What is the treatment for a maxillary cyst?

Treatment of Maxillary Cysts

The treatment of maxillary cysts primarily involves observation ("wait and see") for asymptomatic retention cysts, while symptomatic or large cysts require surgical intervention through techniques such as cystectomy, marsupialization, or decompression based on the cyst size and location. 1

Types of Maxillary Cysts and Diagnosis

• Maxillary cysts can be classified as:

  • Retention cysts (most common, benign)
  • Radicular cysts (odontogenic origin)
  • Nasopalatine cysts
  • Postoperative maxillary cysts

• Diagnosis is established through:

  • Clinical examination (swelling, pain)
  • Radiographic assessment (CBCT, panoramic radiographs)
  • Aspiration cytology when needed
  • Histopathological confirmation

Treatment Algorithm

1. Asymptomatic Retention Cysts

• Observation approach is recommended for most retention cysts 1
• No intervention required if:
  • Cyst is not causing symptoms
  • Not interfering with planned procedures
  • Small cysts that don't affect the osteomeatal complex

2. Symptomatic or Large Cysts

• Surgical intervention is indicated when:
  • Cyst causes pain, swelling, or functional impairment
  • Cyst occupies more than two-thirds of sinus volume
  • Cyst blocks sinus drainage
  • Cyst interferes with planned dental procedures

Treatment Options Based on Cyst Size:

For Large Cysts (>3cm):

• Step 1: Marsupialization and decompression (3 months) to reduce size 2
• Step 2: Surgical endodontic therapy of affected teeth if needed
• Step 3: Complete cystectomy/enucleation

For Medium-Sized Cysts:

• Direct enucleation if anatomical structures are not at risk
• Drainage/deflation during sinus floor augmentation procedures if applicable 1

For Small Cysts:

• Complete enucleation
• For radicular cysts: endodontic treatment of the causative tooth may be sufficient

Surgical Approaches

• Cystectomy (Enucleation): Complete removal of the cyst lining
• Marsupialization: Creating a surgical window in the cyst wall to allow continuous drainage
• Decompression: Placement of a drain to gradually reduce cyst size
• Combined Approach: Initial decompression followed by enucleation for large cysts 2

Special Considerations

• For cysts extending into maxillary sinus:

  • Endonasal blockade of the nasopalatine nerve at its emergence from the pterygopalatine ganglion provides effective anesthesia 3
  • Consultation with an otorhinolaryngologist is recommended 1

• For nasopalatine cysts:

  • Complete enucleation is necessary to prevent relapse
  • Surgical access depends on cyst size and extension 4

Post-Operative Care

• Antibiotic therapy
• Anti-inflammatory medication or analgesics
• Avoidance of pressure changes and nose blowing
• Regular follow-up to ensure proper healing 1

Potential Complications and Pitfalls

• Failure to differentiate between cyst types can lead to inappropriate treatment
• Incomplete removal may result in recurrence, particularly with nasopalatine cysts 4
• Damage to adjacent structures (teeth, nerves, sinus) during enucleation of large cysts
• Sinus drainage obstruction if cyst manipulation affects the natural ostium 1

Interdisciplinary Approach

• Coordination between dental surgeon and ENT specialist is essential for complex cases
• Consultation with an otorhinolaryngologist is recommended for large cysts or when sinusitis symptoms are present 1