for and limitations of endoscopic endonasal surgery for postoperative maxillary cysts are discussed based on experience gained from treating 14 cysts in our department.The indications for endonasal endoscopic surgery include cysts in close contact with the lateral wall of the inferior meatus, and those cysts that can be widely opened to the middle nasal meatus.The following cases could not be treated by endonasal endoscopic surgery:1) cysts that were localized in areas distant from the nasal cavity, 2) cysts in which the lateral wall of the inferior nasal meatus was bony and very thickened, 3) cysts that could not be sufficiently opened to the middle nasal meatus.

A study of cysts in the oral region. Cysts of the jaw.

Clinical cases of cysts of the jaw treated in the Department of Oral Surgery of our university during the 10 y between 1980 and 1989 were studied clinically. Patients with radicular cyst, dentigerous cyst, odontogenic keratocyst and postoperative maxillary cyst, which were found at relatively high frequencies, were further analyzed with regard to age, sex and anatomical distribution. A diagnosis of cyst was established in 1,444 patients during the above period, and 1,234 (85.5%) of them had cysts of the jaw. According to a pathological classification by Ishikawa's method, these patients included 509 (41.2%) with radicular cyst, 259 (27.0%) with dentigerous cyst, 95 (7.7%) with odontogenic keratocyst and 267 (21.6%) with postoperative maxillary cyst. The pattern of age distribution in cases of radicular cyst, odontogenic keratocyst and postoperative maxillary cyst was similar to that found in previous studies. Among patients with dentigerous cyst, those aged under 20 y accounted for about 60%. Radicular cyst occurred most frequently in the maxillary lateral incisors, dentigerous cyst in the mandibular wisdom teeth, and odontogenic keratocyst in the region between the mandibular molar and the ramus of the mandible.

術後性上顎嚢胞症例の副鼻腔冠状断ＣＴ所見

We classified patients with paranasal sinus disease into 3 categories, those with or without a history of previous Caldwell-Luc procedure according to clinical diagnosis. Class A: postoperative maxillary cysts in 22 patients. Class B: paranasal sinusitis in 21 patients who had undergone Caldwell-Luc surgery. Class C: paranasal sinusitis in 62 patients who had not undergone paranasal sinus surgery.This study evaluated the ethmoid, frontal and sphenoid sinuses in these 3 classes of patients on coronal CT scan. High density areas in the ethmoid sinuses were observed in 25.0% of class A, 80.0% of class B, and 82.1% of class C; in the frontal sinuses in 19.0% of class A, 73.7% of class B, and 73.3% of class C; in the sphenoid sinuses in 18.2% of class A, 57.1% of class B, and 51.6% of class C. As a result, the prevalence of high density areas in the ethmoid, frontal and sphenoid sinuses in patients (class A) with postoperative maxillary cysts was significantly lower than those in patients (classes B and C) with paranasal sinusitis. The authors speculated that postoperative maxillary cysts arise in cases that had few or lightly inflammatory changes of the ethmoid, frontal and sphenoid sinuses.

術後性上顎嚢胞の臨床病理学的考察 本症の成因と手術法について

A clinicopathological study in 229 patients with postoperative maxillary cysts (POMC)(unilateral: 215 cases. bilateral: 14 cases) is described.The patients were treated at our hospital between 1979 and 1989. The age of the patients ranged from 18 to 72 years, and their average age was 45.2 years. The chief complaints of these patients were swelling and pain, and POMC were diagnosed based on clinical, radiologic and histopathologic findings.The patients were surgically treated by the following procedures: 1) extirpation of cysts (35 cases), 2) marsupialization to the inferior meatus (120 cases), and 3) radical operation according to the Caldwell-Lucs, method (88 cases).Histopathologic examination revealed various patterns of the cyst wall, including ciliated, cuboidal, squamous, and columnar epithelium, as well as a mixture of two or three kinds of these epithelial cells.Radiological examination using contrast media revealed that the from of cysts was either ovoid or irregular.One of the 243 cases showed recurrence. In this case, there was no passage between the cystic and nasal cavity. These findings suggest that sufficient marsupialization to the nasal cavity is important to ensure a favorable outcome.

