What is it and what types of cysts are there?
The mucous membrane of the maxillary sinus contains many small glands that secrete secretions. If the excretory duct of the gland is blocked due to edema or inflammation, the secretion accumulates and a retention cyst is formed - these are the most common ones. There are also pseudocysts, which arise from the accumulation of fluid under the mucosa, and odontogenic cysts associated with the roots of the upper teeth. Mucocele is separately distinguished - filling the entire sinus with secretion with stretching of its walls; this condition requires surgical treatment.
- Retention cyst - blockage of the mucous gland
- Pseudocyst - accumulation of fluid under the mucosa
- Odontogenic cyst - associated with a diseased tooth
- Mucocele - filling and expansion of the entire sinus
- Single and multiple, unilateral and bilateral cysts
Causes and risk factors
The exact cause of a cyst in a particular person is usually unknown. It is believed that repeated episodes of swelling of the mucous membrane lead to blockage of the gland ducts. Therefore, cysts are more often found in people with chronic rhinitis, allergies, frequent sinusitis and anatomical features that make sinus ventilation difficult. The upper teeth play a separate role: inflammation at the roots, canal treatment with the removal of filling material, or tooth extraction can affect the bottom of the sinus. The cyst is not related to nutrition and is not transmitted to other people.
- Chronic and allergic rhinitis
- Repeated sinusitis
- Deviated septum and narrow sinus anastomosis
- Inflammation of the roots of the upper teeth
- Dental treatment of upper teeth
- Smoking and air pollution
Symptoms
In most cases, the cyst does not cause any sensation and remains a finding on the image. Symptoms appear when it occupies a significant part of the sinus or is located at the outlet and interferes with the outflow. Then there may be heaviness or pressing pain in the cheek area and under the eye, aggravated by bending over and diving, difficulty breathing with one half of the nose, and mucus running down the back wall of the throat. Sometimes the cyst spontaneously opens and yellow liquid flows from the nose. Often, complaints attributed to a cyst are actually caused by rhinitis or migraine.
- More often - asymptomatic
- Pressure or dull pain in the cheek area
- Congestion of one half of the nose
- Draining of mucus into the throat
- Pain during pressure changes on an airplane or when diving
- Repeated sinusitis on one side
- Episodes of yellow fluid leaking from the nose
Diagnostics
The main method for identifying a cyst is a CT scan of the paranasal sinuses: the image shows a round formation with smooth contours on the wall of the sinus. CT allows you to evaluate the size, location, condition of the anastomosis and connection with the roots of the teeth. The ENT doctor complements the study with an endoscopic examination of the nasal cavity to identify a deviated septum, polyps, and signs of chronic inflammation. If the picture is unclear, an MRI is prescribed to help distinguish a cyst from a polyp or tumor. If there is a suspicion of an odontogenic cause, a consultation with a dentist and a dental photograph are needed.
- CT scan of the paranasal sinuses
- Endoscopic examination of the nasal cavity
- MRI - with questionable CT data
- Dental X-ray or CT scan of the jaw if a tooth is suspected
- Allergological examination for concomitant rhinitis
Treatment
An asymptomatic small cyst is usually simply observed: sometimes it shrinks or disappears on its own. Medicines and rinses do not resolve the cyst, but help with the accompanying inflammation. Indications for removal are severe complaints, a large cyst, anastomosis block, repeated sinusitis, suspected tumor, as well as planning a sinus lift or implantation of the upper teeth. The modern method is endoscopic surgery through the nose: the cyst is removed through a natural or enlarged anastomosis without incisions on the face. A puncture of the sinus does not eliminate the cyst, since its membrane remains.
- Observation with control CT scan for asymptomatic cyst
- Treatment of rhinitis and sinusitis as prescribed by a doctor
- Endoscopic maxillary sinusotomy through a natural anastomosis
- Microgaymorotomy - access through the anterior wall of the sinus
- Treatment of the causative tooth with an odontogenic cyst
