Fifty cases of unilateral postoperative cysts of the maxilla were studied. The aircontaining cavities in the postoperative maxillary sinuses were evaluated at sides with cysts and at sides either without cysts or without symptoms.
Frontal cuts at 3 and 4 cm from the nasion using Polytome were used for the quantitative analysis. The sides with cysts showed smaller cavities in comparison to the sides without cysts with statistically significant differences.
The air-containing cavities were connected either to Pars membranacea or ethmoidomaxillary plate or to both. The sites of the communication did not show differences at both sides.
The importance of patent communications to Pars membranacea and to ethmoid cells were discussed to prevent the postoperatove cysts of the maxilla.

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We analysed IgA, IgG, IgM, secretory component, albumin and DNA in the cyst fluid from 20 patients with postoperative maxillary cyst, and compared these with the same parameters of the maxillary secretions from 49 patients with chronic sinusitis.
Concentrations of IgA, IgG, albumin and DNA of cyst fluid were significantly higher than those of maxillary secretions. Mean ratios of IgA to albumin, IgG to albumin and IgM to albumin of cyst fluid were significantly lower than those of maxillary secretions and were similar to the normal range of the serum.
These facts indicate that the cyst fluid may be formed by exudation and/or transudation from serum at the time of onest of symptom and may defined as a result of the acute inflammation. We propose that the postoperative maxillary cyst should be treated by conservative regime.

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Surface pattern of the maxillary cyst from 19 patient with postoperative maxillary cyst was observed by SEM. According to the number of the ciliated cells we divided these structure into 5 types (I-V), and 4 types (A-D) for the surface charactor of the non-ciliated cells. In the type I, cells which had abundant cilia with preserved metachronal wave were predominant feature. In the types II and 111, surface structure showed the same characteristics with less ciliated cells than these of the type I. In the type A, almost all the non-ciliated cells were occupied by the domed-surface cells with slender and dense microvilli, presumably goblet cells. Although I, II and III, and A were found to be dominant, there was no definite surface pattern of the cystic wall at the time of removal. It was suggested that the surface structure tended to be squamous metaplasia with postoperative course and age.

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We treated surgically 92 patients with postoperative maxillary cysts over the 6 year period from 1973 to 1979 in Fukuoka University. We have many other outpatients, who treated conservatively with combined medications and repeated puncture for the maxillary cyst.
The clinical findings in our cases are almost as same as those have been reported before half a century. Reviewing the literatures and our cases reveals most recommendable treatment is to make communication between the cyst and nasal cavity, at first conservatively and at last surgically.

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The following results could be obtained from the authors' clinical experiences with operative treatments mainly against dental diseases of 120 patients with post-operative cystoma of maxillary sinus.
1) Sex, age, and of fected sides Of the total 120 patients, the males were 52 cases (43.3%), while the females were 68 (56.7%), the ratio being 1:1.3. The females outnumbered. Those in their 30s were of the largest share of 47.5%, followed by those in their 40 s of 22.5%. Of the of sides, the right sides amounted to 55 cases (45.8°0), while the left sides 65 cases (54.2%), and the ratio between the left and the right was 1: 1.2.
2) An average of 17.6 years passed in these patients since their radical operations.
3) Those with unidentifiable baseline of the maxillary sinus amounted to 74 cases (61.7%), while those with fragmented baseline of the maxillary sinus amounted to 19 cases (15.8%). Both absorption and destruction of bone at the base of the sinus were very conspicuous.
4) Of the total 120 cases, 39 (32.5%) received the conservative treatments of sinus, while 81 (67.5%) received the operation of the sinus. Of those receiving the dental operations, 26 (32.1%) underwent exodontia (49 teeth), 26 (32.1%) fistula closure in the oral cavity or maxillary sinus, 12 (14.8%) resection of radicular edge, 2 (2.5%) orthopedic treatments of alveolar bone, and 2 (2.5%) extirpation of radiculocystic cells.
5) Findings at operations
A) CALDWELL-LUC'S Operation was conducted with 80 patients, while WATSUJIDENKER'S operation was conducted with one patient.
B) Those with closure of the inherrent opening of the maxillary sinus amounted to 75 cases (92.6%), while those with its opening amounted to 6 cases (7.4%). Wide opening was tried sufficiently in all of these patients.
C) Those with closure of the cavities of the inferor nasal meatus amounted to 49 (60.5%), while those with its closure amounted to 26 (32.1%). The corrective operation against the previously made pair openings was conducted with 43 patients.
D) Of the total cases, those with monocystic cystoma amounted to 42 cases (51.9%), while those with bicystic cystoma amounted to 19 cases (23.5%). Those with tricystIc cystoma amounted to 16 (19.8%), while those with tetracystic cystoma amounted to 4 (4.9%).
E) Those with exposure of the radicular edge in maxillary sinus amounted to 42 cases (51.9%)(88 teeth), while those with fistula formation in the oral cavity or maxillary sinus amounted to 14 (17.3%)(18 teeth). In the majority of these patients, necessity was noted to carry out exodontia and operation for closure of fistula.
6) Histopathological findings
A) In the greater part of the wall of the maxillary cystoma, ciliated epitheliumcould be noted (Type I), while varying conditions could be also noted, such as ciliated columnar epithelium with moderate degeneration accompanied by hydrops-type degeneration and mucinous degeneration together with relatively strong changes in the arrangements and morphology of cells (Type I), or ciliated columnar epithelium with advanced degeneration and multiple lines together with decollement of cilium showing ambiguous separation of each cell. Although in a limited number, there were some cases showing squamous cells.
B) Two cases with radicular cysts were noted. The walls of the cystoma were found lined with multiple squamous cells.
C) The acidic mucopolysaccarides on the wall of the cystoma were stained with Alcian Blue, with which goblet cells, glandular bottons, and the secreted fluid adhering to the inner side of the cystic cells showed strong positivity. The staining with Toluidin Blue showed abnormal staining in the goblet cells. With the PAS staining, the goblet cells responded with strong positivity.

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