Palatal & Alveolar Cysts of Newborns
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Small keratin-filled yellowish cysts (arrows) are found beneath the lip mucosa.

 

 

 

 

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Introduction

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A special form of odontogenic cyst is found in as many as 80% of newborn infants. Although this gingival cyst of the newborn has the microscopic appearance of an epidermoid cyst, it arises from epithelial remnants of the deeply budding dental lamina during tooth development, after the fourth month in utero, and is, therefore, discussed with the odontogenic lesions in the present text. A similar palatal cyst of the newborn is commonly found in the posterior midline of the hard palate, where it arises from epithelial remnants remaining in the stroma after fusion of the palatal processes which meet medially to form the palate. As originally described, the cysts along the median raphe of the palate were called Epstein's pearls and the term Bohn's nodules was used for cysts which originated from palatal gland structures and were scattered more widely over the hard and soft palates. Today these two terms are used interchangeably for both palatal and gingival cysts of newborns.

Palatal cysts of the newborn typically present as multiple (usually less than six) 1-4 mm. yellow-white, sessile mucosal papules of the posterior hard palate, and occasionally of the anterior soft palate. Occasional cysts are located some distance from the midline. The cysts are usually somewhat larger and less numerous than the gingival cysts of the alveolar processes in newborns, but the two entities are otherwise clinically identical. Both types of cyst are so superficial that several may be ruptured at the time of examination.

Both gingival and palatal cysts of the newborn show a thin stratified squamous epithelium cyst lining with a routine fibrovascular connective tissue stroma, usually without an inflammatory cell infiltrate. The cystic lumen is filled with degenerated keratin, usually formed into concentric layers or "onion rings," and the epithelium lacks rete processes. Occasional cysts will demonstrate a communication with the surface.

No treatment is required for gingival or palatal cysts of the newborn. The cysts are very superficial and within weeks will rupture to harmlessly spill their contents into the oral or pharyngeal environment. The cyst lining then fuses with the overlying mucosa and becomes part of it. Occasionally, a larger cyst or a cyst situated more deeply in the submucosal stroma will remain for 6-8 months before rupturing.

Nichamin SJ, Kaufman M. Gingival microcysts in infancy. Pediatrics 1963; 412-415.

Fromm A. Epstein's pearls, Bohn's nodules and inclusion-cysts of the oral cavity. J Dent Child 1967; 34:275-287.

Cataldo E, Berkman MD. Cyst of the oral mucosa in newborns. Am J Dis Child 1968; 116:44-48.

Jorgenson RJ, et al. Intraoral findings and anomalies in neonates. Pediatrics 1982; 69:577-582.

Moskow BS, Bloom A. Embryogenesis of the gingival cyst. J Clin Periodontol 1983; 10:119-130.