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CASE REPORT
doi:10.1111/ors.12365
Figure 3 Dental CT of the area of the extracted upper left canine showing no evidence of bone pathology in the alveolar ridge.
Discussion
Figure 4 Conventional CT revealed a circumscribed mass in contact Searching the MEDLINE/Pubmed database under
to the left nasal cavity (red arrows).
the terms “Nasolabial cyst”, “Nasoalveolar cyst”,
“Nasovestibular cyst” and “Klestadt’s cyst” resulted
and vascular connective tissue, lined by ciliated, in 94 published case reports. These case reports fol-
pseudostratified columnar epithelium (Fig. 6). No low different methodologies in imaging, diagnosis
goblet cells were found. The connective tissue pre- and treatment modalities. Nevertheless, the final
sented focal inflammatory infiltration by plasmacytes diagnosis and confirmation of the nature of a lesion
and lymphocytes, mostly subepithelial, as well as should be performed by histological analysis.
haemorrhagic infiltration (Fig. 7). The final diagnosis In the case presented herein, the clinical, radio-
was nasolabial cyst. graphic and microscopic features were consistent
Post-operative healing course was uneventful with nasolabial cyst. The patient noticed the lesion
while follow-up at 1 year with conventional CT for least a year before presentation, however, he
showed no evidence of recurrence (Fig. 8). asked for medical advice only after it became
Figure 6 The wall of the sac consisted of cellular and vascular connective
tissue, lined by ciliated, pseudostartified columnar epithelium.
an operator dependent method and its interpretation cases where the lesion was surgically excised and a
is determined by the experience of the user18,19. recurrence rate of 2.53% in cases where the transna-
The etiopathogenesis of nasolabial cysts is debat- sal marsupialisation approach was used. Authors
able. Initially, it was considered as a fissural cyst conclude that overall recurrence rate seems to be
derived by epithelial cells entrapped at the fusion irrelevant of the surgical technique involved8. In the
area of the medial and lateral nasal processes and case presented, the nasal mucosa was not perforated,
the maxillary process5,6. Currently, an origin from but the cyst was not removed intact. However, no
embryonic remnants of the nasolacrimal duct tissue recurrence was found in the 1 year follow-up.
is considered more probable and supported by bilat- Sheikh et al.8 in a recent literature review reported 79
eral occurrence of some cysts2,13,20. However, some articles including 311 patients with diagnosed and con-
cysts may develop due to surgical treatments and firmed nasolabial cysts. Several variables, which were
chronic inflammation21. not consistent in all articles, were included. However,
Therapeutically, injection of sclerozing materials, an effort was made to categorise the data based upon
simple aspiration and destruction by cautery13 have patient demographics, location of the cyst, aetiology,
been tried, but show a high recurrence rate2,10,13,22,23. radiological imaging, histology, management and out-
The most common and effective treatment is complete come. Authors concluded that nasolabial cysts are rare,
surgical excision of the cyst, usually performed intrao- are best defined in conventional CT and MRI and the
rally via a gingivolabial incision, under local or general rates of post-operative swelling, pain and recurrences
anaesthesia8. A transnasal approach of endoscopic are similar in the sublabial and transnasal approach.
marsupialisation of nasolabial cysts is described10 that However, they report inconsistencies between articles
according to some8,13,24, but not all25,26 studies shows in the reporting of presentation, cyst characteristics,
good therapeutic results. In a prospective randomised management and complication and they add that the
study27 it was concluded that both methods are effec- heterogeneity of their data may subject their study to
tive. The transnasal marsupialisation has many benefits institutional, geographical and selection bias.
over the conventional intraoral approach, but there is In conclusion, nasolabial cyst, although rare,
no difference with regard to post-operative swelling, should be included in the differential diagnosis in
pain, or overall recurrence rate. Therefore, more stud- cases of sublabial swelling with facial deformity.
ies with longer follow-up periods are needed to esti- Panoramic radiography and CBCT do not give sub-
mate in depth the two different techniques8. A stantial information, therefore, conventional CT or
modification of the above mentioned method that is MRI should be preferred and USG considered. Trans-
suggested is to firstly aspirate the cyst before enucle- nasal marsupialisation or surgical enucleation seems
ation which, according to the authors, exhibits lower to be equally successful in its treatment.
recurrence rates5. Cryosurgery has also been applied as
an alternative treatment method on nasolabial cysts.
Janardhan et al.28 performed cryosurgery, after a sub- Conflict of interest
labial incision, in four patients. The authors suggest The authors confirm that there are no conflicts of
that the application of a cryo probe to the bed of the interest.
cyst after excision is beneficial, especially in cases when
complete cyst wall removal is not a certainty. Further-
more, no complications or recurrence has been Ethical approval
reported with this method. None required.
Care should be taken during surgical excision, as
the tight attachment of the cyst to the nasal mucosa
may lead to perforation of the floor of the nose. References
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