Nasolabial Cyst |
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The nasolabial cyst (nasoalveolar cyst, Klestadt's
cyst) is now considered to originate from remnants of the embryonic
nasolacrimal duct or the lower anterior portion of the mature duct, although
a popular past theory presumed it to arise from epithelial rests remaining
from the "fusion" of the globular process with the lateral nasal process
and the maxillary process. Zuckerkandl
may have been the first to describe this cyst, and at least 200 examples
have thus far been reported, including one family with a father and daughter
having similar involvement. A population study has determined a prevalence
rate of 1 cyst per 25,000 adults (Table 1).
Clinical Features
The nasolabial cyst has a strong female predilection (75% occur in women) and appears to occur more frequently in blacks than in whites. It is found near the base of the nostril, just above the periosteum, or in the superior aspect of the upper lip, and is bilateral in approximately 10% of all cases. The cyst usually obliterates the nasolabial fold and may elevate the ala of the nose on the affected side. It also obliterates the maxillary vestibule and frequently extends into the floor of the nasal vestibule, perhaps causing nasal obstruction or pressure erosion of the bone of the nasal floor. When located in the lip, there almost always is a fibrous or epithelial attachment to the nasal mucosa.
Most examples are less than 1.5 cm. in greatest diameter, but some have reached
much larger sizes. Injection of a radiopague dye into the
lumen will help to define the cyst outline, which may be somewhat irregular,
even bilobed. It is not unusual for this cyst to be secondarily inflamed
and somewhat tender to palpation. Occasional cysts rupture or drain into
the oral cavity or nose.
Pathology and Differential Diagnosis
The nasolabial cyst is lined by respiratory epithelium, stratified squamous epithelium, pseudostratified columnar epithelium or a combination of these. Mucus-filled goblet cells may be scattered within the epithelium and chronic inflammatory cells may be seen in the surrounding fibrovascular stroma.
Treatment and Prognosis
This cyst is treated by conservative
surgical excision, usually using access from the anterior maxillary
vestibule. The surgical procedure may have to be extended
deeply into the nasal sinus and it is sometimes necessary to remove part
of the nasal mucosa in order to remove the entire cyst.
References (Chronologic Order)
Note: General references can be found by clicking on that topic to the left.
Zuckerkandl E. Normale und pathologische Anatomie der Nasenhohle. Vienna; W. Braunmuller, 1882.
Wesley RK, Scannell T, Nathan LE. Nasolabial cyst: presentation of a case with a review of the literature. J Oral Maxillofac Surg 1984; 42:188-192.
Adams A, Lovelock DJ. Nasolabial cyst. Oral Surg Oral Med Oral Pathol 1985; 60Z:118-119.
Cohen MA, Hertzanu Y. Huge growth potential of the nasolabial cyst. Oral Surg Oral Med Oral Pathol 1985; 59:441-445.
David VC, O'Connell JE. Nasolabial cyst.
Clin Otolaryngol 1986; 11:5-8. Table 1: Gender-specific
prevalence rates per 1,000 population for selected oral masses and surface
alterations in U.S. adults, ranked by total frequency. Modified from Bouquot JE.
Common oral lesions found during a mass screening examination. J Am Dent
Assoc 1986; 112:50-57, and Bouquot JE, Gundlach KKH. Oral exophytic lesions
in 23,616 white Americans over 35 years of age. Oral Surg Oral Med Oral
Pathol 1986; 62:284-291. Diagnosis Number of
lesions per 1,000 population* Males Females Total Leukoplakia 43.2 20.9 28.9 Torus palatinus 13.2 21.7 18.7 Irritation fibroma 13.0 11.4 12.0 Fordyce granules 17.7 5.2 9.7 Hemangioma 8.4 4.1 5.5 Papilloma 5.3 4.2 4.6 Epulis fissuratum 3.5 4.4 4.1 Varicosities, lingual 3.5 3.4 3.5 Papillary hyperplasia 1.7 3.8 3.0 Mucocele 1.9 2.6 2.5 Enlarged lingual tonsil 2.4 1.2 1.6 Lichen planus 1.2 1.1 1.1 Buccal exostosis 0.9 0.9 0.9 Median rhomboid glossitis 0.8 0.5 0.6 Epidermoid cyst 0.7 0.4 0.5 Oral melanotic macule 0.5 0.3 0.4 Oral tonsils (except lingual) 0.5 0.3 0.4 Lipoma 0.2 0.1 0.2 Ranula 0.2 0.1 0.2 Buccinator node, hyperplastic 0.1 0.1 0.1 Pyogenic granuloma 0.0 0.07 0.04 Nasoalveolar cyst 0.0 0.07 0.04 Neurofibroma 0.0 0.07 0.04
Torus
mandibularis
9.6
7.9
8.5
Erythema,
inflammatory
4.5
4.8
4.7
Fissured
tongue
3.5
3.1
3.2
Benign
migratory glossitis
3.4
3.0
3.1
Aphthous
ulcer
3.3
3.0
3.1
Herpes
labialis (herpes simplex)
2.4
2.6
2.5
Traumatic
ulcer
2.1
2.1
2.1
Angular
cheilitis
1.8
1.9
1.9
Smokeless
tobacco keratosis
4.3
0.2
1.7
Hematoma or
ecchymosis
2.0
1.4
1.6
Chronic
cheek bite
0.7
1.4
1.2
Squamous
cell carcinoma
2.5
0.1
0.9
Amalgam
tattoo
0.6
1.0
0.9
Leaf-shaped
fibroma
0.4
1.2
0.9
Hairy
tongue
1.2
0.3
0.6
Nicotine
palatinus
1.2
0.2
0.6
Atrophic
glossitis (smooth tongue)
0.6
0.5
0.6
Leukoedema
0.4
0.3
0.3
Gingival
hyperplasia
0.1
0.1
0.1
* total examined population = 23,616 adults over 35 years of
age
