Postoperative Maxillary Cyst Research Articles

MRI of postoperative maxillary cysts.

The purpose of this study is to review the MR characteristics of postoperative maxillary cysts (POMC). The MR findings in 24 patients with 38 surgically confirmed POMC were retrospectively reviewed. Of 32 cysts detected by MRI, 31 cysts (96.9%) were well demarcated. Nineteen cysts (59.4%) were smooth and the others (40.6%) were irregular. Thirty cysts (93.8%) had signal intensities ranging from that of muscle to that of subcutaneous fat on T1-weighted imaging. On T2-weighted imaging 16 homogeneous (50.0% and 5 inhomogeneous (15.6%) cysts showed signal intensities equal to or higher than subcutaneous fat. The peripheral rims of 11 ring-like cysts (34.4%) also showed signal intensities equal to or higher than subcutaneous fat on T2-weighted imaging. Nine patients (37.5%) had multiple cysts. Their characteristic high signal intensities or ring-like patterns on T2-weighted imaging and well-demarcated margins enabled them to be discriminated from other tumors of the maxillary sinus, such as carcinoma. MR imaging is useful for diagnosis of POMC.

レーザーによる内視鏡下鼻副鼻腔手術

The method of endonasal surgery has been improved by using an endoscope and a Video system (CCD - camera, TV monitor etc.). The KTP/532 laser is a surgical laser whose delivery system with noncontact and contact flexible fibers allows its use with the nasal endoscopes for intranasal surgery. The KTP/532 laser was applied in endoscopic endonasal surgery for chronic sinusitis, postoperative maxillary cyst, hypertrophic turbinate.The patient sat in a supine posture, and the operation was performed under local anesthesia. This operation could be completed without giving any pain to the patient by radiation within 5 seconds with a laser output 10-14 watts. The intranasal and intrasinus lesions were vaporized, coagulated, and cut with excellent hemostasis by the KTP/532 laser. The postoperative courses were satisfactory.

術後性上顎嚢胞のＭＲＩ

Magnetic resonance images of 47 patients with postoperative maxillary cyst were analyzed for size, location, and signal intensity. The smallest cyst was confirmed at surgery to be 1cm×1cm×1cm and the largest 5cm×5cm×5cm.The cysts were usually found in the superomedial and inferomedial parts of the maxillary sinus (44%). Many patients (60%) had multiple cysts or bilateral cysts (30%).In most the signal intensiy was low in the T1-weighted SE (500/40) images and high in the T2-weighted SE (2000/80) images.Cysts with a hemorrhagic component, though rare, showed high signal intensity in both T1-and T2-weighted images.

An analysis of the postoperative maxillary cyst using computed tomography

The diagnostic value of computed tomography (CT) as compared with conventional radiographs in the study of postoperative maxillary cysts (POMC) in 64 patients (85 sides) was evaluated. Typical CT findings of POMC were of a unilocular or multilocular homogeneous soft tissue density mass with expansile bony resorption. A comparison between conventional radiographs and CT proved that CT could determine the location and multilocularity of the cyst, the status of the antral walls, and abnormalities of the other paranasal sinuses and adjacent structures more precisely than conventional radiographs. CT also facilitated the ability to predict the direction of extension of the lesion. In conclusion CT was indispensable for accurately diagnosing POMC. In some cases the inferior extension of the lesion should be examined by conventional radiography because this can be obscured by degradation caused by metal artefacts during CT.

