Diagnosis and treatment of maxillary sinus cysts

Cysts of the maxillary sinuses are a very common disease, often representing random clinical findings during radiography and computed tomography of the paranasal sinuses.

 

Aim: The aim of the study was to assess the conformity of the radiological manifestations of the pathological process in the sinuses with the results of histopathological studies in patients with cysts of the maxillary sinus.

 

Materials and research methods: The study group consisted of 50 patients with a preliminary diagnosis of a maxillary sinus cyst, confirmed by clinical manifestations, x-ray and computed tomography of the paranasal sinuses. All patients underwent surgery.

 

Results: As a result, patients included in the study group were diagnosed with a preoperative diagnosis: maxillary sinus cyst. However, histopathological confirmation of this diagnosis was received only in 58.8% of cases. Pathological diagnoses were distributed as follows: The largest number (42.8%) were samples with a diagnosis of true cyst. Their wall was represented by connective tissue lined on both sides by a flattened multirow ciliated epithelium, in which goblet cells were found with the basal membrane unchanged. Own plate consisted of connective tissue fibers with vessels and cellular elements. The second group consisted of false cysts - 16% of the studied samples. The morphological difference of the wall of the false cyst was the presence of a unilateral epithelial lining. The cyst wall was represented by fibrous tissue with dystrophic changes in the form of hyalinosis without an internal epithelial lining, although in some places the epithelial lining was preserved. In the cyst wall, blood vessels with signs of plethora, sclerosis with hyalinosis, stromal-vascular dystrophy were visible. In a quarter of the samples examined (25%), a fibro-edematous polyp was revealed, which manifests itself as a hyperplastic process with excessive proliferation of connective tissue, squamous metaplasia of the ciliated epithelium into a stratified squamous. Fibro-edematous polyp with cystic transformation was detected in 16.2% of cases. Its wall was lined with multi-row epithelium, in some cases sclerotic changes were visible in the wall.

Thus, having carried out a detailed analysis of clinical and radiological data, we found that the diagnosis of cystic sinusitis, based on the clinical manifestations and results of an X-ray examination, is not always consistent with the histopathological diagnosis. In addition, having studied the long-term results of surgical treatment of patients, we came to the conclusion that the presence or absence of recurrence of the pathological process was also independent of the histopathological diagnosis.

Author(s): Ulugbek Vokhidov

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