Sinus surgery: mucoceles versus mucous retention cysts–whats the difference?

Mucoceles of the sinuses

There is quite a bit of confusion about mucous retention cysts (found on CT scan) and mucoceles, which are much less common and treated very differently.

 

In my practice, this causes a fair amount of un-necessary confusion, and, frankly unnecessary angst, since most are mucous cysts and require no intervention in the vast majority of cases.

Lets start with mucoceles, which do require some intervention in most cases.  I’ll add a couple of visuals to help illustrate these differences.

Mucoceles of the sinuses can cause chronic bacterial infections of the sinuses or chronic sinusitis.  Mucoceles almost always require surgery to correct them.   Mucoceles are much less common than chronic sinusitis with polyps or chronic sinusitis without polyps.   Mucoceles  are so distinct from the chronic sinusitis with or without polyps  that they deserve special attention.

Mucoceles are fluid filled sacs that slowly fill up with mucus and then expand slowly– pushing, compressing, eroding bone and moving structures around them.   These mucoceles may expand and push into the eye socket (the orbit) or push into the brain or nose.   If a mucocele sac expands into the orbit, it can push the eye out and cause a bulging eye, double vision, or change in vision.  If the mucocele pushes into the brain it may not cause many symptoms, unless it gets infected.  If a mucocele next to the brain or eye gets infected, there can be a sudden and serious infection of the eye or brain.   So patients that come to the doctors with a mucocele usually have symptoms from the mucocele already, and if they don’t, they are at risk of developing a serious complication.   So mucoceles usually require surgery.    Once in a while, they are observed or followed to see if they will cause problems.

Mucoceles versus mucus retention cysts

Now there is a terminology problem around mucoceles.   Some doctors call “cysts” in the sinuses “mucoceles”, when in fact they are just cysts.   So, as a patient, it is important to know the difference between a “mucus retention cyst” and a mucocele.   A mucus retention cyst is just a cyst along the sinus lining.   It’s a fluid filled sac, yes, but a retention cyst does not expand and push into the eye socket, brain, or nose and it doesn’t cause problems in the vast majority of cases.   So a cyst is very different than a mucocele.

 

Notably, mucus retention cysts in the sinuses are very, very common.  In fact about 30-40% of people with absolutely no complaints of sinus problems will have cysts of the sinuses when they have a CT scan performed.  Most retention cysts of the sinuses spontaneously shrink or don’t change over the long term, based on a study by JH Wang in 2007  . Dr. Wang’s  findings suggest that, in the absence of associated complications, “wait and see” may be the appropriate management strategy for these retention cysts.  Most every sinus surgeon in the U.S. feels that way too.

Several cysts in the maxillary (cheek sinuses)

How common are mucus retention cysts? Mucus retention cysts are very common.  For instance, patients who get a CT scan of there eye for an eye problem will have their sinuses show up on the CT scan, and 30-40% of them have sinus cysts.    Well, you may wonder, what does it mean to have a retention cyst?   Does anything need to be done for a cyst?   Do they cause problems?   Most retention cysts of the sinuses spontaneously shrink or don’t change over the long term, based on a study by JH Wang in 2007)  . These findings suggest that, in the absence of associated complications, “wait and see” may be the appropriate management strategy for these retention cysts.   That is how the vast majority of American surgeons treat these cysts.  In fact, wait and see really is usually translated to the patients as “nothing needs to be done for this” or “don’t worry about this, it’s normal to have cysts” or “it’s very unlikely that this cyst will ever cause you problems”, or “nothing further needs to be done, and a follow up CT scan is or examination is not needed”.  Doctors are usually reluctant to say a cyst (or a few cysts)  “will never cause you problems”.   Occasionally a sinus cyst will fill with fluid and then fall into the nose and cause a blockage, but this is very rare.   If a cyst did get large enough to cause problems, there would be some symptom, so most doctors say “you don’t need to come see me again unless your symptoms change dramatically”.

But there are always exceptions.

Occasionally, these cysts are mis-named as “mucoceles” by a radiologist.   The doctor who ordered the test gets a type-written report that erroneously labels the cysts as a “mucocele”.    The doctor who ordered the test may never actually see the films (so can’t see its just cyst—not an expanding mucocele)  and the patient is referred to a surgeon.   Now most surgeons agree that these cysts are just that, innocent cysts, and can be totally ignored.   They are of no clinical consequence in the vast, vast majority of cases.   But occasionally there is a surgeon who has had an experience where he or she has removed a cysts and the patient said he or she was better.  So, there are some surgeons who remove these “innocent” retention cysts, hoping the patient will get better.  Suffice it to say, that the vast, vast majority of these cysts do not need to be removed.    If a surgeon says that a “retention cyst” needs to be removed, and you question the explanation yourself, consider getting a second opinion.   A second opinion is almost certainly justified.

Please send me your comments on my blog Sinus411.com

Jeffrey E. Terrell, MD

Michigan Sinus Center, Ann Arbor, MI

Blog:   www.Sinus411.com

102 comments to Sinus surgery: mucoceles versus mucous retention cysts–whats the difference?