Large postoperative maxillary cyst

Large postoperative maxillary cyst

顎嚢胞裏装上皮のケラチン分布，レクチン結合性に関する組織化学的検討

Epithelial linings of 170 post operative maxillary cysts (POMCs) were microscopically examined, and correlations between lining epithelia and clinical findings were investigated. Then, using 45 of 170 POMCs (including ciliated (38), squamous (4), and composite lining epithelia (3 cases)), 30 radicular cysts (composed of ciliated (2), non-keratinized squamous (25) and of these composite epithelia (2), and keratinized epithelium (1)), and also using 25 dentigerous cysts revealing keratinized or non-keratinized epithelia in 8 and 17 cases, respectively, lectin-bindings and keratin localization were histochemically examined.Ninety walls of the subjected POMCs were lined with ciliated columnar epithelium, and linings of cuboidal, squamous and their combinations were seen in 6, 19, and 20 cases, respectively. Many POMCs lined with squamous epithelium revealed infection during past history, and a correlation between squamous lining and the infection was noted. RKSE60 keratin (56. 5 KD) only existed in the keratinized layer of squamous linings, while RGE 53 keratin (45 KD) was detected not only in all columnar epithelia, but also in all POMCs lined with squamous epithelia and 4 cases of maxillary radicular cysts. Tissue culture study of rabbit respiratory ciliated epithelium revealed that squamous cells, seemingly derived from originally columnar epithelium, and some newly proliferated squamous cells, induced with prostaglandin E1, E2 and dibutyryl cyclic AMP, reacted with RGE53 antibody. RGE53 keratin was therefore considered to be continuously maintained even after squamous metaplasia. From these results, it seems certain that epithelial linings of maxillary radicular cysts are sometimes derived from the respiratory epithelium associated with squamous metaplasia, and that RGE53 keratin is a useful marker for identification of metaplastic squamous cells.Most squamous epithelia bound strongly with SBA, Con A and UEA-I, while columnar epithelia showed weak bindings. Only a few linings of the tested cysts bound with SVGA. Among these lectins tested, SBA bindings revealed the most contrastive dramatic difference between both epithelia. Con A bound most prominently to squamous linings, and binding of UEA-I and SBA followed in this order. RKSE60 keratin-positive (i.e. keratinized squamous) epithelia had no glycoconjugates with SBA on basal cells. Contrarily, basal cells negative for this keratin had some lectin-binding sugar residues in most cases. From the above findings and other previous reports regarding keratin localization and lectin-binding in reduced enamel epithelium and dental lamina, it seems likely that keratinized lining of some dentigerous cysts may be derived from the early stage of tooth germ development. Metaplastic squamous epithelia intensely bound with SBA, Con A and UEA-I throughout the whole layer, and ciliated epithelium coexisting with squamous cells had similar staining patterns to those of metaplastic squamous epithelium. Ciliated epithelia of radicular cysts were also positive for SBA, Con A and UEA-I. Additionally, cultured respiratory epithelium gradually increased SBA binding ability corresponding to the degree of metaplastic change. Taking these facts into consideration, it is therefore likely that lectin binding sugar residues are expressed in advance on squamous metaplasia-ready columnar cell surfaces.

中耳腔と上顎洞貯留液の比較 生化学的および細胞学的検討

Both paranasal and middle ear cavities are surrounded by bony walls and are lined with upper respiratory mucosae. Thus it can be worthwhile to compare the biochemical and cytological characteristics of the fluids in these cavities, and this gives valuable information to help us to understand the pathogenesis of otitis media with effusion. The fluids in the otitis media with serous effusion (OME-S), otitis media with mucoid effusion (OME-M) and acute otitis media (OMA) were sampled for the middle ear diseases, and those in postoperative maxillary cyst (POMC) and acutely aggravated chronic maxillary sinusitis (CMS) were chosen for maxillary sinus group. LDH (lactate dehydrogenase). ALP (alkaline phosphatase), CHO (total cholesterol), LDH isozymes and ALP isozymes of these effusions were assayed and the results of each group were compared. Coincidently, through smear samples of these effusions, infiltrating cell count, cell differential count and cholesterol crystals were observed microscopically. LDH activity of the fluids was extremely higher than those of the serum in all diseases. The LDH activity ratios to serum were CMS greater than or equal to OMA greater than or equal to OME-M greater than POMC greater than OME-S in order of activity. LDH isozyme analysis showed higher LDH 4 and 5 than LDH 1 and 2 in all diseases. ALP activity ratios to serum were OME-S greater than or equal to OMA greater than OME-M much greater than POMC greater than or equal to CMS in order of activity. Middle ear diseases manifested higher ALP activities than maxillary diseases. CHO ratios to serum were POMS greater than OME-M greater than or equal to OME-S greater than CMS greater than or equal to OMA in order of quantity. This result agreed with the frequencies of cholesterol crystallization of these fluids. The fluids of OME-M showed mild infiltration of cells, and cell differentiations were polymorphonuclear leucocyte greater than lymphocyte much greater than macrophage much greater than epithelial cell in order of cell numbers. There were few infiltrating cells in the fluids of OME-S and differentiations were lymphocyte greater than or equal to polymorphonuclear greater than or equal to macrophage in order of numbers. There were a few cells but were many cell debris in the fluids of POMC, and cells were polymorphonuclear much greater than macrophage greater than lymphocyte in order of cell count.

