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.