Mandible / maxilla
Nonodontogenic cysts within bone and oral mucosal / oral cavity
Surgical ciliated cyst

Editorial Board Member: Kelly Magliocca, D.D.S., M.P.H.
Editor-in-Chief: Debra Zynger, M.D.
Anthony Chi, M.D., Ph.D.

Topic Completed: 30 January 2019

Revised: 23 May 2019

Copyright: 2002-2019, PathologyOutlines.com, Inc.

PubMed Search: Surgical ciliated cyst AND free full text[sb]

Anthony Chi, M.D., Ph.D.
Page views in 2019 to date: 570
Cite this page: Chi A. Surgical ciliated cyst. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/mandiblemaxillasurgicalciliatedcyst.html. Accessed September 18th, 2019.
Definition / general
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
Sites
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
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
Radiology description
Prognostic factors
Case reports
Treatment
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.
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Cystic lesion in maxilla, intraosseous

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Columnar epithelial lining

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Prominent cilia

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Cyst with thin wall in maxilla, intraosseous

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Ciliated cyst lining

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No cytologic atypia

Immunohistochemistry
  • 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.
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 question #1
    What is the most important consideration in establishing the correct diagnosis of this cystic lesion in the maxilla?


  1. Age
  2. Race
  3. Sex
  4. Surgical history
Board review answer #1
D. While many patients of surgical ciliated cysts are in their 30s to 40s, there is a wide range of age. There is no sex predilection for surgical ciliated cysts. While 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 question #2
    Which is true when comparing surgical ciliated cyst and glandular odontogenic cyst?

  1. Both entities never recur
  2. Cilia is only seen in surgical ciliated cyst
  3. Mucous goblet cells can only be seen in glandular odontogenic cyst
  4. Cyst with microcystic / duct-like spaces is a differentiating feature
Board review 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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