Late Developed Unusual Nasal Involvement of Postoperative Maxillary Cyst Following Maxillary Sinus Augmentation: A Case Report

Postoperative maxillary cyst (POMC) is a benign expansive cystic lesion of the maxilla generally related to invasive maxillary surgeries or trauma. POMC can also develop after maxillary sinus augmentation (MSA), but many dentists are not well-aware of such complication of MSA. A 56-year-old male patient had undergone bilateral MSA. After 18 years, the patient reported painless swelling on the left palate. On the panoramic radiographs, no specific findings were found, but a large unilocular lesion was detected at the medial side of the previous augmentation of the left maxillary sinus on cone-beam computed tomographic examination. The lesion expanded medially and downward to destruct the medial wall of the maxillary sinus and palatal bone. Medial expansion of the lesion also reached the nasal septum and inferior meatus. Due to the extent and the location, the lesion was hard to manage using an intraoral surgical approach. The patient was then referred to an otolaryngologist in a university hospital. Endoscopic marsupialization was performed under general anesthesia. Previous augmentation and dental implants could be maintained during the marsupialization. The removed tissue sample revealed respiratory epithelium with inflammatory cell infiltration, confirming that the lesion was a postoperative maxillary cyst (POMC). There has been no recurrence of POMC to date. POMC is a rare postoperative complication of maxillary sinus augmentation, but clinicians should be aware of the possibility of POMC and the necessity of regular radiological monitoring.

Trans-antral endoscopic assisted excision of odontogenic maxillary cyst

Key points: • Intraoral, sublabial, and transnasal endoscopic approachs are used to manage odontogenic maxillary cysts. • Transnasal endoscopic approach includes inferior meatal antrostomy, middle meatal antrostomy, and endoscopic medial maxillectomy approach. • Trans-antral endoscopic assisted excision of odontogenic maxillary cyst approach have the advantage of direct lesion access of the sublabial approach as well as the advantages of better illumination, magnification, and small access of endoscopic approach. • The trans-antral endoscopic assisted approach co-morbitity seems to be the least comparing to the benefit of complete excision of the cyst within its entire wall in all the cases with minimal injury of the unaffected maxillary sinus mucosa as well as avoidance of injury of any nearby structure if there is defect in the sinus wall.

Cisto maxilar pós-operatório: relato de caso

Introdução: ­­Cisto cirúrgico ciliado ou cisto maxilar pós-operatório é uma lesão que ocorre próximo ao ápice dos dentes, porém é originária do epitélio do seio maxilar. É definido como um sequestro da membrana do seio que fica aprisionado e se prolifera, gerando uma cavidade cística verdadeira. Tem aspecto radiográfico semelhante ao cisto radicular, sendo unilocular de centro radiolúcido e bordas radiopacas bem delimitadas. O tratamento é a remoção do epitélio, sendo recomendada a enucleação cirúrgica do cisto. Raramente é relatado recorrências da lesão. Objetivo: relatar um caso clínico e a conduta adotada para resolução do caso de cisto maxilar pós-operatório. Relato de Caso: A paciente de gênero feminino, 59 anos, leucoderma, edentada total, procurou a clínica de odontologia da Universidade Estadual do Oeste do Paraná para confecção de novas próteses totais superiores e inferiores. No exame radiográfico panorâmico, constatou-se uma lesão unilocular em maxila direita. Clinicamente não apresentava nenhuma alteração e nenhuma sintomatologia. Foi realizada a punção da lesão, sob anestesia local, que revelou conteúdo seroso. Em seguida, a lesão foi enucleada. Não houve comunicação com o seio maxilar. A paciente permaneceu em acompanhamento clínico e radiográfico por 3 anos apresentando reparação total da loja sem sinais de recidiva. Conclusão: O acompanhamento à longo prazo é essencial em casos de lesões intraósseas. Mesmo pacientes edêntulos necessitam de exames de imagens para avaliação inicial, descartando alterações intraósseas.Descritores: Cirurgia Bucal; Cistos Ósseos; Seio Maxilar.ReferênciasLi CC, Feinerman DM, MacCarthy KD, Woo SB. Rare mandibular surgical ciliated cysts: report of two new cases. J Oral Maxillofac Surg. 2014;72(9):1736-43.Neville BW, Damm DD, Allen CM, Bouquot JE. Patologia oral e maxilofacial. 3. ed. Rio de Janeiro: Elsevier; 2009.Shafer WG, Hine MK, Levy BM, Tomich CE. Tratado de Patologia Bucal. 4. ed. 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Improving Oral Surgery: A Workflow Proposal to Create Custom 3D Templates for Surgical Procedures

