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Table of Contents
CLINICAL CASE
Year : 2016  |  Volume : 18  |  Issue : 2  |  Page : 65-67

Nasolabial cyst: A case report


1 College of Medicine, King Khalid University, Abha, Saudi Arabia
2 Division of Otorhinolaryngology, Asser Central Hospital, Abha, Saudi Arabia

Date of Web Publication6-Jan-2020

Correspondence Address:
MD Al Abdullah Al Musleh
Assistant Professor, Consultant Otolaryngology, Head and Neck Surgeon, Head of Simulation Center, King Khalid University, College of Medicine, P. O Box 641
Saudi Arabia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1319-8491.275266

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  Abstract 


Nasolabial cyst is a rare non-odontogenic, soft- tissue cyst arising in the maxillofacial tissues. The patient usually presents with a slowly enlarging asymptomatic swelling, alar nose elevation, and upper lip projection. We report a nasolabial cyst in a 56 -year-old man and discuss the diagnosis, differential diagnosis, and treatment in the light of the literature.

Keywords: Nasolabial cyst - Non-odontogenic cyst - Enucleation - Klestadt cyst - Nasal alveolar cyst


How to cite this article:
Al Musleh A, Alshahrani A. Nasolabial cyst: A case report. Saudi J Otorhinolaryngol Head Neck Surg 2016;18:65-7

How to cite this URL:
Al Musleh A, Alshahrani A. Nasolabial cyst: A case report. Saudi J Otorhinolaryngol Head Neck Surg [serial online] 2016 [cited 2021 May 5];18:65-7. Available from: https://www.sjohns.org/text.asp?2016/18/2/65/275266




  Introduction Top


The nasolabial cyst is a rare non-odontogenic cyst originating in maxillofacial soft tissues. This lesion was first described in 1882 by Zuckerkandl [1]. In 1953, Klestadt [2] investigated the pathogenesis of nasolabial cysts in depth. Thoma [3] suggested the term nasoalveolar cyst. In 1951, Rao [4] first used the term nasolabial cyst. The pathogenesis of nasolabial cysts is not fully understood. Two hypotheses are currently accepted: the first hypothesis postulates that they originate from facial fissure cysts or from remnants of the nasolacrimal ducts and suggests that these cysts derive from sequestering of embryological epithelial tissue in facial fissures resulting from fusion of the maxillary and nasal processes (lateral and medial).The second hypothesis suggests that persisting nasolacrimal duct epithelial remnants located between the maxillary and nasal processes gives rise to nasolabial cysts.

They commonly present as a localized painless swelling in the nasogenian sulcus and the nasal alar base. Diagnostic tests [5] include flexible nasofibroscopy, computed tomography (CT) and magnetic resonance imaging (MRI). Treatment is surgical, usually cyst marsupialization or enucleation. The recurrence rate varies according to the technique, but it is generally low.


  Case Report Top


A 56-year-old man was seen in the ENT Department. The patient’s main complaint was swelling and elevation of the right nasolabial region that expands the lips outwards [Figure 1]. He had a history of having tooth extraction one year ago. The past medical history was unremarkable. On examination, there was a facial asymmetry due to a bulge on the right side of the nose, obstructing the right anterior nostril. The swelling was 2.8 cm 2.6 cm and soft, fluctuating, nontender, subcutaneous tissue was causing obliteration of the nasolabial fold. Intra-oral examination, revealed bulging of the buccoalveolar sulcus by the swelling [Figure 2]. CT scan revealed a non-odontogenic cyst in the nasolabial area with minimal bony erosion and some scalloping in adjacent bone [Figure 3],[Figure 4]. Based on radiographic and clinical findings, the lesion was suspected to be a nasolabial cyst. The lesion was removed surgically via a sub-labial incision approach under local anesthesia, and the surgical specimen was sent for biopsy [Figure 5]. Histopathologic findings of the excised lesion were as follows: The section of the cyst wall showed pseudostratified columnar epithelium with intermittent occurrence of goblet like mucin producing cells and also cuboidal epithelial lining. The stroma exhibited non specific chronic inflammatory infiltrate. The lesion measured 2.5 x 2 x 1 mm. The nasal and buccal structures healed well without any recurrence of the lesion after one year [Figure 6].
Figure 1: pre-operative extra-oral photograph

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Figure 2: Pre-operative view of the lesion in Nasolabial fold

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Figure 3: Axial view of the computer tomography showing Cystic lesion with smooth ring enhancement in the right nasal cavity

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Figure 4: the Coronal CT shows rounded soft tissue inferior to the nasal process of maxilla on the floor of right nasal cavity.

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Figure 5: Intraoperative view of left nasolabial cyst exposed through a sub-labial incision.

