Sinus Cysts: Causes, Treatment, and Recurrence Risks

Q: Sinus Cysts: Causes, Treatment, and Recurrence Risks

Hello： 1. <br>If the cystic area is too large, it may be necessary to first place a drain to reduce the size of the area that will be surgically removed later, minimizing the extent of sacrifice to the bone and surrounding tissues during the surgical procedure. <br>2. <br>If the

About nasal sinus cysts?

Hello, about two years ago, I visited Mackay Memorial Hospital due to swelling and pain on the left side of my face, along with post-nasal drip on the left side.
After examination, I was diagnosed with a sinus cyst.
Four years prior, I had undergone treatment for an impacted wisdom tooth at a hospital in Taipei.
After consulting with the doctor at Mackay, I was informed that there was no significant connection, and it was just unfortunate that I developed the cyst.
I subsequently underwent surgery at Mackay, stayed in the hospital for three days, and the doctor later informed me that the biopsy results showed it was a benign fluid-filled cyst.
There were no issues for two years after the surgery.

However, in the past six months, I have started to experience swelling and pain on the left side of my face again, along with post-nasal drip.
I returned to Mackay for X-rays and a CT scan, which revealed that I still have a sinus cyst, and there is also bone hyperplasia around the left maxillary sinus.
The doctor mentioned that recurrence is possible, but it does not significantly affect my daily life.
Therefore, we decided to perform an outpatient biopsy and place a drainage tube through the gum to reduce the cyst size.
Later, the doctor informed me that the biopsy results indicated an odontogenic keratocyst, and I would need surgery to completely remove it.
After placing the drainage tube for a month, the doctor fitted a dental obturator to prevent communication with the oral cavity.
The doctor said the obturator needs to be in place for several months, but I still frequently experience severe pain while the drainage tube and obturator are in place.
At times, the pain is so intense that it triggers migraines, requiring me to take pain medication for relief.
I have the following questions:
1.
Does this cyst require drainage and an obturator, and is immediate surgery not an option? The discomfort is affecting my normal work and daily life.
2.
During my recent follow-up visits, the doctor has not consistently performed X-rays or CT scans, nor has he clearly communicated how long the obturator needs to remain in place.
How should I inquire further with my physician?
3.
Although the doctor mentioned there is no significant correlation, since the locations are similar, I would like to ask if there is any possibility that this keratocyst is related to the previous wisdom tooth and cyst? Is there a chance of recurrence?
Thank you for your assistance.

Mr. Huang, 20~29 year old female. Ask Date: 2022/10/19

Dr. Lin Jiayong reply Dentistry

Hello: 1.
If the cystic area is too large, it may be necessary to first place a drain to reduce the size of the area that will be surgically removed later, minimizing the extent of sacrifice to the bone and surrounding tissues during the surgical procedure.
2.
If the drainage and occluder are causing significant discomfort, it is advisable to directly inform the physician so that they can determine the appropriate timing for surgical intervention.
3.
It is recommended to check if Mackay Memorial Hospital has an oral pathology department, as they may be able to infer information from the two pathology reports.
However, even if there is a correlation between the two or three reports, it cannot influence or change the subsequent treatment plan, nor can it predict whether there will be a recurrence in the future.

Reply Date: 2022/10/19

More Info

Understanding sinus cysts, particularly in the context of your experience, involves recognizing their causes, treatment options, and the potential for recurrence. Sinus cysts, including the types you’ve encountered, can be a source of discomfort and may require careful management.

Causes of Sinus Cysts
Sinus cysts can arise from various factors. In your case, the initial diagnosis of a nasal cyst followed by the identification of a keratinizing cyst likely indicates a connection to the dental structures, particularly if they are located near the maxillary sinus. Keratinizing cysts, such as odontogenic keratocysts, are often associated with the jaw and can develop due to the remnants of dental tissues. The relationship between your previous dental surgery (the extraction of an impacted wisdom tooth) and the development of these cysts is plausible, as disturbances in the surrounding tissues can lead to cyst formation.

Treatment Options
The treatment for sinus cysts typically depends on their size, symptoms, and the specific type of cyst. In your situation, the initial approach involved surgical removal of the cyst, which is standard practice for symptomatic cysts. The fact that your cyst was benign and filled with fluid is reassuring, but the recurrence indicates that the underlying issue may not have been fully addressed.

When a cyst recurs, as in your case, further intervention may be necessary. The use of a drainage tube and an obturator (the device placed to prevent communication between the oral cavity and the sinus) suggests that your healthcare provider is taking a conservative approach to manage the cyst while minimizing the risk of complications. This approach allows for the cyst to shrink and for inflammation to subside before considering definitive surgical removal.

Recurrence Risks
Recurrence of sinus cysts is not uncommon, especially if the cystic structure is not completely excised or if there are ongoing irritants in the area. The presence of bone changes, such as the bone thickening you mentioned, can also indicate ongoing pathology that may contribute to the recurrence. It is essential to monitor these changes through imaging studies, as they can provide insight into the cyst's behavior and help guide further treatment.

Questions to Discuss with Your Doctor
1. Need for Drainage and Obturator: It’s reasonable to ask your doctor why immediate surgery wasn’t performed. You can inquire about the risks and benefits of the current approach versus immediate surgical intervention. If your symptoms are significantly affecting your quality of life, express this concern clearly.

2. Follow-Up Imaging: If your doctor has not scheduled regular follow-up imaging, you should ask about the rationale behind this decision. Regular imaging can help track the cyst's size and any changes in the surrounding bone, which is crucial for determining the next steps in management.

3. Connection to Previous Dental Issues: While your doctor may have indicated that there is no direct correlation between your previous wisdom tooth extraction and the current cyst, it’s valid to seek clarification. Understanding the potential links can help you manage your expectations regarding future occurrences.

Conclusion
In summary, sinus cysts can be complex, and their management often requires a tailored approach based on individual circumstances. Your experience highlights the importance of clear communication with your healthcare provider regarding your symptoms, treatment options, and the rationale behind the chosen management strategy. If your discomfort persists or worsens, advocating for further evaluation and intervention is essential to ensure your quality of life is maintained.

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