Head and Neck Pathol (2013) 7:155–158

DOI 10.1007/s12105-013-0424-5

SINE QUA NON RADIOLOGY-PATHOLOGY

Nasolabial Cyst
Angel J. Perez • James T. Castle

Received: 8 January 2013 / Accepted: 12 January 2013 / Published online: 6 February 2013
Ó Springer Science+Business Media New York (outside the USA) 2013

Keywords Nasolabial cyst
Klestadt cyst
Nasal Radiographic Features

alveolar cyst
History
A 54 year-old woman complained of a 3-week history of
sinus pain and swelling. A 1-week course of antibiotic use
did not provide relief and her symptoms worsened. She
subsequently presented with a visible swelling in the area
of the right maxillary sinus and anterior maxilla with
swelling extending into the anterior right naris (Fig. 1).
An axial computed tomography (CT) image (Fig. 2)
showed an oval lesion with slight peripheral enhancement
emanating from the lateral wall of the right nasal cavity.
The point of egress was just distal to the lacrimal ostium
(Fig. 3). The lesion measured 2.0 9 2.3 9 1.6 cm with an
internal density measuring 25 Hounsfield units and sug-
gested a simple cystic lesion. The lesion extended anteri-
orly to the maxillary dentition but no significant underlying
osseous erosion was appreciated.
Diagnosis

The hemotoxylin and eosin stained surgical specimen from

Disclaimer the views expressed in this article are those of the
author(s) and do not necessarily reflect the official policy or position
of the Department of the Navy, Department of Defense or the United
States Government. We are military service members. This work was
prepared as part of our official duties. Title 17 U.S.C. 105 provides
that ‘Copyright protection under this title is not available for any work
of the United States Government.’ Title 17 U.S.C. 101 defines a
United States Government work as a work prepared by a military
service member or employee of the United States Government as part
of that person’s official duties.
A. J. Perez
Department of Otolaryngology-Head and Neck Surgery, Naval
Medical Center Portsmouth, Portsmouth, VA 23708, USA
J. T. Castle (&)
Department of Anatomic Pathology, Naval Medical Center
Portsmouth, 620 John Paul Jones Circle, Portsmouth,
VA 23708, USA
e-mail: James.Castle@med.navy.mil
the cystic lesion was composed of a thin cuboidal epithelial
lining which transitioned into areas of pseudostratified low-
columnar epithelium focally surfaced by cilia. The epi-
thelium additionally showed focal decapitation secretion of
mucoid material. The wall of the cyst was composed of
moderately cellular fibrous connective tissue, notable for
containing numerous adjacent seromucous glands. The
histology coupled with the imaging studies and location
allowed for a diagnosis of nasolabial cyst.
Discussion
Although the pathogenesis of the nasolabial cyst is not
completely known, it is uniformly recognized to be of other
than odontogenic origin even though it always displays a
proximate location to the maxillary alveolar process. The
main proposed theories suggest an origin of displaced
epithelium from embryonic nasolacrimal duct resting upon