眼症状をきたした右側術後性上顎嚢胞の１例

眼症状をきたした右側術後性上顎嚢胞の１例

上顎洞手術にキチンスポンジ付ガーゼタンポンを用いた臨床経験

The results of the application of tamponade with chitin sponge coated gauze (chitin) in the operation of maxillary sinus are reported.Gauze tamponade has so far been used in radical maxillosinusectomy, but may be responsible for some infection and for bleeding and pain upon its extraction.Recently, the author was presented with tampons with chitin sponge which the Central Research Institute of Unitika has developed with a view to promoting wound healing and easy extractability. In the present study, the tampon, which has already been proved to be clinically useful as adsorbent suture and wound coating protective, was used as a substitute for the conventional gauze tampon in maxillary sinus surgery, the tampon was used in 21 patients clinically diagnosed as postoperative maxillary cyst, dental siagonantritis and the like. Good results were obtained with little pain and bleeding upon extraction, and a high concentration of lisozyme was noted in the chitin sponge following extraction, suggesting induction of lisozyme in the wound area, i.e. an action to promoote wound healing.

Surgical ciliated (postoperative maxillary) cysts following mid-face osteotomies

Surgical ciliated (postoperative maxillary) cysts have been reported extensively as occurring 6 months to 50 years after radical surgery for maxillary sinusitis. Three cases are presented in which these aggressive cysts occurred 3 to 4 years after Le Fort I, II and III mid-face osteotomies. The presentation, treatment and possible aetiology are discussed and some attempt made to clarify the descriptive terms used in the literature.

Computed tomography in the evaluation of postoperative maxillary cysts

Twenty-two cases (34 sides) of postoperative maxillary cysts evaluated with axial and coronal computed tomograms were reviewed. Precise characteristics pertaining to the extent of maxillary sinus involvement, loculation, presence of septae, bony perforation, and associated cystic projection or extension into adjacent structures were determined. Of the 34 sides, 13 cysts involved the sinus completely. Twelve were multilocular. Thirteen exhibited incomplete septae. Perforations were most frequent in the anterolateral and medial bony walls (28 and 27, respectively); however, the 14 posterolateral wall perforations showed a higher percentage of cystic projection into adjacent structures. Ethmoid extension was seen on two sides, orbital extension on one. Nine sides showed tooth roots communicating with the cyst. The routine use of computed tomography in the evaluation of this type of cyst is proposed.

Experimental comparison of radiographic techniques in the detection of maxillary sinus disease.

