術後16年を経て出現した術後性上顎骨嚢胞と思われる症例を, 腸骨を用いて再建し, 再発も無く整容的にも満足しえたので報告した。また本例も含め, 上顎骨周囲に発生する疾患について若干の文献的考察を加えた。

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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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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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Postoperative maxillary cysts occurring in 74 patients who received the paranasal sinusitis operation from October 1972 to August 1979, were studied.
Average lapse of time after operation was 16 years. The importance of complete removal of the pathological mucous membrane and that of drainage were emphasized.

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Four patients with postoperative maxillary cyst and patent lateral nasal window were examined fiberscopically and radiologically. The window of two patients remained widely open (more than 4.2mm in diameter), but that of other two had a narrow opening less than 4.2mm. Three of the 4 patients had a recurrence of maxillary cyst 3 to 5 years after the first surgery to remove the cyst.
Fiberscopic examination revealed a patent window in all cases, but 3 windows were shown to be closed by radiological examination.

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Recent patients with cystic diseases of the paranasal sinus in our clinic,78 patients, were observed clinically and statistically.
Postoperative cysts were predominant accounting for 76%. Many of them occurred in the maxillar sinus and non-operative ones were found frequently in the frontal sinus.
The male patients tended to be more in the postoperative cysts with a sex ratio o f 2: 1, but difference due to sex was not observed in the non-postoperative patients.
The age distribution in patients with postoperative cysts was c ompared with that reported hitherto. Although the age distribution of the first operation for sinusitis was unchanged, there was tendency to predominance in elderly patients as for the age of cysts occurrence with a mean age of 43.2 years, because the time that elapsed after operation became longer. Onset at advanced ages was found more in patients with non-postoperative cysts than in those with postoperative ones and mean age in the former was 58.5 years.
The age distribution was analyzed by sex in patients with postoperative cysts. Since the age of the first operation for sinusitis was greater in males, the age of onset of cysts tended to shift to a higher ages than in the cases of females.

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Cystic lesions of the maxilla could be generally divided etiologically and anatomically into those related or not related to the teeth. During the past eight years, two hundred cases of cystic lesions of the maxilla were observed. Among them, 178 cases (89%) were postoperative maxillary cysts. Three cases of cysitc lesions of the maxilla were related to the teeth. The summary of our investigations is as follows: 1. Two cases of large radicular cysts had complaints, resembled those of postoperative maxillary cysts. And one case of postoperative maxillary cyst with the dental infection. 2. Orthopantomography was most helpful for the diagnosis. 3. An examination of the dental pulp by the electric pulp tester was important. 4. Filling of the root canal for the nonvital teeth required the extirpation of the maxillary cyst. 5. The first CALDWELL-LUC operation must be performed carefully in order to aboid causing a maxillary cyst.

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Statistical observation of 58 cases with postoperative maxillary cysts, which were treated surgically and conservatively at the department of otolaryngology of Saga Medical School from November 1981 to October 1984, was performed. The results are summarized as follows; 1) The age of the patients ranged from 23 to 69 years. The average age was 44.0 years. 2) The male to female ratio was 37: 21. No significant lateral preference of affected maxillary sinus was found. 3) The incubation period from the last surgical treatment to onset of the symptoms was an average of 17.7 years; the shortest was four months and the longest was 43 years. 4) Most of the patients complained of symptoms such as cheek swelling and/or pain, regardless of the number and site of the maxillary cysts. 5) It appears that ENT doctors should perform follow-up examinations on patients for three months after surgery in fear of the development of maxillary cysts.

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We reviewed the radiological findings on 47 cases of postoperative maxillary cyst that had been operated on between 1983 and 1988.
Our radiographic classification using p olytomographic frontal section was done according to air containing cavity connected to Pars membranacea, as retraction of lateral sinus wall and inferior extension of the cyst. We classified all cases into four types and found statistical results as follows.
A postoperative c yst located in the lower portion of the maxillary sinus was observed in many cases (20 cases,43%). The type without postoperative exchange of maxillary sinus and the type of cyst with lower extension had a high incidence. In the former type, the period after the first operation due to chronic sinusitis was shortest of all other types. Therefore the cyst was considered to be caused by closure of the internasal opening from the maxillary sinus to nasal cavity. In the latter type, first operative age due to chronic sinusitis was oldest of all other types, therefore we could not disregard the relation between inferior extension of cyst and maxillary growth and root of teeth.

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術後性上顎嚢胞 (以下POMC) は口腔外科臨床で遭遇する機会の多い疾患である。POMCに対し臨床的, 組織学的に種々の検討がなされてきているが, その発生機序については定説がみられず, POMCに関する発表の中で組織学的所見と臨床的所見との関連についての報告はあまりみられない。著者らは, 手術を施行したPOMC90例について臨床的に検討するとともに, このうち手術材料の組織学的検討を行い得た83例について上皮成分を検索し, 臨床的所見と対比検討した。

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Fine structure of the epithelia of the postoperative maxillary cysts has been studied under scanning and transmission electron microscope. Of 23 cases examined, 22 cases had the intact epithelial layer of different types.
The ciliated cells were present in 19 cases, but there were large variations in number. Based on the surface structures, we classified the epithelia into the following types.
Type I: densely ciliated surface with regular pattern of metachronal wave. (This type is very
close to the normal pseudostratified ciliated epithelium.)
Type II: epithelial surface with non-cilliated area of various extents.
Type IIa: no morphological changes in ciliary structures.
Type IIb: marked decrease in number of the cilliated cells with ultrastructural changes in the cillia.
Type III: complete absence of the ciliated cells in the surface.
Type IV: absence of regular surface structures occupied by various types of elliptical cells.
Metaplasia towards the squamous epithelium was observed in 3 cases. The goblet cells were increased in many cases. The fine structure of the mucosa of this disease was compared with those of the frontal mucocele and the chronic sinusitis. There were no obvious morphological differences among them.
Theories have been stated on the pathogenesis of this disease, discussed. The sinus obstruction theory seems most probable, although there are some cases not to be explained by this theory.

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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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One hundred and eight cases of the postoperative maxillary cysts experienced at Tohoku University Hospital from 1972 to 1978 are reviewed.
The following result were obtained: 1) Male to female ratio was 1: 1.4, this result was not in agreement with those in other reports. 2) Fifty-three cysts were found in the right sinus, and 47 in the left. Bilateral cysts were noticed in the 8 cases. 3) The average age of the patient undergoing initial Caldwell-Luc operation was 20.4 years. The first clinical signs of the cyst formation was noticed about 21.4 years on the average after the operation. 4) The presence of the epithelium was confirmed in the 34 cases observed by the S. E. M. The complete loss of the ciliated cells was observed in 6 out of the 34 cases.
Further ultrastructual observations under T. E. M. are also discussed in this paper.

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One hundred and fourty cases of postoperative cysts of maxilla underwent revision-surgeries of Caldwell-Luc operation during the five years from 1975 to 1979.
Statistical analyses were done for incidences of male and female, and the affected sides, the age at onset, and years after the initial sinus surgeries.
Similar analyses of these items seen in the major reports in the past were compared with the results of the present report.
Only the ratio of male to female by incidence showed a changing pattern and the ratio tends to decrease. A brief review concerning the etiology of the cysts was done and it is suggested that the decreasing tendency of male to female ratio by the postoperative cysts of the maxilla is due to the already decreased ratio of male to female at the initial sinus surgeries.
Other items such as ratio of right to left, age at onset, and years after the initial sinus surgeries did not show significant changes.

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