  • brent

    About 10 years ago I had 2 golfball-sized mucous retention cysts removed from my right sinus, and also had endoscopy and had a deviated septum straightened. Prior to the surgery, my symptom was stuffiness in the right side of my nose. No breathing improvement following procedure, but did lose some sense of smell and taste. Also had distorted sense of smell at times. Later (about 3 yrs ago)noticed another large cyst on right side in dental x-ray. This time a differet ENT recommended ignoring it. So I did. Today, 3 yrs later, I was sitting in church and clear, yellowish fluid came pouring from the right nostril lasting for a couple of minutes, and did again slightly about an hour later. I feel fine now. Do you think the cyst burst?

    • admin

      While its difficult to comment on one particular case, cysts can burst, and when they do, often the fluid is very clear and golden color. Hope that helps.

      • Binu

        Hi Doc,
        About one month back i detected a soft area below cheek bone, went to dentist he prescribed dental xray and antibiotics one week past, area is growing and pain and fever, dentist suspected some other cause he was in doubt, by the time two weeks over, my right cheek got swollen like balloon, iv anti bios were give Ct scan was done, which showed right max sinus with large mucocelen cyst with +ve bone erosion anterior wall on sinus, ent sur removed thick chocolate colour cyst by underlip surgery, sent for biopsy report infected benign cyst.
        what was the cause of cyst? my surgeon say it may be due to old injury in last one year, (i’m not recollecting),

  • willy reid

    Yes, but what if the ENT and the Endodontist both refer to it as a retention cyst, and it has only been discovered because of years and years of suffering by the patient with “sinus” infections root canal, etc? Is it right to say a mucous retention cyst is not causing problems if the person has constant sensation (aching) and occasional sinus infections that get better only with antibiotics? Would removing it not get rid of the pain and suffering of the patient?

    • admin

      This blog is limited to generalities, and particular cases may not fit generalities. Patients should consult their physicians with specific questions. But the blog may stimulate questions.

  • Nickalie Doney

    I recently had a CT scan of my neck, it read on the results: Large 2.5 cm mucous retention Cyst or Polyp in right maxillary sinus. Mild mucoperiosteal thickening in bilateral ethmoids.Minimal and large lymph nodes in are subcentimeter most likely reactive.
    Everything else was normal, I have been having really bad pain in right side of neck and throat, it is worst some days and not bad others. I have been having other symptoms as well like headaches and eye pain occasionally.I first noticed the enlarged lymph nodes seven months ago, but they have gotten a lot smaller. I would like to know if this is something to worry about.

    • admin

      While it is difficult to give advice on any particular problem without seeing a patient, I have written some on Cysts in the sinuses. Its not unusual to have some surgeons offer surgery for cysts, but many, if not most academic sinus surgeons do not recommend surgery for simple cysts. More information on the blog: http://www.sinus411.com/?p=53

    • Tara Bailey

      This could have been written by me. I also have all those symptoms & no one can give me any answers. I’m beyond frustrated & tired of being in pain. I was curious what you’ve found out?

  • Sue Elledge

    I have been diagnosed with a mucus retention cyst. I have had several episodes of “sinus infection” presenting without mucus, stuffiness, and pain. This occurrs only on the right side. The pain is very intense with enough swelling to loosen teeth. After a period of time, the swelling goes down and “gets better”. Surgery has been recommended by my doctor. Are there other treatment options available to me?

    • admin

      Sinus infections that loosen teeth is extremely unusual and concerning.
      I can’t give advice on your case, but asking your surgeon these questions, or getting a formal second opinion is a good idea.

  • Carol

    Do you have any experience with sinus cysts causing severe pain and headaches when the weather changes/pressure changes? Particularly when low pressure fronts move in? Are sinus cysts associated with chronic ringing in the ears? Would treatment of the sinus cysts be considered in either of these conditions?

    • admin

      Without comment specifically on your case (as there are always exceptions), sinus Cysts do not typically cause any pain at all. That would be very rare. No association with ringing. Surgery is not generally accepted recommendation for these scenarios, but again, these are generalizations.

  • Betty

    I have had dizziness for almost a month they had suspected another stroke but have ruled that out. Can these cysts put pressure that causes dizziness?

    • admin

      Sinus cysts would be an almost unheard of cause of dizziness, but I don’t have all of your information, and I can’t really give advice over the internet. But I would be very reluctant, if I were you, to attribute dizziness to a cyst, for the vast , vast majority of people, just statistically speaking.

  • Debbie

    I have had a reoccuring sinus infection going on 5 months, have been on several antibiotics for this as well. I have had really foul smelling discharge from my rt sinus with a lot of congestion in my rt nares. Antibiotics have helped but it is only short lived. I recently had a CT scan of my sinuses and was told that I had two possible”cysts” in my maxillary sinus, one was located in the upper part of the sinus cavity approx 1 cm diameter and one near a old root canal which was a bit larger. I was told to see my endodonist and would watch the other and follow up with another CT in the near future. What implications does the larger one near the old root canal and what is usually done with these?

    • admin

      Surgery is not usually necessary for cysts, but there are rare exceptions, and yours might be one of them.
      You should seek a full , second opinion, for a thorough review of all of the data (and an exam).

    • OMG Debbie, I just have to tell you that my name is Debbie also and have the EXACT same symptoms as you do. Whe I read your msg. I thought, wow this person has the same symptoms as I do. Then I looked at the name and started laughing and told my boyfriend that is was MY old blog that I must of written before……we laughed and then kept reading your msg and realized it WASN’T me because I just had my first CT scan done today Oct. 18th and yours was done months ago. It was then I realized it was someone else that had the same name and symptoms (especially the foul odor) as I do. WOW, way too coincidental for me. Hope you’re doing better with your sinus, I’m having surgery on Tuesday. Turns out I have a large cyst.

