can you explain the status of bony orbital wall?? is it perforated or intact? Using cornoy inside maxillary sinus not only poses threat to orbital contents but also to the nasal mucosa. I encountered similar problem few yrs back, however the orbital wall was intact and i didnt used either cornoy or peripheral ostectomy rather i went for complete enucleation of lining/residual lining . The patients is still in followup since last 3 years and havnt reported any recurrence.

Regards

Thanks Dr Tripathi.

The orbital floor is intact. I am not convinced just ennucleation would work. Earlier I felt ennucleation would be enough as the sinus osteum contributes to decompression. However this patient with Gorlin syndrome is having second recurrence after ennucleation. I wonder if cryotherapy has a place?

Dont use Carnoy near orbital floor. What about a decompression? You could do a little hole and add a tube inside lesion. Due to lower osmotic pression, keratocyst will decrease in size, and removal, some weeks later, could be safer

Thanks Dr Grillo.

This is what I do for mandibular keratocysts. I leave the tube for a few months depend on the size of the cyst. Maximum was 9 months. I got good results. However, I never did this to a keratocyst in the maxillary sinus. It will be tricky as the patient will have a fistula for a resoanble length of time. I am tempted to do this if the patient is consenting.