Mandible & maxilla
Cysts of the jaw
Surgical ciliated cyst
Author: Anthony Chi, M.D., Ph.D.
Editorial Board Member: Kelly Magliocca, D.D.S., M.P.H.
Editor-in-Chief: Debra L. Zynger, M.D.
Last author update: 30 January 2019
Last staff update: 19 November 2024 (update in progress)
Copyright: 2002-2024, PathologyOutlines.com, Inc.
PubMed Search: Surgical ciliated cyst pathology
Table of Contents
Definition / general | Essential features | Terminology | ICD coding | Epidemiology | Sites | Pathophysiology | Clinical features | Diagnosis | Laboratory | Radiology description | Prognostic factors | Case reports | Treatment | Gross description | Microscopic (histologic) description | Microscopic (histologic) images | Immunohistochemistry & special stains | Molecular / cytogenetics description | Sample pathology report | Differential diagnosis | Board review style question #1 | Board review style answer #1 | Board review style question #2 | Board review style answer #2Cite this page: Chi A. Surgical ciliated cyst. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/mandiblemaxillasurgicalciliatedcyst.html. Accessed November 29th, 2024.
Definition / general
- Surgical ciliated cysts develop mostly in maxilla at a site of previous surgery or trauma
- Rare occurrences at mandible have been reported (J Oral Maxillofac Surg 2014;72:1736, Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2005;100:36)
- Surgeries may be Caldwell-Luc / Le Fort I osteotomy, orthognathic or for chronic sinus inflammatory disease (J Oral Maxillofac Surg 2014;72:1736, J Oral Maxillofac Surg 2012;70:e264)
Essential features
- Prior surgical procedures or trauma
- Cystic lining cells are respiratory type epithelium with cilia
Terminology
- Postoperative maxillary cyst
- Postoperative paranasal cyst
- Implantation cyst
ICD coding
- J34.1: cyst and mucocele of nose and nasal sinus
Epidemiology
- Frequently encountered bony cyst in Asian population, including Japan (~20%) (Oral Surg Oral Med Oral Pathol 1986;62:544)
- Rare in non Asian populations (J Oral Maxillofac Surg 2012;70:e264)
- No gender predilection (J Oral Maxillofac Surg 2014;72:1736)
- Patients often in 30's to 40's, but wide age range (J Oral Maxillofac Surg 2014;72:1736)
- Time between first surgery and development of cyst varies from six months to 50 years (Br J Oral Maxillofac Surg 1990;28:264)
Sites
- Most common at posterior maxilla (J Oral Maxillofac Surg 2014;72:1736)
- Mandibular locations have been reported (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2005;100:36, J Oral Maxillofac Surg 2014;72:1736)
Pathophysiology
- Entrapment of maxillary sinus mucosa in the wound by a surgical procedure (e.g. Caldwell-Luc procedure, Le Fort I osteotomy)
- Ensuing inflammatory process that induces cystic changes of the trapped respiratory mucosa
- Expansion of the cyst by the osmotic difference from the surrounding tissue (J Prosthet Dent 1990;64:466, J Oral Maxillofac Surg 2014;72:1736)
Clinical features
- Most commonly presenting with swelling or pain of the cheek and the mucogingival fold (J Oral Maxillofac Surg 1988;46:310)
Diagnosis
- Histomorphology is not entirely specific; a final diagnosis should only be rendered with, most importantly, a documented history of surgery, along with collaborating radiologic findings
- If the biopsy tissue is limited and does not appear cystic, one may need to consider the possibility of sampling of normal sinonasal mucosa
- In such case, a communication with the submitting surgeons may be necessary
Laboratory
- Fluid aspirated from the surgical ciliated cyst contains predominantly glycosaminoglycans (hyaluronic acid and heparan sulfate) (Oral Surg Oral Med Oral Pathol 1988;65:222)
Radiology description
- Well demarcated, unilocular radiolucency with a sclerotic or well corticated border (J Oral Maxillofac Surg 2014;72:1736, J Prosthet Dent 1990;64:466, J Oral Maxillofac Surg 2003;61:138)
Prognostic factors
- Recurrences are rare but could happen, if cystic lining incompletely removed (J Oral Maxillofac Surg 1982;40:487)
Case reports
- 22 year old man with gradual swelling and tenderness of the chin region (Br J Oral Maxillofac Surg 2015;53:1040)
- 22 year old man with history of Le Fort I maxillary advancement osteotomy (J Oral Maxillofac Surg 2003;61:138)
- 27 year old Caucasian woman with two radiolucencies in the mandible (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2005;100:36)
- 45 year old woman with a slow growing swelling at the left posterior maxillary region (J Oral Maxillofac Surg 2012;70:e264)
- 72 year old Caucasian man with painless swelling in the anterior mandible and history of rhinoplasty and genioplasty at age 16 (J Oral Maxillofac Surg 2014;72:1736)
Treatment
- Surgical enucleation or curettage
- Marsupialization, if the lesion is extensive and involves the cortical bone (J Oral Maxillofac Surg 1982;40:487)
Gross description
- Cysts, often containing slimy cystic fluid
Microscopic (histologic) description
- Cystic lumen lined by pseudostratified ciliated columnar epithelium with occasional mucous goblet cells (characteristic of maxillary sinus lining)
- Occasional areas of squamous metaplasia and secondary inflammation
Microscopic (histologic) images
Contributed by Anthony Chi, M.D., Ph.D.
