Maxillary sinus polyp vs mucous retention pseudocysts.

[cdmOMR]

Hello all!

Coming over from oral radiology in peace. Just wanted to get some clarification from the people mostly working in this region on a fairly innocuous topic. In dentistry on CBCTs we see mucous retention pseudocysts all the time, we pretty much ignore them unless they are obstructing the OMC. However there seems to be confusion regarding mucous retention pseudocysts vs polyps when the entity arises from the superior aspect of the sinus and hangs down. Some radiologists call it a polyp some call it a pseudocyst. We dont have a way with CBCT to accurately measure the Hounsfield units to help determine internal contents. I've attached a couple examples of what we often call polyps. Wanted to get your opinion on this topic and also your thoughts on you treat these any more aggressively or differently than a pseudocyst? Generally seems to be little more than semantics but just wanted to get some clarification. Thanks!

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[OtoHNS]

As far as I know, there is no way to distinguish a polyp from a mucus retention cyst on CT.

Different radiologists have different ways of describing these entities. If you wanted to hedge your bets and CYA, you could probably dictate something like "There is a smooth polypoid lesion based on the superior wall of the maxillary sinus. This could represent a mucus retention cyst, inflammatory polyp, or other neoplasm. Clinical correlation recommended."

From the ENT side of things, I don't do anything for these lesions (whether inferiorly-based or otherwise) unless there are A. localized symptoms and B. radiographic signs of ostial obstruction or inflammation/infection in the sinus.

By far the most common scenario is that the cyst was found incidentally on imaging done for another reason, and the patient has no symptoms of sinusitis. In this case, I tell the patient there is nothing further to do, and to follow up PRN if sinusitis symptoms develop.

 

[cdmOMR]

As far as I know, there is no way to distinguish a polyp from a mucus retention cyst on CT.

Different radiologists have different ways of describing these entities. If you wanted to hedge your bets and CYA, you could probably dictate something like "There is a smooth polypoid lesion based on the superior wall of the maxillary sinus. This could represent a mucus retention cyst, inflammatory polyp, or other neoplasm. Clinical correlation recommended."

From the ENT side of things, I don't do anything for these lesions (whether inferiorly-based or otherwise) unless there are A. localized symptoms and B. radiographic signs of ostial obstruction or inflammation/infection in the sinus.

By far the most common scenario is that the cyst was found incidentally on imaging done for another reason, and the patient has no symptoms of sinusitis. In this case, I tell the patient there is nothing further to do, and to follow up PRN if sinusitis symptoms develop.

Perfect. Thank you for your input!