Surgical ciliated cyst after maxillary orthognathic surgery: a literature review and case report

Surgical Ciliated Cyst Secondary to Orthognathic Surgery: Report of three cases and review of the literature

“…In all the other cases, the initial surgery was described as "antral surgery" (in the largest series, the Japanese one from Nishioka et al [6]), "undescribed" (in the second largest series, the one by Kimizuka et al [7]), "maxillary radical surgery", or "maxillary surgical intervention". Of these patients, only 20 cases developed the SCC speci cally after orthognathic surgery, 16 cases after a LeFort I osteotomy (alone or combined with other procedures) [3][4][5][8][9][10][11][12][13], 3 cases after a bimaxillary orthognathic surgery [14,15], and 1 patient after a LeFort II naso-maxillary advancement (Henderson-Jackson technique) [11] The average time of latency for SCC after the rst surgery was 20.1 years (range: 0.5 -60.0 years). Only 3 papers described relapses (a British case from the paper of Sugar et al [11], one of the cases of Kimizuka et al [7], and 3 cases from the series of Higuchi et al [16]), describing no recurrence of 32 cases in 24 papers (mostly in case reports), but the remaining 34 papers did not mention anything about relapsing.…”

“…Different hypotheses for the pathogenesis of SCC have been stated: (1) residual mucosa trapped in the bone during the surgical procedure [1,3,4,6,9,15,24,[31][32][33]; (2) retention of blood or sinus tissue uid that forms a closed space without communication with the outside [1,8,31,[34][35][36]; (3) a racial predisposition to secondary mucoceles after chronic sinusitis surgery [6,32,37]; (4) implantation of sinus mucosa in a different location [2,5,8,15,25]; (5) early closure of the ostium for the natural drainage before the complete mucosalization of the sinus, with regeneration of granulation tissue [3,9,11,32,38-43]; (6) trauma, being the SCC secondary to accidental traumatisms or surgery (especially to the Caldwell-Luc procedure) [6,43]; (7) in ammation, being the SCC secondary to a continuous in ammatory process in a scarcely ventilated space, due to the occlusion of the drainage ostium [6,32]; and (8) metaplasia from irritation, changing the original strati ed epithelium of the nasal mucosa to respiratory epithelium [39,41]. (9) Pluripotentiality of odontogenic epithelium in a cystic lesion with odontogenic origin with the presence of respiratory epithelium [5,12,15,25,37,44].…”

“…The previous surgery was a LeFort I procedure previous in all the cases, as described in other SCC in the literature [3][4][5][8][9][10][11][12][13], where it is not clear why there are so few cases associated with orthognathic surgery.…”

“…Most of the reports and scienti c papers come from the Asian literature and most often from Japan [3][4][5], but in the last years, many authors all over the world have described this entity. However, there are important differences about the size of the series (larger series coming from Asia and shorter ones from Occidental countries) and about the given details of the cases (scarce in Asian papers and thorough in Occidental reports.…”

Surgical Ciliated Cyst of the Maxilla: A Case-Series of Three Cases

“…Surgical ciliated cysts, also called post-operative maxillary cysts, are benign, frequently iatrogenic cysts of the jaws that develop after maxillofacial surgical procedures. These cysts develop after inadvertent implantation of the epithelial lining of the maxillary sinus into adjacent maxillary bone following procedures such as the Le Fort 1 osteotomy, Caldwell-Luc antrostomy, and complex surgical extraction of posterior maxillary teeth [1]. Surgical ciliated cysts are characterized radiographically by well demarcated, unilocular radiolucencies of varying sizes located in the surrounding bone but separate from the sinus [2].…”