  • Charlie

    Hello,
    had a ct scan and the doctor said that i need a mr
    for further analisys. the ct shows almost like the right maxillary of the second picture, but in my case just the one below the eye orbit and another below.

    the mr is next week so. can i say i have a retention cysts?

  • Lisa

    A mucouse retention cyst was found on MRI in my right maxillary sinus three years ago, as well as a small amout of retention fluid. Could this be the casue of long-standing sinus tract (about two years) that appears above teeth # 2-3, that has been treated with two root canals and three apicoectomies? An 8 week course of amox resolved the infection for four months then the sinus tract appeared again. Significant bone loss from infection was seen during the apicos. Thank you!

    • admin

      Your case sounds very complicated, and too difficult to give advice, even if I could.
      I would consider asking your surgeon, or getting a second opinion. JET.

  • Elias

    Can retention cyst be drained in the course of a sinuplasty?

    • admin

      Generally, retention cysts require no surgery. Draining them doesn’t prevent them from recurring. They seal up and fill up with fluid again. But , again, thats not a problem because cysts don’t require interventions.

  • Holly

    Hi, my daughter was treated for a year and a half for horrible headaches that they thought were migraines well after finally doing a mri they saw a very large arachnoid cyst that two neurosurgeons said needed to be removed we did less than a yr ago it went great but problems are back bad headaches syncopal spells 20 lb wt loss since surgery very weak and coloring is very pale now the drs done a ct that showed the brain had not squished back down from previous cyst and the cyst is coming back but she has had a horrible deep cough since then and the dr told us the other day that the last new ct showed a 17mm mucus retention cyst in the sphenoid sinus what is your view on all of this my daughter is not any better and I do not know what to do ( I even took her to a IM Dr a reg neurologist a third one and they done a echo of her heart and heart 24 halter monitor nothing and sugar is fine also) what would you do if it were your child I dont want to look like a parent that is wanting her child to be sick to get attention like I have seen on TV I want my child well period :(

    • admin

      Good luck with your daughter. Sorry for the delay. I can’t give out medical advice, but I would like to direct you to my blogs about migraine and other headaches. Cysts are usually asymptomatic: that is, for the vast, vast majority of people. Puzzling problems sometimes warrant an evaluation at an academic medical center.

    • Christina Moldovan

      Hi Holly
      I’ve the most wonderful neurologist Brian Sorin, MD he is in Dallas… you might have to wait a couple of months to see him… but trust me he is worth waiting for. Best of luck to you and you daughter.

      Dear admin,
      Just like holly, I have the same situation with my son and I found SINUS411 helpfull, thanks you so much!!! His MRI reads: The cervical modularly junction is normal. Flow phenomenon is seen in both intracavemous carotid arteries. An up to 2-cm retention cyst is noted along the floor the right maxillary sinus. The mastoid air cells are clear.
      Retrocerebellar midline arachnoid pouch noted in the posterior cranial fossa.
      Mild right colpocephaly.
      Thank you,
      Christina

  • Nikki

    I had a MRI two weeks ago and it showed a “moderate right maxillary sinus mucous retention cyst”. I have been having severe headaches which is why the MRI was ordered by my doctor. I am going to an ENT tomorrow, but will he be able to do or prescribe anything to relieve the severe headache pain that I am having 3 to 4 times per week?

    • admin

      I can’t give out medical advice, but I would like to direct you to my blogs about migraine and other headaches. Cysts are usually asymptomatic: that is, for the vast, vast majority of people.

  • Tricia

    I had a CT scan done anout 2 years ago because I had constant headaches and pain behind my right cheek and problems breathing as well. My ENT found that I had a deviated septum and a right sinus cyst. He gave me surgery to correct the deviated septum and after I did breath better only a few months later I had severe right cheek pain again. And recently I had such bad cheek pain that I got another CT Scan done and it revealed I still have the right sinus cyst. My cheek hurts so bad that I can’t even sleep on that side or else I wake up in severe pain. I’ve done everything they’ve told me to do including nasal sprays, saline washes, and even taking strong migraine medication and allergy medicine. Nothing helps. I see the doctor tomorrow and I would really like to see if they can check the cyst out more carefully. Do you think that is what is causing all my pain? I also have trouble seeing clearly out of my right eye sometimes. But the doctors make it seem like it’s harmless. Do you think they would do surgery on it considering all of my symptoms? I don’t know what else to do to get rid of the pain! :(

    • admin

      I can’t give medical advice over the internet, but you might consider reading about migraines, trigeminal neuralgia, and sinus cysts. Severe pain is commonly due to migraines or neuralgia. Also, Dental infections can cause severe pain. Dental infections often are accompanied by tooth sensitivity tol cold liquids, hot liquids, or biting down. Good luck. Let us know how it turns out.

  • I have been hurting about a year now with severe headaches every day.about 15years ago I was diagnosed with sinusitis. My pain is so bad sometimes I can’t get out of bed.I went to the E.R because my pain was unbarriable they did a CT and said I had a large mucos cyst told me to go to a Eye ear and nose specialist. I have no insurance and have tried to get indigent help but no one will help me.I stayed in bed allday yesterday because I hurt so bad until I actually got sick I am hurting now. What can I do? Does this mean I ill never quit hurting if this cyst is not removed. I need help.Please tell me what I can do.Thank You. Rhonda. Hartgrove

    • admin

      I can’t answer your specific questions, but generally speaking mucoceles do not cause symptoms. There are very very rare exceptions.

