Recently, I had an MRI for an epileptic seizure. The MRI showed a large cyst in my left sinus. The doctor acted as if it were no big deal. Just looking at that picture, I could not believe it was nothing to worry about. I do have occasional breathing problems (through my nose), but nothing I would consider life-threatening. Also, it may have nothing to with this condition, but the MRI was normal as to my idiopathic epilepsy.

Jeff

When I read your letter, I danced a mental jig because your doctor "acted as if it were no big deal." Thank heavens, you have a rational, well-educated doctor! Thank heavens, no one is telling you that you need surgery!
Let me tell you a little story. After I finished otolaryngology training to become an ear, nose and throat specialist (ENT), I stayed on for a year as a faculty member. (Or perhaps it was a remedial year. I can't remember now.) During this year, a patient came to my private practice, asking for a third opinion. She had been to the OTHER big academic institution in town, and had been told by a well-known professor of otolaryngology that she needed an operation on her sinuses. She then went to one of the more successful private-practice otolaryngologists in town and received the same opinion.

So here I am, not even one year out of training, asked to give a third opinion, after the patient had consulted with two BIG names ... and I look at the CT and see what you describe, called "maxillary sinus mucus retention cysts." Like most people who have these critters, she had no symptoms from these cysts. She was very happy to hear from me that she did NOT need surgery.

These cysts are very common. They are present in perhaps 10 percent of healthy individuals. On rare occasions, the cyst may become infected. Such an infection would cause one or more of the following symptoms: pressure and/or pain in the cheek, decreased sensation or abnormal sensation of the cheek skin, pain in the teeth immediately below the cyst-bearing sinus, and pain or a sense of pressure in the eye above the cyst-bearing sinus. Similarly, cysts can very occasionally be large enough to obstruct the natural drainage pathway from the sinus. Such a sinus may be prone to secondary infection, resulting in the symptoms just described. In these two scenarios, an operation may be necessary to get rid of the cyst.

The key question, of course, is this: Is this just a maxillary sinus mucus retention cyst, or is it something else? The vast majority of radiologists are competent to tell the difference between a cyst and something more ominous, like a tumor or a fungal infection. For your sake, your doctor needs to be certain that this is just a cyst. Many patients are referred to an otolaryngologist to confirm the diagnosis of cyst. If there is any doubt from the MRI, a sinus CT scan may be necessary. Only if the diagnosis is still ambiguous (after a CT) would a biopsy be necessary. This is RARELY the case.

Your nasal breathing problems have nothing to do with the cyst, by the way. If this symptom is bothering you, discuss it with your doctor and think about seeing an ENT.