The maxillary sinus is the largest of the paranasal sinuses, situated in the cheekbones on either side of the nose, just above the upper jaw and teeth. A maxillary sinus cyst is a common benign finding, appearing as a smooth, dome-shaped, fluid-filled sac located within this cavity. These lesions are generally slow-growing and often discovered incidentally during routine dental or head imaging. Removal depends on the cyst’s type and whether it is causing symptoms, but modern techniques prioritize minimally invasive approaches.
Understanding the Maxillary Sinus Cyst
These lesions are broadly categorized based on their structure. A true mucous retention cyst forms when a duct from a seromucous gland lining the sinus becomes obstructed. This blockage causes mucus to accumulate, resulting in a thin sac lined with epithelial cells.
An antral pseudocyst, a more common variant, lacks a true epithelial lining. This lesion forms from inflammatory exudate accumulating within the subepithelial tissue of the sinus lining. The fluid lifts the sinus membrane, creating the characteristic dome shape. Both forms are benign, and their cause often relates to inflammation, infection, or irritation, sometimes originating from dental issues.
Deciding When Intervention is Needed
Maxillary sinus cysts are frequently asymptomatic and often discovered by chance. For these individuals, watchful waiting is adopted, involving periodic monitoring with imaging to track the cyst’s size. Many small cysts do not grow or may even spontaneously regress over time.
Intervention is considered when the cyst causes symptoms. Indications for removal include chronic facial pain, pressure or fullness in the cheek, or persistent headaches. Surgery is also recommended if the cyst grows large enough to obstruct the sinus ostium, the natural opening that drains the sinus into the nasal cavity. Obstruction disrupts normal drainage and can lead to recurrent or chronic sinusitis.
Surgical Approaches for Removal
The preferred contemporary method for removing a maxillary sinus cyst is Functional Endoscopic Sinus Surgery (FESS). This minimally invasive procedure is performed entirely through the nostrils, eliminating the need for external facial incisions. The surgeon uses a rigid endoscope to visualize the nasal cavity and sinus directly.
The endoscope guides specialized instruments to access the maxillary sinus through its natural drainage pathway. The procedure involves carefully removing the cyst lining and any inflammatory tissue while restoring the function of the sinus drainage opening. The goal of FESS is to ensure the sinus can drain properly afterward, promoting long-term sinus health.
A secondary approach, the Caldwell-Luc procedure, is reserved for complex situations. This method involves making an incision under the upper lip to create an opening in the anterior maxillary sinus wall. This direct access is necessary for very large, extensive, or recurrent cysts, or those associated with complex dental issues. For extremely large cysts, marsupialization may be used, where a portion of the cyst wall is removed to allow drainage.
Post-Procedure Expectations and Recovery
Following either procedure, a patient can expect normal post-operative sensations, including nasal congestion, mild facial discomfort, and temporary bloody discharge. These effects are standard and typically subside within the first week. Pain is generally manageable with medication.
A crucial component of post-operative care, particularly after FESS, is nasal saline irrigation. Rinsing the nasal passages helps cleanse the surgical site, remove crusting, and promote faster healing. Patients should avoid strenuous activity, heavy lifting, and actions that create pressure, such as forceful nose blowing, for one to two weeks. Regular follow-up appointments monitor healing and ensure the sinus drainage pathway remains clear.