PMC4958477_01
Clinical findings: discreet swelling and reddening infraorbital on the right side, only visible in comparison to the contralateral side.
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A 68-year-old female consulted the Department of Oral, Maxillofacial and Plastic Surgery with a painful swelling on the right infraorbital side of the face (Figure 1).
Panoramic X-ray: unilocular, well-defined radiolucency of the right maxillary sinus region without dental focus.
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Intraorally, no signs were noted (Figure 2), apart from scars in the region of the unattached gingiva of the maxilla (Figure 3).
Oral view: scarred tissue in the vestibule of the upper jaw after surgery in childhood.
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Intraorally, no signs were noted (Figure 2), apart from scars in the region of the unattached gingiva of the maxilla (Figure 3).
MRT (T2): coronal (a) and sagittal (b) view. Bilateral cystic lesions of the maxillary sinus with elevation of the orbital floor on the right side.
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In the left maxillary sinus, a cyst was detected as well (Figure 4).
CT: coronal view showing osseous defects in the nasal part of the right sinus and the orbital floor.
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Bony defects were visible in the nasal part of the right sinus and the orbital floor (Figure 5).
Intraoperative view of the right maxillary sinus: after incision and preparation of the right upper jaw, a defect of the facial bone sinus on the right side appears.
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At operation, after incision of the gingiva, no bony wall of the right maxillary sinus was evident (Figure 6).
Intraoperative view of the left maxillary sinus: after preparation on the lift side, a bony defect is visible, smaller than on the right side. After osteoclastic preparation, the whole cystic lesion was removed.
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Cystectomy was performed with infraorbital nerve preservation and cystic tissue was removed intact (Figure 7).
(a) Histology: overview of the cystic tissue with focally intact epithelium and loose fibrotic stroma (haematoxylin and eosin; original magnification x20). (b) Histology: cystic wall with thin, fibrotic, and partly edematous tissue. Little inflammatory infiltrate with granulocytes; cyst lined by a combination of stratified nonkeratinizing squamous epithelium and pseudostratified ciliated columnar epithelium (haematoxylin and eosin; original magnification x20).
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Clinical signs and histological report confirmed a postoperative bilateral maxillary cyst (Figures 8(a) and 8(b)).