Can Maxillary Retention Cysts Cause Headaches?

Maxillary retention cysts are small, benign cysts that can develop in the maxillary sinuses. These fluid-filled sacs are usually asymptomatic but can sometimes cause issues when they grow large or become obstructed. One of the symptoms associated with problematic maxillary retention cysts is headaches.

What is a Maxillary Retention Cyst?

The maxillary sinuses are air-filled cavities in the maxilla, which is the bone that forms the upper jaw and part of the nasal cavity. Maxillary retention cysts, also known as antral cysts, are dome-shaped lesions that can form in the epithelial lining of the maxillary sinuses when mucus produced by the lining gets obstructed and pools up.

Maxillary retention cysts are fairly common incidental findings, with studies estimating a prevalence of up to 9% in the general population. They occur more frequently in adults and the elderly. These cysts are usually small, ranging from just a few millimeters to 2 centimeters in diameter. The vast majority are asymptomatic and discovered incidentally on imaging like CT scans or MRIs done for other reasons.

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How Do Maxillary Retention Cysts Cause Headaches?

Although maxillary retention cysts are typically benign, they can sometimes lead to issues when they grow very large or obstruct the drainage pathways of the maxillary sinus. This is when they have the potential to cause symptoms like headaches.

There are a few ways maxillary retention cysts are thought to contribute to headaches:

Size of the Cyst

As the cyst grows in size, it takes up space within the maxillary sinus. This can lead to pressure on surrounding structures like the trigeminal nerve, which provides sensation to the face, or other sensitive areas like the lining of the sinus. The constant pressure on these pain-sensing structures can result in headache pain.

Sinus Obstruction

Maxillary retention cysts that obstruct the natural ostium or opening of the maxillary sinus can prevent mucus drainage and lead to a buildup of fluid in the sinus cavity. This fluid accumulation increases intra-sinus pressure which is also thought to trigger headache pain through pressure on local nerve endings.

Infection

On rare occasions, a maxillary retention cyst can become infected. This is called a mucopyocele. The pus and inflammation associated with a mucopyocele puts additional pressure on surrounding structures. It can also spread infection to other areas. Both of these effects may generate headaches.

Specific Headache Patterns Linked to Maxillary Cysts

Based on reports in medical literature, there are some typical headache patterns and characteristics associated with problematic maxillary retention cysts:

• Location – Headaches are often reported as unilateral (one-sided), localized to the same side as the cystic maxillary sinus. However, bilateral or diffuse headaches can also occur if both sinuses are affected.
• Quality – Dull, pressure-like pain or sensations of fullness in the facial region are commonly described. Sharp, throbbing pain may occur with larger cysts exerting more pressure.
• Onset – Gradual onset of headache symptoms is typical, as cysts enlarge slowly over time.
• Duration – Persistent or chronic headaches are more common than acute episodes. Symptoms often worsen over many weeks or months.
• Triggers – Bending over, straining, coughing, or other Valsalva maneuvers that increase intra-sinus pressure often exacerbate the headaches.

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Documented Cases Linking Maxillary Cysts to Headaches

There are a number of reports in medical journals that provide detailed documentation of headaches attributed to maxillary retention cysts:

• A 2013 case report described a 48-year-old man with a 2-month history of left-sided headaches that worsened when bending over. CT imaging revealed a 1.5 cm retention cyst in the left maxillary sinus pressing on the sinus wall. The cyst was surgically removed and the patient’s headaches resolved.
• A 2012 paper reported a case of a dentigerous cyst developing in the maxillary sinus of a 25-year-old man after a tooth extraction. His main symptom was unilateral headache worsening when tilting his head forwards. Once the cyst was extracted, the headache dissipated.
• A maxillary cyst in a 60-year-old woman led to symptoms of recurrent unilateral headaches and cheek numbness, as detailed in a 2010 case study. Removal of the obstructing cyst successfully treated her symptoms.
• A rare case of bilateral maxillary retention cysts causing chronic headaches was detailed in a 2008 report. After endoscopic sinus surgery to drain both cysts, the patient experienced complete headache resolution.

Diagnosing Maxillary Cysts as a Cause of Headaches

Because maxillary retention cysts often cause non-specific headache symptoms, imaging tests are needed to confirm the presence of a cyst. Some guidelines for accurate diagnosis include:

• Medical History – Inquire about headache location, duration, triggers, and other associated symptoms like sinus congestion. Headaches worsening with position changes or straining are suggestive.
• Physical Exam – Look for sinus tenderness, drainage, or asymmetry indicating unilateral sinus pathology.
• Imaging – Order a CT scan or MRI of the sinus cavities to visualize maxillary cysts as well as identify any other sinus disorders contributing to headaches.
• Nasal Endoscopy – This involves inserting a small scope into the nasal passage to directly examine the maxillary sinus ostia and drainage pathways to ascertain any obstruction.
• Symptom Improvement After Treatment – Confirmation that treating the maxillary cyst (such as with surgery) relieves the patient’s headaches helps prove it as the cause.

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Treating Headaches from Maxillary Retention Cysts

The primary treatment for symptomatic maxillary retention cysts is surgical removal, which provides definitive relief of headaches and other associated symptoms in most cases. Treatment options include:

• Functional Endoscopic Sinus Surgery (FESS) – This minimally-invasive technique uses an endoscope inserted through the nasal passage to visualize and access the maxillary sinus in order to drain and excise the cyst through the natural ostia. FESS has a high success rate for resolving headaches caused by maxillary cysts.
• Caldwell-Luc Operation – This procedure creates an artificial opening in the anterior maxillary sinus wall to allow cyst extraction. It has fallen out of favor compared to FESS due to its more invasive nature.
• Sinus Aspiration – Using a needle to aspirate or drain the fluid within the cyst through the nasal passageway is occasionally done for temporary headache relief, but has a high recurrence rate without cyst removal.

Medical management is generally ineffective, although some physicians may try prescription corticosteroid nasal sprays or analgesics to provide temporary headache relief while preparing for surgery. But definitive treatment requires the complete excision or marsupialization of the offending cyst.

Outlook After Treatment of Maxillary Cyst Headaches

For most patients with headaches clearly attributable to maxillary retention cysts, surgical removal results in complete and permanent headache resolution as well as stabilization of the maxillary sinus.

Recurrence rates after FESS have been estimated between just 0-3%, so prognosis is good if the cyst is excised in its entirety. Post-operative monitoring with endoscopy and/or CT scans at regular intervals can detect any rare instances of recurrence requiring re-operation.

With the cyst eliminated and drainage pathways restored, normal maxillary sinus function is re-established. Patients can expect long-term freedom from headaches and other related symptoms with appropriate treatment of maxillary retention cysts causative of headaches.

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Conclusion:

While usually benign incidental findings, maxillary retention cysts can sometimes grow large enough or obstruct sinus drainage to the point of causing headaches. Typical headache patterns include unilateral, dull, persistent pain exacerbated by straining or position changes. Imaging like CT scans is crucial for identifying causative maxillary cysts, and surgical removal is the definitive treatment for resolution of cyst-related headaches in most cases. With appropriate diagnosis and management, patients can achieve lasting relief from headaches due to problematic maxillary retention cysts

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