Surgical ciliated cyst of the maxilla with mature hyaline cartilage fragments following le fort i osteotomy: a case report

Abstract Background Surgical ciliated cyst , also referred to as postoperative maxillary cyst, represents a rare, delayed complication of maxillofacial and sinonasal surgical procedures. It is believed to originate from the iatrogenic entrapment of respiratory epithelium within osseous or soft tissue compartments during surgical manipulation. Although traditionally associated with the Caldwell–Luc procedure, surgical ciliated cysts have increasingly been documented following orthognathic surgery and other maxillary interventions. Owing to their rarity, delayed clinical presentation, and overlap with other cystic lesions of the maxilla, accurate diagnosis necessitates careful clinicoradiographic and histopathologic correlation. Case presentation A 26-year-old woman presented with a two-month history of progressive facial fullness and recent intermittent pain in the left midfacial region. Her surgical history was notable for orthognathic surgery (Le Fort I osteotomy) with maxillary fixation performed approximately seven years earlier for correction of a Class III malocclusion. The lesion was initially identified incidentally on a routine panoramic radiograph, with clinical symptoms manifesting shortly thereafter. Cone-beam computed tomography demonstrated a well-defined, corticated cystic lesion measuring approximately 5.0 × 5.0 cm in the left mid-maxillary/subantral region (inferior to the maxillary sinus floor), with associated cortical thinning and focal bony perforation adjacent to the nasal floor. The maxillary sinus itself remained clear without opacification. The lesion was surgically enucleated. Histopathologic evaluation revealed a cystic lining composed predominantly of pseudostratified ciliated columnar respiratory epithelium, accompanied by seromucous glands, chronic inflammatory cell infiltration, and mature hyaline cartilage fragments within the cyst wall. These findings were consistent with the diagnosis of a surgical ciliated cyst . The adjacent titanium screws remained stable, uninvolved, and were retained. Conclusions This case underscores the importance of including surgical ciliated cyst in the differential diagnosis of delayed maxillary cystic lesions following orthognathic surgery. The presence of mature hyaline cartilage fragments is a rare but valuable morphologic clue supporting postoperative sinonasal tissue entrapment. Integrated clinicoradiologic-pathologic assessment is essential for accurate diagnosis and differentiation from other cystic entities.