      But consider this: 30-40% of people have mucoceles, and 12-13% of women get terrible headaches from Migraines (or occasional some other headache syndrome).
      so nearly 5% of women will have both migraines and sinus cysts, just coincidentally. That is very common to find in my practice.

  • So many questions asked about this issue:)

    The first picture is a very rare case. Mucocele compressed the left orbit.

    Easy come, Greetings …

    • admin

      Yes, the real mucocele in the first picture is pretty rare. At an academic medical center, however, I see them about 5-10 times a year, at least.

  • Sarah

    Would/could a sinus cyst cause dental problems? I have a fistula and the dentist is recommending root canal. I’m wondering if I should have the cyst removed first and see if the fistula goes away.

    • admin

      While I cannot comment on your particular case, or give medical advice, let me say this: There are different types of sinus Cysts. One is very common. That is a sinus mucocele or a retention cyst. These are found in 30-40 % of people in the general population, and typically warrant no intervention. They are not associated with dental pathology, dental abscess, or bad “roots” , so they would not typically warrant any type of surgery at all. There are also “dentigerous cysts” which are much, much less common. They have a bony rim around them. They are cysts that arise from tooth roots. If they occur with a dental infection, most knowledgable ENT doctors or sinus specialists will recommend that those cysts be removed. Its important to differentiate between the common one and the much, much less common type of cysts. I have written about sinus Cysts in this blog under mucoceles, as you have probably read.

  • Sarah

    thank you for replying. I have the common retention cyst so I guess the fistula is an unrelated issue.

  • cammy l

    I was told I had maxillary sinus mucus retention cysts, one on each side. I was told one is pushing on my nose bone and should be removed but should have both removed if they are going in for one. I was also told if i was a smoker it will have to be tested for cancer. I understand about a second opinion but what are the common risks of having them removed? And should it be tested for cancer? I also have headaches at times so unbareable i can not sleep or they wake me up and was told the cysts could be the cause of them. Thank you :)

    • admin

      I’m sorry I can’t give medical advice about specific cases, but if, after reading the material, you have questions, you should ask your doctor very specific questions, or maybe get a second opinion.

  • Maria

    I got a concussion during a soccer game in which another player and I collided heads. She caught the left side of my head with her forehead. The pain went on for months, and I still have headaches (the game was in October). We were sent to get an MRI done, and they found a cyst in my sinuses. I was diagnosed with PCS (Post Concussion Syndrome, but the doctor said to let him know if my symptoms (headaches, inability to focus, sinus congestion) worsened. I regained the ability to focus, but the headaches got worse and my sinuses were still a little backed up. I let the doctor know and he suggested I go to an ears, nose, and throat doctor. The doctor set up surgery to have the cyst removed, and said that the cyst was more than likely the cause for my headaches. I go in for surgery in 10 days. My head still hurts 2 or 3 days a week, and there are those occasions where my head hurts so badly that I have trouble holding my head up, or I feel dizzy. Do you think this is caused by the cyst?

    • Stephen

      Maria!, I’ll make it short but I have had 3 terrible concussions and I have suffered for three years with headaches depression foggy feeling everything. I’ve done every possible thing and been to every doctor. A doc recently found a retention cyst in my MRI and is sending me to nose and ear doc. Do you think that the cyst couldn’t be the reason I’ve been in pain for soo long?

  • Belinda

    I have constant pain and pressure in left cheek.The left side of my cheek stays swollen,some days it is larger than others.Could this be symptoms of MRC.Is there a way to MRC to bust without surgery?

  • Abel

    Hi; I’m male healthy fit and 27
    Around four years ago I have had a couple of surgeries following a compound fracture of my cheek bone (zygomatic arch).

    One was the ablation and cauterization of the turbinates.

    Recent CT scans done by a dentist and forwarded to a radiologist have found what in a letter they called a mucocele and recommended I visit a doctor.

    Another scan done two weeks later after a course of antibiotics prescribed by my doctor was described in another letter as extensive inflammatory mucosal thickening in the left nasal passage almost occluding the passage posteriorly. And also a moderate degree of inflammatory mucosal thickening with polypoid formation in the left antrum.

    Does this describe a mucocele?

    My eyes are always red (i look stoned, even when well rested and hydrated)and sometimes vision seems blurred though I have recently passed vision checks. Could this be a symptom?

    How often should someone get CT scans done to keep an eye on sinus inflammation and mucoceles that do not require immediate attention, can they change suddenly or grow very gradually?

    I ask this mainly due to a loss of feeling in the cheek after the fractures, nerve damage may be hiding pain which could signal something.

