Clinical diagnosis
Case 33
When washing the pus at the surface of the swollen mass at the anterior oral palate behind the upper lip induced the more pus flowing into oral cavity from the swollen mass behind the incisive teeth, which indicated the presence of the fistula. The patient was given antibiotics for several days and was scheduled to undergo the surgical removal.
【Discussion】
Nasopalatine duct cyst is also called incisive canal cyst. This cyst is clinically present as the swollen lesion in the anterior of the palate and behind the incisive teeth (1-3) . This is not always on midline (3-6). Nasopalatine duct cysts are not odontogenic but developmental and evolutionary (1). Nasopalatine duct is the communication between the nasal cavity and anterior maxilla in the developing fetus (1). As fetal development continues, this connection gradually narrows and fuses before birth. This cyst is believed to be originated from the epithelial remnants of the nasopalatine duct (1, 2). Pathological findings show stratified squamous, cuboidal or columnar cells. Nerves, small arteries and veins exist surrounding the cyst wall (1). The incidence of palatine duct cyst is reported approximately 1 % of the population (4-6). The onset ages vary from teens to seventies (4-6). In our case, the cyst was present almost at the midline, but not symmetric as shown Fig. 3B. The patient age was 68.
Nasopalatine duct cyst is slowly growing. Presentation might include asymptomatic, swelling, pain, and drainage from the hard palate (3-6). A well-circumscribed, round, ovoid, or heart-shaped radiolucency is located in the midline of the anterior maxilla between the root of the central incisors teeth, seen on computed tomography (3-6). Our case presented as painful well-circumscribed cystic mass. The pus at its surface was macroscopically found. Radiograph and CT showed the eclipse-shaped radiolucent area and the osteolytic area of the anterior palate with the surrounding gingiva abscess. Enucleation from the side of the palate is the preferred treatment with low recurrence rates and protection of the nasopalatine nerve (7, 8). If there is a risk of loss of teeth vitality or creation of a nasal fistula in the mouth and sinus, the marsupialization method is another alternative surgical procedure (7, 8). The rate of recurrence of this lesion has been reported 2-30% (7, 8) and malignant changes have also rarely been reported (7, 8). Enucleation is scheduled to be given after antibiotics administration in our case.
【Summary】
We present a patient with inflammatory nasopalatine duct cyst. The mass was found at the gingival behind the upper lip and behind the anterior (incisors) teeth. Panorama radiograph showed eclipse-formed radiolucent lesion and CT showed osteolytic lesion penetrated anterior oral palate with the surrounding gingival abscess. Nasopalatine duct cyst is not uncommon with the incidence of approximately 1% of the population. Then, we should routinely keep in mind of this cyst appearing at the gingiva behind the upper lip or in the oral cavity behind the anterior (incisors) teeth.
【References】
1.Brenda L. Nelson et al. Nasopalatine Duct Cyst Head Neck Pathol. 2010 Jun; 4(2): 121–122. Published online 2010 Mar 4. doi: 10.1007/s12105-010-0169-3 PMCID: PMC2878629
2.Albayram, MS, et al. Radiology quiz case: Nasopalatine duct cyst. Arch Otolaryngol Head Neck Surg 2001;127:1283-1285.
3.Francolí JE, Marqués NA, Aytés LB, Escoda CG. Nasopalatine duct cyst: report of 2 cases and review of the literature. Med Oral Patol Oral Cir Bucal. 2008;13(7):E438–E443. [PubMed]
4.Swanson KS, Kaugars GE, Gunsolley JC. Nasopalatine duct cyst: an analysis of 334 cases. J Oral Maxillofacial Surg. 1991;49:268–271. doi: 10.1016/0278-2391(91)90217-A. [PubMed] [Cross Ref]
5.Daley TD, et al. Relative incidence of odontogenic tumors and oral and jaw cysts in a Canadian population. Oral Surg Oral Med Oral Pathol 1994;77:276-280.
6.Vasconcelos R, Aguiar MF, Castro W, Araújo VC, Mesquita R. Retrospective analysis of 31 cases of nasopalatine duct cyst. Oral Dis. 1999;5(4):325–328. [PubMed]
7.Gnanasekhar, JD, et al. Misdiagnosis and mismanagement of a nasopalatine duct cyst and its corrective therapy: A case report. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1995;80:465-470.
8.Elliott, KA, et al. Diagnosis and surgical management of nasopalatine duct cysts. Laryngoscope 2004;114:1336-1340.
2016.11.23
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