Functional surgery for the treatment of dentigerous cyst in the maxillary sinus

Dentigerous cyst (DC) in the maxillary sinus is rarely seen. Several complications are observed after the Caldwell-Luc operation, which is combined with endoscopy. Still, a more perfect treatment method is yet to be discovered.

The purpose of this study was to explore and assess a new functional surgical treatment with fewer complications, which not only insured normal maxillary sinus cilia restoration and bony integrity but also did little damage to maxillary sinus natural ostium.

Dentigerous cyst in the maxillary sinuses of 20 patients had conditions diagnosed through radiographic imaging and the locating of bone windows' positions according to preoperative 3-dimensional computed tomography (CT) (3D CT). All the patients underwent a functional surgery in which a bony lid was created anteriolaterally of maxillary sinus with piezosurgery and reimplanted by titanium plates after enucleating the cyst, leaving the maxillary sinus mucosa in place with or without endoscope's assistance. Therapeutic efficacy was evaluated by clinical examination and radiographic imaging at regular intervals; the longest follow-up was 24 months.

All the patients recovered except for one, who underwent plate removal and radical maxillary sinusotomy owing to infection. Patients were asymptomatic, and CT images showed integrated maxillary bone. Extrusion deformation of the sinus was improved to different extents after 6 to 24 months of follow-up.

Functional surgery for the treatment of DC in the maxillary sinus is a new approach and has the advantages of less surgical trauma, restoration of mucosa and bony wall, and more satisfactory results.