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

Abstract

Background: Surgical ciliated cysts (SCC) of the maxilla appear as a delayed complication after surgery in the maxillary sinus, midface osteotomies, traumatic tooth extraction, and maxillary fractures. They are defined as a lytic lesion with entrapment of the pseudostratified columnar epithelium.Report of three cases: We present three patients in which after orthognathic surgery a slowly enlarging asymptomatic swelling mass was developed. On CT, all the cases presented lytic expansive lesions in the alveolar ridge. In the three cases, lesions were completely excised, and upon histological examination, ciliated pseudostratified columnar epithelium with goblet cells was found so they were diagnosed as SCC. An exhaustive review of the medical literature was conducted. The PubMed database was searched for PubMed Central (PMC). 44 references were found, reporting 1555 cases: 11 series and 33 case reports, being the largest series from the Asian countries. The mean age was 46.5 years, and more frequently described in male patients. The most frequent form of presentation was as unilateral unilocular cysts in the posterior maxilla. They were described most frequently after a Caldwell-Luc approach. The average latency time was of 19.9 years.Conclusion: SCC is a rare complication after orthognathic surgery, but large series have been published, so maybe it could be interesting to include these cysts in the next Edition of the World Health Organization Classification of the Head and Neck Tumors: Odontogenic and Maxillofacial Bone Tumors, making clear the difference between SCC and mucoceles to avoid future confusions.