Quick Review for Patients

 
 

 

 

 

Introduction

Note: click on underlined words for more detail or photos.

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).

Top of This Page

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.

Top of This Page

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.

Top of This Page

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.

Top of This Page

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

Torus mandibularis 9.6 7.9 8.5

Hemangioma

8.4

4.1

5.5

Erythema, inflammatory 4.5 4.8 4.7

Papilloma

5.3

4.2

4.6

Epulis fissuratum

3.5

4.4

4.1

Varicosities, lingual

3.5

3.4

3.5

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

Papillary hyperplasia

1.7

3.8

3.0

Mucocele

1.9

2.6

2.5

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

Enlarged lingual tonsil

2.4

1.2

1.6

Chronic cheek bite 0.7 1.4 1.2

Lichen planus

1.2

1.1

1.1

Squamous cell carcinoma 2.5 0.1 0.9
Amalgam tattoo 0.6 1.0 0.9

Buccal exostosis

0.9

0.9

0.9

Leaf-shaped fibroma 0.4 1.2 0.9

Median rhomboid glossitis

0.8

0.5

0.6

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

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

Leukoedema 0.4 0.3 0.3

Lipoma

0.2

0.1

0.2

Ranula

0.2

0.1

0.2

Gingival hyperplasia 0.1 0.1 0.1

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

* total examined population = 23,616 adults over 35 years of age 


 

Pictures

Note: To see enlarged photo, click on the left-hand picture; 
return here with your BACK ARROW button.