Surgical Ciliated Cyst Following Maxillary Sinus Floor Augmentation: A Case Report
Maxillary sinus floor augmentation is considered to play a critical role in dental implant treatment. Although many complications, such as maxillary sinusitis and infection, are well known, few reports are available on the risk of surgical ciliated cyst following the procedure. Here, we report a case of surgical ciliated cyst following maxillary sinus floor augmentation. A 55-year-old Japanese woman was referred to our hospital because of alveolar bone atrophy in the bilateral maxilla. We performed bilateral maxillary sinus floor augmentation by the lateral window technique without covering the window. The Schneiderian membrane did not perforate during the operation. She returned to our hospital after 9 years due to swelling of the left buccal region. Computerized tomography revealed a well-defined radiolucent area with radiodense border intraosseously localized in the left maxilla. We performed enucleation of the cyst with the patient under general anesthesia. Histological examination of the specimen showed a surgical ciliated cyst. In conclusion, the course of this patient has 2 important implications. First, the sinus membrane entrapped in the grafted bone without visible perforation and or tearing can develop into a surgical ciliated cyst. Second, there is a possibility that covering the lateral window tightly might prevent the development of a surgical ciliated cyst.
Panoramic (a) and para-axial (b) images of computerized tomography at the first visit reveal slight edema of the left sinus membrane and no cystic lesions.
Figure 2. Intraoral view when the patient returned to our hospital shows mild swelling and tenderness at the left upper gingivobuccal fold accompanied by decubitus ulcer and erythrogenic of the mucosal surface (black arrowhead). Figure 3. Panorama XP when the patient returned to our hospital shows well-defined unilocular radiolucency in the left upper dentoalveolar region below the maxillary sinus (white arrowhead). Figure 4. (a) Coronal computerized tomography (CT) plane. (b) Axial CT plane. CT shows a bilocular, well-defined radiolucent area with radiodense border intraosseously localized between the left upper implant fixtures. Hydroxyapatite granules have migrated toward the buccal side through the lateral window, not only toward the diseased side (red circle) but also toward the healthy side (yellow circle). Figure 5. Biopsy specimen reveals that the cystic wall consists of squamous epithelium.
Figure 6. (a)Intraoperative view of the enucleation. The cystic cavity is partially contiguous with the implant fixtures and completely separated from the maxillary sinus by bone. (b) The enucleated cyst wall is 15 × 10 mm and includes hydroxyapatite granules. Figure 7. (a) Surgical specimen reveals that the cyst is lined by pseudostratified ciliated epithelium (a) and focally by squamous epithelium (b). Figure 8. (a) Coronal computerized tomography (CT) plane. (b) Axial CT plane. CT shows that the cystic cavity is healed and there is no recurrence at the left maxilla.
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