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Figure 6: One-year post-operative extra-oral and intra–oral photograph.

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  Discussion Top


Nasolabial cysts are usually unilateral, with no prevalence of side occurrence but bilateral cases have been also reported [2]. It has been estimated that approximately 10% of the cases are bilateral [3],[4]. Other significant findings include a greater incidence in females adults in the fourth to fifth decades of life [5]. The diagnosis of nasolabial cysts is essentially clinical. Bi-digital palpation reveals a fluctuating swelling between the floor of the nasal vestibule and the gingivolabial sulcus, which helps to confirm the diagnosis. Radiographs do not detect this soft tissue lesion except when it causes significant maxillary bone erosion like this case. More sophisticated image diagnosis, such as computed tomography (CT) and magnetic resonance imaging (MRI), may reveal the cystic nature of these lesions in greater detail and reliability, their relation with the nasal alae and the maxillary bone, as well as bone involvement, which facilitate the diagnosis. The differential diagnosis is made with odontogenic lesions such as canine space abscess, follicular, periodontal and residual cysts, and salivary gland neoplasms [6]. Only one case of carcinoma progressing from a nasolabial cyst has been described in literature. Infected nasolabial cysts may be mistaken for furuncle of the nasal vestibule floor; except for this entity, however, the features of infected nasolabial cysts are very specific, and there is little doubt in the diagnosis. The treatment can be made by surgical excision, injection of sclerozing materials in the cyst or endoscopic marsupialization methods [7]. Excision of the cyst via the sub-labial incision is the most preferred treatment modality with very low recurrence rate and cosmetic reasons. Subl-abial incision is much better than external incision especially in terms of cosmetic reasons. Recurrence does not happen if the wall of the sac is completely removed. There is a reported case of malignant degeneration of the cyst in the literature [8]. The aims of complete excision are to prevent reccurrence, to establish a histopathological diagnosis and to ameliorate a cosmetic deformity. Care must be taken not to rupture the cyst and it should be removed intact, although there have been no reports of recurrence of these cysts after intraoperative rupture. Because this cyst is usually closely related to the floor of the nose, perforation of the nasal mucosa may be expected during its removal. When very small perforations are caused, they can be left untreated; however, larger ones must be sutured.



 
  References Top

1.
Kuriloff DB. The nasolabial cyst-nasal hamartoma. Oto-Laryngol Head Neck Surg. 1987; 963:268-272.  Back to cited text no. 1
    
2.
Klestadt W. Nasal cysts and the facial cleft cyst theory. Ann. Otol Rhinol Laryngol. 1953; 62:84.  Back to cited text no. 2
    
3.
Thoma KH. Nasoalveolar cysts. Am J Orthod. 1941;2 7:48-52.  Back to cited text no. 3
    
4.
Rao RV. Nasolabial cyst. J Laryngol Otol. 1995; 69:352-354.  Back to cited text no. 4
    
5.
Schuman DM. Nasolabial cysts: Mechanisms of development. Ear Nose Throat J. 1981; 60:389-94.  Back to cited text no. 5
    
6.
Nixdorf DR, Peters E, Lung KE. Clinical presentation and differential diagnosis of nasolabial cyst. J Can Dent Assoc. 2003; 69:146-9.  Back to cited text no. 6
    
7.
Precious DS. Chronic nasolabial cyst. J Can Dent Assoc. 1987; 53:307-308.  Back to cited text no. 7
    
8.
Smith RA, Katibah RN, Merrell P. Nasolabial cyst: Report of a case. J Can Dent Assoc. 1982; 11:727-729.  Back to cited text no. 8
    
9.
Roed-Petersen B. Nasolabial cysts: A presentation of five patients with a review of the literature. Br J Oral Surg. 1969; 7:84-95.  Back to cited text no. 9
    
10.
Cohen MA, Hertzanu Y. Huge Growth potential of the nasolabial cyst. Oral Surg. 1985; 59:441-445.  Back to cited text no. 10
    
11.
El-Hamd KEAA. Nasolabial cyst: A report of eight cases and a review of the literature. J Laryngol Otol. 1999; 113:747-749.  Back to cited text no. 11
    
12.
Su CY, Chien CY, Hwang CF. A new transnasal approach to endoscopic marsupialization of the nasolabial cyst,. Laryngoscope. 1999; 109 (7):1116-1118.  Back to cited text no. 12
    
13.
López-Ríos F, Lassaletta-Atienza L, Domingo-Carrasco C, Martinez-Tello FJ. Nasolabial cyst: report of a case with extensive apocrine change. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and Endodontics, Vol. 84, No. 4, pp. 404-406,1997.  Back to cited text no. 13
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]



 

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