Nasopalatine Duct Cyst 

  • Author: Piotr Kurnatowski, MD; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Apr 25, 2011
 

Background

Nasopalatine duct cysts (NPDCs) are developmental, epithelial, nonneoplastic cysts that are considered to be the most common (about 70%) of the nonodontogenic cysts.[2] Nasopalatine duct cyst is one of many pathologic processes that may occur within the jawbones, but it is unique in that it develops in only a single location, which is the midline anterior maxilla.

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Pathophysiology

The development of the face and the oral cavity takes place between the fourth and eighth weeks of intrauterine life. The secondary palate is formed during the eighth and 12th weeks. In the midline between the primary and secondary palates, 2 channels (the incisive canals) persist. The palatine processes probably partly overgrow the primary palate on either side of the nasal septum. Thus, the incisive canals represent passageways in the hard palate, which extend downward and forward from the nasal cavity. Just before exiting the bony surface of the hard palate (incisive foramen or incisive fossa), the paired incisive canals usually fuse to form a common canal in a Y shape.[3]

The fusion of facial processes in the embryologic development of the maxilla results in the formation of a pair of epithelial strands (the nasopalatine ducts) that traverse the incisive canals downward and forward, connecting the nasal and oral cavities. The nasopalatine duct leads from the incisive fossa in the oral cavity to the nasal floor, in which it ends in the nasopalatine infundibulum.[4]

The types of epithelia that line the nasopalatine duct are highly variable, depending on the relative proximity of the nasal and oral cavities. The most superior part of the ducts is characterized by a respiratory-type epithelial lining. Moving downward, the lining changes to cuboidal epithelium. In the most inferior portion closest to the oral cavity, squamous epithelium is the usual type. In addition to the nasopalatine ducts, branches of the descending palatine and sphenopalatine arteries, the nasopalatine nerve, and mucus-secreting glands are present within the incisive canals.[3, 5] In some vertebrates (eg, snakes), the nasopalatine duct plays a role in the reception of odorants.[6]

The nasopalatine ducts ordinarily undergo progressive degeneration; however, the persistence of epithelial remnants may later become the source of epithelia that gives rise to nasopalatine duct cyst, from either spontaneous proliferation[3, 7, 8, 9] or proliferation following trauma (eg, removable dentures), bacterial infection, or mucous retention.[3, 8, 10, 11] Genetic factors have also been suggested.[8, 12] The mucous glands present among the proliferating epithelium can contribute to secondary cyst formation by secreting mucin within the enclosed structure.[13] Nasopalatine duct cysts can form within the incisive canal, which is located in the palatine bone and behind the alveolar process of the maxillary central incisors, or in the soft tissue of the palate that overlies the foramen, called the cyst of the incisive papilla.[14]

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Epidemiology

Frequency

United States

Data concerning the prevalence of nasopalatine duct cysts differ considerably, with rates of 0.08%[15] to 33%[16] having been reported. Nasopalatine duct cysts account for approximately 12% of all jaw cyst tumors.[17] They occur in both black and white populations.[10]

Race

No racial predilection is known. Nasopalatine duct cysts that occur in young Afro-Caribbeans appears to be more clinically aggressive than those that occur in other ethnic groups.[8]

Sex

Males are affected 1.1-20 times more often than females,[2, 13, 18, 19] although the predilection for males is not so obvious in all studies.[8, 20, 21, 22]

Age

Nasopalatine duct cysts occur over a wide age range (7-88 y), and they also occur in fetuses.[10, 23] Most patients who are affected are aged 30-60 years.[2, 7, 24, 25, 1]

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Contributor Information and Disclosures
Author

Piotr Kurnatowski, MD  Professor, Department of Otolaryngology, Medical University of Lodz, Poland

Disclosure: Nothing to disclose.

Coauthor(s)

Deborah Cleveland, DDS  Director of Oral Pathology, Associate Professor, Department of Oral Pathology, Biology and Diagnostic Sciences, University of Medicine and Dentistry of New Jersey

Deborah Cleveland, DDS is a member of the following medical societies: American Academy of Oral and Maxillofacial Pathology, South Dakota State Medical Association, Southeastern Dermatological Association, Southeastern Society of Plastic and Reconstructive Surgeons, Southeastern Surgical Congress, Southern Association for Oncology, Southern Clinical Neurological Society, Southern Medical Association, Southern Orthopaedic Association, Southern Society for Pediatric Research, Southern Thoracic Surgical Association, Southwest Oncology Group, Southwest Pediatric Nephrology Study Group, Southwestern Surgical Congress, Special Operations Medical Association, State Medical Society of Wisconsin, Swedish Medical Association, Sydenham Society, Tennessee Medical Association, Tennessee Radiological Society, Teratology Society, Texas Medical Association, Texas Orthopaedic Association, Texas Pediatric Society, and Texas Society of Plastic Surgeons

Disclosure: Nothing to disclose.

Camila K Janniger, MD  Clinical Professor of Dermatology, Clinical Associate Professor of Pediatrics, Chief of Pediatric Dermatology, New Jersey Medical School

Camila K Janniger, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Specialty Editor Board

Jacek C Szepietowski, MD, PhD  Professor, Vice-Head, Department of Dermatology, Venereology and Allergology, Wroclaw Medical University; Director of the Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, Poland

Disclosure: Stiefel GSK Company Salary Employment; Orfagen Consulting fee Consulting; Maruho Consulting fee Consulting; Astellas Consulting fee Consulting; Abbott Consulting fee Consulting

David F Butler, MD  Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic, Northside Clinic

David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Robert A Schwartz, MD, MPH  Professor and Head, Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, University of Medicine and Dentistry of New Jersey-New Jersey Medical School

Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, and Sigma Xi

Disclosure: Nothing to disclose.

Glen H Crawford, MD  Assistant Clinical Professor, Department of Dermatology, University of Pennsylvania School of Medicine; Chief, Division of Dermatology, The Pennsylvania Hospital

Glen H Crawford, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Phi Beta Kappa, and Society of USAF Flight Surgeons

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD  Director, Department of Dermatology, Geisinger Medical Center

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

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An ovoid radiolucent area between the central incisor teeth with a poorly defined sclerotic outline can be suspected to be a cyst.
An ovoid, clearly radiolucent area with a sharply defined outline and sclerotic margin that has a bearing on the teeth appendix; secondary draw aside of incisor roots.
An ovoid radiolucent area with a poorly defined sclerotic outline between the central incisor teeth.
 
 
 
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