The radiographic examination of the maxillary sinus is usually accomplished by the Waters' projection. However, some lesions, such as the mucous retention cyst, postoperative maxillary cyst and maxillary sinus carcinoma, as well as some lesions extending into the maxillary sinus, may be shown by panoramic radiography. The present study was conducted to confirm the ability of panoramic radiography in the detection of maxillary sinus disease. The representation of a globular radiopaque mass at different locations in the maxillary sinus of a dry skull was compared in Waters' and panoramic projections. A mass with a diameter of 10 mm situated on the posterior wall or floor of the maxillary sinus was shown better by panoramic radiography. The Waters' projection was less effective; the mass, especially on the floor of the sinus, was not clearly demonstrated due to superimposition of the maxillary molar teeth.

顎骨嚢胞におけるＴ‐ｚｏｎｅ組織球の分布に関する研究

In order to investigate the potential role of the cell-mediated immune system in jaw cysts, the presence and distribution of T-zone histiocytes (Langerhans cells and indeterminate cells) were studied immunohistochemically using antisera to S-100 protein in the walls of six different groups of jaw cysts in relation to the degree of inflammatory cell infiltration (macrophages, MT-1 positive lymphocytes, MB-1 positive lymphocytes, plasma cells and neutrophils) and the thickness and type of covering epithelium. Materials consisted of 42 radicular cysts, 19 odontogenic keratocysts, 9 dentigerous cysts, 8 postoperative maxillary cysts, 7 nasopalatine duct cysts and 7 cysts of unknown diagnosis. Twenty samples of oral mucosa served as control.In contrast to 95% in the control oral mucosa, intraepithelial T-zone histiocytes were found in only 37% of 75 cysts having epithelial lining. The value in the supporting connective tissue was 74% and T-zone histiocytes were found more often in cysts with inflammatory cell infiltration. The mean numbers of T-zone histiocytes in a given field of the connective tissue for radicular cysts, odontogenic keratocysts, dentigerous cysts, postoperative maxillary cysts, nasopalatine duct cysts, cysts of unknown diagnosis and oral mucosa were 1.2, 1.2, 4.9, 0.2, 1.3, 2.6 and 2.5, respectively. A tendency to decreased T-zone histiocytes was observed in radicular cysts with little to very mild or severe inflammatory cell infiltration, but like in oral mucosa, the number in the odontogenic keratocyst-dentigerous cyst group was related to that of inflammatory cells, whereas there was no such correlation in the postoperative maxillary cyst-nasopalatine duct cyst group. A significant correlation was also observed between the number of T-zone histiocytes and the thickness of the covering epithelium in all cysts but those of unknown diagnosis. In addition to the thickness of covering epithelium, MT-1 and MB-1 positive lymphocytes were the factors related to the number of T-zone histiocytes in radicular cysts and odontogenic keratocyst-dentigerous cyst group in the multiple regression analysis.In conclusion, T-zone histiocytes were found to be contributing in the induction of immune response in the presence of adequate inflammation except when it is too mild or too severe to cause extensive damage of cyst wall tissues. However, further study is needed to clarify their contribution in cysts with epithelial lining of respiratory origin.

口腔領域各種疾患における組織内活性酸素消去系酵素の活性値に関する研究

Specific activities of free radical scavenger enzymes such as superoxide dismutase (SOD), glutathione peroxidase (GSH-Px) and catalase were assayed with oral tissues of patients with oral diseases. The tissues were classified pathologically into 10 different groups ; maxillary sinusitis (n=38), radicular cyst (n=18), follicular dental cyst (n=6), odontogenic keratocyst (n=6), postoperative maxillary cyst (n=8), fibroma (n=3), epulis granulomatosa (n=5), pleomorphic adenoma (n=4), ameloblastoma (n=4) and gum cancer (squamous cell carcinoma) (n=38). Healthy gum (n=38) was used as control. Activities of free radical scavenger enzymes in oral tissues were found to vary among oral diseases. 1. Total SOD (Mn-SOD+Cu・Zn-SOD) activities were high in fiber tissue enriched diseases such as fibroma and low in maxillary sinusitis and gum cancer. 2. Cu・Zn-SOD activities were low in maxillary sinusitis and radicular cyst as well as in gum cancer. 3. GSH-Px activities were high in maxillary sinusitis, radicular cyst, fibroma, epulis and gum cancer. 4. Catalase activities were high in maxillary sinusitis and odontogenic keratocyst, and low in epulis.