Evaluation of Long-term Healing Process Following Surgical Treatment of Postoperative Maxillary Cysts

Evaluation of Long-term Healing Process Following Surgical Treatment of Postoperative Maxillary Cysts

慢性副鼻腔炎術後の上顎洞冠状断ＣＴ所見 長期経過症例について

The clinical features were correlated with the coronal CT scan appearance of the paranasal sinuses of 49 patients who had received the Caldwell-Luc operation 16 to 58 years ago. The clinical diagnosis at the time of the CT scan was postoperative maxillary cyst in 22 patients, chronic sinusitis in 21 patients, trigeminal neuralgia in 3 patients, radicular cyst, postoperative ethmoid cyst and inverted papilloma in one patient each. The CT scans of the 91 operated maxillary sinuses showed obliterated cavity in 21 cases, small cavity in 46 cases, cystic formation in 24 cases. The authors speculated that some maxillary sinuses which appeared in CT scans as small cavities might cause the clinical symptoms of postoperative maxillary cyst in the future.

術後性上顎嚢胞のパノラマ X 線所見に関する研究

This study was carried out to further understand the panoramic radiographic findings of postperative maxillary cysts. Of the radiographs kept in the Department of Dental Radiology at Kyushu Dental College Hospital, 160 cases of panoramic radiographs of postoperative maxillary cysts were analyzed. One hundred and sixty cases consisted of 100 males and 60 females. The results obtained by this study were as follows : 1. Of the 160 cases of postoperative maxillary cysts, 79 cases (49%) were located througout the anterior, posterior walls of the maxillary sinus and the alveolar bone. Sixty-two cases (39%) were located within the area from the anterior wall of the maxillary sinus to the alveolar bone. Two cases (1%) were located from the anterior wall to the posterior wall of the maxillary sinus. 2. Of the 160 cases of postoperative maxillary cysts, 144 cases (90%) were mono-locular. Sixteen cases (10%) were multi-locular ; 11 cases were di-locular and 5 cases were trilocular. 3. The average vertical dimension of postoperative maxillary cysts was 2.96±0.88 cm in males and 2.70±1.03 cm in females. The average horizontal dimension was 3.00±0.82 cm in males and 2.74±1.02 cm in females. There was no statistical significance in the difference between males and females in either dimension of postoperative maxillary cysts. 4. Of the 160 cases of postoperative maxillary cysts, 106 cases (66%) had a well-defined margin, while 54 cases (34%) did not. There was no significant relationship found between definitions of cyst margins and the clinical symptom of pain. 5. Of the 160 cases of postoperative maxillary cysts, 81 cases (51%) had a marginal sclerosis, while 79 cases (49%) did not. There was no significant relationship found between the marginal sclerosis of the cysts and the clinical symptoms of pain. 6. Of the 640 teeth in affected sides, 428 teeth (67%) were vital. One hundred and fifty-two teeth (24%) were missing. Sixty teeth (9%) were non-vital. 7. Of the 160 cases of postoperative maxillary cysts, 72 cases (45%) revealed an ill-defined appearance of the panoramic innominate line in affected sides, while 73 cases (46%) of an ill-defined appearance were in non-affected sides. Forty-five cases (28%) showed a thickened panoramic innominate line in affected sides, while 50 cases (31%) were seen in non-affected sides. In 11 cases (7%) the panoramic innominate line disappeared in affected sides, while in 3 cases (2%) of non-affected sides disappeared. 8. Of the 160 cases of the maxillary sinus in non-affected sides, 84 cases (53%) revealed a tri-angular shape. Forty-three cases (27%) revealed a tri-angular shape accompanied by a cyst-like radiolucency. Twenty-three cases (14%) revealed a normal shape.

Protrusion of Postoperative Maxillary Sinus Mucocele into the Orbit: Case Reports

Maxillary sinus mucocele, which appears more than 10 years after Caldwell-Luc surgery, is very rare in the United States or Europe. However, it is very common in Japan. It is called "postoperative maxillary sinus mucocele" or "postoperative maxillary cyst." In this paper, postoperative maxillary sinus mucoceles, which protruded into the orbits, are reported. One patient, a 50-year-old man, underwent Caldwell-Luc surgery 31 years ago, and the other patient, a 61-year-old woman, underwent Caldwell-Luc surgery at the age of 18. The incidence of this disease, symptoms, diagnosis and treatment are discussed in this paper.