    Thank you

  • Lee

    I recently had an MRI ordered as I have persistent tingling sensation on my one side, especially around my face, but sometimes into my arm and leg as well. It showed increased T2 signal in the left side of the sphenoid sinus which extends into the adjacent left sphenoid wing. I was then sent for a CT scan which stated “the possibility of a mucocele is raised as the inferolateral recess on the left appears to be somewhat expanded compared to the nonaerated right inferolateral recess.” It concluded by stating “Prominent inferolateral recess of the left sphenoid sinus which is filled with combination of soft tissue density and flake-like calcifications. The possibility of a mucocele at this location may be a consideration. ENT opinion would be useful in this case.” My family doctor told me that this can’t be causing the numbness as there are no nerves around there. However, in researching this, I understand he is wrong. Could this be causing my numbness? I also get headaches… persistent, dull ones that are worse when I bend forward suddenly and feel some pressure behind my eyes, but had been doctoring because of the persistent numbness more than anything. Another symptom I frequently have is that I lose hearing a lot. My head feels full when this happens. I have always been told it is because of allergies and that the eustachian tubes swell up. I am now on a wait list to see an ENT as I have just been referred to one. I was seeing a neurologist before, which is who ordered the MRI. I have already been doctoring for 3 years for this, so learned to live with it, but it is terribly annoying. In your opinion, is this something that could be serious and how soon should it be dealt with? Are these types of things usually benign and what is meant by flake-like calcifications?

  • Lee

    For the record, the rest of my sinuses were clear except for “appearances of sequela of sinusitis involving the right maxillary antrum.”

  • Pam Moore

    My ENT says I need surgery for a cysct above my adnoids. I have pain between my ears and behind my throat that comes and goes and can get very bad. Does this sound like a cyst?

  • Katy

    I’ve had MRIs of the brain done on a regular basis for another medical problem and they’ve shown a mucous retention cyst in the left maxillary sinus which has grown over the course of several years to 3 cm x 4cm on my last MRI 2 yrs ago. Never had any problems but am starting to feel pressure. How large can they grow? Are they encapsulated differently than mucoceles?

  • Natasha

    The MRI said I had a mucus retention cyst along the medial wall of the maxillary sinus. Can it be cancerous?

  • Neil

    It was determined I have sinusitis because of WTC dust exposure and lately I have been having extreme headaches which is localized above my right eye and temple . I feel good while lying flat on my bed but if I get up quickly the fluid in my frontal sinus causes pain. If the antibiotics don’t work should I ask for a CT scan or MRI . Blood pressure normal pupils normal but the pain come on quick like a stroke. Could a sinus infection cause brain infections or strokes if left in treated ?

  • Jennyct

    Thank your for the medical perspective on sinus cysts. At what point are the cysts considered as the source of pain? If both sinuses contain very large cysts 2.8 cm+ (in addition to the sphenoid 1 cm), and there are symptoms of chronic head pain, eustachian tube dysfunction, a contact point (bone spur) noted, dizziness and visual changes with unilateral eyelid weakness… would you say there just might be a reason for surgery?

    Granted, MOST cysts asymptomatic, and one would be a fool to want to endure surgery to remove something that will most likely come back, but how do you get your ENT to take you seriously?

    • admin

      Cysts are pretty common.
      Other symptoms require a workup and each of the symptoms you mention might require a slightly different workup.

      Keeping a diary, looking for patterns of symptoms, will sometimes help the docs figure out whats wrong. REading books on headaches (and I love “Migraines for Dummies” or other books on Migraines, is very helpful.

      Good Luck. I’m sorry I can’t give specific medical advice.

  • Ger

    Hi, I’ve been diagnosed with mucocele with the size of a plastic bottle cap on my left maxillary sinus after I had MRI. I have headache which they assumed as migraine but the pain also caused swollen gums and enlarging of my lymph nodes, discomfort of my left cheek as if it was being pressed on and numbness on the left side of my neck. When I pushed my left cheek, it really feel hurt even with slightest touch. I’m going under surgery next month although sometimes I doubted, maybe because I’m scared of surgery, but I’ll let the specialists handle it. Thank you for sharing with us what you know. I enjoy reading your opinion. God bless.

  • Val

    I have just been diagnosed with an inch long polyp in my ethmoid sinus only on one side. Dr. Said it looks a little different than normal and needs to biopsied. Could there be something else developing? Also wouldn’t the MRI or ct scan show exactly what it is?

    • admin

      Probably need to follow advice of your doctor, or get a second opinion. I can’t give advice by internet, not at an individual level.
      A CT scan or MRI can’t give a “tissue” diagnosis, like a pathologist could by looking at it under the microscope.

  • LeAndra

    I had a mucocele removed earlier today. When we first found it on a CT it was over 3cm and had pushed up against my nasal bones cause then to curve and they called it a cyst and ignored it (it looks much like the image of a mucocele up top just not that close to my eye). But over the past 2 years it grew and caused me many problems and discomfort. I’m just upset the first doctor to find it on accident didn’t realize the potential dangers it could cause and just wrote it off as a cyst even though it is likely a migraine trigger he didn’t want to do the scan in the first place. And three other doctors (my primary, an ENT and an Otolaryngologist) looked at the original and two other CT’s of the mucocele and immediately decided it had to be removed. I’m just upset with the ER doctor for not even referring me to a specialist just in case because of the size and complication I had complained of.

