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Endoscopic surgical treatment of maxillary odontogenic cysts

M axillary odontogenic cysts have traditionally been treated using surgical approaches such as enucleation, curettage, maxillectomy, and tooth extraction.1–3 These procedures require a transoral incision and most of the affected teeth are extracted along with the cyst walls. Potential morbidity includes oroantral fistulas, need for extensive reconstruction, loss of surrounding dentition, and chronic rhinosinusitis. Odontogenic cysts originate from epithelial-lined structures associated with odontogenesis. The most common types are radicular cysts, followed by dentigerous cysts and odontogenic keratocysts (OKCs).4 Some authors have argued that OKCs are a benign odontogenic neoplasm rather than an aggressive odontogenic cyst because of the higher recurrence rate.5–7 Large lesions can expand into and occupy the maxillary sinus. In these cases, extensive resection may be needed. In addition, obtaining adequate exposure to access the entirety of the lesion may require extensive dissection along the maxilla. Advances in transnasal endoscopic techniques can allow surgeons to access a wide variety of pathology involving the maxillary sinus. It may be feasible to resect extensive lesions involving the maxillary sinus using these techniques, allowing for less invasive treatment options. This series describes the use of an endoscopic intranasal approach for the management of large maxillary odontogenic cysts with an aim to reduce these complications and morbidity.