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Fig. 1 The endoscopic view shows intranasal extension of the cystic
mass confined to the lateral half of the anterior nasal floor
Fig. 2 The axial computed tomography image shows a low density,
ovoid, cystic soft tissue mass with faint medial erosion and
encroachment of the right nasal fossa and nasal cavity floor
the alveolar process surface whereas, others suggest it is a
developmental fissural cyst formed by entrapped epithelial
remnants of the lateral nasal, globular and maxillary pro-
cesses [1, 2].
Nasolabial cysts have been known by many names.
Zuckerkandl first described them in 1882 [3], then sub-
sequent names such as Klestadt cyst [2, 4], nasal alveolar
cyst, nasal wing cyst, and mucoid cyst of the nose [5]
appeared, until Rao [6] coined the term ‘‘nasolabial’’ as a
more accurate descriptor and which has remained in use to
this point.
The clinical presentation is that of an asymptomatic,
albeit cosmetically unappealing distention of the nasolabial
fold due to a swelling that also incorporates and raises the
lateral nasal ala. This mass may also extend inferiorly into
the labial sulcus or laterally into the facial soft tissues
which will cause a widening of the nasal vestibule,
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Head and Neck Pathol (2013) 7:155–158
Fig. 3 A sagittal computed tomography image shows an oval mass
with peripheral enhancement emanating at the area of the lateral right
nares wall distal to the lacrimal ostium
elevation of the nasal floor and swelling seen in the upper
lip and oral cavity [7] and can range in size from 1 cm to
more than 5 cm in greatest dimension [8]. These cysts can
grow to a large size if left unchecked which then leads to
pressure erosion of the underlying bone [8]. Intranasal
extension can also occur, but is usually confined to the
inferior-lateral half of the anterior nasal floor but may also
extend into the inferior meatus [9]. Most patients are East-
Asian, women and in the fourth or fifth decade of life. Most
cases are unilateral, but occasional bilateral cases have
been reported [8].
Plain periapical or occlusal films are of little value for
diagnosis save for the exclusion of an intrabony process. A
subtle radiolucent halo may be seen in the area of the
maxillary incisor apices but these lesions are better
observed with injected contrast medium [10]. On an axial
CT scan, which is the preferred imaging method, a naso-
labial cyst will appear as an ovoid, well-circumscribed,
extra-bony lesion lateral to the piriform aperture at the alar
base [10].
The histologic features consist of a cyst lined by epi-
thelium of varying character ranging from mundane strat-
ified squamous epithelium to pseudostratified columnar
epithelium that may show cilia and contain scattered
mucous or goblet cells (Figs. 4, 5). Apocrine changes have
also been reported in the cyst lining [11]. Most often, the
wall of the cyst is composed of fibrous connective tissue
with an occasional skeletal muscle bundle included but, in
the present case, adjacent seromucous glands were seen,
Head and Neck Pathol (2013) 7:155–158
Fig. 4 Cyst lining with focally ciliated pseudostratified columnar
epithelium containing occasional goblet cells
Fig. 5 Cyst lining composed of stratified squamous epithelium and
adjacent seromucous glands indicating involvement of nasal cavity
floor
Fig. 6 Endoscopic view after transnasal endoscopic marsupialization
of the right-sided nasolabial cyst
owing to the fact that expansion led to erosion and eventual
communication with the floor of the nasal cavity. Most
often, the contents of the cyst consist of thin mucoid or
straw-colored serous fluid, but when secondarily infected,
purulent material can dominate.
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The treatment of choice remains simple enucleation
achieved from an intraoral sublabial approach, although
transnasal mursupialization has been performed with mostly
successful results [9]. An extra-osseous, well-circumscribed,
rubbery, cystic swelling is what is normally encountered
during surgical excision. The reported benefits of marsupi-
alization (Fig. 6) are that a less invasive procedure can be
performed in an outpatient setting under local anesthesia and
potentially this procedure carries a lower risk of complica-
tions and that recurrence rates are comparable to surgical
excision [9]. If excised, these cysts should be removed intact,
but there have been no case reports of recurrent tumors fol-
lowing intraoperative rupture [12].
Although a nasolabial cyst arises in a consistent location
with a unique appearance, additional entities should be
entertained when considering a list of differential diagno-
ses. Lesions that mimic the same clinical appearance when
located in the upper lip include tumors of salivary gland
origin such as pleomorphic adenoma, canalicular adenoma,
mucopeidermoid carcinoma, adenoid cystic carcinoma and
polymorphous low-grade adenocarcinoma. An anterior
maxillary tooth could present with an acute or chronic
inflammatory lesion such as a periradicular cyst or granu-
loma that could also manifest as a canine eminence
swelling. An odontogenic lesion such as a keratocystic
odontogenic tumor (odontogenic keratocyst), ameloblas-
toma or a benign fibro-osseous lesion such as an ossifying
fibroma, when located in the anterior maxilla, could also be
considered as relevant entities. Obvious bone involvement
would be the main detractor when compared to the extra-
osseous aspect of a nasolabial cyst. A nasopalatine duct
cyst may clinically produce a bulge at the floor of the nose,
but is located in a midline position and appears as an
intrabony radiolucency. A skin cyst or tumor such as an
epidermal inclusion cyst or chondroid syringoma should
additionally be considered.
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