  • Steph

    Can you please tell me where to find information about distinguishing a mucocele from a sinus retention cyst? They found a retention cyst in my maxillary sinus on a CT 6 months ago, then I went back for a repeat CT yesterday…and now there’s another one beside it. They want to do an MRI in 6 months. I went into the dr’s office quite happy that I haven’t had a sinus infection for a whole 6 months…but now I’m a little worried. I want to be sure its just a retention cyst and nothing else. The ENT never mentioned mucocele, and he told me not to worry – I just don’t understand why an MRI is indicated. I read the CT report, and the radiologist used the term “retention cyst”. I do have frequent, almost constant low-grade headaches, but I have alot of environmental allergies…

  • Steph

    Do mucocele symptoms wax and wane? I have a congenital retina problem that required several laser treatments many years ago. Last year I ran to that doctor 3 times complaining of visual problems and finally he told me to stop and to consider seeing a neurologist about migraines. But then I realized that I was always on antibiotics + prednisone for “sinus infections”, prescribed by an old school allergist who would phone in an Rx based on my descriptions. That’s why I asked to go to an ENT…but now I have had no infection for 6 months…but they are watching something grow. Its a bit unnerving! I had a two year period of similiar symptoms in my early teens that just resolved on their own – but that’s when they found my retina defect and said it was all related to that.

  • Christiana Panayiotou

    Hi,
    I have a small cyst in the left sinus. My doctor, having seen an mri, said that I should not worry about it because it is very small. Recently a teeth (panoramic) x-ray revealed some part of it. I had the impression that the day I have brought the mri to my doctor, he did not pay much attention to it; it was on a Saturday and he tried to locate it by putting the mri in the Sun (May be this is the right approach, but still I am a bit worried). He gave me a nose spray without any effect though.
    I have my left nose breathing impaired and during some days it is more obvious that the cyst is there because of the swallowing of my left cheek – this was the reason that made me decide for on mri in the sinuses area.
    Would you think that it was possible for my doctor, by a mere look at the cyst, to recognize its type? (i.e. mucus retention retention vs mucocele?)
    Very soon I travel to Uk for work. Is there any place where I could check more thoroughly my sinus?
    Thank you,
    Have a nice day!

  • Jeannette

    So recently I had a toothache and my first instinct is that I need a root canal because I already had a filling on it in the past. Before the root canal I had pain in the maxillary area. After the root canal was done, I had extreme amounts of pain then my face literally blew up over night. They put me on different antibiotics and a majority of the swelling is gone except for the maxillary area. Its sore to touch and almost feels like a knot in that area. Now I’m getting headaches and pain behind the eye. I’m starting to wonder if this is a sinus issue. I’m going back to the dentist to see what the next step is butt this is becoming miserable. Could I have a cyst or am I venturing into the wrong direction?

    • admin

      Swelling of the face, particularly swelling that is noticeable “across the room”, located under the eye, at the cheek fold area, and is associated with severe pain–that is far more likely to be dental in origin. An abscessed tooth is most common. A cyst would be much less common. Talk to your doctor, who has all the data, of course.

  • Tom

    Who is admin and why does this person never really give an answer.

  • Bernadette Davis

    I have two cavities of what I believe to be mucous retention cysts, and they’re hiding in a discreet corner around the back of my tongue. I’ve noticed two more (not cavities, but single potential mucous retention cysts) reoccurring directly across from each other on the inside of my cheeks. I’ve always known these two single cysts to swell right after I eat sweets, and I always pop them. Part of what they discharge is clear, while the other part is bloody and thick and slimy. Do you think that these are, in fact, mucous retention cysts? If so, with such a proliferation, is it still better to do nothing about them, as well as the more easily accessible ones?

  • Stephanie

    My 6 year old daughter has been dealing with esotropia (turning of her right eye inward) for the last 2 years. We have done therapy, seen many surgeons and are left puzzled as to why glasses do not correct her problem. In 2 MRI’s done, the only thing found were these sphenoid cysts. Wondering if anyone has heard of these cysts causing vision problems and/or eye turns? They seem harmless, yet our opthomologist recommended seeing a ENT to ask about them.

  • Robin

    I was diagnosed with a mucous retaining cyst after a CT. Approx. the size of a quarter. I feel like my airflow is blocked on that side, and I smell a horrible odor on the side that the cyst is. Is the cyst causing this?

    • admin

      Cysts in a sinus will not cause airflow obstruction.
      Polyps in the nose will usually cause some degree of nasal obstruction.
      Odors in the nose may or may not be related to cysts, but they usually are not.
      Ask an ENT doctor, maybe?

  • nals

    hi i was suffering with headache for the past 2 years. sometimes, i couldn’t tolerate the pain. and also the pain is moving from one side to another side over a period of time. sometimes its paining in the areas of eyes, particularly the nerves of eyes. today only i took CT scan. i got report that”soft tissue density lesion in left maxillary sinus with small nodular calcification in posterior wall- possibility of polyp/ retention cyst” and “mild adenoid hyperplassia”.

    doctor suggested for a small surgery.

    my question is, is it required to go for surgery?
    what it means……..what i should do?

  • Christy

    I had my nose broken when I was 6 and now I’m 45. I’ve had two surgeries to straighten a deviated septum (first one at 23, second one at 44) and I was addicted to nasal spray on and off for 30 years. As it turns out, I have mucous retaining cysts on both sides and most nights I can barely breath through my nose. I also have a dysfunctional eustacian tube in my left ear, some hearing loss, and loud tinitus. I continuously have to blow my nose on the left side in order to restore my hearing in my left ear. No headaches or anything, just chronic sinus and ear infections my whole life. I’m scheduled to have the surgery next month to have the cysts removed and help things drain. I hope this helps my ear problem too.

    I can relate to so many things being said here! From the low pressure fronts seemingly causing the mucous retaining cysts to get worse, to the constant ringing in the ears. Good luck everyone! I’m happy I’m going to have the surgery and I hope it helps in my case.

