Case of Surgical Treatment Using Nasal Endoscopy for a Maxillary Bone Lesion Occurring in Maxillary Sinus

We report here on a case in which a maxillary bone lesion occurred in the maxillary sinus and was treated surgically, by means of nasal endoscopy, with a good outcome. The patient was a 33-year-old female. Starting from around 2011, pus discharge from the nasal cavity and oral cavity was observed. The patient was seen at a local otolaryngology clinic and a dental clinic, but no improvement in symptoms was observed, and she was seen at our facility in August 2013.  CT findings indicated a cyst adjacent to the inferior wall of the left orbit, in the left maxillary third molar, surrounding the crown. In September, the left maxillary second molar was extracted, and a drain was placed in the tooth socket. Fenestration was performed and an antimicrobial agent (CAM, 400 mg/day) was administered for a period of 3 months. In January 2014, the site was evaluated once again using CT. Because no improvement was observed in the condition of the maxillary sinus area, treatment was planned involving enucleation of the cyst in combination with tooth extraction, under general anesthesia. The normal surgical approach to a cyst in the maxillary sinus is to perform radical surgery on the maxillary sinus, and then cut away the bone of the anterior wall of the maxillary sinus and remove the cyst, together with the tooth in which the problem originated. Because this approach involves removal of the entire mucous membrane of the maxillary sinus in addition to cutting away the bone of the anterior wall of the maxillary sinus, it is highly invasive. Because of this, we performed enucleation of the cyst using nasal endoscopy and removed the impacted tooth. Starting from Day 1 post-surgery, the pain was within manageable bounds, and there was only mild post-surgical swelling of the jaw area. Compared to previous cases in which radical surgery of the maxillary sinus was performed, all of the symptoms were mild. In the case described here, nasal endoscopy was performed to treat cystic disease that occurred in the maxillary sinus, in a less invasive approach that produced a good outcome.

References

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