Background: Computer-guided technologies are adopted in various fields of surgery to limit invasiveness and obtain patient benefits in terms of surgery duration and post-operative course. Surgical templates realized through CAD/CAM technologies are widely diffused in implant dentistry. The aim of this work is to propose, beyond implantology, the feasibility of application of 3D printed surgical templates in oral surgery procedures requiring osteotomies (like maxillary cyst enucleation and tooth disimpaction) in order to obtain accurate surgeries, avoid anatomical damage of surrounding structures and decrease patient’s morbidity, using a simple, low-cost protocol of fabrication. Objective: To provide a reliable CAD-CAM workflow for the realization of surgical templates in oral surgery. Methods: Three clinical scenarios are described: A maxillary canine disimpaction, a mandibular cyst removal, and an orthodontic miniscrew placement. Each one was managed using custom surgical templates realized using the proposed workflow. A Stereolithography (STL) file of maxillary structures was obtained by the use of a 3D medical image processing software (Materialise Mimics 20.0) a segmentation toolbox acquiring RX volumes by Cone-Beam Computed Tomography (CBCT). Digital models of the teeth, acquired as STL files directly, are imported in the same 3D medical image processing freeware (Materialise Mimics 20.0) to merge STL files of maxillary structures and teeth. Data are transported into Blue Sky Plan 4.0 (Blue Sky Bio, LLC), a software for 3D implant guides fabrication, together with the DICOM images package of maxillary volumes to carry out the pre-surgical treatment planning. Anatomical structures at risk are identified; a contour of ideal incision shape and bone osteotomy extent is drawn. Finally, the resulting three-dimensional guide is digitally generated and the surgical guide printed. The resulting 3D template shows the following major features: teeth support, flap management and bone osteotomy design. Results: The proposed work-flow aided the surgeon in both pre-operative and intra-operative work phases through accurate virtual planning and the fabrication of precise surgical guides to be used in oral surgery practice. In each clinical scenario, the use of custom 3D templates allowed better control of the osteotomy planes and flap management. No adverse events occurred during both surgical and healing phases. Conclusion: The proposed digital workflow represents a reliable and straightforward way to produce a surgical guide for oral surgery procedures. These templates represent a versatile tool in maxillary cyst enucleations, tooth disimpaction, and other surgical procedures, increasing accuracy, minimizing surgical complications, and decreasing patient’s morbidity.

Successful Management of Dental Implants in Postoperative Maxillary Cyst: A Case Report With a 13-Year Follow-Up

The report is presenting a case of implant placement in the postoperative maxillary cyst (POMC) with a follow-up of 13 years. The POMC is a complication associated with various surgical interventions involving maxillary sinus diseases such as Caldwell-Luc operation, orthognathic surgery, and sinus grafting procedures. The lesion of POMC is believed to develop as a result of the changes of ciliated cells or the blockage of ostia inside the maxillary sinus. Two dental implants were placed near the lesion that was later confirmed to be POMC. Of the 2 dental implants placed, one was explanted and the other was successfully managed with surface debridement followed by guided bone regeneration. The removed specimen inclusive of the implant and surrounding tissue was evaluated with clinical photographs, radiographs, and histology and the findings are described in the paper.