Bilateral Maxillary Soft-Tissue Disease: What Is Making Your Cheeks Swell?

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About the Maxillary Soft Tissue

The maxilla is the bone forming the upper part of the human jaw and the lowest anterior portion of the skull. Within the maxilla, there are hollow spaces, called sinuses, on both sides of the nasal cavity. These sinuses are lined with soft mucous producing tissues. The mucosa is susceptible to any number of bilateral maxillary soft-tissue diseases. Most of these diseases are not fatal, but it is important to understand the differences.

Diseases of the mucosal lining in the maxillary sinus take the shape of cysts, tumors and inflammation. Each has its own symptoms and treatments.

Maxillary Sinusitis

Maxillary sinusitis is an inflammation of the soft mucosal tissue which lines the maxillary sinuses. It can present as an acute or chronic disorder.

Acute sinusitis manifests itself as pain in the cheeks and, at times, the teeth. Swelling of the cheeks may be present, along with pressure and a stuffy nose. It is generally treated with decongestants, nasal sprays, expectorants, antihistamines and, if an infection is present, antibiotics.

Chronic sinusitis generally presents as tender, painful cheeks, facial swelling and abnormally long-lasting nasal discharge. It is treated with bed rest, decongestants and antibiotics. More severe cases may require surgical intervention to remove obstuctive matter.

Cysts

Cysts are a mass of connective tissue, lined internally by epithelium and, generally, filled with fluid, keratin or cellular debris. There are a few different cysts that affect the soft tissue of the maxillary sinus. These cysts are benign. The most common cyst that forms in the maxillary sinus is an odontogenic keratocyst (OKC). These cysts can grow rapidly and cause bone to expand. Therefore, they often present as painless swelling in the lower cheeks. They generally require surgical removal, along with intense follow-up care, due to a high rate of recurrence.

It is worth mentioning here that patients displaying multiple OKCs should have a family history check performed. These patients are candidates for a genetic disorder called nevoid basal cell carcinoma sydrome, also known as Gorlin sydrome. Patients with this inherited disorder tend to suffer from carcinomas of the skin’s basal cells on their face and chest, along with bone abnormalities.

Tumors

A tumor is an abnormal growth of cells. A common tumor that affects the maxillary sinus mucosa is an ameloblastoma. They are found more often in the mandible, but do occur in the maxilla. They are, fortunately, a benign tumor. Treatment includes surgical removal and ,often, facial reconstruction.

There also exists a set of malignant tumors which affect the sinuses. These carcinomas require surgery to remove the tumor and surrounding tissues. If a large amount of tissue is removed, facial reconstruction may have to be considered. Patients must also undergo radiation therapy following surgery to prevent the recurrence or metastasis of the tumor. In more advanced cases, chemotherapy treatments are required.

References

UCLA Periodontics Information Center: Odontogenic Cysts

Journal of Oral Pathology and Medicine: Dentigerous Cyst Versus Unicystic Ameloblastoma

Official Journal of The American Academy of Pediatrics: Not Everything in the Maxillary Sinus is Sinusitis

University of Washington: Maxillary Sinus: Abnormal

Toothy: Odontogenic Diseases of the Maxillary Sinus

Mayo Clinic: Odontogenic Lesion Treatment

RadioGraphics: Cysts and Cystic Lesions of the Mandible: Clinical and Radiologic-Histopathologic Review

University of Washington School of Dentistry: Odontogenic Keratocyst (OKC)

Journal of Surgery Pakistan: Ameloblastomas and Their Management: A Review

Stanford Medicine Cancer Center: Cancer in the Maxillary Sinuses

City of Hope: Treatment Options for Paranasal Sinus and Nasal Cavity Cancers