Surgical technique:
Under general anesthesia while the patients were supine with head
elevated a 2% lidocaine with 1:100,000 epinephrine was injected into
the upper sublabial area on the affected side. A small incision about 2
cm, 3 mm above the gingivolabial sulcus was done. Careful dissection was
done to expose the anterior wall of the maxillary antrum (avoid injury
of the infraorbital nerve). The cutting drill was used to do a small
window in the anterior wall of the maxillary sinus in the canine fossa.
The 0 degree 4 mm telescope was used in the surgical opening of the
maxillary antrum to explore the cyst within the maxillary sinus (figure
1). The endoscopic instruments (dissectors, curette, and forceps) were
used to carefully dissection of the cyst with its content and its entire
wall from its attachment. Sometimes there were erosions within the walls
of the maxillary sinus, so careful dissection had been achieved with
help of better illumination and magnification of the endoscope (figure
2). Throughout the procedure avoidance of injury of healthy unaffected
maxillary sinus mucosa, complete removal of the entire cyst wall, and
ensure hemostasis had been achieved.
In patients with dentigerous cyst (figure 3), the affected tooth was
removed with the cyst in all cases while in radicular cyst patients the
tooth is preserved. The covering maxillary mucoperiosteum and soft
tissue was returned to their original site with wound closure by 3/0
vicryl sutures.