OBJECTIVE To investigate the surgical approaches for maxillary sinus cyst. METHODS A total of 32 patients with maxillary sinus cyst underwent operation for removal the cysts. Among them, 8 patients with maxillary sinus cyst and sinusitis were operated on through Messerklinger approach, 19 patients with maxillary cyst received modified Caldwell-Luc operation under nasal endoscope and 5 patients received endoscopic removal of maxillary cyst through the maxillary sinus antrostomy at the inferior nasal meatus. RESULTS All the patients were followed up for 6 months to one year. There was no recurrence found in patients received modified Caldwell-Luc operation. There were 2 patients recurred in 8 patients who were operated on through Messerklinger approach and one patient had closure of the maxillary sinus ostium and adhesion of nasal cavity. One patient recurred and 2 lost follow up in 5 patients who received endoscopic removal of maxillary cyst through the maxillary sinus antrostomy at the inferior nasal meatus. CONCLUSION The optimal surgical method for maxillary cyst is modified Caldwell-Luc operation under nasal endoscope. Messerklinger technique may suitable for patients with complicated sinusitis.