  • Francisco

    I went to my ENT and they did a CT as noted below, he said i have fluid coming from my brain so i have post nasal drip on my right nostril drips like opening a water faucet. Anyways he wants to do surgery to something i forgot, but heres the ct report hopefully you can help me thank you.

    CT MAXILLOFACIAL BONES WITHOUT CONTRAST
    Findings:
    There is deviation of anterior nasal septum towards the left.There is no concha bullosa. There are rounded densities most consistent with mucous retnetion cysts in the right maxillary sinus measuring 1.7 x 1cm, in the left maxillary sinus measuring 8 x 7 mm and 8 x 3 mm, in the right frontal sinus measuring 8mm. There is mucosal thickening in bilateral ethmoid and right maxillary sinuses. There is narrowing of osteomeatal complexes. No lytic or blastic bone lesion is noted. There is opacification of right mastoid and right middle ear, likely chronic.

    IMPRESSION:Chronic bilateral maxillary, bilateral ethmoid and right frontal sinusitis. Multiple mucous retention cysts as described.
    Right mastoiditis and right otitis media, problaby chronic

    • admin

      You’ll need to discuss this with a doctor that examined you.
      Sometimes there can be brain fluid, coming out the nose, that originates in the mastoid (middle ear) area. Its always worth asking doctors whether profuse, clear, watery runny nose could be leakage of CSF (cerebral spinal fluid) coming from the nose area, or from the ear area.

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  • Hello, It looks as if I have the basic CT finding: reported from ENT “this is either a Maxillary right polyp or a cyst”. Have you heard of these cysts or polyps enlarging without pain? When they get larger what would a ENT do?

    • admin

      Rarely a maxillary sinus cyst gets large enough to prolapse into the nose and cause nasal obstruction, called an antrochoanal polyp. But that is very rare.

  • teresa davis

    Have any of you had anxiety attacks following being diagnosed with these cysts?

  • Mayra

    Hello. I just had a radiology test done after complaining to doctors of my inability to breath normally. My nasal muscles get swollen daily in the afternoon and eevenings precluding me to sleep normally. I depend on corticoesteroids that take about 36-48 hours to reduce inflammation. The side that suffers the blockage is my right nostril but the radiology results read left side mucuous retention cyst. I had mentioned the doctors of the pressure on the eyes like something was pushing from behind and the constant headaches. Is there a chance that mucoceles and incorrectly diagnosed as mucuous retention cysts?

    • admin

      That would be rare, that mucoceles and incorrectly diagnosed as mucuous retention cysts.
      I can’t give medical advice, but seeing an ENT doctor may help.
      Dont forget allergies.

  • Binu

    Hi Doc,
    About one month back i detected a soft area below cheek bone, went to dentist he prescribed dental xray and antibiotics one week past, area is growing and pain and fever, dentist suspected some other cause he was in doubt, by the time two weeks over, my right cheek got swollen like balloon, iv anti bios were give Ct scan was done, which showed right max sinus with large mucocelen cyst with +ve bone erosion anterior wall on sinus, ent sur removed thick chocolate colour cyst by underlip surgery, sent for biopsy report infected benign cyst.
    what was the cause of cyst? my surgeon say it may be due to old injury in last one year, (i’m not recollecting),

  • radi

    hi, i have been suffering from headaches for the past month. i had a normal ct scan and a normal brain mri. the mri showed a sinus mucuous retention cyst. could this cause headaches? in the begining i sort of felt something “dripping” in the top part of my head. my headache is more of a sensation than a pain. any thoughts?

  • Barbara Caldwell

    I have had recurring sinus “flare ups” for almost a year. Numerous courses of antibiotics tried have either not remediated the symptoms or perhaps some improvement noted at the end if drug course, then symptoms returning. And the symptoms? A clogged Eustacian tube which does not clear with yawning, holding nares closed and blowing out to pop out eardrum and a crackling noise in ear with swallowing. Also, post nasal drainage so copious at times that I feel as if I might strangle because it will not go up (blow nose or cough) or go down with swallowing (yuk); just a constant fullness in the back of my throat. When I lie down, the fluid pours down my throat and this adds to my fear of strangling during my sleep. Also a constant cough caused by a tickle in my throat which does not stop because nothing clears. Frequently causing wheezing at end of expiration. This coughing is different from those with cold which with inspiration a deep clearing occurs. Air intake is shallow at best so force of cough is decreased. Oh, I have tried everything I can find to alleviate these symptoms, including cough suppressant, mucolytics, various antihistamines, chest/throat vapor rubs, facial saunas, nose and ear drops, and, saving the best for last, nasal irritations. At my last medical visit, my physician ordered a 10 day course of Augmentin and nasal spray containing steroid twice daily. She also ordered a sinus CT which, because of insurance precertification, could not be done until day 6 of Augmentin. Results: no evidence of acute or chronic sinusitis but a 14mm nodule located at the base of the right maxillary Antrum probably reflecting a mucous retention cyst or polyp. My question? Could this nodule be the cause of all my problems? She wanted to know if I wanted a referral to an allergist but, to me, would not an ENT referral be more prudent? Now remember, all my symptoms have lasted almost a year and frequent sinus infections as well. Suggestions please.