術後性上顎嚢胞の臨床的研究

This study was undertaken to investigate postoperative maxillary cyst from the clinical aspect such as patient's sex, affected side, patient's ages at the first examination, at the primary radical operation of sinus maxillaris and at the onset of postoperative maxillary cyst, duration between the first medical examination and onset of the symptoms, chief complaints, clinical symptoms, location and nature of the cyst, possible relationship between root of the tooth and the cyst, bleeding during operation, postoperative complaints, and so forth.These findings were compared with those already reported in the papers and similar results were obtained. Interesting findings among them were as follows.(1) Axial CT examination showed closure of the nasal meatus in 86.8%.(2) Bone absorption was observed in all cases, and multilocular cyst were found in more than 70 percent of the 38 cases examined.(3) Penetration of the tooth root into the maxillary cyst or the sinus was found in 10 out of 37 cases, of which first or second premolar protruded most frequently into the cavity.(4) The average blood loss was less estimated during operation under local anesthesia than under general anesthesia.(5) The frequency of postoperative complaints concerning nasal and paranasal cavities was lower in patients treated with secondary closure than in those with primary closure when the medical examination was carried out in 23 patients elapsed more than one year after operation.

下鼻道対孔の開存した術後性上顎嚢胞

Four patients with postoperative maxillary cyst and patent lateral nasal window were examined fiberscopically and radiologically. The window of two patients remained widely open (more than 4.2mm in diameter), but that of other two had a narrow opening less than 4.2mm. Three of the 4 patients had a recurrence of maxillary cyst 3 to 5 years after the first surgery to remove the cyst.Fiberscopic examination revealed a patent window in all cases, but 3 windows were shown to be closed by radiological examination.

The postoperative maxillary cysts. Experience with 23 cases

The postoperative maxillary cysts. Experience with 23 cases

術後性上顎嚢胞に関する臨床的研究 第2報 手術症例の長期経過観察

術後性上顎嚢胞に関する臨床的研究 第2報 手術症例の長期経過観察

Clinical investigation on the postoperative maxillary cyst

Clinical investigation on the postoperative maxillary cyst

副鼻腔疾患におけるＢモード超音波診断法

As a routine preoperative evaluation for chronic sinusitis and postoperative maxillary cyst (mucocele and pyocele), CT scans and B-mode ultrasonic diagnosis including three methods, linear, sector, and convex scans, were performed. By chronic sinusitis, 112 sides by linear scans, 43 sides by sector scans, and 29 sides by convex scans were included in the study. By the postoperative cyst, 43 sides by linear scans, 24 sides by sector scans, and 12 sides by convex scans were included. The positive diagnostic finding by ultrasonography is defined as the depicted echo of the posterior wall. In chronic sinusitis, positive diagnostic rates were as follows: linear scans, 73.2%, sector scans, 88.2%, and convex scans, 77.8%. As for the scan planes, horizontal plane yielded more positive than sagittal one. In postoperative cyst similarly, linear, 86.0%, sector, 95.8%, and convex, 83.3%. Horizontal more positive than sagittal also. The negative findings were caused, in chronic sinusitis, by attenuation by the air in the sinus, thick anterior wall, and artifacts. In postoperative cysts, the negative findings were caused by specific location of the cysts (lateral or posterior). Our results recommend the use of sector scan because of its easy manipulation and higher positive diagnostic rates due to the radial beam conforming to the curvature of the posterior wall. Especially, the sector scan was higher diagnostic rate than linear scan, because the sector scan transmitted radial beam, and received its reflective wave easily from a curved posterior wall of the maxillary sinus. The sector scan, its manipulation is easy, and its diagnostic rate is higher than any other scans.