Cystic lesion in maxilla, intraosseous
Columnar epithelial lining
Prominent cilia
Cyst with thin wall in maxilla, intraosseous
Ciliated cyst lining
No cytologic atypia
Immunohistochemistry & special stains
- Not often utilized for diagnosis
Molecular / cytogenetics description
- No molecular testing utilized
Sample pathology report
- Right maxillae, cyst, curettage:
- Respiratory lined cyst, consistent with surgical ciliated cyst (see comment)
- Comment: Imaging noted a 3 x 2 cm well demarcated unilocular cystic lesion at right maxilla. Microscopic examination reveals a cystic lesion with its cyst wall lined by ciliated respiratory type epithelium. The cyst wall is variably fibrotic with sparse chronic inflammation. No cytologic atypia is seen. In this patient with a documented history of Le Fort surgery, the findings are consistent with surgical ciliated cyst.
- Respiratory lined cyst, consistent with surgical ciliated cyst (see comment)
Differential diagnosis
- Glandular odontogenic cyst
- Microcysts or duct-like spaces (good features to separate from surgical ciliated cysts)
- Lined by stratified eosinophilic cuboidal cells
- Apocrine snouting of hobnail cells
- Epithelial spheres or plaque-like thickening
- May have cilia
- Mucous goblet cells may be present
- High recurrence rate (up to 50%)
- Dentigerous cyst
- Association with an impacted or unerupted tooth (good features to separate from surgical ciliated cysts)
- Lined by non keratinizing stratified squamous epithelium
- Primordial odontogenic cyst
- A developmental odontogenic cyst
- Lined by simple stratified squamous epithelium
- Mucous or ciliated cells may be present
Board review style question #1
What is the most important consideration in establishing the correct diagnosis of this cystic lesion in the maxilla?
- Age
- Race
- Sex
- Surgical history
Board review style answer #1
D. This image is a surgical ciliated cyst. This lesion occurs over a wide age range, although many patients are in their 30s to 40s. There is no sex predilection. Although surgical ciliated cysts are more common in Asian patients and relatively rarer in non-Asian populations, the surgical history is the most important consideration in establishing the diagnosis given its pathophysiology/etiology.
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Board review style question #2
- Which is true when comparing surgical ciliated cyst and glandular odontogenic cyst?
- Both entities never recur
- Cilia is only seen in surgical ciliated cyst
- Mucous goblet cells can only be seen in glandular odontogenic cyst
- Cyst with microcystic / duct-like spaces is a differentiating feature
Board review style answer #2
D. While recurrence of surgical ciliated cyst is rare, it does occur, especially if the cyst is incompletely removed. Glandular odontogenic cyst has a recurrence rate of 20 - 50%. Cilia can sometimes be seen in glandular odontogenic cysts. Mucous goblet cells can sometimes be seen in surgical ciliated cysts. Microcystic / duct-like spaces in the cyst lining are characteristically seen in glandular odontogenic cysts but not in surgical ciliated cysts.
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