  • Jane

    Dear admin, you keep saying retention cysts have no symtoms or cause pain but you see so many people on this web with almost identical symtoms. I think you need to re evaluate your advise. Also why r u even writing back ? You keep repeating that you can’t comment on anyone’s case and cysts don’t hurt.you r helping no one you repeat the same answer over and over so what r u hping people with. I to has a retention cyst and I was getting severe headaches in the sinus eye area and dizzy spells. Had it removed 6 months ago and am fine all symtoms gone. I think you r one of them doctors who think cuz the med book said this and that 20 years ago it’s right. You r suppose to help people you seem lazy to me!

    • admin

      I am glad you are better. 30-40 percent of people have cysts. 12% of women, approximately (fewer men) have migraines. So one would expect that 30% x 12% or roughly 3-4% of people will have cysts and pain (due to migraines or some other cause). Those patients would be much, much, much more common than people with Cysts that actually are the cause of the pain. But I am glad you are better.

  • person

    Just to clarify I think some people are confusing antral pseudocysts (secondary to chronic sinusitis or odontogenic origin) and mucous retention cyst (usually not radiographically or clinically evident and are usually diagnosed histologically associated with nasal polyps)

  • Carrie Johns

    I’m a musical! I have a cyst in my left sinus.I have lost low end frequency in my right ear.I sing & this has devastated me.My ENT says this is just something I have to live with! I have little money & loosing my music could take more of my income.I need help!Headphones

  • Dr Lew Rassaby

    Hi, your blog is great by the way. I am a physician, a general practitioner aged 64yrs. I am in reasonable health. I’ve had a mild headache for about a week, localised to the left upper cheek and temple. A couple of days a ago I had a sudden copious discharge of straw coloured fluid from the nostril on the same side. The headache seemed to resolve. The same thing happened last night and this morning. The nostril feels slightly raw. No odour. No history of head injury.

    I am in a small town and am insanely busy. I suppose I should get a CT and see and ENT. Do you agree?

    • admin

      Interesting. Sometimes the retention cysts can get large, and rupture (sometimes people say its clear-yellow colored fluid). This can re-accumulate and then rupture again. Sound like thats a possibility. CT would show it. Then you have to decide if you’ll wait and watch or intervene. Good luck. Sorry for delay

  • Ric

    I had colon cancer a few years ago and, after the doctor cut the cancer out, I went on a course of Xeloda to mop up any left-over cancer cells especially since the cancer had ruptured before being cut out. During the course of chemotherapy (Xeloda) I started getting headaches every few weeks. Over time the headaches still occurred but the time between the bouts of headaches was lengthening. Three weeks ago the headaches started and are still going. Today I went for a CT scan and the results show that I have a mucosal retention cyst. What are the chances that the cyst was caused by the Xeloda?

  • admin

    Cysts and mucoceles are very different on CT scans, but people still confuse the words, and occasionally use them interchangeably.

    Bravo that your ENT said she was not concerned with the cysts.

    Second opinions are good if you are not confident in the first opinion, and have the fortitude to try to decide what to do if the opinions are different. Usually, when there are different opinions, one can ask some follow up questions and get a gut sense of which opinion makes the most sense, and which provider / surgeon seems most professional and competent.

    Good luck.

  • admin

    Cysts are very common, and easily seen and reported upon by radiologists.
    CT is better, but the round shape can be seen on plain x ray, fairly often.
    Sinus cancer is very, very rare.
    Cysts are present in 30-40% of the population.

    I would not routinely get a CT scan for a patient who has a cyst on X-ray. My treatment would depend on all the other symptoms, not the x ray finding of a cyst.

    JET

  • admin

    I can’t give medical advice. You should ask your ENT. And read the post again.
    Cysts are fairly common in the sphenoid sinus too.
    I believe that most doctors just monitor them.
    Your case is unusual already.
    Please ask your doctors.

  • admin

    Hi,
    Sorry, I can’t review CTs on this blog. There is software on your CD. Small is usually a few millimeters.

  • admin

    Cysts are very, very common, and very, very rarely cause any symptoms.
    Cysts are usually very separate, and unrelated to allergies, as best we know.

  • admin

    Sinus disease can cause problems with Eustachian tube functioning. Ears may not pop well, and can fill with fluid, which can cause hearing loss.
    Many people with sinus disease don’t have any ear problems at all.

    So, indirectly, sinus disease can cause SOME TYPES of hearing loss. That would be hearing loss due to fluid in the ear.

    Nerve hearing loss is different. Its not usually related to sinus disease at all. That would be uncommon, not unheard of (there are rare disorders), just very uncommon.

  • admin

    It makes a big difference if it was a mucocele, or a retention cyst.

    But really, either of them can come back. There are so many things to consider (as a surgeon) when telling someone the risk of it coming back.

    Ask your doctor about those chances. Its difficult, and inappropriate, for me go give advice by internet, especially without a complete set of data.

    Good luck.

  • admin

    This type of lump should be looked at by an ENT doctor . Cysts in a sinus do not typically go beyond the boney confines of the sinus. That would be rare.

  • admin

    what you describe is not common. Cysts can occassionally rupture, perhaps when straining or bending over. Thats not common. When it does, the patient can have a gush of clear or golden fluid come out. Some cysts get fillled with pus, and if pus sits there, it can start to have an odor. If it slowly leaks, it can form crusts that occassionally fall out. The crusts can have an odor, and the cyst filled with debris can. Neither are common. Probably need to see an ENT.

  • admin

    Its not likely at all. I hope you feel better soon.

  • admin

    If the description is correct, its not likely. Show an ENT if no other cause found.

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