Giant follicular cysts extended in pterygo-maxillary fossa, antro-naso-ethmoidal and orbital space associated to exophtalmos and diplopia in young patients

Follicular cysts develop from the enamel epithelium of an un-erupted tooth. Two cases of extremely large and extended follicular cysts related to the upper impacted third molars in young patients and treatments are described. Case 1 Female, aged 16 with swelling of the right cheek and oral vestibule, right exophthalmos and diplopia. Spiral Computed Tomography (CT) showed a massive lesion occupying the maxillary sinus with extension into the pterygo-maxillary space, due to the destruction of the posterior antral bone wall. Above the lesion was compressing the orbital floor. Transantral surgical excision was performed approaching to the pterygo-maxillary space and orbital structure also using the operating microscope. 5-years follow-up shows good restoring of the involved structures without relapse. Case 2 - Female, aged 22, with swelling of the left cheek and oral vestibule, left nasal obstruction, orbital pain and diplopia. Spiral CT-MR integrated study allowed a very accurate analysis: the lesion occupied the entire maxillary sinus, the pterygo-maxillary space, the left nasal cavity, ethmoidal structures with posterior orbital compression. Transantral surgical excision was performed approaching to the pterygo-maxillary space; nasal-ethmoidal and orbital structures were approached by endoscopic technique. Follow-up shows good clinical, anatomical and functional conditions. Histological examination confirmed in both cases the diagnosis of follicular cyst. Giant follicular cysts require an accurate preoperative study due to the delicate structures that may be involved. In the reported cases, the operating microscope and endoscopic surgical procedures were needed in the delicate surgical steps to perform the detachment in deep areas.