|Year : 2016 | Volume
| Issue : 2 | Page : 65-67
Nasolabial cyst: A case report
Al Abdullah Al Musleh1, Ali Alshahrani2
1 College of Medicine, King Khalid University, Abha, Saudi Arabia
2 Division of Otorhinolaryngology, Asser Central Hospital, Abha, Saudi Arabia
|Date of Web Publication||6-Jan-2020|
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
Source of Support: None, Conflict of Interest: None
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
| Introduction|| |
The nasolabial cyst is a rare non-odontogenic cyst originating in maxillofacial soft tissues. This lesion was first described in 1882 by Zuckerkandl . In 1953, Klestadt  investigated the pathogenesis of nasolabial cysts in depth. Thoma  suggested the term nasoalveolar cyst. In 1951, Rao  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  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|| |
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 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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| Discussion|| |
Nasolabial cysts are usually unilateral, with no prevalence of side occurrence but bilateral cases have been also reported . It has been estimated that approximately 10% of the cases are bilateral ,. Other significant findings include a greater incidence in females adults in the fourth to fifth decades of life . 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 . 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 . 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 . 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|| |
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[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]