Treatment of Maxillary Cysts
For mucous retention cysts in the maxillary sinus, small lesions can be drained during sinus surgery without negative effects, while large cysts require otorhinolaryngology referral for endoscopic removal prior to any dental procedures. 1, 2
Classification and Initial Assessment
The term "maxillary rotundum cyst" likely refers to cysts in the maxillary region, which require differentiation based on type and size:
- Mucous retention cysts appear as radiopaque, dome-shaped masses on imaging, typically filled with yellow serous fluid, and are benign lesions originating from the sinus floor 2
- Evaluate cyst size relative to sinus volume—cysts occupying two-thirds of sinus volume may block drainage if the membrane is elevated 1
- Assess whether the cyst interferes with the osteomeatal complex, as this determines urgency of treatment 2
Treatment Algorithm Based on Cyst Size
Small Mucous Retention Cysts
- Aspiration or deflation at the time of sinus floor augmentation is the treatment of choice, allowing safe membrane elevation 2
- Simple drainage during surgery shows no negative effects on outcomes, with most demonstrating radiographic disappearance after proper drainage 1
- The cumulative implant survival rate remains 96.8% when small cysts are drained intrasurgically 2
Large Mucous Retention Cysts
- Refer to otorhinolaryngology prior to any sinus procedures for endoscopic removal 1, 2
- Large cysts have a 3% recurrence rate after endoscopic treatment 1
- Avoid elevating large cysts during dental procedures, as this could block the natural ostium and cause inflammatory or infectious complications 2
Odontogenic Cysts (If Applicable)
For developmental or inflammatory odontogenic cysts in the maxilla:
- Large lesions require initial biopsy followed by surgical excision with the involved tooth 3
- Begin with marsupialization and decompression for 3 months to reduce lesion size, then proceed with definitive surgical removal 4
- Complete excision is mandatory to prevent recurrence 3
- Enucleation with peripheral ostectomy for unilocular lesions; marginal or partial jaw resection for multilocular lesions 5
Critical Pitfalls to Avoid
- Never overfill the maxillary sinus during augmentation when a cyst is present, as this leads to technical complications 2
- Do not attempt to elevate large cysts during sinus procedures—this blocks mucosal drainage and causes sinusitis 2
- Avoid simple enucleation or curettage alone for large odontogenic cysts, as this carries a 29.2% recurrence rate 5
- Always obtain preoperative 3D imaging (CBCT) to assess cyst extent and relationship to vital structures 6, 3
Preoperative Evaluation Requirements
- Computed tomography is mandatory for surgical planning 6
- Refer to otorhinolaryngology if membrane thickening exceeds 4 mm 6
- Interpret radiologic findings alongside sinus history and clinical symptoms 2
- Assess cortical plate integrity—perforation or erosion indicates more aggressive behavior requiring wider resection 5