Mucous Retention Cyst: How do I handle this situation?

Sun, 07/25/2010 - 08:59 — RJKellyDMD

I have a patient with missing molars on the right side of the maxilla. I did a Cone Beam CT I discovered a lesion that looks mucous retention cyst.
The lesion occupies over 40% of the right maxillary sinus. I referred the patient for surgical removal of the lesion with ENT specialist. The ENT refused to do the surgery. He stated that according to ENT guidelines this kind of lesion does not require any treatment if asymptomatic, and that success of sinus graft will be decreased due to this lesion. He reommended not doing the implant.
What should I do?

Comments

Wed, 07/28/2010 - 01:43 — dssohn

Management of Mucous retnetion cyst

After making lateral window, aspirate cystic fluid with syringe & 18G needle. And elevate sinus membrane.
If cystic fluid is mucous, aspiration doesn't work.
In that case, make stab incision and suction the cystic fluid. Cyst shows very little effect on sinus graft. DS

Fri, 07/30/2010 - 04:01 — OMFS GUY

Management of the mucous retention cyst: Good Approach

DS Sohn. Very nice approach. I do the same. I usually use a small needle in these cases. You have to be careful not to tear the membrane.

If worse comes to worse you may need to clean it out and come back and regraft at a later date.

Mon, 08/09/2010 - 11:29 — mrohrer

Mucus retention cyst

This lesion is NOT a mucus retention cyst. It is an antral pseudocyst. It is not cystic but consists of an inflammatory exudate (serum, not mucus) that has accumulated under the maxillary sinum mucosa and caused a sessile elevation. No comparable mucus extravasation similar to that seen in salivary tissue occurs in the maxillary sinus. The ENT was partially correct, these lesions do not need treatment. But they should not compromise an implant in the area.
These lesions do not need treatment if they:
1. Are inferiorly based
2. Smoothly domed on panoramic radiograph
3. Are asymptomatic
4. Are recognizable as an antral pseudocyst, not a total radiopacity of the sinus.
MDR

Mon, 08/09/2010 - 11:58 — DrTimberlake

MRohrer: Question on Antral Pseudocyst

MRohrer,

Thanks for the explanation. I am new to implant dentistry so these issues can be perplexing. How can you tell the difference betweem a mucous retention cyst and a antral pseudocyst?

Is there an increase chance of implant complications with these lesions?

Is there a way to clear up the pseudocyst?

Thank you,

Jill

Tue, 08/10/2010 - 03:55 — dr-debbie